Differential Diagnosis and Referral Flowa

Differential Diagnosis and Referral Flow a. Differential Diagnosis Differential diagnosisis the differentiation of a particular disease or condition from others that present a similar clinical picture. Differential diagnostic procedures are used by physicians to diagnose specific diseases in patients, or, at least, to eliminate any lifethreatening conditions in the near future. b. Referral Flow The referral system is a health service delivery system that implements the delegation of reciprocal responsibility for one case of disease or health problem vertically (to a unit that is better able to handle it) or horizontally (between units of the same level of ability). 1) Basic principles - The most ideal situation for referral is an antepartum referral (referral while the fetus is still in the womb). However, not all conditions can be diagnosed early, so early referral can be made. - Changes in conditions and illnesses in newborn babies are so rapid, this requires immediate and adequate management at more complete and closest facilities. - If the baby is referred to a more complete facility, make sure that the baby will get benefits or positive values compared to if he were only cared for at his place of origin. - It must be noted that when referring, the baby must be in a stable condition or at least any danger signs have been managed first - It is necessary to involve parents or family in making the decision to refer and explain why the baby must be referred. During the midwife referral, breast milk is always provided. If this is not possible, breast milk must still be expressed so that the breasts remain productive. When handling newborns, officers are always expected to: 1) Be aware of risk factors 2) Recognize the signs of high risk 3) Know the referral indications Factors that influence the success of referral implementation: The functioning of the referral mechanism from the community level and community health center to the referral hospital - There is 2-way communication between the referrer and the referral place - Availability of health workers who are capable, skilled and on standby 24 hours - Availability of medical equipment and medicines according to needs at the referring place and referral place - Availability of facilities and transport/transportation for 24 hours - For families who cannot afford it, financial support is available for transport, midwifery and hospital treatment - Availability of incentive funds for health workers who are on standby 24 hours 2. Cases or situations that require referral to more complete facilities: - Low birth weight babies ≤ 2000 gr - The baby does not want to drink breast milk - The baby's hands and feet feel cold - The baby experiences problems/difficulty breathing - The baby is bleeding or suspects bleeding - The baby is having convulsions - The baby experiences increasing symptoms of jaundice - The baby experiences gastrointestinal disorders accompanied by vomiting, diarrhea, or not defecating at all with a bulging stomach - The baby shows signs of serious infection such as meningitis or sepsis - Babies with congenital abnormalities Procedures for implementing newborn referrals: 1. Stability of the baby's condition during transportation The baby is declared to be in a stable condition if the body temperature, blood pressure, body fluids and oxygenation are sufficient. Some stabilization treatments before referring are as follows: - Babies with dehydration should be given an IV drip to provide fluids - Babies with seizures need to be given anticonvulsant treatment first so that the baby's condition does not get worse - Shortness of breath babies with cyanosis should be given oxygen - The baby's body temperature is monitored so that it remains warm within normal limits. One way to maintain a baby's body temperature is with the kangaroo method - Babies who are vomiting or gassy or experiencing aspiration should have a tube inserted into the stomach (nasogastric tube) - Open lesions such as meningocele, gastroschisis, are covered with gauze moistened with NaCl liquid 2. Conditions for transportation: - The baby is in stable condition - The baby must be warm - The transport vehicle must also be warm. Accompanied by health workers who are skilled in carrying out resuscitation measures, at least ventilation. - The necessary equipment and medicines are available b. Collaborative relationship between the referring officer and the officer at the referral location During the trip, the referring officer needs to contact the officer at the referral place to convey information about the baby's condition. This connection can be through fast communication facilities available at the community health center or sub-district, for example: radio communication, telephone, courier, etc. With this information, officers at the referral site have enough time to prepare all the needs, so that referral cases can be handled directlyEach referral site must always be on standby 24 hours to receive referral cases. c. Referral feedback and post-referral case follow-up The referral place sends feedback regarding the baby's condition along with recommendations for post-referral follow-up on the baby to the referring officer (puskesmas/polindes). Post-referral follow-up for sick babies is carried out by village midwives or regional officers assisted by the Community Health Midwife approach d. Preparation for Making a Referral: Midwife, Tools, Family, Letters, Medicine, Vehicles, Money