STEP 4 - BUILD REFERENCE AND COUNTER REFERENCE PROCESS

PRESENTED BY:

LUIS FERNANDO ENRÍQUEZ

ANA KAREN BASTIDAS

BTHI ZARAHIDA GALLARDO

YASMIN VIVIANA GAMBOA

YOHANA ACOSTA

TUTOR: ADRIAN QUIROGA RODRÍGUEZ

GROUP 151024_8

NATIONAL OPEN AND REMOTE UNIVERSITY UNAD

SCHOOL OF HEALTH SCIENCES (ECISA)

CARE ADMINISTRATIVE PROCESS II

MAY 2020
 INTRODUCTION

This work makes the Recognition and analysis of the execution of the development of the process
of the reference and counter-reference systems, in Colombia the Reference and Counter-reference
System is defined as the set of Technical and Administrative Standards that guarantee the
adequate provision of the services of health, according to the level of care and degree of
complexity of the health institution.

The management of the health services provider covers in Annex number 9 and number 10
elements, one internal and one external, the reference counter-reference system is part of the
Mandatory Health Care Quality Guarantee System, according to Decree 1011 of 2006 and ending
with Resolution 2003 of 2014.
 GOALS

General objective

 Identify the steps according to the regulations of the reference and counter-reference
process, know what the responsibilities are in charge within the entities serving health.

Specific objectives

 It seeks to provide the population with functional and opportunity-based universal access
to comprehensive health care.
 It provides the user with comprehensive health care at the appropriate level of technology
with criteria of timeliness, efficiency and effectiveness.
 It defines the processes, procedures and activities that allow health services to be
adequately provided, to guarantee the quality, accessibility, timeliness, continuity and
comprehensiveness of the services.
 It articulates the organizations according to the level of care and monitoring according to
the degrees of complexity, which allows the population to access comprehensive health
care in a timely and functional manner.
 It contributes to rationalizing health resources for user satisfaction by providing efficient
services.
 He sees the need to train the community in the concepts of reference and counter-
reference to properly use the service network.

CASE PRESENTATION
A 75-year-old male patient is admitted to the emergency department on an ambulance stretcher,
accompanied by an assistant nursing doctor and family member. Family member reports “They
were at lunch time when the patient had difficulty speaking, loss of body strength, deviation of
the corner of the mouth”, 2 hours of evolution.

Upon admission to the ESE emergency department, the patient presented: Vital signs: BP.
180/200 mmhg, HR 90', RR 20'.

Medical history: Hypertension, currently being treated with losartan 100 mg daily, taken
irregularly, ASA 100 mg. Additionally, type 2 diabetes mellitus was treated with Metformin for 1
day, showing follow-up of diet.

During the medical examination, neurological deterioration, mixed aphasia, right hemiparesis,
and anisocoria pupils were observed.

Diagnostic impression. stroke

Plan:

Paraclinical, Troponins, PT, PTT, EKG Chest X-ray, simple head CT IMR simple brain,
neurology assessment.

The following are performed: Paraclinical, Troponins, PT, PTT, EKG, Chest X-ray, there is a
delay in the results of blood tests because the processor is undergoing preventive maintenance, a
portable chest , it is necessary to take the patient to the Rx room.

The institution does not have a tomography, neurology service, or intensive care unit.

Due to the patient's pathology, priority attention is required at a higher level for medical
management and diagnosis.

DEVELOPMENT
The reference and counter-reference area brings together processes and activities, which allow
care and provision of health services to a patient, in addition to ensuring that they have continuity
of care in the event that the entity does not have the required services.

The reference emphasizes the sending of patients by one service provider to another provider to
help with pending examinations or procedures or that could not be performed for reasons beyond
their control.

Counter-referral is the response given by the health service provider.

In this case, the patient had to be referred in order to perform some tests and continue with the
treatment, since he requires level III and IV care.

To this end, the Ministry of Health, through Decree Number 4747 of 2007, which regulates some
aspects of the relationships between health service providers and the entities responsible for
paying for the health services of the population at their disposal. post.

Resolution 4331 of 2012 is also validated, which validates annexes number 9 and 10, which are
the formats to complete the reference and counter-reference process in Colombia.

Taking into account the case presented, the respective filling out of these forms was carried out,
sent to the entity to which they were sent, and it is also worth clarifying that all complementary
documents such as medical history, medical orders, and results of examinations performed were
sent.

REQUIREMENTS TO TAKE INTO ACCOUNT

- Compliance with institutional policies.

- Before being referred to a health organization, the user must be previously evaluated and
clinically stabilized.
- Compliance with biosafety standards.
- The responsibility for the care of the referred user is with the referring agency until they
enter the receiving institution.
- Every user must be accompanied by some health personnel and a family member.
- The institution must guarantee the adequate transfer of the users to be referred and the
referral control form must always be completed.
- Verify complete user documentation to be sent.
- Act under the coordination of the departmental CRUE and/or lines established for this
purpose by the EAPB or IPS.
- Counter-refer the patient to a less complex center when his clinical condition shows
stability or he has left the acute phase so that he can finish his therapeutic management at
a lower level of care or closer to his home.
- Guarantee continuity in user service under the principles of interdisciplinarity, quality,
ethics and speed.

OBJECTIVES OF THE REFERENCE AND COUNTER REFERENCE SYSTEM

- It seeks to provide the population with functional and opportunity-based universal access
to comprehensive health care.
- It provides the user with comprehensive health care at the appropriate level of technology
with criteria of timeliness, efficiency and effectiveness.
- It defines the processes, procedures and activities that allow health services to be
adequately provided, to guarantee the quality, accessibility, timeliness, continuity and
comprehensiveness of the services.
- It articulates the organizations according to the level of care and monitoring according to
the degrees of complexity, which allows the population to access comprehensive health
care in a timely and functional manner.
- It contributes to rationalizing health resources for user satisfaction by providing efficient
services.
- He sees the need to train the community in the concepts of reference and counter-
reference to properly use the service network.

THE PATIENT MUST BE REFERRED WITH THE FOLLOWING DOCUMENTS:

- Remission and counter-remission format according to what is stipulated in resolution

1995
- Summary of medical history that includes the reason justifying the referral, summary of
care and treatment established before transfer
- Ambulance log with the minimum necessary information that identifies the patient and
the management established during the transfer.
- Audit indicators of rationality and relevance. Audit instruments.
Flowchart of the Reference and Counter-Reference process
 REFERENCE FORMAT

TECHNICAL ANNEX No 9
STANDARDIZED PATIENT REFERENCE FORMAT
MINISTRY OF HEALTH AND SOCIAL PROTECTION

STANDARDIZED PATIENT REFERENCE FORMAT

Date 15/04/2020 Hour 16:40

PROVIDER INFORMATION

NIT x 90056734
NAME
THAT DC

CODE 000045 ADDRESS OF THE PROVIDER Kr 12 45 77 Center

MUNICIPA
PHONE 7685599 DEPARTMENT Nariño LITY Grass

PATIENT'S DATA

Juan Pablo Gomez

DOCUMENT TYPE DOCUMENT NUMBER

CIVIL REGISTRATION 1234523455

IDENTITY CARD

x CITIZENSHIP CARD

FOREIGN CERTIFICATE BIRTHDATE

PASSPORT 07/02/1945

ADULT WITHOUT IDENTIFICATION

MINOR WITHOUT IDENTIFICATION

ADDRESS Calle 34 45 - 76 Miraflores PHONE 7735870

DEPARTMENT Nariño MUNICIPALITY Grass

ENTITY RESPONSIBLE FOR

PAYMENT EMSSANAR SAS CODE Eps0018

DATA OF THE PERSON RESPONSIBLE FOR THE PATIENT

Maria Eugenia Lopez

DOCUMENT TYPE DOCUMENT NUMBER

CIVIL REGISTRATION 36954223

IDENTITY CARD

x CITIZENSHIP CARD
 FOREIGN CERTIFICATE BIRTHDATE

PASSPORT 21/15/1989

ADULT WITHOUT
IDENTIFICATION

MINOR WITHOUT
IDENTIFICATION

ADDRESS Calle 34 45 - 76 Miraflores PHONE 3215469988

DEPARTMENT Nariño MUNICIPALITY Grass

PROFESSIONAL WHO REQUESTS THE REFERENCE AND SERVICE TO WHICH IT IS REFERRED

NAME Gerardo Guerrero PHONE 7225466

SERVICE REQUESTING THE REFERENCE Hospitalization

SERVICE FOR WHICH REFERENCE IS REQUESTED Hospitalization

RELEVANT CLINICAL INFORMATION

A 75-year-old male patient is admitted to the emergency department on an ambulance stretcher, accompanied by an assistant nursing
doctor and family member. Family member reports “They were at lunch time when the patient had difficulty speaking, loss of body strength,
deviation of the corner of the mouth”, 2 hours of evolution.

Vital signs: BP. 180/200 mmhg, HR 90', RR 20'.

Medical history: Hypertension, currently being treated with losartan 100 mg daily, taken irregularly, ASA 100 mg. Additionally, type 2
diabetes mellitus was treated with Metformin for 1 day, showing follow-up of diet.

During the medical examination, neurological deterioration, mixed aphasia, right hemiparesis, and anisocoria pupils were observed.
Diagnostic impression. stroke

Plan:
Paraclinical, Troponins, PT, PTT, EKG Chest X-ray, simple head CT IMR simple brain, neurology assessment.

The following are performed: Paraclinical, Troponins, PT, PTT, EKG, Chest X-ray, there is a delay in the results of blood tests because the
processor is undergoing preventive maintenance, a portable chest , it is necessary to take the patient to the Rx room.

The institution does not have a tomography, neurology service, or intensive care unit.
Due to the patient's pathology, priority attention is required at a higher level for medical management and diagnosis.

SIGNATURE OF THE PROFESSIONAL WHO REMITTED. Ferney Paredes

MEDICAL RECORD 584152-2

 COUNTER REFERENCE FORMAT

TECHNICAL ANNEX No 10
STANDARDIZED PATIENT COUNTER REFERENCE FORMAT
MINISTRY OF HEALTH AND SOCIAL PROTECTION

STANDARDIZED PATIENT COUNTER REFERENCE FORMAT

Date 15/04/2020 Hour 16:40

INFORMATION OF THE
RESPONSING PROVIDER

NIT x 901856322
NAME
COORPOSALUD CLINIC DC

ADDRESS OF THE PROVIDER CL 18 45 23

CODE 000856 AURORA

MUNICIPA
PHONE 7214577 DEPARTMENT Nariño LITY Grass

PATIENT'S DATA

Juan Pablo Gomez

DOCUMENT TYPE DOCUMENT NUMBER

CIVIL REGISTRATION 1234523455

IDENTITY CARD

x CITIZENSHIP CARD

FOREIGN CERTIFICATE BIRTHDATE

PASSPORT 07/02/1945

ADULT WITHOUT IDENTIFICATION

MINOR WITHOUT IDENTIFICATION

ADDRESS Calle 34 45 - 76 Miraflores PHONE 7735870

DEPARTMENT Nariño MUNICIPALITY Grass

ENTITY RESPONSIBLE FOR

PAYMENT EMSSANAR SAS CODE Eps0018

DATA OF THE PERSON RESPONSIBLE FOR THE PATIENT

Maria Eugenia Lopez

DOCUMENT TYPE DOCUMENT NUMBER

CIVIL REGISTRATION 36954223

IDENTITY CARD

x CITIZENSHIP CARD

FOREIGN CERTIFICATE BIRTHDATE

PASSPORT 21/15/1989

ADULT WITHOUT
IDENTIFICATION

MINOR WITHOUT
IDENTIFICATION

ADDRESS Calle 34 45 - 76 Miraflores PHONE 3215469988

DEPARTMENT Nariño MUNICIPALITY Grass

PROFESSIONAL WHO COUNTER REFERS

315487258
NAME Dr. Carolina Carmona Paz PHONE 8

SERVICE THAT COUNTERREFERS Hospitalization

RELEVANT CLINICAL INFORMATION

Validating the diagnosis that the patient refers, a study is made of what was requested and it is verified that the patient meets the characteristics
to be accepted in our entity, it is also verified that examinations are required, which are necessary to clarify the user's illness. .

An availability study is carried out, and the bed and necessary equipment are available for the patient to be referred. It is reported that the patient
must have all updated results and medical history in the same way.
If the patient takes medications, please bring them with the companion.
Please manage the ambulance service with your EPS, and request Hospitalization in the ICU for timely treatment of the user.

PATIENT ACCEPTANCE IS CONFIRMED.

SIGNATURE OF THE REFERRING PROFESSIONAL Dr. Carolina Carmona Paz

MEDICAL RECORD 62145-0

 CONCLUSIONS

The systematization of processes carried out in health entities in conjunction with the entities in
charge of monitoring and controlling these standards, it has been concluded that they are
important and of current rigor, since evidence is presented that since the beginning of care Until
the end of it, its use covers administrative areas, human talent areas, medical areas, billing,
supplies and pharmacy, so that the patient's health is preserved and gradually improved, in the
event that the entity cannot continue care for For several reasons, your transfer must be
guaranteed, and for this we observe the importance of the reference and counter-reference areas,
which by fulfilling their function, guarantee care in another entity that does comply with what is
required to safeguard life.

Everything is important when providing care and the details make the health entity be classified
as the best in the sector and stand out, generating quality and safety with its clients, in this case
the patients.
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