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Referral Process

1. The document discusses the nursing referral process and system. It defines nursing referrals as contacts made to satisfy a client's needs at the proper level of care. 2. There are four levels of referral: primary, secondary, tertiary, and quaternary care. Referrals can be internal within a hospital or external between facilities. 3. The ISBAR framework is used for effective communication during referrals. It includes introducing the patient situation, providing background, doing an assessment, and making a recommendation.

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212 views

Referral Process

1. The document discusses the nursing referral process and system. It defines nursing referrals as contacts made to satisfy a client's needs at the proper level of care. 2. There are four levels of referral: primary, secondary, tertiary, and quaternary care. Referrals can be internal within a hospital or external between facilities. 3. The ISBAR framework is used for effective communication during referrals. It includes introducing the patient situation, providing background, doing an assessment, and making a recommendation.

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REFERRAL PROCESS/

SYSTEM

BY GROUP C:

Jaica Sophia Briones


Darlene Anne Buensalida
Quincy Lou Buenvenida
Camille Anne Bulasa
Reyna Cabidog
Jastine Jade Cabillan
Mitz Jenielle Candido
Katyana Cesar
Philip Joshua Chu
Jessa Mae Coricor
Jazmin Rea Kintana
Esther Angeli Velasquez
I. WHAT IS NURSING REFERRAL?

Referrals are contacts made by the nurse and other members of the healthcare team in order to
satisfy the client's needs at the proper level of care and in the proper setting. Along the
continuum of care, registered nurses manage and coordinate care.

II. REASONS FOR REFERRAL


⚫ To seek expert from advice on the client
⚫ Seeking additional or alternative services for the client
⚫ Seeking admission and client management
⚫ Seeking diagnostic and therapeutic tools

III. 4 LEVELS OF REFERRAL

1. PRIMARY LEVEL OF CARE


⚫ Developed to urban and rural areas
⚫ Referral site for the health worker and basic health units
⚫ Usually the first contact level between community and other levels of health facility
⚫ Provide management for common and minor alignments requiring simple
uncomplicated interventions
⚫ Center physicians, public health nurses, rural health midwives, traditional healers.
⚫ Barangay Health Station, Rural Health Unit

2. SECONDARY LEVEL OF CARE


⚫ Referral site for the primary care facilities
⚫ Given by physicians with basic health training.
⚫ Usually given in health facilities either private owned or government operated.
⚫ Rendered by specialists in health facilities.
⚫ Provide care for serious conditions that needs technical interventions & inpatient care
which are not expected to available at P.H.C level.
⚫ Municipal Hospital, District Hospital, Out-patient Departments

3. TERTIARY LEVEL OF CARE


⚫ Referral site for the secondary care facilities.
⚫ Can be Medical centers, Regional, Provincial Hospitals and Specialized Hospitals.
⚫ Provide care for complicated, uncommon and serious diseases requiring highly
specialized or high technology interventions

4. QUATERNARY LEVEL OF CARE


⚫ The fourth and highest level of health care.
⚫ These hospitals will consist of very highly specialized referral units which together
provide an environment for multi-speciality clinical services, innovation and research.
⚫ People are referred to these hospitals by Provincial Tertiary Hospitals.
⚫ The types of quaternary care include: experimental medicine and procedures and
uncommon and specialized surgeries

IV.TYPES OF REFERRAL

1. Internal Referral
- It happens within the hospital, from one employee to another.
- This type of referral is used to request an opinion or suggestion, co-management, additional
management, or specialty care.

2. External Referral
- is a movement of a patient from one facility to another.

a. Vertical, where a patient is referred from a lower to a higher level of facility or the other way
around.
b. Horizontal, where a patient is referred between similar facilities in different
c. It can be divided into two:catchment areas.
V.BENEFITS OF REFERRAL
For the patient:
⚫ Prompt diagnosis and management
⚫ Save time, money and effort
⚫ Better outcome

For the nurse:


⚫ Learning and training
⚫ Gaining self confidence
⚫ Increase communication between the healthcare staff
⚫ Improve the quality of the patient’s management
⚫ Increase communication between the healthcare staff

Others:
⚫ Prevents revenue leakage
⚫ Decreased lead times
⚫ Completing the loop of healthcare
⚫ Enhanced healthcare system
⚫ Improved patient access
⚫ Quality patient time

VI.STEPS OF REFERRAL SYSTEM


1. Establish a good relationship with the patient
2. Establish the need for referral
The need for referral may be one of the following reasons:
• 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.
3. Set objectives for the referral
4. Explore resources availability
5. Patient decides to use or not use
6. Make pre-referral treatment
7. Facilitate, coordinate referral
8. Evaluate and follow-up

Example of Referral Form


VII. PROCESS OF REFERRING PATIENT TO ATTENDING PHYSICIAN
USING ISBAR

ISBAR
The “ISBAR” framework is used for effective communication. It aims to give users the
capacity to adapt, implement and evaluate an approach to clinical communication
around clinical handover in a health care setting. The ISBAR framework is simple. It
consists of 5 elements that focus a conversation to relevant detail. This helps to focus the
information and eliminate irrelevant information. These elements are:

I – INTRODUCTION
⚫ Who you are, your role, where you are and why you are communicating.
⚫ Patient’s name, age, gender and location

S – SITUATION
⚫ Briefly state the problem
⚫ What is happening at the moment?

B – BACKGROUND
⚫ What are the issues that led up to this situation?
⚫ State client admission diagnosis and date of admission.
⚫ State pertinent medical history.
⚫ Provide brief summary of treatment to date.
⚫ Code status (if appropriate)

A – ASSESSMENT/ ACTION
⚫ What do you believe the problem is?
⚫ Use ABCDE approach
✓ Airway
✓ Breathing
✓ Circulation
✓ Disability
✓ Exposure
⚫ Vital signs.
⚫ Pain scale.
⚫ Is there a change from prior assessments?

R – RESULT/ RESPONSE/ RECOMMENDATION/ RATIONALE


⚫ What should be done to correct this situation
⚫ Ask if HCP wants to order any tests or medications.
⚫ Ask HCP if she/he wants to be notified for any reason.
⚫ Ask, if no improvement, when you should call again.

Examples:
Introduction:
> ‘This is Dr Nicko Cabillan calling from Masirom nga Malubak Street brgy Trinidad,
can I please discuss a patient with the Doctor in charge.
> Doctor in charge comes to the phone and identifies himself as Dr Berguia, and Dr
Cabillan identifies himself again.
> I would like to discuss one of my patients, Mrs Amorelle Borata, date of birth
02/14/1985, Medical Record Number 1234567’

Situation:
> Mrs Borata presented to our emergency department today at 1:05 pm with chest pain
and shortness of breath. She is markedly unwell and I suspect she is suffering with
infective exacerbation of chronic obstructive airways disease. We are over capacity due
to the COVID-19 Pandemic and do not currently have resources to provide the level of
care she requires.’

Background:
> Mrs Borata has a long history of chronic obstructive airways disease and anxiety, with
increasing hospital admissions over the last 5 years. Her last hospital admission was
10/12/2021. She is a reformed smoker. Her medication regime includes home oxygen,
inhaled corticosteroid, theophylline and a long-acting bronchodilator. Mrs Borata lives
with her 5 daughters and 6 sons due to limitation in her activities of daily living. She
does not have an advanced care directive in place, but she does have modifications in
effect for her vital signs given the chronic nature of her airways disease.

Assessment/Action:
> Mrs. Borata is extremely anxious and distressed. Her presentation for this event is
more severe than on previous occasions. An ECG was negative for acute changes. On
physical assessment her temperature is 37.1C, blood pressure 120/80 mmHg, heart rate
99 bpm, respiratory rate 10 per minute, oxygen saturations 90% on 4 liters of oxygen
per minute via nasal specs. She is unable to perform a peak flow reading. Inspiratory
and expiratory accessory muscle use is evident. This is consistent with acute
exacerbation of her chronic obstructive airway disease. Blood and sputum specimens
have been taken prior to commencement of an intravenous fluid regime and antibiotics.

Recommendation:
> I recommend that Mrs Borata be retrieved to your institution for definitive
management of exacerbation of chronic obstructive airways disease as soon as possible.’

SEMI URGENT EXAMPLE


I > Hi Dr Hanson, it’s Nurse Camille calling from Ward 1 looking after Julia Diaz in bed
8.
S > She is admitted with pneumonia on a background of Type 2 diabetes.
B > Her BGL before lunch is 20.5mmol/L. She reports feeling a little dizzy and
nauseated, and she looks quite pale.
A > All her other observations are within normal parameters. She has had her morning
NovoRapid dose of 6u and is not due any more insulin until 2000hrs.
R > Would you be able to review her before lunch? Please contact me as soon as
possible on 811. Thank you..
NON-URGENT EXAMPLE
I > Hello Good morning, is this Social Work department? it’s Nurse Catalina calling
from Ward A at Philippian’s Hospital.
S > I’m the nurse looking after Jazmin Cesar.
B > She lives alone and is currently unemployed.
A > She has reported to me today stating she is experiencing financial difficulties at
present, and would like to speak to someone from Social Work to see what assistance is
available to her.
R > We anticipate that she will be discharged early next week once she is medically
stable. Please call me on 811. Thank you.

EXAMPLE OF BEDSIDE HANDOVER


I > “Nurse Sophia, this is (checks wristband) Mitz Liza, hospital number is 56985 DOB
1/3/1950.
S > She has been admitted to us with a L fractured NOF post mechanical fall at home.
B > She has a history of AF on Warfarin, OA and dementia. She has a high risk for falls
and has a documented allergy to Morphine which causes hallucinations. She has a
documented advanced care directive.
A > Her pain has been well controlled with the femoral nerve block from this morning,
and regular analgesia as per the medication chart. Her vital signs have been within
normal limits throughout the shift. She is currently fasting for theatre this evening,
consent has not been done yet – the treating team are awaiting her MPOA to come in
and meet with the team. She has a 12/24 bag of N/Saline running.
R > She will need an IDC inserted and a theatre pack completed prior to going to OT.
Did you have any questions in regards to Mitz’s care?”

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