Evaluation of Referral System Barriers at Dr. Pirngadi Hospital, Medan City: Qualitative Study of In-depth Interviews

Abstract

The referral system plays an important role in ensuring the continuity of health services, especially in advanced referral hospitals such as RSUD dr. Pirngadi Medan City. However, its implementation still faces various obstacles, ranging from coordination between health facilities, limited facilities, to administrative issues. The purpose of this study was to analyze the obstacles in the implementation of the referral system at RSUD dr. Pirngadi Medan City and evaluate its impact on the effectiveness and quality of health services. The study used a qualitative approach with a case study method and in-depth interview techniques with key informants, consisting of specialist doctors, nurses, and administrative officers. Data were analyzed thematically using the Braun & Clarke method (2021). The results of the study showed that internal hospital coordination was effective, but obstacles still emerged when making external referrals to other hospitals, especially related to slow responses and bed availability. Several units at RS Pirngadi also experienced limited medical personnel and equipment. However, administrative procedures were considered not to be a significant obstacle because they were supported by an electronic medical record system and BPJS/UHC policies. It was found that there were obstacles in the referral system at RSUD dr. Pirngadi Medan generally came from external factors and certain resource limitations. Strengthening external coordination, provision of facilities, and optimization of information systems are needed to increase the effectiveness of referrals.