Standard 3.7 Referral Services.

 Standard 3.7 Referral Services.

Referral services are carried out in accordance with the provisions of policies and procedures.

Referral services are carried out if the patient requires treatment that is not within the competence of the first level health facility.

a. Criterion 3.7.1

The implementation of referral services is carried out in accordance with the provisions of established policies and procedures and refers to the provisions of laws and regulations.

1) Main Thoughts:

a) If the patient's need for services cannot be met by the Puskesmas, the patient must be referred to a health facility that is able to provide services based on the patient's needs, either to another FKTRL Puskesmas, home care, and palliative care.

b) To ensure continuity of service, information about the patient's condition is stated in a referral cover letter which includes the patient's clinical condition, procedures and examinations that have been carried out and the patient's further needs.

c) The referral process must be regulated by policies and procedures, including alternative referrals so that patients are guaranteed to obtain the services they need at the referral place at the right time.

d) Communication with more capable health facilities is carried out to ensure the capability and availability of services at FKRTL.

e) Patients who will be referred are stabilized in accordance with reference standards.

f) The patient/patient's closest family has the right to obtain information about the referral plan which includes (1) the reason for the referral, (2) the health facility being addressed, including other health facility options if any, so that the patient/family can decide which facility to choose, and (3) when the referral should be made.

g) If a patient needs to be referred to another health facility, efforts must be made to ensure that the referral process is carried out in accordance with the patient's needs and choices so that the patient is assured of receiving services in accordance with these needs and choices with the consequences.

h) The patient's needs and preferences are identified (for example transportation needs, competent accompanying personnel, medical facilities, and accompanying family, including the choice of referral health facility) during the referral process.

i) During the direct patient referral process, competent care providers continue to monitor the patient's condition and the health facility receiving the referral receives a written resume regarding the patient's clinical condition and the actions that have been taken.

j) At the time of handover at the referral place, the officer accompanying the patient provides complete information (SBAR) about the patient's condition to the officer receiving the patient transfer.

2) Assessment Elements:

a) The patient/patient's closest family obtains referral information and gives consent for the referral to be made based on the patient's needs and referral criteria to ensure continuity of services to other health facilities (D, W).

b) Communication is carried out with the health facility that is the referral destination and stabilization measures are carried out first for the patient before being referred according to the patient's condition, medical indications and the capabilities and authority possessed so that patient safety during the referral can be guaranteed (D,W).

c) The patient is handed over accompanied by complete information including situation, background, assessment, recommendation (SBAR) to the officer (D, W).

b. Criterion 3.7.2

Follow-up is carried out on return referrals from FKRTL.

1) Main Thoughts:

a) To ensure continuity of service, for patients who are referred back from FKRTL follow-up is carried out in accordance with referral feedback and the results are recorded in the medical record.

b) If the Community Health Center receives patient referral feedback from advanced referral health facilities or other health facilities, follow-up is carried out according to applicable procedures through a review process taking into account recommendations from the referral feedback.

c) In the implementation of reverse reconciliation, monitoring and documentation of the implementation of reverse reconciliation must be carried out.

2) Assessment Elements:

a) The doctor/dentist in charge of the service reviews the medical condition before following up on feedback from FKRTL in accordance with established policies and procedures (R, D, O).

b) The doctor/dentist in charge of the service follows up on referral feedback recommendations in accordance with established policies and procedures (D,O,W).

c) Monitoring in the reverse referral process must be recorded in the monitoring form (D).