PRINTED IN JAMAICA BY MONA GRAPHIC PRINTERS CO., LTD. The production of this Policies and Procedures Manual for the Referral and Transfer of Patients took place with the technical and financial support of the Pan American Health Organization/World Health Organization. ACKNOWLEDGEMENT This Policy and Procedure Manual reflects the wisdom, advice, and judgment of internal, external, local and international stakeholders, and international expertise in health management. The Ministry of Health wishes to recognize all the specialists, many individuals and organizations that have contributed to the technical review of this document. • From the public health sector: Directors and programme managers at all levels within the Ministry of Health, Directorate of Regional Health Authorities, Senior Medical Officers, Medical Officers of Health, Director Nursing Services of Hospitals, Consultants, Parish Managers, Chief Executive Officers and Paramedical staff. • From Professional Associations: Nurses Association of Jamaica, Medical Association of Jamaica, Jamaica Medical Doctors Association, Association of Government Medical Consultants. • From the private health sector: Chief Executive Officer of hospitals, diagnostic services and specialized clinics. • From academia: The University of the West Indies. • From International Public Health Partner: Pan American Health Organization. • From local health sector partners: National Health Fund and CHASE Fund. The Ministry also wishes to recognize the excellent work done by Dr. Christine Moodie in formulating the first Linkage Manual in 1995. That manual has formed the framework of this current publication. Dr. Moodie was a former Principal Medical Officer; Primary Care, Jamaica who was a pioneer in the implementation of the primary care approach for strengthening of the health services. POLICY AND PROCEDURE MANUAL FOR THE REFERRAL AND TRANSFER OF PATIENTS 2016 | 3 TABLE OF CONTENTS 1. INTRODUCTION....................................................................................................7 1.1 RATIONALE FOR THE REFERRAL SYSTEM.....................................................................................8 1.2 PURPOSE OF THE REFERRAL MANUAL.........................................................................................9 2. HEALTHCARE DELIVERY IN JAMAICA..................................................................10 2.1 PUBLIC HEALTH SECTOR.................................................................................................................12 2.1.1 Primary Health Care......................................................................................................................12 2.1.2 Secondary Health Care................................................................................................................14 2.1.3 Specialist Support Services........................................................................................................15 2.2 PRIVATE HEALTH SECTOR................................................................................................................15 3. NATIONAL REFERRAL SYSTEM.............................................................................16 3.1 GUIDING PRINCIPLES........................................................................................................................17 3.2 GENERAL PROCEDURES..................................................................................................................18 3.2.1 Preparing referral and transfer..................................................................................................18 3.2.2 Conducting and managing the transfer................................................................................20 3.2.3 Post-referral period.......................................................................................................................21 3.3 PRIMARY CARE HEALTH SERVICES...............................................................................................22 3.3.1 Referrals within Primary Care.....................................................................................................22 Specialist Referral at Primary Care......................................................................................................22 3.3.2 Referrals from Primary to Secondary or Tertiary care........................................................23 Emergency Services.................................................................................................................................23 Physiotherapy & Nutrition......................................................................................................................23 Laboratory, Imaging, and other Diagnostic Services...................................................................24 Social Services............................................................................................................................................24 3.4 SECONDARY & TERTIARY HEALTH CARE SERVICES................................................................25 3.4.1 Internal Referrals............................................................................................................................25 3.4.2 External Referrals...........................................................................................................................26 3.4.3 Specific Information for Emergency Referrals.....................................................................27 3.5 PROTOCOLS FOR TRANSFER TO TERTIARY INSTITUTIONS..................................................27 3.5.1 Procedures for Emergencies......................................................................................................27 3.5.2 Requirements for Specific Emergencies............................................................................29 Instructions to Relatives in Emergencies.....................................................................................29 POLICY AND PROCEDURE MANUAL FOR THE REFERRAL AND TRANSFER OF PATIENTS 2016 | 4 3.5.3 Protocol for Elective Patient Transfer to Tertiary Care.......................................................29 3.5.4 Protocol for Transfer and Admission to Intensive Care Unit (ICU)................................30 3.6 Counter-Referral of Patients..........................................................................................................31 3.7 ADDITIONAL PROTOCOLS FOR REFERRAL FLOW .....................................................31 3.7.1 Private Providers.............................................................................................................................31 3.7.2 Protocol For Transfer Using Air-Lift..........................................................................................32 3.7.3 Protocol For International Patient Transfer...........................................................................33 3.8 PROTOCOL FOR REFERRAL TO TYPE S HOSPITALS.................................................................33 3.8.1 Referral Protocol for Bustamante Hospital for Children (BHC)......................................34 3.8.2 Referral Protocol for the Bellevue Hospital (BVH)..............................................................35 3.8.3 Referral Protocol for the Hope Institute Hospital...............................................................37 3.8.4 Referral Protocol for National Chest Hospital......................................................................38 3.8.5 Referral Protocol for Sir John Golding Rehabilitation Centre........................................38 3.8.6 Referral Protocol for Victoria Jubilee Hospital (VJH).........................................................39 4. MONITORING AND EVALUATION......................................................................41 5. APPENDIX............................................................................................................43 Appendix 1: National Referral System..............................................................................................44 Appendix 2: Glossary of Key Terms....................................................................................................45 Appendix 3: Geographic Location of Primary Health Care Facilities.....................................46 Appendix 4: Public Hospitals................................................................................................................55 Appendix 5: Private Hospitals..............................................................................................................57 Appendix 6: Referral Form A................................................................................................................58 Appendix 7: Referral Form B.................................................................................................................61 POLICY AND PROCEDURE MANUAL FOR THE REFERRAL AND TRANSFER OF PATIENTS 2016 | 5 1. INTRODUCTION RATIONALE FOR THE REFERRAL SYSTEM 1.1 Referrals and counter- referrals facilitate access to different levels of care and MINISTRY OF HEALTH, different health institutions JAMAICA to ensure comprehensive care covering the full range of health care services: Vision: promotion, prevention, Healthy Population, Healthy early diagnosis, treatment, rehabilitation, palliative Environment care, and support for self– management of chronic Mission: conditions. To ensure the provision of accessible quality health services There