Reference and contrareference in pediatrics

Analysis of the situation in the Pediatric Hospital of the Pereira Rossell Hospital Center

Abstract

Introduction: following a global trend, the health system in our country is undergoing modernization and reform processes with the purpose of making their capabilities suitable for the needs of the population. Under this framework, the structure and management of the health system are important tools to achieve this goal. To this end, the different levels of health care providers need to be well coordinated. A reference-contrareference system is a tool that provides physicians with criteria and homogeneous procedures that enable their channeling the demand for health care services and to use the system efficiently.
Objectives: the study aims to analyze how patients consulting at the Emergency Department and the General Pediatrics Reference Policlinic are referred to the Pereira Rossell Hospital.
Method: a descriptive study was conducted, based on performing triage assessment of interconsultations at the first level of health care to neuropediatrics, neumology and gastroenterology services in the General Pediatrics Reference Policlinic from August 2005 to December 2005. Referrals were analyzed from the emergency service at the Pereira Rossell Hospital from September to December, 2006.
Coded tables were prepared to evaluate interconsultations with specialists and referrals to the Emergency Service. Percentages were calculated and the data was analyzed using Epi Info 6.04.
Results: evaluation of children referred to a specialist, 69% of them came from Montevideo. After performing triage assessment, 69% of all interconsultations were referred to the reference policlinic. Neuropediatrics was the most requested specialty in 60% of cases. Subsequent to triage, 30% of all children referred to neuropediatrics were redirected to this specialty, 0.05 were referred to gastroenterology and 0.03 to neumology. The data quality was good in 30% of the cases. Referral was appropriate in 89% of cases.
Evaluation of referrals to the Emergency Service. Out of all consultations during the period of study, 24% resulted from referrals. 7.6% of them were ananlyzed. 73.2% came from Montevideo and 20% from Canelones. 39% of patients were referred by mobile emergency units. 26% of patients were referred by pediatricians and the rest by general physicians or family doctors. The most frequent cause for referral (29.6%) corresponded to specialists’ request. The quality of referral was good in 64% of cases.
57% of patients were transferred by an ambulance along with a physician. In 58.5% of cases it was not necessary to refer them to the third level of assistance.
Conclusions: results show resources are inefficiently used. We need to set specific measures to rationalize the health care system and promote its efficacy. Measures to improve functioning of the reference-contrareference system and the timely and appropriate referral to a specialist at the Perreira Rossell Hospital are suggested.