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Specialty Consultations & Inter-Facility Referrals

The Referrals & Transfers module in MOANA manages the seamless continuity of care when a patient requires specialized clinical expertise or transfer to another healthcare institution. It encompasses intra-hospital specialty consultations, outpatient specialist bookings, and emergency inter-facility tertiary escalations with encrypted clinical transfer dossiers.

Referrals Management Hub showing outbound referrals, incoming referral inbox, and triage priority statuses.
Referrals Management Hub showing outbound referrals, incoming referral inbox, and triage priority statuses.🔍 Click to enlarge

1. Referral Types & Clinical Pathways​

MOANA supports three distinct referral workflows:

graph TD
    A[Referring Clinician] --> B{Referral Scope}
    B -->|Internal Ward Review| C[1. Inpatient Specialty Consultation]
    B -->|Outpatient Clinic| D[2. Outpatient Specialty Referral]
    B -->|Higher Level of Care| E[3. Inter-Facility Tertiary Transfer]
    
    C --> C1[Target Clinical Team alerted within hospital]
    D --> D1[Patient booked in Specialist Outpatient Queue]
    E --> E1[Encrypted Clinical Package sent to Referral Hospital]
  1. Inpatient Specialty Consultation (Internal): An admitted patient requires bedside review by another clinical discipline (e.g., Internal Medicine requests Cardiology review for post-op arrhythmia).
  2. Outpatient Specialty Referral (Internal/Regional): Outpatient clinic patient referred to a specialist clinic (e.g., General OPD refers complex case to Ophthalmology or Orthopedics).
  3. Inter-Facility Tertiary Transfer (External): Patient escalated from a primary/district facility to a provincial or national tertiary referral center (e.g., transfer for emergency neurosurgery, cardiac catheterization, or pediatric intensive care).

2. Step-by-Step Referral Creation​

Click "+ New Referral" within the patient encounter or the central Referrals hub:

New Referral Modal with specialty selector, urgency grading, and clinical indication fields.
New Referral Modal with specialty selector, urgency grading, and clinical indication fields.🔍 Click to enlarge

1. Destination & Receiving Provider​

  • Internal Consultation: Select the target clinical department (e.g., Nephrology, Infectious Diseases, ENT).
  • External Transfer: Select the receiving accredited hospital (e.g., Port Moresby General Hospital, Angau Memorial Hospital).

2. Clinical Urgency Grading:​

  • 🔴 Emergency (Immediate / STAT): Life- or limb-threatening condition requiring immediate receiving team dispatch or ambulance transit.
  • 🟡 Urgent (Within 24–48 Hours): High-risk presentation requiring rapid specialist assessment.
  • 🟢 Routine (Next Available Slot): Elective chronic disease review or second opinion.

3. Automated Clinical Dossier Bundling:​

MOANA automatically compiles and encrypts the patient's continuous longitudinal health summary into the referral package:

  • Active SOAP notes and primary provisional diagnosis (ICD-10).
  • Baseline vitals, MEWS/NEWS2 trend charts.
  • Current medication list and documented allergies.
  • Recent LOINC laboratory test results and links to DICOM PACS imaging studies.
  • Transportation requirements (e.g., Medical Escort RN, Oxygen Support, IV Infusion Pump, Critical Care Ambulance).
  1. Click "Submit Referral" to transmit the electronic referral package.

3. Referral Intake & Specialist Triage Inbox​

Receiving specialists manage incoming cases through the Referrals Triage Inbox:

Referral Detail Drawer displaying patient clinical dossier, diagnostic attachments, and triage action buttons.
Referral Detail Drawer displaying patient clinical dossier, diagnostic attachments, and triage action buttons.🔍 Click to enlarge
Referral Detail Drawer displaying patient clinical dossier, diagnostic attachments, and triage action buttons.
Referral Detail Drawer displaying patient clinical dossier, diagnostic attachments, and triage action buttons.🔍 Click to enlarge

Triage Actions:​

  • Accept & Schedule: Assigns the patient an appointment slot in the specialist clinic or allocates an inpatient bed.
  • Request Further Information: Communicates back to the referring clinician requesting additional diagnostics before intake.
  • Redirect / Re-Triage: Routes to a more appropriate specialty if misdirected.
  • Reject with Justification: Declines the referral with a mandatory clinical rationale (e.g., Condition manageable at district level with provided guidance).

4. Bi-Directional Counter-Referral Feedback Loop​

When the specialist completes consultation or when the patient is discharged back from the tertiary hospital:

  1. The specialist authors a structured Consultation Response / Counter-Referral Note.
  2. Key treatment recommendations, modified medications, and follow-up plans are electronically transmitted back to the referring primary provider.
  3. The originating doctor receives an alert on their Doctor Command Dashboard, closing the continuity of care loop.