REFERRAL OF HOSPITALIZED PATIENTS TO THE NATIONAL NETWORK OF INTEGRATED CONTINUING CARE

Abstract

The aging population in Portugal and the reduction of the birth rate have led to an increase in the demand for health services. In response to this achievement, the National Network of Continuing Care was created to provide support to patients in situations of dependence, providing a model of continued and adequate care. This work is focused on the analysis of the referencing process of hospitalized patients, identifying the challenges faced in the transition of care. The article points out that the overload of professionals, bureaucracy and technological limitations hinder the referencing process, prolonging the time of hospitalization and increasing hospital costs. As a solution, it is suggested to hire a Specialized Nurse to perform referrals effectively and efficiently, promoting an agile and adequate care transition. The use of tools such as the Cause-Effect Diagram and the PDCA Cycle allows to identify and mitigate the factors that contribute to delays in the process of reinsertion, proposing improvements in practices to optimize the workflow and effectiveness of the health system.