Vol. 8, Issue 3, Part B (2025)

Background: Referral is a process in which a healthcare worker at one level of the health system, who lacks the necessary resources to manage a clinical condition, seeks assistance from a more capable facility at the same or a higher level. There are two types of referral systems, the external, which refers the patients directly from the health care centers to the hospitals departments, and the 2nd type, internal of patients from health care centers to polyclinics (there is one polyclinic in each health district containing specialists of pediatric, surgery, gyn/obs and rheumatology).
Objectives: To clarify the pattern of the referral system in Baghdad Al-Karkh through comparing the role of the internal referral system to decrease the external referral system and also to identify the indications for referrals and which hospital departments. Lastly assess the quality of the referral letters to ensure the continuity of the health services and to decrease the referral cases to the hospital.
Subject: The study involved 98 health centres and 9 polyclinics over a nine-month period, from 1st October 2024, to 31 June 2025. 
Method: A retrospective study reviewing all referral letters to estimate the total patients visiting and referrals to hospitals, data obtained from referral letters and registers by trained personnel in special forms. 5% of referral letters were selected randomly for quality assessment. Data analysis was done using Excel software format, and the results were presented in tables and figures. Exclusion data for the Al-Tajee, Al-Eelam, and Al-Tarmyia health districts is noted as they do not include polyclinics.
Results: The total number of patient attendances at health centres was 1,493.607 of them, 28.853 were referred directly to hospitals. Out of the referred patients, 8,245 were referred to the pediatric, surgical, gyn/obs, and rheumatological departments of the hospitals, while through internal referral from health care centres, to the pediatric, surgical, gyn/obs, and rheumatological of the polyclinics, there were 4,017, so the total number of referred patients was 12,375. Therefore, the internal referral sharing lowers the external referral rate to 67%, females more than males, and the most referral patents from age group 0-15 years, 28%. The main indication for referring hospitals is 49% for sharing or getting a second opinion from a specialist in the hospital for mor diagnosis, 25% of patients referred to internal medicine department. 
Conclusion: There is an obvious effect of polyclinics on crowding in the outpatients of the hospital, and there is a need to continuously support polyclinics with diagnostic equipment and medication. open internal medicine clinics in polyclinics to decrease external referral to the hospitals.the referral rate remains the most important part of the monitoring process and the quality of referral letters significantly influenced the writing of replies by hospital staff.