Referral is a system of transferring a patient to another healthcare facility. Here is what I have compiled for you about obstetrics referral flowchart, to give you as a reference, welcome to read!
Obstetrics referral flow chartHigh-risk maternal referral system
First, the scope of high-risk maternal referral
High-risk maternal refers to ? Anyone whose pregnancy may jeopardize the mother, fetus and newborn or lead to obstructed labor due to certain factors. Modern medicine believes that high-risk pregnancy in addition to pathological factors should be expanded to social, economic, transportation, culture and other social risk factors. In addition to pregnant women found to have comorbidities and complications during prenatal checkups, pregnant women living in remote areas of high mountains, inconvenient transportation, whose husbands are not at home for a long time, as well as those with backward concepts and poverty, should also be treated as high-risk pregnant women for the management of high-risk pregnancies, and dealt with as early as possible, and mobilized to hospitalize in advance to await delivery. The specific referral scope is:
1, pregnant women with high-risk pregnancy prenatal score of 10 points must be routinely required to refer to the next level, if necessary, can be referred to the next level. The scoring criteria refer to the Ministry of Health "high-risk pregnancy prenatal scoring standards" (see Annex 3).
2, when the pregnant woman has unexplained vaginal bleeding, abdominal pain, shock.
Second, the organization and management
(a) health administration
1, the Municipal Health Bureau is responsible for the city's high-risk maternal emergency referral industry norms and management, quality supervision and departmental coordination, and to designate municipal health care institutions with strong comprehensive rescue capabilities as the higher referral institutions to receive emergency and critical care of pregnant women. The establishment of maternal emergency leading group and office, the organization of experts in relevant areas to set up a municipal maternal emergency expert group
2, district (city, county) Health Bureau should set up a maternal emergency leading group, and in accordance with the regional health planning, the establishment of the county obstetrics emergency center, the organization and deployment of medical emergency resources in the county, and coordination of the relevant units involved in the work of emergency care for critically ill pregnant women; is responsible for the village, townships, the County The construction of the maternal emergency referral network, and to promote its normal operation, to ensure that high-risk maternal referral channel open.
(B) maternal and child health institutions
Municipal and county-level maternal and child health institutions are high-risk maternal referral professional management institutions.
1, the city maternal and child health hospitals are responsible for standardizing and guiding the construction of high-risk maternal referral network at the city and county levels, business management, screening, management, referral and treatment of high-risk pregnant women, and organizing the training of relevant technical personnel in the city and county.
2, county-level maternal and child health institutions to assist the same level of health administration, the county-level obstetric emergency center and village, township, county maternal emergency referral network construction business guidance and management, standardize the management of maternal referral within the jurisdiction of the critically ill; is responsible for guiding high-risk maternal screening and management, the organization of townships, villages, technical training for health personnel.
(C) the responsibilities of other medical institutions
Responsible for screening, management, treatment and referral of high-risk pregnant women.
Third, the construction of high-risk maternal emergency referral network
High-risk maternal emergency network includes village, township, county-level maternal management network and county-level obstetric emergency center (sub-center), the designated municipal level or above, with the capacity of maternal emergency health care institutions.
(a) Village
Village-level maternal and child health personnel or village doctors to grasp the dynamics of high-risk pregnant women in their villages, timely communication with the township-level maternal and child specialists in high-risk pregnant women, contact, and urge high-risk pregnant women to choose the appropriate health care institutions for prenatal checkups and hospital delivery, the inconvenience of the area, the village committee should set up a maternal escort group, responsible for escorting pregnant women to the township (township). The village committee should set up a maternal escort group, responsible for escorting pregnant women to the township (township) health centers or county-level obstetric emergency centers for hospital delivery or treatment.
(2) Township
Township (township) health centers are responsible for the management of high-risk pregnant women in their townships (townships), carrying out high-risk screening and early identification of pregnant women in the area, reporting and feeding back information, and guiding and supervising high-risk pregnant women in choosing the appropriate health care institutions for prenatal checkups and hospital delivery. Township health centers approved to be able to carry out midwifery technology must set up primary maternal rescue teams to carry out the initial rescue of obstetric and postpartum complications while strictly implementing the hierarchical consultation and management system, and promptly transferring critically ill pregnant women to the ? Obstetric emergency center (sub-center)? Referral. Central health centers should be divided (designated by the county-level health administrative department) is responsible for helping general health centers to deal with general difficult births, can not deal with difficult births should be immediately transferred to the county-level health care institutions without delay, there is no blood transfusion and resuscitation conditions of the general township health centers or central health centers in principle do not carry out cesarean section.
(C) county-level obstetric emergency centers (including sub-centers)
1, set up: by the county-level health administrative departments to assess the assessment, each county to set up an obstetric emergency center (in principle, should be located in the county-level general hospitals), the county range of large, relatively remote areas, according to the actual needs of the sub-centers can be set up under the 1-2 regional obstetric emergency sub-centers, the administrative department of health to be announced to the community! Meet the specifications of the ? Obstetric emergency center (sub-center)? The list.
2, construction standards: see the annex.
3, first aid organization: county-level obstetric emergency center (sub-center) must set up maternal emergency expert group, responsible for guiding and participating in maternal first aid and related first aid technology training. Expert group members by the local obstetrics and gynecology, pediatrics, internal medicine, surgery, emergency medicine, anesthesiology, laboratory and other aspects of the composition of experts, the head of the emergency center by the emergency health care institutions where the person in charge of the Obstetrics Emergency Center for the implementation of the head of the division of labor and cooperation and 24-hour duty work system.
4, responsibilities: responsible for receiving high-risk maternal referrals within the jurisdiction, undertake diagnosis and treatment of critical maternity and rescue; responsible for obstetric diagnosis and treatment of critically ill patients, the lower hospitals put forward the consultation and rescue request, should be immediately organized 3
Organization of personnel to the scene to guide and participate in the rescue and treatment. In accordance with the principle of subdivided referral responsibility, the receiving ambulance in general by the rescue notice received by the unit responsible for, if the hospital ambulance out of the hospital, should be quickly contacted and implementation of other institutions of the ambulance, and reported to the regional health administrative department to coordinate the nearby hospitals to solve, can not be delayed to shift the blame for the time of the resuscitation. In case of emergency, the health administrative department will coordinate and solve the problem. If the condition is critical, the county obstetric emergency center is difficult to deal with, should be immediately transferred to the municipal level or above with maternal emergency capacity of the institution for consultation and treatment.
(D) municipal referral institutions
Municipal People's Hospital and Maternal and Child Health Hospital for municipal acceptance of high-risk, acute and severe maternal referral institutions, is responsible for the city-wide municipal high-risk maternal reception, emergency and referral. Municipal referral institutions should ensure the smooth flow of maternal emergency channels, simplify the admission procedures, procedures, and shall not use any reason to shirk and delay the treatment of critically ill patients.
(E) other medical institutions
Other approved by the opening of obstetrics maternal and child health care practices should be set up in the hospital maternal emergency group, responsible for hospital obstetric emergency, difficult consultations, discussions, etc., the practice should be effectively carry out the diagnosis and treatment of high-risk pregnancy and childbirth and referral functions, all can not be correctly diagnosed and treatment of pregnancy and childbirth should be promptly transferred to the county obstetric emergency center or the municipal level or above, with a maternal emergency center. Municipal-level or above organizations with emergency obstetric care capacity for diagnosis and treatment. The referral should be treated in a positive and proactive manner, and not delayed or shirked.
Fourth, high-risk maternal management
(a) high-risk maternal screening system
Pregnant women should be mobilized by health care personnel at all levels to the township health centers (community health service centers) to build a card (booklet), the use of a unified maternal health care handbook, and regular prenatal checkups. All health care institutions that carry out maternal health care services 4
Health care institutions should carry out high-risk screening at each pregnancy health care checkup in accordance with the Prenatal Scoring Standard for High-Risk Pregnancy.
(2) First visit system for high-risk pregnant women
Healthcare institutions that first detect high-risk factors in pregnancy and childbirth shall make a? High-risk? red triangle marking, detailed registration in the high-risk maternal registry, proper treatment and regular reporting. At the same time, pregnant women should be informed of the adverse outcomes of high-risk pregnancies, identify hospitals for delivery, and implement interventions such as termination of pregnancy or early hospitalization for delivery as early as possible.
(C) high-risk maternal reporting and feedback system
Village-level discovery or suspicion of high-risk pregnant women should be promptly reported to the township health center, the township health center is responsible for the management of high-risk pregnant women throughout the township, and monthly scores of more than 10 points will be reported to the county Maternal and Child Health Agency, the critical cases reported in a timely manner, the county and above the principle of local management of the health care institutions will be obstetrics outpatient clinics or hospitalized monthly, and the hospitalization of high-risk pregnant women to the location of the hospital, and the hospitalization of high-risk women. The high-risk pregnant women reported to the local county-level maternal and child health care institutions.
County-level maternal and child health institutions will mobile high-risk maternal information timely feedback to the maternal household registration of the township (township), township health centers will be screened out of high-risk maternal situation feedback to their village.
(D) high-risk pregnant women tracking follow-up system
County-level maternal and child health institutions to score 15 points or more of high-risk pregnant women generally have to carry out more than two visits (designated person in charge). After receiving a report of a high-risk pregnant woman with a score of 15 or more, within 20 working days, the woman will be given the first face-to-face visit and a comprehensive examination, establish a case card of the high-risk pregnant woman, and then a second face-to-face visit when she enters the expected date of delivery, with a focus on guiding hospitalized deliveries and related precautions. Township-level maternal and child health personnel to the township (township) high-risk pregnant women should also be more than two visits, visit time and work content with reference to the requirements of the county-level visits.
(E) high-risk maternal referral system
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1, high-risk, critical pregnant women to implement the village, township, county or county, city and province three-level referral model. If necessary, cross-level referrals can be made.
2, high-risk, critical maternity in principle, the implementation of inter-hospital referral. Township and county health care institutions should undertake the task of referral of high-risk pregnant women, where there is an ambulance health care institutions must be designated by the county health administrative department is responsible for the transportation of high-risk pregnant women, the county obstetrics emergency center (sub-center) is mainly responsible for the jurisdiction of the critical pregnant women's emergency. In principle, high-risk pregnancy prenatal score of 5 points of pregnant women, depending on the situation can be delivered in health centers; ≦ 15 points of pregnant women, can be delivered in the center of health centers above the health care institutions; ≦ 25 points of pregnant women, should be promptly referred to the county-level obstetrics emergency center or the municipal referral institutions; ﹥ 25 points of high-risk pregnant women must be promptly referred to the municipal people's hospitals for treatment. It is strictly prohibited for high-risk pregnant women to deliver babies at the village level.
3, county and township-level health care institutions, once identified high-risk pregnant women, or found in the course of labor and delivery stagnation, difficult labor, and beyond their own rescue conditions and capabilities, should be in accordance with the high-risk maternal referral flow chart (see Annex
1), immediately referred to the rescue capacity of the county obstetrics emergency centers (sub-centers) or the municipal referral institutions for treatment, referral should be informed by a physician and a certain degree of emergency obstetrics capacity. Physicians and medical personnel with certain obstetric emergency capacity and experience escort, referral on the way to do a good job of condition observation, a good handover, and the use of a unified "high-risk maternal referral notification form" (see Annex 2); the situation is critical, it is inconvenient to refer at the time, we must immediately report to the county obstetric emergency center to send a backbone to the scene to participate in and guide the resuscitation.
V. Other
1, the health care institutions should consciously in accordance with this approach, conscientiously carry out screening, management, diagnosis and treatment of high-risk pregnancy and childbirth and referral, any health care institutions shall not be intercepted on any pretext beyond the hospital's ability to save the critically ill pregnant women must be called for help in a timely manner or referral, to avoid delays in the condition.
2, the districts (cities, counties) Health Bureau to carry out the management of high-risk pregnancy and childbirth in all health care institutions, referral work as an important part of its mother and child health care services licensing approval and verification, where high-risk pregnancy and childbirth 6