NORTH CENTRAL

Template for Workshop 1 (Groupings per ILHZ)

Areas/Elements Existing practices, Policies, Gaps/Deficiencies/Challenges Recommendations for

guidelines and protocols improvement/enhancement
(separate for out-patient and
emergency case if applicable)
Flow of patient’s referral
House BHS RHU referral Referral flow is not followed for
Guide questions: facility(TLJMPH/CLMMRH) RHU for patients nearer to the RHU
1. Make an illustration and or 1st level hospital than the BHS
describe the general
patient/client’s flow from
source to the first level facility
up to the end referral facility
and back.

2. Referral flow for MNCHN

BHS Birthing facility(BHS,RHU)
Referral facility BHS

3. Referral Flow for TB BHS RHU TLJMPH/nearest Tx

satellite for genx/MDR RHU
(MTB not detected, RR not
detected, for evaluation and
treatment) BHS( For DOTS)

BHS RHU ABTC

4. Referral Flow for Rabies (ABTC)
5. Referral flow for Provincial Hospital with blood request Brgy
Blood Center (indigenous cert, blood donor card)
RHU (blood issuance form)
Blood center Hospital
Communication System

Guide questions:
1. What are the available
communication facilities for Mobile phone/ 2 way radio - Brgy
referral at the following levels:
- purok/barangay Mobile phone/ 2 way radio- BHS
- BHS
Telephone line
- RHU
- hospital
(community/municipal) Mobile phone/ Fax/ Email- RHU
District) Telephone line

Mobile phone/ Fax/ Email- Hospital

Telephone line

2. Who is responsible in
communicating/coordinating
when referring patients to the
ff facilities:
BHW/MIDWIFE Midwife not residing in
- BHS to RHU
- RHU to Hospital
MDs/ Nurses catchment area
(community, district)
- Community/district MDs
hospital to Tertiary hospital
 Referral form
3. What are the communication Telephone call before transport of Landline not accessible at all Improve communication facilities
and coordination protocols in patient times by installing dedicated hotlines for
referring clients/patients to Return slip referral
the next level or lower level
facility?

Transportation System

1. What are the available

transportation facilities at the
following levels:
- purok/barangay Tricycle, habal habal, minicab, brgy Not all brgys have emergency Purchase of ambulance that meets
ambulance . vehicles . DOH standard

Tricycle, habal habal, minicab, brgy Ambulance not functional at all

- BHS
ambulance . time in the RHU and hospital

- RHU Ambulance

- Hospital Ambulance
(community/municipal,
district)

2. What are the LGU policies on
the use of
ambulance/emergency vehicle
in referring/transporting
* Free use of ambulance for Not all LGUs have written policy
residents only.
*Free use but transport of patients
 patients? from home to hospital is under the
discretion doctor on duty or nurse
on duty if no doctor.

* Can not transport patient to govt

hospital in Bacolod w/o referral

3. What are the hospital policies Hospital to hospital only and free
on the use of ambulance in for indigents; fuel replacement for
referring/transporting the non indigent.
patients?
Disaster vehicle and patrol car. DRRM vehicles are not available
4. When a hospital or LGU at all time
ambulance is not available,
what are the possible options?
No arrangement
5. What is the arrangement
when a private vehicle is being
used in transporting patients?

6. What is the guideline or policy *On duty & on call ambulance Develop policies/ guidelines per
to ensure timely provision of *arrangement with disaster office ILHZ
transportation facilities to to take over when ambulance is not
emergency cases? around.

Accompanying person/staff to
the referred client/patient

1. Who is responsible in
accompanying the
patient/client to the following
facility?
 - Community to
BHS/RHU/hospital Folks/BHW

- BHS to RHU Folks/BHW/Midwife

- RHU to
community/Municipal/City Case to case basis (Nurse or MD)
hospital
- RHU to district hospital
- RHU to tertiary hospital Case to case basis (Nurse or MD)
- District Hospital to tertiary Case to case basis (Nurse or MD)
hospital Case to case basis (Nurse or MD)

2. What will the accompanying Expected to do administer life Lack of training of health
person or health staff saving measure or be able to personnel accompanying the
expected to do when referring handle delivery when necessary. patients
patient to the facility?

3. Who will bear the

Lack of personnel
transportation expense of the N/A
accompanying health staff if Not to be considered as an option
the ambulance is not
available?

Assessing/attending to patients
received at the facility

1. Who is responsible in
receiving the referred
client/patient at the following
facility:
- BHS
 - RHU
- Municipal/City hospital
- District hospital
- Tertiary hospital
-
2. What are the standard
protocols in
assessing/attending to the
referred patients?
3. How long will it take for the
patient’s assessment in order
to know whether he/she will
be admitted or referred to the
next level facility?
Referral slip/form (required
attachments)
1. What referral slip is being
used in referring patient from:
- Barangay to BHS
- BHS to RHU
- RHU to Mun/City Hospital
- RHU to district hospital
- District hospital to tertiary
hospital
2. What are the guidelines in the
filling up of the referral slip?
Who is responsible in filling up
BHW/Midwife
Midwife/Nurse/Physician
Nurse/ Physician
Nurse/ Physician
Nurse/ Physician
Endorsement of referral slip to
receiving facility assessment of
patients status.
Make necessary plan of
management
RHU-30mins
Provincial hospital-not more than
30 mins
Barangay to BHS -none
BHS to RHU- provincial referral form
RHU to Mun/City Hospital -provincial
referral form
RHU to district hospital- provincial
referral form
District hospital to tertiary hospital
-provincial referral form
RHU: The doctor decides for
admission and fill up the referral
 and signing the referral slip? slip. In the absence of the doctor
the nurse decides and fill up the
referral form and signs the referral
slip.

3. Who is responsible in
endorsing the referral slip to Health personnel accompanying
the receiving facility? the patient.

4. What is the policy to ensure

that the referral slip is NO EXISTING POLICY. Return referral slip should be 2 way referral slip not practiced
received at the facility? filled up & returned to the
referring health facility
5. When the patient was
admitted at the Provincial referral form.
community/district hospital
and referral to the next level
hospital is needed, what
referral slip will be used?

6. What is the policy to ensure Develop a policy on ensuring that

that the return referral slip will NO EXISTING POLICY. 2 way referral is implemented
be returned and received by
the referring facility?

7. What is the guideline on the
use of referral slip for patients
picked up at home or any
place by the emergency
vehicle or ambulance?
No written guidelines but drivers Develop a policy for referring
are instructed to transfer patient to patients picked up at home.
nearest govt hospital
Recording and reporting of the
referrals Logbook

Recording:
1. What are the forms utilized
in recording the incoming
Emergency room, admitting
and outgoing referrals?
section, maternity clinic, nurses
2. Where (department,
section, etc) is it being
maintained? Nurses

3. Who is responsible in the

recording of referrals? None

Reporting: For PHO to develop standard

1. What are the forms utilized
in reporting of referrals?
2. Who is responsible in filling
up the report forms?
3. When is the reporting
period and where do you
submit reports?
Monitoring and Evaluation
Nurse forms for monitoring/ reporting of
referrals
RHUs do not submit report of
referral/ Monthly hospital
submission to hospital operation
division

1. Who is responsible in COH/CHO/MHO/ILHZ

monitoring the SDN and
referral system?

2. What are the areas to

# of referrals made vs # of referral
monitor in order to ensure
 proper implementation of slips returned
the SDN and Referral
System in the Province of
Negros Occidental?

3. How often will the

monitoring be done?
Monthly
4. What are the possible Results pf monitoring to be
venues or meetings where TWG ILHZ meeting discussed during the ILHZ board
the results of the meeting.
monitoring can be properly
discussed and acted upon?
Policy Support Develop local legislation to be
discussed during ILHZ meeting.
1. What policies should be in Local issuances (E.O, resolutions)
place to ensure proper
implementation of the SDN
and referral system in the
Province of Negros
Occidental?
Policy for Medico-Legal Cases

1. Who will act as Medico Legal MHO/CHO

Officer in the Municipality?

2. What are the All medico legal cases are handled

protocols/guidelines in
by the MHO/CHO where the
handling medico-legal cases?
incident occurred or or by the
hospital where the patient is
managed , unless arrangement is
made between the ILHZ member
where the MHO/CHO not available