Private Hospitals Referral Management Guidelines

Private Hospitals Referral Management Guidelines

Introduction

Referral is a process by which a health worker/facility transfers the responsibility of care to another health worker/facility or social worker. Referral can be vertical, horizontal or diagonal to Public, private, community based, traditional and alternative medicine practitioners. The health care system is divided into three main levels of health care delivery namely primary, secondary, and tertiary. With regard to referral services, currently patients are referred from primary to secondary and tertiary levels. However, the current referral system is not functioning properly due to the absence of a referral policy to guide the referral of patients from one level to another. Therefore there was a need to develop a referral policy that will guide the referral of patients between the different levels of health care provision in an effective, efficiency and systematic way.

There are major problems that are negatively affecting the smooth running of the referral system, these are: paucity of transport, inadequate communication network, insufficient resources, inadequacy in numbers and skills mix of key health personnel, lack of equipment and  insufficient level of infrastructure, and logistics.

There is lack of involvement in the arrangement or processing of referred patients by some heads of units in health facilities. The arrangement of referrals is left to the staff at the booking offices.

Many patients are referred without initial work up being done. This results in increased length of patients’ stay in hospitals and unnecessarily high bed occupancy rates. The specialist support to intermediate and district hospitals is inadequate, leading to unnecessary referrals.

There is poor coordination of referrals between different levels of health service delivery which causes delay in treatment of patients and overloading of patient buses. In addition, some patients overstay in hospitals due to poor coordination between ambulance/transport services and booking offices at different levels.

Very few formal agreements on referral services between state and private health facilities exist, but those health facilities without formal agreements pay high costs to private health facilities when certain specialist services are required.

Ø   Rationale: Continuum of care

Ø   Benefits of good referral system:

     - increases the efficiency and effectiveness of the health system

     - strengthens peripheral health facilities and improves decision making capacity at lower levels

     -promotes cooperation and complementation between the three levels of care

Elements of a Referral System

·         Group of organizations

·          Coordinating units

·         Focal persons/liaison officers

·         Directory of services

·         Standard Operating Procedures

·         Standard referral form

·         Feedback loop

·         Documentation

                                                                                      

Content of Service Directory

·         General information of health facility

·         Addresses of CEOs and MDs

·         Liaison officers contact details

·         Type of health professional available

·         Type of service provided-clinical & diagnostic

·         Weekly schedule of specialty cases

Reasons for Referral

·         Medical and in the Interest of the Patient

·         Expert advice

·         Technical Examination

·         Technical Intervention

·         Care beyond the facility’s capability

·         Unavailability of resources

Roles and Responsibilities

Ø  Referring Health Worker

·         Knows what, where and when to refer

·         Fills referral form and attach documents

·         Explains to patient-reason, preparation, cost, expected out come

·         Answers queries from liaison officer or receiving facility

·         Secures result of referral

Ø  Referral Coordinator/Liaison officer

·         Responsible for both referrals in and out

·         Facilitates scheduling by using communication methods like telephone

·         Ensures availability of service at receiving end

·         Facilitates transportation for emergency cases

·         Keeps referral registry

Ø  Referring Facility

·         Ensures staff awareness

·         Continuous supply of Referral Form

·         Keeps directory of health facilities

·         Ensures recording of referral activities

·         Devises mechanisms to track referral

·         Provides transport to emergency cases

·         Assigns referral coordinator/liaison officer

Ø  Receiving Facility

·         Assigns referral coordinator

·         Ensures staff at point of entry understand referral process

·         Ensures referred patients are seen by appropriate professional

·         Considers attached investigations

·         Ensures prescheduled referrals are seen without delay

·         Devises follow up plans

Management of referrals

·         Facility level

·         Regional and national levels

·         Ministry of Health (MOH) level

Ø  Facility level

·         Referral Coordinator coordinates all referral activities

·         Records, compiles, analyzes and interprets referral data

·         Arranges regular review meetings within and outside health facility

·         Supportive supervision

·         Ensures feedback is sent

Regional Referral Hospitals

·         Equip health facilities as per standard

·         Assign referral coordinating unit

·         Prepare regional service map and directory

·         Referral Standard Operating Procedures

·         Community awareness

·         Priority to emergency without any restriction

·         Regional registry

·         Regular meetings to analyze and take measures

District Health Office

·         Assigns referral focal unit

·         Initiates legislation, policy as necessary

·         Sets standards for health facilities

·         Capacity building

·         Monitoring and coordination at national level

·         Revision and updating the document as necessary

·         Assists regions with preparation of directory

Accountability

·         Monitoring mechanism by UNAPH and District Health Office

·         Legislation

·         By pass fee

·         Queuing system

·         Public education and communication

·         Equipping health facilities as per the standard and building public confidence

Monitoring and Evaluation

Ø  Referral rate

·         The number of referrals per 100 new patients

·         Acceptance and compliance of referrals

  

Uganda National Association of Private Hospitals

(UNAPH)

www.unaph.org

www.ugandaprivatehospitals.blogspot.com

P.O. Box 29324 Kampala, Uganda

Email: unaph22@yahoo.com , unaphserv@gmail.com