A Referral System connects the different healthcare providers within a specific area for a coordinated, cost-effective, and efficient delivery of healthcare services. It helps ensure that people receive the best possible care at the appropriate facility without incurring unreasonable costs. It also optimizes the utilization and capacity of healthcare facilities designed to provide mostly primary, secondary, or tertiary care.
With the COVID-19 pandemic, a solid referral system is essential in managing cases to augment the capacity of health facilities taking on COVID-19 and non-COVID-19 cases. Depending on the level of care needed, there are different levels within the referral system that the local government can refer to for the optimal use of health facilities.
COVID-19 Referral Algorithm
The DOH-prescribed referral algorithm for handling COVID-19 cases follows the same movement across the levels within the referral system, with the addition of step-down facilities. Aside from ensuring the continuity of basic health services, primary and secondary facilities can also perform the initial assessment and segregation of potential COVID-19 patients. Mild cases that do not require referral to designated COVID-19 hospitals can be transferred to the government quarantine facility or be advised for home isolation. Barangay health workers would be the ones to monitor them in case of the latter. Meanwhile, moderate, severe, or high risk cases must be transferred to the designated COVID-19 hospital to undergo further testing and monitoring. Critical cases can be admitted to the Intensive Care Unit (ICU) of the COVID-19 hospital, while less severe cases can simply be admitted as in-patients.
The center can be accessed in three different ways: first, by downloading the Pure Force Citizens application online for free; second, by calling the OHCC dedicated lines 02-886-505-00, 0915-777-7777, and 0919-977-3333; and third, by scanning the designated QR codes.
🔍 From the ground: Local practices on creating the Referral System
The creation of a referral system in Cagayan de Oro City emerged out of the need to decongest their apex hospital, Northern Mindanao Medical Center (NMMC), which had become a dedicated COVID-19 referral hospital. To unload NMMC of their non-COVID-19 patients, a referral system was created to transfer non-COVID-19 patients to J.R. Borja General Hospital, the local government unit (LGU)-owned hospital in the city.
The capacity of both hospitals was further optimized when the City Health Office (CHO) advocated the use of birthing centers and other primary care facilities for all normal deliveries so that the hospitals could focus on delivering higher level services.
The LGU also established an agreement with their local private hospitals in which patients who are referred to them from the LGU hospital will not be billed for payment. With this system, Cagayan de Oro City’s local health facilities were able to continue servicing both COVID-19 and non-COVID-19 patients.
The City Government of Tabaco took on a proactive approach in establishing a functional referral system. Even before the issuance of an order from the national government, the local government unit (LGU) already reached out to private and public hospitals in their area and advised them on the protocols for isolation and reporting of possible COVID-19 cases.
This referral chain begins with the Barangay Health Emergency Response Teams (BHERTs) all the way to the public and private hospitals.
- “Management of health facilities: Referral systems,” Management, World Health Organization, accessed April 22, 2021, https://www.who.int/management/facility/referral/en/.
- “Algorithm For COVID-19 Referral And Triage,” Department of Health, last modified July 20, 2020, https://doh.gov.ph/node/23828.
- Department of Health, Interim Guidelines on Step Down Care for COVID-19 Response (April 7, 2020), Department Memorandum No. 2020-0161.
- Department of Health, “DOH Launches One Hospital Command Center For Faster And More Efficient COVID-19 Case Referral,” published August 6, 2020, https://doh.gov.ph/press-release/DOH-LAUNCHES-ONE-HOSPITAL-COMMAND-CENTERFOR-FASTER-AND-MORE-EFFICIENT-COVID-19-CASE-REFERRAL