draft policy on referral system

8/18/2019 Draft Policy on Referral System

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Metro Tuguegarao ILHZ

Local Health Support Division

Provincial Health Team Office

METRO TUGUEGARAO INTER-LOCAL HEALTH ZONE

(DRAFT)

(Drafted Januar !"# !$%$)

ADMINISTRATIVE ORDER

No. 001, s. 2010

SUBJECT: Pol!"s #$% G&%"l$"s o$ R"'"((#l S)s*"+ 'o( M"*(o T&&"#(#o ILHZ

I. BACGROUND AND RATIONALE:

(&overnment hospitals) Health Facilities are not supposed to refuse patients' Hoever#

there are instances hen a particular patient cannot e handled in such hospital ecause it

has no e*uipment necessar for its mana+ement and man other reasons that ould e for

the etter treatment of the patients' ,ut transferrin+ patients entails a lot of administrative

procedures' -t has een noted that in some cases# transferrin+ patients from one hospital to

another result to complications and to the detriment of the patient' To address theseconcerns# these +uidelines are issed to ensure that proper procedures are folloed in

transferrin+ .mer+enc Room (.R) patients as ell as referrals of admitted patients'

Referral sstem is an inte+ral part of the -nter/Local Health 0one (-LH0)' The movement

of people throu+h the health sstem of the -LH0 ill depend on the R.F.RRAL

1.2HA3-S1' Rationale4

%'% The most common to the most complicated and life threatenin+ diseases re*uire

different levels of health or5ers and health care facilit

%'! 1a6imi7es limited resources

%'8 Avoids duplication of services

%'9 Promotes cooperation and complementation of primar# secondar and tertiar health

facilities

%': Appropriate level of care is made availale considerin+ +eo+raphic factors# time# cost

and ur+enc

%'; Promotes continuit< sustainailit of treatment< health care

II. DEINITION O TERMS

--'% R"'"((#l S)s*"+/is a set of activities underta5en a health care provider or facilit

in response to its inailit to provide the necessar intervention of patients= need' -tincludes referral from the commuinit to the hi+hest level of care and ithin the

1/abs

Republic of the Philippines

DEPARTMENT ! HEALTH

"ENTER !R HEALTH

DE#ELPMENT




hospital<RH> internal sstem' -t is a to/a relationship that re*uires cooperation#

coordination and e6chan+e of information eteen the primar health facilit and the

first referral hospital durin+ the referral and dischar+e of patient from the hospital'

Referral sstem delineates the levels of dia+nostic# sur+ical and medical services

appropriate for the referral hospital and other health service providers in the -LH0'--'! E+"("$!) Roo+ P#*"$*s/are patients ein+ evaluated and mana+ed in the

emer+enc room ut are not et admitted

--'8 I$/#*"$*s/are admitted patients in the ards or private rooms

--'9H"#l* C"$*"(/

• 1ain institution lin5in+ the health services to the communit

• Frontline facilit capale of providin+ preventive and curative services more

advanced than those achieved throu+h communit health action ut less

sophisticated than those availale in hospitals

• Has a team providin+ a ran+e of services and ma or ma not have a doctor

--':Hos/*#l/• A health facilit for the dia+nosis# treatment and care of individuals sufferin+ from

illness or disease# in?ur# deformit# need of sur+ical# ostetrical# medical or

nursin+ care

--'; S"(!" C#/#l*)3C#/#l*) o' Hos/*#ls/refers to the ailit of the hospitals to

mana+e cases ased on their tpe of hospital# accreditation of departments#

suspecialties# manpoer# e*uipment# etc'

Levels of care4

1. PRIMAR4 CARE HOSPITAL 5AMH,BMH,BCH6

• 3on/departmentali7ed hospital that provides clinical care and mana+ement of the

prevalent diseases in the localit@ has much more than ?ust a curative function inan -LH0@

• to main functions4

e6ternal/relationship < the communit# has the capacit to interact

< communit memers and their or+ani7ations on health matters

in the catchment areas served

internal/clinical services# trainin+ function

• 2linical services include +eneral medicine# pediatrics# ostetrics and +necolo+#

sur+er and anesthesia

• Administrative and ancillar services (clinical la# radiolo+# pharmac)

• 3ursin+ care for patients ho re*uire intermediate# moderate and partial cate+or

of supervised care for !9 hours

2. SECONDAR4 CARE HOSPITAL 5TCPGH6

• Departmentali7ed hospital that provides clinical care and mana+ement on the

prevalent diseases in the localit# as ell as particular forms of tratment# sur+ical

procedure and intensive care

• 2linical services provided in primar care# as ell as specialt clinical care

• Administrative and ancillar services

• 3ursin+ care provided in primar care# as ell as total and intensive s5illed care

7. TERTIAR4 CARE HOSPITAL 5CVMC6

%/abs




• Teachin+ and trainin+ hospital that provides clinical care and mana+ement on the

prevalent diseases in the localit# as ell as speciali7ed forms of treatment#

sur+ical procedure and intensive care

• 2linical services provided in secondar care# as ell as su/specialt clinical care

•

Administrative and ancillar services• 3ursin+ care provided in secondar care# as ell as continuous and hi+hl

speciali7ed critical care

8. INIRMAR4

• A health facilit that provides emer+enc treatment and care to the sic5 and

in?ured# as ell as clinical care and mana+ement to mothers and neorn aies

9. BIRTHING HOME

• A health facilit that provides maternit service on pre/natal and post/natal care#

3SD and care of neorn aies

. ACUTE CHRONIC PS4CHIATRIC CARE

•A health facilit that provides medical service# nursin+ care# pharmacolo+icaltraetment and pschosocial intervention for mentall ill patients

;. CUSTODIAL PS4CHIATRIC CARE ACILIT4

• A health facilit that provides lon+/term care# includin+ asic human services such

as food and shelter# to chronic mentall ill patients

!'" P#!<#"s o' S"(!"s-The rationale for definin+ essential pac5a+es of health care

services for the -LH0 is to ensure that the limited health resources are tar+eted toards

provision of essential health activities' This results in improved health status of the

communit and the cost/efficient use of health care resources' Another reason for settin+

minimum and complementar pac5a+es of services at all levels is to ensure appropriateservices are provided at different levels of the referral facilities'

TH. PA2A&.S OF .SS.3T-AL S.RB-2.S

A 1inimum Pac5a+e of Activit (1PA) for primar health care services

A 2omplementar Pac5a+e of Activit (2PA) for core referral hospitals@ and

A Tertiar Pac5a+e of Activit (TPA) for the provincial +overnment referral hospital

M$+&+ P#!<#" o' A!**) 'o( P(+#() H"#l* C#(" S"(!"s 5BHS, RHU6

Pre natal care

3ormal deliver and post partum care

-mmuni7ation

Famil plannin+

3utrition (vitamin a and iron supplementation

&roth monitorin+

2ontrol of communicale diseases (e'+' AR-# T,# DD# STD# malaria)

2ontrol of non/communicale diseases (e'+' related to diet # alcohol# toacco)

1inor sur+er (e'+' suturin+# draina+e of ascess# circumcision)

Dental health

Appropriate referral to referral hospitals or specialist phsicians

.nvironmental health services ,asic laorator services

&/abs




Health promotion and education

1ana+ement of pulic health services# coordination ith non/+overnment or+ani7ations

(3&Os) and the private medical sector# participation in -LH0 mana+ement

Trainin+ of human resources

Supervision of health services and human resources ithin the municipal catchment area

Co+/l"+"$*#() P#!<#" o' A!**) 'o( Co(" R"'"((#l Hos/*#l 5PGH, AMH, BMH, BCH6

Outpatient consultations for patients referred from the primar level

-n patient medical and sur+ical care

.mer+enc room care

1inor sur+er (caesarian section# trauma sur+er# appendectom)

2omplicated deliveries

,asic orthopedics (e'+' settin+ of simple fractures)

3utrition services

Referral of more ur+ent cases to a hi+her level of care

C/ra (T2P&H onl) Laorator services

,lood transfusion

Pharmac services

1ana+ement of hospital services and participation in -LH0 mana+ement

Pulic health promotion and education

2oordination ith pulic health services# 3&O and the private medical sector

Transport and communication lin5a+es ith other levels of care

1edical Social Services

T"(*#() P#!<#" o' A!**) 'o( P(o$!#l Go"($+"$*3DOH R"*#$"%3E$% R"'"((#lHos/*#l 5CVMC6

Pediatric# sur+ical# medical# orthopedic# ostetric and +necolo+ departments)

.6panded sur+ical capailit (e'+' craniotom# orthopedics# urns)

-ntensive care# neonatal intensive care# coronar care

Ophthalmolo+

Rehailitative medicine (phsiotherap# occupational therap)

A full ran+e of dental services

Advanced dia+nostics (e'+' 6/ra# ultrasound# laorator)

Pulic health laorator (e'+' malaria# schistosomiasis# ater analsis# referral laorator

for RH>s and core referral hospitals) ,lood an5 and transfusion services

1edical social services# veterans and senior citi7ens medical services

Pharmac services

Dietar and nutrition services

ellness 2enter Pro+ram

Hospital administration and mana+ement services

.mer+enc transport

-n/house en+ineerin+ and maintenance

III. GUIDING PRINCIPLESThis polic frameor5 is +uided the folloin+ principles4

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---'% R"/&l! A!* =2884 EAn act penali7in+ the refusal of hospitals and medical

clinics to administer appropriate medical treatment and support in emer+enc or

serious cases# amendin+ for the purpose ,atas Pamansa ,ilan+ $!# otherise

5non as An act prohiitin+ the demand of deposits or advance paments for the

confinement or treatment of patients in hospitals and medical clinics in certain casesE'Salient Features4

• -n emer+enc or serious cases# it shall e unlaful for an emploee of the

hospital to re*uest# solicit# demand or accept an deposit or an other form of

pament as a prere*uisite for confinement<medical treatment or to refuse to

administer medical treatment and support to prevent death or permanent

disailit

• hen the patient is unconscious# incapale of +ivin+ consent or

unacompanied# the phsician can transfer the patient even <o his consent

provided that such transfer can e done onl after necessar emer+enc

treatment and support have een administered and that it has een estalishedthat there is less ris5 to transfer patient than continued confinement

• 3o hospital or clinic after ein+ informed of the medical indications for such

transfer# shalll refuse to receive the patient nor demand an deposit or advance

pament

• After the hospital or medical clinic mentioned aove shall have administered

medical treatment and support# it ma cause the transfer of the patient to an

appropriate hospital consistent < the needs of the patient preferal to a

+overnment hospital@ speciall in the case of poor indi+ent patients

---'! The polic frameor5 is a response to A%+$s*(#*" O(%"( No. 9-B, s.1>>=

Salient Features4

TRA3SF.R OF PAT-.3TS

GThe transferrin+ and receivin+ hospital shall as much as practicale e ithin %$5m

radius of each other

GThe transfer of patients contemplated under this act shall at all times e properl

documented'

GHospitals ma re*uire a deposit or advance pament hen the patient is no lon+er

under the state of emer+enc and she or he refuses to e transferred

GHospital and clinic mana+ers shall instruct their personnel to provide prompt and

immediate medical attention to emer+enc and serious cases <o an prior

re*uirement for an deposit or pament'

GAll hospitals shall use a >niform Dischar+e< Transfer Slip for cases covered RA

"!99 hich shall include the folloin+ information4

• Admission Form of transferrin+ hospital

• Transfer Form of transferrin+ hospital to include ut not necessaril limit ot

the folloin+ information4 vital si+ns# name of Attendin+ Phsician# treatment

+iven to patient# name of receivin+ hospital# name of contact person and

approvin+ official at receivin+ hospital

• 2onsent of the pt<companion/-n case of an unaccompanied minor patient# the

ma e transferred <o consent provided that the provisions of RA "!99 is

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strictl oserved' The hospital shall endeavor to use all forms of media to

contact the ne6t of 5in of the unaccompanied minor patient

• -n case of refusal of transfer# the name of the hospital# the name of person ho

refused and the reasons for the refusal

IV. PROGRAM GOALS AND OBJECTIVES

9'% G"$"(#l O?"!*":

The overall o?ective is to improve the referral sstem of health facilities in the -LH0 of

1etro Tu+ue+arao from the communit to the primar (,HS#RH>)# secondar

(1unicipal<District Hospital) or tertiar (Provincial Hospital# 1edical<Re+ional 2enter)

level of care'

9'! S/"!'! O?"!*"s:

• 1inimum pac5a+e of services at the primar facilities and complementar

services at the secondar and tertiar facilities determined

• Appropriate referral form# referral flo# recordin+# reportin+ and monitorin+

forms standardi7ed

• Policies and +uidelines on the referral sstem of the -LH0 implemented

V. COVERAGE AND SCOPE

B'% This polic shall cover the hole health care deliver sstem that includes hospitals

and pulic health facilities hether +overnment or private of the entire 1etro

Tu+ue+arao -LH0@ in the event that there ill e additional health facilities ithin the

cluster# the shall automaticall e covered under these re+ulations'

B'! Hospitals# Health Facilities and other -nter/Local Health 0ones ho ish to follo

this procedure shall coordinate ith the Technical 1ana+ement 2ommittee and&overnin+ ,oard of 1etro Tu+ue+arao -LH0'

VI. GENERAL POLICIES 3 GUIDELINES ON REERRAL S4STEM

B-'% Local centers (,HS=<RH>s) should e promoted as an entr point into the

health care deliver sstem@ referral flow: pls see attached annexes

B-'! Patients should not e refused at an level of the referral sstem' Hoever#

the should e evaluated and thereafter referred to the appropriate facilit@

B-'8 Active communit participation is re*uired for a successful referral sstem'

This should include 3&Os# People=s Or+ani7ations (POs)# ,r+ Officials# ,Hs and

other communit +roups@B-'9 All participatin+ a+encies< communities should e aare of each other=s

capailities in an up/to/date manner (service capailit# service fees# etc)@

B-': The referral sstem should not e interpreted as an assurance that free

medicine and services ould e provided@ hoever# char+es shall e collected to

maintain hospital operation and the hi+h cost of facilit up+radin+@

B-'; Patients need health care providers= +uidance in the proper use of health care

resources and thefore communit aareness re+ardin+ referral shall e stren+thened @

B-' Practice professional ethics' Respect each others= mana+ement decision ( if

correction is necessar# do so discretel)@

B-'" Patients= elfare is the primar consideration in referral sstem@B-' 2onfidentialit must e practiced at all times at all levels@

)/abs




B-'%$ A to/a referral must e oserved@

B-'%% Hospital and field health personnel are e6pected to maintain proper decorum

at all times in relatin+ ith patients# patients= relatives and co/emploees@

B-'%! Supervisors shall orient and train all hospital and field health personnel in the

operations of the comprehensive referral sstem# in the area of -LH0@

B-'%8 2oordination and teamor5 amon+ all health providers shall serve as acommon approach to attain +oals and o?ectives@

B-'%9 Services to e rendered to a patient shall# depend on the facilities# its

capailities# and manpoer resources@

B-'%: Referral sstem shall ta5e into consideration the +eneral elfare of the patient

and the capailities of the facilities ithin the sstem@

B-'%; Tas5s at an level of health care facilit shall e clearl defined# mutuall

understood# and reasonal *ualified' Actual performance shall also e evaluated

re+ularl@

B-'% All patients shall e attended to immediatel upon arrival# +ivin+ preference to

emer+enc cases< or seriousl ill patients@

B-'%" 2lear# ritten health referral policies and +uidelines shall e availale in allhealth facilities' Standard referral forms must also e availale at an +iven time@

B-'% .ssential dru+s and medicines shall alas e availale in all health facilities@

B-'!$ Services not currentl availale shall e accessed from the ne6t level of care@

B-'!% Patients ho have een referred must e sent ac5 to ori+inatin+ facilities for

follo/up and disposition@

B-'!! 2luster aran+as and municipal health care units refer patients to the core

referral hospital of the -LH0 here the elon+# unless services are not availale in

that area@

B-'!8 Patients ma e transported to and from health facilities usin+ a service

amulance or other means of transportation' Amulance fee must e determined

the -LH0 and char+ed accordin+l ased on the patient=s ailit to pa@

B-'!9 2ommunication sstem must e in place to facilitate the referral@

B-'!: -n areas or -LH0 here there is no +overnment hospital# netor5in+ ith private

hospital facilities ith availale services shall e developed@

B-'!; Availale services at each facilit shall e determined and a 1emorandum of

A+reement (1OA) eteen the private and municipal and provincial +overnment

should e underta5en@

B-'! 2ontinuous trainin+ and updatin+ of capailities of the health service providers

shall e utmost consideration@

B-'!" A separate lo+oo5 shall e maintained for monitorin+ and evaluatin+ records of

all patients@ andB-'! .ach level of health care unit shall have a list of essential e*uipment'

VII. INSTITUTIONAL POLICIES3GUIDELINES

-n conformit ith national policies# and ith concurrence of the local health oard# supportin+

issuances shall e availale in the folloin+ areas4

B--'% Technical Policies4

/accidents<+unshots ounds<sta ounds

/action on rape case

/alcohol verification<dru+ test polic

/medical phsical e6am

*/abs




• 2onduct of autops

/autops e6amination

/post/mortem e6amination

'!' Administrative Policies

3etor5in+ of health facilities ithin the -LH0

>se of vehicle (e'+' amulance) Transport of patient

.6tension of services outside catchment area

/mana+ement of medico/le+al cases

/issuances of medical certificates

/attendance to court hearin+ of medical/le+al cases and

/incentives for usin+ appropriate facilities (e'+' hi+her user fees for usin+

inappropriate health facilities

VIII. POLICIES ON MEDICO-LEGAL CASES

B---'% As a +eneral rule# all 1HOs shall act as medico/le+al officers in theircommunit in the asence of the provincial medico/le+al officer@

B---'! All re*uests for medico/le+al e6aminations must e accompanied an official

re*uest from the police authorities of the concerned municipalit or aran+a@

B---'8 1edico/le+al re*uests not ithin the capailit of the 1HO concerned should e

referred immediatel to the 3,- to+ether ith correspondin+ reasons for referral@

B---'9 -n cases here the 1HO of the area concerned is out/of/ton and after all

efforts to locate him<her een e6hausted# the hospital ithin or the 1HO or hospital

of the nearest municipalit ithin the -LH0 must perform the re*uested e6amination@

B---': (All) 1edico/le+al cases shall e the responsiilit of the 1HOs# unless the

patient ould re*uire the services of the hospital for further evaluation and treatment'

Durin+ ee5ends and holidas# the hospital can attend to medico/le+al patients@• 1edico/le+al cases re*uirin+ sur+er (in asence of accompanin+) consent ill e

si+ned attendin+ phsician@

• ,lood transfusion ma not e +iven hen it ecomes a reli+ious issue (aiver should

e si+ned patient)@

B---'; Transport vehicle to fetch the 1HO must e provided the re*uestin+ parties

concerned' -f (autops) post/mortem e6amination is conducted in a private settin+#

the 1HO should e escorted a police officer@

B---' 1edico/le+al fees shall e paid to the 1HO ased on the rate provided the

1A&3A 2ARTA for P>,L-2 H.ALTH OR.RS' This polic is# hoever#

su?ect to the availailit of funds and the usual accountin+ and auditin+ rules and

re+ulations@

B---'" -n some instances here there are no 1HOs availale in the area or -LH0

concerned# the Provincial Health Officer (PHO) ma# upon prior notice# direct an

+overnment phsician# preferal ith e6pertise on the case# to perform the re*uired

e6amination' This is# hoever# su?ect to the presentation of a certification from the

office of the L2. concerned that the 1HO is not availale@ and

B---' All other policies not included herein in relation to the aove/mentioned su?ect

matter shall e referred to the Provincial Health Officer for evaluation and approval

and suse*uent inclusion in this +eneral polic +uideline on referral of medico/le+al

cases'

I@. GENERAL GUIDELINES IN THE EMERGENC4 ROOM

+/abs




The .mer+enc Room is considered the sho/indo of the hospital and as such

reflects the mana+ement of the entire hospital' -t should e the responsiilit of the

2hief of Hospital to ensure that enou+h manpoer and e*uipment are availale to

meet the emer+enc needs of ever patient' Some reasons fro transferrin+ the patient

is primaril internal prolems in the .mer+enc Room' As such the folloin+ policiesshall e folloed4

-C'% All hospitals havin+ departmentali7ed services should e6ercise some form of

autonom in the .mer+enc Room' 3urses and administrative staff should e

permanentl assi+ned to the .mer+enc Room so as not to disrupt the services and to

provide continous trainin+ s5ills competencies in emr+enc care@ residents and interns

should have a fi6ed time frame of rotation e'+' !/8 months and not pulled out antime

the different departments of units' -n the sma manner# emer+enc e*uipment

should e solel for .R use onl@

-C'! Rotation in the .mer+enc Room should e primaril service oriented' Hence

seminars and trainin+ on Balue Reorientation# Ri+hts of Patients# 2lient Satisfaction#Art of 2ommunication etc' are su++ested topics durin+ orientation@

-C'8 The .mer+enc Room shall e manned no less than a second ear resident

up' -f ever there ill e first ear resident he<she should not e a front/liner@

-C'9 All residents mannin+ the .mer+enc Room in addition to all health personnel

should have formal riefin+ the Head of the .mer+enc Room@

-C': All medical personnel should have under+one Advanced 2ardiac Life Support

in addition to the ,asic Life Support efore ein+ assi+ned to the .mer+enc Room'

Li5eise# all administrative personnel shall under+o ,asic Life Support@

-C'; Respective Departments have administrative supervision over those rotatin+ in

the .mer+enc Room hoever the Head of the .mer+enc Room shall have technicalsupervision over the said personnel'

@. GUIDELINES IN TRANSERRING EMERGENC4 ROOM PATIENTS

C'%Attendin+ phsician in consultation ith the senior resident of the .mer+enc Room

or the senior resident of the service ma5es the decision in transferrin+ the paitent

ased on the capailit limitation of the hospital@

C'!Onl the senior resident or Head of the .mer+enc Room Department should inform

the patient or relative as to the reason for transferrin+ the patient and have them si+n

on the space provided in the Hospital Referral Form I% (no nurse# no intern# no first

ear resident should e authori7ed to inform the patient or relative)@C'8Attendin+ phsician should fill up the necessar papers for transfer and rief the

Senior House Officer Or Department Head'@

C'9Senior House Officer< Head of .mer+enc Room should ma5e the call to the Senior

House Officer< Head of .mer+enc Room of the receivin+ hospital' Receivin+

hospital should e chosen ased on capailit of the hospital' The telephone lines

should e used in discussin+ the patienr and not the radio communication located in

the .R of all hospitals (This is reserved for emer+enc and disaster calls)@

C':Transport the patient an amulance and properl accompanied a resident ith

the official referral slip and laorator and 6/ra results if availale' Ac5noled+ment

,/abs




form should e filled up and 5ept the transferrin+ hospital (see attached Hospital

Referral Form I!)@

C';-n case there is no hospital to receive the patient and the onl reason for referral is no

vacanc and not capailit# the patient should e oserved for not more than si6 hours

after hich there should e final disposition# that is# to admit the patient' -n the

meantime# the patient should e properl monitored# mana+ed and correspondin+

chart should e issued@

C'The transfer coul e done in oth as# that is# tertiar hospitals could also transfer

patients to secondar hospitals to decon+est the hospitals and< or ma5e availale eds

for tertiar cases that ill come or e transferred'

@I. GUIDELINES OR INTER-HOSPITAL REERRAL OR REUEST OR

PROCEDURE

C-'% The service senior resident or the service consultant ill recommend

procedures needed an inpatient@C-'! Fill up Hospital Referral Form I 8 to e si+ned the Head of Department or

Desi+nate# and approved Hospital Director or Desi+nate@

C-'8 Social service of referrin+ hospital should assess and classif the financial

status of the patient# and at the same time source out and ma5e funds availale' The

Social Service should have an updated list of all hospitals and correspondin+ availale

procedures includin+ their rates'

C-'9 The Attendin+ Phsician should coordinate ith the hospital aout the

schedule and preparation of the patient'

C-': 2onduct patient an amulance ith a resident@

C-'; Receivin+ hospital to fill up the ac5noled+ment report (Hospital Referral

Form I8)'

@II. GUIDELINES OR TRANSERRING INPATIENTS

C--'% The Attendin+ Phsician or the Service 2onsulatant recommends transferrin+

of patients alread admitted in the hospitals@

C--'! Prepare Form I9 to e si+ned the Attendin+ Phsician and approved the

Deaprtment Head@

C--'8 Social Service should fill up the Patient=s 2lassification and Justification@

C--'9 Attendin+ Phsician should coordinate ith the receivin+ hospital aout the

necessit of transferrin+ the patient and the schedule of the transfer@

C--': Transfer patient an amulance ith a resident@

C--'; Referrin+ hospital to fill up the ac5noled+ment receipt (Referral Form I9)

and receivin+ hospital +to si+n' Detach this portion to e 5ept referrin+ hospital'

@III. TRANSERRING O PATIENTS DURING DISASTERS AND EMERGENCIES

-n times of disasters# emer+encies or an moili7ation of the -LH0 Disaster >nits in

anticipation of mass casualties# the rules and procedures ill e unsuitale in .mer+enc

Referrals descried aove' -n such cases the folloin+ procedures ill e folloed4

C---'% All &eneral Hospitals are desi+nated as receivin+ hospitals to accept victims

of disasters@ the have the option to transfer patients even ithin their capailit to

1-/abs




decon+est their emer+enc rooms and for them to prepare for victims that ill e

rou+ht in@

C---'! All other hospitals should accept cases ein+ transferred even ithout the

proper calls as re*uired' -n these cases# the ill e informed throu+h the radio

communication via the Operation 2enter (OP2.3) of the DOH/2HD2B

C---'8 The announcement and the termination of the disaster ill e announced

the OP2.3 of DOH' Once it is lifted# everthin+ ill revert ac5 to the usual

procedure descried aove'

@IV. IMPLEMENTING MECHANISM

C-B'% M#$#"+"$*

• At the national level# the overall mana+ement of the referral sstem shall e

the responsiilit of the Department of Health/,ureau of Local Health

Development< Office of Health Facilities (OHF)@

• At the re+ional level# it shall e the responsiilit of the 2enter for Health

Development throu+h the Local Health Support Division (LHSD) K Licensin+

and Re+ulator .nforcement Division (LR.D)@

• At the provincial level# the Provincial Health Team Office (PHTO)# throu+h

the DOH Representatives shall provide updates and advise -LH0 ,oards and

municipal Local Health ,oards on DOH polic +uidelines and standards@

• At the -LH0 Level# the Technical 1ana+ement 2ommittee shall provide

technical advice and recommendations to the &overnin+ ,oard and catchment

facilities re+ardin+ health referral sstem and other matters concernin+ health

of the catchment areas'

C-B'! S&/"(so$, Mo$*o($ #$% E#l&#*o$• Periodic monitorin+ and evaluation of the pro+ress of the implementation of

the Polic &uidelines on Referral Sstem shall e estalished# institutionali7ed

and inte+rated in the Pro+ram -mplementation Revies (P-Rs)@

• 1odels of +ood practice shall e documented and disseminated to

sta5eholders of the -LH0 catchment areas@

• uarterl reports shall e sumitted the -LH0 hospitals to PHTO/2B#cop

furnished LR.D of the 2HD ever first ee5 of the first month of the

succeedin+ *uarter@

• The -LH0 T12 shall evaluate and propose polic chan+es to the -LH0

&overnin+ ,oard@

• The 1edical Director< 2hief of Hospitals#throu+h the chief of clinics shall

administer these re+ulations and sumit *uarterl reports to 2HD/2B@

• The different Department Heads especiall in the .R of the -LH0 hospitals

shall directl the implementation of these procedures at the hospital level@

hecshall report to the director throu+h the chief of clinics'

@V. EECTIVIT4 CLAUSE

This Administrative Order shall ta5e effect upon the approval of the &overnin+ ,oard#

su?ect to chan+e as the need arises'Prepared 4

11/abs




ABIGAIL DANICA SORIANO-BATTUNG, RN, RM, MSN

DOH Representative

Revieed 4

EMMANUEL ACLUBA, MD, PHA

2hairman# Technical 1ana+ement 2ommittee

Approved 4

HON. DELIN T. TING

2hairman# 1etro Tu+' &overnin+ ,oard

2c4.L.3A T' T>LA>A3#R3#1S3 1A' &RA2.LM3 P' D.L-1#1D#1PH L.T-2-A T' 2A,R.RA# 1D#1PA

2luster Head PHTO/2a+aan O-2/LHSD 2hief

.DARD A' AL,A3O#1D#1PH T-TA 3' 2ALL>.3&#1D#1PH#DT1KH 1HOsK2OHs of 1T/-LH0

O-2/Director --- O-2/Director -B

1%/abs




ANNE@ES

DAT. K

T-1.R.FF.RR.D

3A1.

OFPAT-.3T

A

&.

S

.C

2O1PL.T.

ADDR.SS

-1PR.SS-O3

(&iven Referrin+ Facilit)

REERRED

ROM

R.ASO3

FOR R.FF.RAL

1.THOD OF

TRA3SPORT<2O11>3-2AT-O3

R.T>R3

SL-P(returned or

not)

.heet 1 Monitoring !or for Incoing Referrals

/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Sheet ! 1onitorin+ Form for Out+oin+ Referrals

DAT. A3D

T-1.

R.FF.RR.D

3A1.

OF

PAT-.3T

A

&

.

S

.

C

2O1PL.T.

ADDR.SS

1.D-2AL

-1PR.SS-O3<

D-A&3OS-S

REERRED

TO

R.ASO3

FOR

R.FF.RAL

1.THOD

OF

TRA3SPORT

R.T>R3

SL-P (returned

or not)

/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Sheet 8 uarterl Report Form for -ncomin+ Referrals ( per municipality)

A&. S.C,ARA3&AM

REERRE

D ROM

SP.2-F-2 R.ASO3 FOR R.FF.RRAL 2LASS-F-2AT-O3 OF 2AS.

1 F 1.D-2O

L.&AL

PR-OR-TM

FOR AD1-SS-O3

(for hospitals onl)

OPD

2AS.

OTH.RS 1.D P.D O,/

&M3

S>R&.RM

$/%%

%/9

:/%8

%9/

9

:$/

;9

;: Kup

1&/abs




1'/abs




Top Ten Leadin+ Referred 2ases (for all facilities) 3o' of 2ases

%'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN !'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN

8'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN 9'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN

:'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN ;'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN 'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN "'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN 'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN %$'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN

TOTAL 3O' OF R.F.RR.D 2AS.S4 NNNNNNNNNNN

R.1ARS4

NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN'

NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN'

Prepared ,4 Approved ,4 NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN (Si+nature) (Si+nature)//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Sheet 9 uarterl Report Form for Out+oin+ Referrals ( per municipality)

A&. S.C,ARA3&AM

REERRE

D TO

SP.2-F-2 R.ASO3 FOR R.FF.RRAL 2LASS-F-2AT-O3 OF 2AS.

1 F 1.D-2O

L.&AL

PR-OR-TM

FOR AD1-SS-O3

(for hospitals onl)

OPD

2AS.

OTH.RS 1.D P.D O,/

&M3

S>R&.RM

$/%%

%/9

:/%8

%9/9

:$/

;9

;: K

up

Top Ten Leadin+ Referred 2ases (for all facilities) 3o' of 2ases

%'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN !'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN

8'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN 9'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN :'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN ;'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN

'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN "'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN 'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN %$'NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNN

TOTAL 3O' OF R.F.RR.D 2AS.S4 NNNNNNNNN TOTAL 3>1,.R OF R.T>R3.D SL-PSNNNNNNNNN

R.1ARS4

NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN'

NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN'

Prepared ,4 Approved ,4

1(/abs




NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN (Si+nature) (Si+nature)

Fi+ure % Operational Frameor54 2omprehensive To/a Referral Sstem

1)/abs

1st LE#EL PRIMAR0 HEALTH "ARE

%n LE#EL PRIMAR0 HEALTH "ARE

&r LE#EL PRIMAR0/.E"NDAR0 "ARE

'th LE#EL TERTIAR0 LE#EL ! "ARE

(TH LE#EL TERTIAR0 LE#EL ! "ARE

PRI#ATEH.PITAL

BHS

RHU

M2NI"IPAL/DI.TRI"TH.PITAL

PR#IN"IALH.PITAL

MEDI"AL/RE3INAL"ENTER

"ounit$




1*/abs




.lements of Successful Referral4

• 2onsent of pt

• 2larit of purpose of referral

• 2ompleteness of re*uired information

• Open line of communication

• Pt education and empoerment

• Acceptance the phsician and institution

• Performance of the tas5s re*uired the referral

• ""%#!< ) *" ("'"(("% /)s!#$ o( $s**&*o$

Patient Referral Form should contain4

• Pt=s data4 name# a+e# se6# etc

• 2linical astract 4H6#P.

• D6tc procedures done and results

• Prolem<assessment

• Reason for referral

• Additional data<findin+s

• or5/up done and results

• Final D6

• 1ana+ement and opinion

• 1edicines +iven# if applicale

• 2omments< su++estions includin+ pro+nosis< outcome

Roles and responsiilities of Referrin+ Phsician4

• Should 5no hta# hen# hom# and here to refer

• Accomplish referral form ith all ne essar information

• .6plain to pt rationale for choice of doctor<hospital# preparation# e6pected cost#

possile outcome of referral

• Facilitate schedulin+ and transport of pts

• Secure result of referral

Roles and responsiilities of 2onsultant Phsician4

• Respond promptl for a re*uest for consultation

• Report in detail all pertinent findin+s and recommendations to the referrin+ doctor

and ma outline opinion to the pt

• 2ommunicate < pt and his famil aout hat the should 5no re+ardin+ the

medical conditions

• Return the pt to the referrin+ doctor

• 3ot to attempt ord or deed# to usurp or undermine the primar phsician=s

role

2urrent -ssues of the Referral Sstem4

1+/abs




• -nsufficient Facilities4 old<non/functional# don+radin+# poor mana+ement

• -nade*uacies of Health Personnel4 lac5 of personnel and competencies# poor

attitude

• -nade*uate Sstems4 lac5 of administrative polic on RS# non/utili7ation of

referral forms# no donard<feedac5 referral# asence of information<communication sstem

• 2ommunit Factors<perceptions4 loer level provide poor service# lac5 of

information of services availale and the referral netor5# pro6imit to hi+her

level facilities

• Political .nvironment4 lac5 of le+islative support to referral sstem# referral to

hi+her level facilities politicians# lo priorit on health

Role of Health 2enters and Hospitals in a Referral Sstem of -LH04

• &>-D-3& PR-32-PL.S FOR D.T.R1-3-3& TH. D-STR-,>T-O3 OF

TASS ,.T' F-RST 2O3TA2T L.B.L A3D F-RST R.F.RRAL HOSP-TAL4

%' hat is not done at the health center should e done at the hospital and vice

versa

!' Overlaps to e avoided

8' The Health 2enter is the place here the snthesis is made and responsiilit

lies for providin+ comprehensive# inte+rated and continous care

9' The hospital function is one of ac5/stoppin+

:' The first contact level unit has the overall responsiilit of ta5in+ char+e of

the pts

;' .ver aspect of health care has technical and human relations' As a rule# hen

human relations are more important and techni*ue less so# the health center is

a etter place than a hospital' hen the human relations aspects are mar+inal#

and techni*ue more important or complicated# the hospital is a etter place

1,

draft policy on referral system

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