Referrals Flashcards
Reasons for Referral:
PEMPPF
PDPD
- Provide continuity of care or treatment
- Ensure that the patient receives optimal care at the appropriate level
- Medico-legal concerns by the px, doctor, or both
- Patient requires inpatient care
- For co-management or further management of a specific case
- Px and/or family shows doubt or lack of confidence involving the diagnosis, treatment or management of a given case
- Px requires medical and/or surgical intervention that is not within the capacity of the primary health care provider
- Doctor is dissatisfied with the px’s progress or unsure of the diagnosis
- Px needs further investigation that includes radiographs, laboratory tests, and other diagnostic or therapeutic procedures which may not be available in the primary health care facility
- Doctor needs expert or special advice regarding a specific case
A two-way process/system in which a health care provider with insufficient resources to manage a certain condition may either seek the assistance of a qualified consultant/specialist or coordinate with a health care facility in order to address the specific condition to appropriately manage a patient’s case.
Referrals
Benefits of Referral:
(for the Patient)
- prompt diagnosis, tx, and management
- saves time, money, and effort
- better outcome and/or prognosis
Benefits of Referral:
(for the Doctor)
- continuous education and training
- gaining self-confidence
- increases communication between health care providers
Benefits of Referral:
(for the Consultant)
- improves the management and quality of patient care
- increases communication between health care providers
Basic Principles of Referrals:
- Merits of the referral process - refers to the objective of the referral
- Pragmatism of the referral process - considers the practical component wherein time, money, and effort should not be wasted
- Individualized to the patient - focuses and meets the needs or requirements of a single px
Factors that Affect the Referral Process
(ADPLUUC)
- Availability of qualified doctor or specialist
- Doctor’s specialty
- Patient’s characteristics
- Length of training, education, and experience
- Unexplained or inconclusive findings
- Uncertainty of diagnosis
- Cost or reimbursement plan
Steps of the Referral Process:
ESSEP
PFE
- Establish a good and harmonious doctor-patient relationship
- Substantiate the need for a referral
- Set objectives for the referral
- Explore the availability of resources
- Px will decide what resources to use and not to use
- Perform pre-referral treatment
- Facilitate and coordinate the referral
- Evaluation and follow-up
Requisites of a Referral Letter:
Must be:
- dated
- retained for at least 18 months
- duly signed by the referring doctor
- in writing except for medical emergencies
- received before the service is provided
Must specify the service to be rendered by the consultant
Period of Validity of Referrals:
(General Practitioner)
12 months
Period of Validity of Referrals:
(Specialist)
Outpatient: 3 months
Inpatient: 3 months or the duration of admission
Period of Validity of Referrals:
(Indefinite referrals)
- used only when px’s clinical and chronic condition requires continuous care and management of a specialist for a specific and stated condition
When period of validity has lapsed and the course of treatment is not yet complete, this is referred as?
Consequent consultation
I. Traditional Classification
Referring doctor or healthcare provider decides that the following resolutions may be best for the px:
- solicit an expert’s opinion for treatment and diagnosis
- seek hospital admission and management of the case
- request further investigation for patient’s care
ROUTINE REFERRAL
I. Traditional Classification
Referring doctor aims to reach the specialist on time and before the onset of deterioration while providing relevant information in the referral letter
EMERGENCY REFERRAL
I. Traditional Classification
Patient, on their own accord, visits a specialist due to the following reasons:
- for an expert’s opinion
- hospital admission
- further investigation
- treatment
- management
OPPORTUNISTIC REFERRAL
I. Traditional Classification
When a doctor refers a px to a health care facility that they own or receive a financial compensation.
Can be considered as a conflict of interest.
SELF-REFERRAL
II. Modern Classification
Px is referred for complete care during a limited period.
INTERVAL REFERRAL
II. Modern Classification
Referring doctor retains overall responsibility, but refers the patient for care regarding a specific problem which may require short-term or long-term treatment.
COLLATERAL REFERRAL
II. Modern Classification
Px is advised to see another doctor, once accepted, the referring doctor has no further responsibility for the px’s care.
CROSS-REFERRAL
II. Modern Classification
Px is under the care of multiple specialist wherein responsibility for the px’s care is divided/shared more or less evenly between two or more doctors.
SPLIT REFERRAL
III. Classification according to the Case
Case in which the px is likely to worsen or suffer harm if not referred.
MANDATORY REFERRAL
III. Classification according to the Case
Case in which px wis unlikely to worsen or suffer harm if not referred.
ELECTIVE REFERRAL
IV. Classification according to Hierarchy and/or Location
Begins with the px in a community and he/she passes through different health care facilities concerned.
Can be Vertical or Horizontal referral.
EXTERNAL REFERRAL
