Metro Tuguegarao ILHZ Local Health Support Division Provincial Health Te am Office METRO TUGUEGARAO INTER-LOCAL HEALTH ZONE (DRAFT) (Drafted Januar!"# !$%$) ADMINISTRATIVE ORDERNo. 001, s. 2010 SUBJECT: Pol!"s #$% G&%"l$"s o$ R"'"((#l S)s*"+ 'o( M"*(o T&&"#(#o ILHZ I. BACGROUND AND RATIONALE: (&ove rnmen t hospi tals) Health Facili ties are not supposed to refuse patients' Hoever# there are instances hen a particular patient cannot e handled in such hospital ecause it has no e*uipment necessarfor its mana+ement and manother reasons that ould e forthe etter treatment of the patients' ,ut transferrin+ patients entails a lot of administrative procedures' -t has een noted that in some cases# transferrin+ patients from one hospital to another result to complications and to the detriment of the patient' To address these concerns# these +uidelines are issed to ensure that proper procedures are folloed in transferrin+ .mer+encRoom (.R) patients as ell as referrals of admitted patients' Referral sstem is an inte+ral part of the -nter/Local Health 0one (-LH0)' The movement of people throu+h the heal th sstem of the -LH0 i ll depe nd on the R.F.RRAL 1.2HA3-S1' Rationale4 %'% The most common to the most complicated and life threatenin+ diseases re*uire different levels of health or5ers and health care facilit%'! 1a6imi7es limited resources %'8 Avoids duplication of s ervices %'9 Promotes cooperation and complementation of primar# secondarand tertiarhealth facilities %': Appropriate level of care is made availale considerin+ +eo+raphic factors# time# cost and ur+enc%'; Promotes continuit< sustainailitof treatment< health care II. DEINITION OTERMS --'% R"'"((#l S)s*"+/is a set of activities underta5en a health care provider or facilitin response to its inailitto provide the necessarintervention of patients= need' -t includes referral from the commuinitto the hi+hest level of care and ithin the 1 /abs Republic of the Philippines DEPARTMENT ! HEALTH "ENTER !R HEALTH DE#ELPMENT
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(&overnment hospitals) Health Facilities are not supposed to refuse patients' Hoever#
there are instances hen a particular patient cannot e handled in such hospital ecause it
has no e*uipment necessar for its mana+ement and man other reasons that ould e for
the etter treatment of the patients' ,ut transferrin+ patients entails a lot of administrative
procedures' -t has een noted that in some cases# transferrin+ patients from one hospital to
another result to complications and to the detriment of the patient' To address theseconcerns# these +uidelines are issed to ensure that proper procedures are folloed in
transferrin+ .mer+enc Room (.R) patients as ell as referrals of admitted patients'
Referral sstem is an inte+ral part of the -nter/Local Health 0one (-LH0)' The movement
of people throu+h the health sstem of the -LH0 ill depend on the R.F.RRAL
1.2HA3-S1' Rationale4
%'% The most common to the most complicated and life threatenin+ diseases re*uire
different levels of health or5ers and health care facilit
%'! 1a6imi7es limited resources
%'8 Avoids duplication of services
%'9 Promotes cooperation and complementation of primar# secondar and tertiar health
facilities
%': Appropriate level of care is made availale considerin+ +eo+raphic factors# time# cost
and ur+enc
%'; Promotes continuit< sustainailit of treatment< health care
II. DEINITION O TERMS
--'% R"'"((#l S)s*"+/is a set of activities underta5en a health care provider or facilit
in response to its inailit to provide the necessar intervention of patients= need' -tincludes referral from the commuinit to the hi+hest level of care and ithin the
hospital<RH> internal sstem' -t is a to/a relationship that re*uires cooperation#
coordination and e6chan+e of information eteen the primar health facilit and the
first referral hospital durin+ the referral and dischar+e of patient from the hospital'
Referral sstem delineates the levels of dia+nostic# sur+ical and medical services
appropriate for the referral hospital and other health service providers in the -LH0'--'! E+"("$!) Roo+ P#*"$*s/are patients ein+ evaluated and mana+ed in the
emer+enc room ut are not et admitted
--'8 I$/#*"$*s/are admitted patients in the ards or private rooms
--'9H"#l* C"$*"(/
• 1ain institution lin5in+ the health services to the communit
• Frontline facilit capale of providin+ preventive and curative services more
advanced than those achieved throu+h communit health action ut less
sophisticated than those availale in hospitals
• Has a team providin+ a ran+e of services and ma or ma not have a doctor
--':Hos/*#l/• A health facilit for the dia+nosis# treatment and care of individuals sufferin+ from
illness or disease# in?ur# deformit# need of sur+ical# ostetrical# medical or
nursin+ care
--'; S"(!" C#/#l*)3C#/#l*) o' Hos/*#ls/refers to the ailit of the hospitals to
mana+e cases ased on their tpe of hospital# accreditation of departments#
suspecialties# manpoer# e*uipment# etc'
Levels of care4
1. PRIMAR4 CARE HOSPITAL 5AMH,BMH,BCH6
• 3on/departmentali7ed hospital that provides clinical care and mana+ement of the
prevalent diseases in the localit@ has much more than ?ust a curative function inan -LH0@
• to main functions4
e6ternal/relationship < the communit# has the capacit to interact
< communit memers and their or+ani7ations on health matters
in the catchment areas served
internal/clinical services# trainin+ function
• 2linical services include +eneral medicine# pediatrics# ostetrics and +necolo+#
sur+er and anesthesia
• Administrative and ancillar services (clinical la# radiolo+# pharmac)
• 3ursin+ care for patients ho re*uire intermediate# moderate and partial cate+or
of supervised care for !9 hours
2. SECONDAR4 CARE HOSPITAL 5TCPGH6
• Departmentali7ed hospital that provides clinical care and mana+ement on the
prevalent diseases in the localit# as ell as particular forms of tratment# sur+ical
procedure and intensive care
• 2linical services provided in primar care# as ell as specialt clinical care
• Administrative and ancillar services
• 3ursin+ care provided in primar care# as ell as total and intensive s5illed care
• Teachin+ and trainin+ hospital that provides clinical care and mana+ement on the
prevalent diseases in the localit# as ell as speciali7ed forms of treatment#
sur+ical procedure and intensive care
• 2linical services provided in secondar care# as ell as su/specialt clinical care
•
Administrative and ancillar services• 3ursin+ care provided in secondar care# as ell as continuous and hi+hl
speciali7ed critical care
8. INIRMAR4
• A health facilit that provides emer+enc treatment and care to the sic5 and
in?ured# as ell as clinical care and mana+ement to mothers and neorn aies
9. BIRTHING HOME
• A health facilit that provides maternit service on pre/natal and post/natal care#
3SD and care of neorn aies
. ACUTE CHRONIC PS4CHIATRIC CARE
•A health facilit that provides medical service# nursin+ care# pharmacolo+icaltraetment and pschosocial intervention for mentall ill patients
;. CUSTODIAL PS4CHIATRIC CARE ACILIT4
• A health facilit that provides lon+/term care# includin+ asic human services such
as food and shelter# to chronic mentall ill patients
!'" P#!<#"s o' S"(!"s-The rationale for definin+ essential pac5a+es of health care
services for the -LH0 is to ensure that the limited health resources are tar+eted toards
provision of essential health activities' This results in improved health status of the
communit and the cost/efficient use of health care resources' Another reason for settin+
minimum and complementar pac5a+es of services at all levels is to ensure appropriateservices are provided at different levels of the referral facilities'
TH. PA2A&.S OF .SS.3T-AL S.RB-2.S
A 1inimum Pac5a+e of Activit (1PA) for primar health care services
A 2omplementar Pac5a+e of Activit (2PA) for core referral hospitals@ and
A Tertiar Pac5a+e of Activit (TPA) for the provincial +overnment referral hospital
B-'%% Hospital and field health personnel are e6pected to maintain proper decorum
at all times in relatin+ ith patients# patients= relatives and co/emploees@
B-'%! Supervisors shall orient and train all hospital and field health personnel in the
operations of the comprehensive referral sstem# in the area of -LH0@
B-'%8 2oordination and teamor5 amon+ all health providers shall serve as acommon approach to attain +oals and o?ectives@
B-'%9 Services to e rendered to a patient shall# depend on the facilities# its
capailities# and manpoer resources@
B-'%: Referral sstem shall ta5e into consideration the +eneral elfare of the patient
and the capailities of the facilities ithin the sstem@
B-'%; Tas5s at an level of health care facilit shall e clearl defined# mutuall
understood# and reasonal *ualified' Actual performance shall also e evaluated
re+ularl@
B-'% All patients shall e attended to immediatel upon arrival# +ivin+ preference to
emer+enc cases< or seriousl ill patients@
B-'%" 2lear# ritten health referral policies and +uidelines shall e availale in allhealth facilities' Standard referral forms must also e availale at an +iven time@
B-'% .ssential dru+s and medicines shall alas e availale in all health facilities@
B-'!$ Services not currentl availale shall e accessed from the ne6t level of care@
B-'!% Patients ho have een referred must e sent ac5 to ori+inatin+ facilities for
follo/up and disposition@
B-'!! 2luster aran+as and municipal health care units refer patients to the core
referral hospital of the -LH0 here the elon+# unless services are not availale in
that area@
B-'!8 Patients ma e transported to and from health facilities usin+ a service
amulance or other means of transportation' Amulance fee must e determined
the -LH0 and char+ed accordin+l ased on the patient=s ailit to pa@
B-'!9 2ommunication sstem must e in place to facilitate the referral@
B-'!: -n areas or -LH0 here there is no +overnment hospital# netor5in+ ith private
hospital facilities ith availale services shall e developed@
B-'!; Availale services at each facilit shall e determined and a 1emorandum of
A+reement (1OA) eteen the private and municipal and provincial +overnment
should e underta5en@
B-'! 2ontinuous trainin+ and updatin+ of capailities of the health service providers
shall e utmost consideration@
B-'!" A separate lo+oo5 shall e maintained for monitorin+ and evaluatin+ records of
all patients@ andB-'! .ach level of health care unit shall have a list of essential e*uipment'
VII. INSTITUTIONAL POLICIES3GUIDELINES
-n conformit ith national policies# and ith concurrence of the local health oard# supportin+
>se of vehicle (e'+' amulance) Transport of patient
.6tension of services outside catchment area
/mana+ement of medico/le+al cases
/issuances of medical certificates
/attendance to court hearin+ of medical/le+al cases and
/incentives for usin+ appropriate facilities (e'+' hi+her user fees for usin+
inappropriate health facilities
VIII. POLICIES ON MEDICO-LEGAL CASES
B---'% As a +eneral rule# all 1HOs shall act as medico/le+al officers in theircommunit in the asence of the provincial medico/le+al officer@
B---'! All re*uests for medico/le+al e6aminations must e accompanied an official
re*uest from the police authorities of the concerned municipalit or aran+a@
B---'8 1edico/le+al re*uests not ithin the capailit of the 1HO concerned should e
referred immediatel to the 3,- to+ether ith correspondin+ reasons for referral@
B---'9 -n cases here the 1HO of the area concerned is out/of/ton and after all
efforts to locate him<her een e6hausted# the hospital ithin or the 1HO or hospital
of the nearest municipalit ithin the -LH0 must perform the re*uested e6amination@
B---': (All) 1edico/le+al cases shall e the responsiilit of the 1HOs# unless the
patient ould re*uire the services of the hospital for further evaluation and treatment'
Durin+ ee5ends and holidas# the hospital can attend to medico/le+al patients@• 1edico/le+al cases re*uirin+ sur+er (in asence of accompanin+) consent ill e
si+ned attendin+ phsician@
• ,lood transfusion ma not e +iven hen it ecomes a reli+ious issue (aiver should
e si+ned patient)@
B---'; Transport vehicle to fetch the 1HO must e provided the re*uestin+ parties
concerned' -f (autops) post/mortem e6amination is conducted in a private settin+#
the 1HO should e escorted a police officer@
B---' 1edico/le+al fees shall e paid to the 1HO ased on the rate provided the
1A&3A 2ARTA for P>,L-2 H.ALTH OR.RS' This polic is# hoever#
su?ect to the availailit of funds and the usual accountin+ and auditin+ rules and
re+ulations@
B---'" -n some instances here there are no 1HOs availale in the area or -LH0
concerned# the Provincial Health Officer (PHO) ma# upon prior notice# direct an
+overnment phsician# preferal ith e6pertise on the case# to perform the re*uired
e6amination' This is# hoever# su?ect to the presentation of a certification from the
office of the L2. concerned that the 1HO is not availale@ and
B---' All other policies not included herein in relation to the aove/mentioned su?ect
matter shall e referred to the Provincial Health Officer for evaluation and approval
and suse*uent inclusion in this +eneral polic +uideline on referral of medico/le+al
The .mer+enc Room is considered the sho/indo of the hospital and as such
reflects the mana+ement of the entire hospital' -t should e the responsiilit of the
2hief of Hospital to ensure that enou+h manpoer and e*uipment are availale to
meet the emer+enc needs of ever patient' Some reasons fro transferrin+ the patient
is primaril internal prolems in the .mer+enc Room' As such the folloin+ policiesshall e folloed4
-C'% All hospitals havin+ departmentali7ed services should e6ercise some form of
autonom in the .mer+enc Room' 3urses and administrative staff should e
permanentl assi+ned to the .mer+enc Room so as not to disrupt the services and to
provide continous trainin+ s5ills competencies in emr+enc care@ residents and interns
should have a fi6ed time frame of rotation e'+' !/8 months and not pulled out antime
the different departments of units' -n the sma manner# emer+enc e*uipment
should e solel for .R use onl@
-C'! Rotation in the .mer+enc Room should e primaril service oriented' Hence
seminars and trainin+ on Balue Reorientation# Ri+hts of Patients# 2lient Satisfaction#Art of 2ommunication etc' are su++ested topics durin+ orientation@
-C'8 The .mer+enc Room shall e manned no less than a second ear resident
up' -f ever there ill e first ear resident he<she should not e a front/liner@
-C'9 All residents mannin+ the .mer+enc Room in addition to all health personnel
should have formal riefin+ the Head of the .mer+enc Room@
-C': All medical personnel should have under+one Advanced 2ardiac Life Support
in addition to the ,asic Life Support efore ein+ assi+ned to the .mer+enc Room'
Li5eise# all administrative personnel shall under+o ,asic Life Support@
-C'; Respective Departments have administrative supervision over those rotatin+ in
the .mer+enc Room hoever the Head of the .mer+enc Room shall have technicalsupervision over the said personnel'
@. GUIDELINES IN TRANSERRING EMERGENC4 ROOM PATIENTS
C'%Attendin+ phsician in consultation ith the senior resident of the .mer+enc Room
or the senior resident of the service ma5es the decision in transferrin+ the paitent
ased on the capailit limitation of the hospital@
C'!Onl the senior resident or Head of the .mer+enc Room Department should inform
the patient or relative as to the reason for transferrin+ the patient and have them si+n
on the space provided in the Hospital Referral Form I% (no nurse# no intern# no first
ear resident should e authori7ed to inform the patient or relative)@C'8Attendin+ phsician should fill up the necessar papers for transfer and rief the
Senior House Officer Or Department Head'@
C'9Senior House Officer< Head of .mer+enc Room should ma5e the call to the Senior
House Officer< Head of .mer+enc Room of the receivin+ hospital' Receivin+
hospital should e chosen ased on capailit of the hospital' The telephone lines
should e used in discussin+ the patienr and not the radio communication located in
the .R of all hospitals (This is reserved for emer+enc and disaster calls)@
C':Transport the patient an amulance and properl accompanied a resident ith
the official referral slip and laorator and 6/ra results if availale' Ac5noled+ment