Referral System

At each level of health care infrastructure, there is need for support from higher level of health structure and also from secondary & tertiary level hospitals for better care and promote credibility of primary health care system.

An effective referral system ensures a close relationship between all levels of the health system and helps to ensure people receive the best possible care closest to home. It also assists in making cost-effective  use of hospitals and primary health care services. Support to the centres and outreach services by experienced staff from hospitals or district health office helps build capacity and enhance access to better quality care. A good referral system can help to ensure:

1. Clients receive optimal care at the appropriate level and not unnecessarily costly.
2. Hospital facilities are used optimally and cost-effectively.
3. Clients who most need specialist services can accessing them in a timely way.
4. Primary health services are well utilized and their reputation is enhanced.

Definition of referral system

"Referral system is defined as a system of transferring cases which are beyond the technical competence of one infrastructure to higher level infrastructure / institution having technical competency and all other resources to provide desired health services".

In another word "a referral can be defined as a process in which a health worker at a one level of the health system, having insufficient resources (drugs, skills, equipment) to manage a clinical condition, seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or take over the management of, the client's case.

Key reasons for deciding to refer either an emergency or routine case include:

• To seek expert opinion regarding the client.
• To seek additional or different services for the client.
• To seek admission and management of the client.
• To seek use of diagnostic and therapeutic tools. 

Terms

1. Initiating facility: The facility that starts the referral process is called the initiating facility, and they prepare an outward referral to communicate the client condition and status.
2. Receiving facility: The facility that accepts the referred case is called the receiving facility and at the end of their involvement, they prepare a back referral on the lower part of the forms to let the initiating facility know what has been done. This completes the referral loop between the two facilities.
3. Referral register: It is a means of maintaining a list of all outward and inward referrals for one facility or service provider. Information registered includes client referred, to where, when and why, whether the case is closed or continuing, and whether it was an appropriate referral or if there were any issues.
4. Directory of services: Some areas maintain a directory of services that lists all organizations providing specialist care. Such a directory can facilitate the  search for the most appropriate service provider for a particular referral. Where such a directory is used, it is important that the contact information is kept up-to-date.

 Components of a referral system

Referral system in Indian health system

Referral system is vertical in nature.

Types of Referral

[A] Normally there are three types of referral:

[B] Types of referral according to the case:

[C] Modern classification of referral:

Referral Form

A referral form has the following information.

1. Patient details (name, location, age and sex)
2. Detail of referral doctor or hospital,
3. Reasons for referral.
4. Degree of urgency for appointment.
5. Clinical problem.
6. Important previous history.
7. Findings and Physical examination.
8. Findings on investigation.
9. Detail of given mediation, treatment and any drug sensitivities.
10. Expected outcome and desirable follow up.

Health institutions maintains the 'Register of Referrals OUT' and 'Register of Referrals IN' of all clients.