Development of Referral System for Emergency patients at Ban Phai Hospital, Khon Kaen Province

Abstract

      This action research aimed to develop and improve the quality of the emergency patient referral system at Ban Phai Hospital, Thailand, to enhance service standards and patient safety. The study applied the PAOR cycle (Planning, Action, Observation, and Reflection) as the framework for system development. Participants included 14 administrators, 81 healthcare providers, and emergency patients with their relatives receiving referral services during the study period. The study was conducted from April to December 2025. Data were collected using interview guides, practice assessment                    forms,          and satisfaction questionnaires. The research instruments demonstrated acceptable content validity  (CVI = 0.85) and reliability (Cronbach’s alpha = 0.785).The findings resulted in the development of 12 emergency referral standards, comprising eight structural standards and four process and outcome standards. The structural standards focused on ambulance readiness, equipment, personnel, referral information, medications and supplies, financial support, patient safety, and governance.            The process and outcome standards addressed patient preparedness, patient transfer and immobilization, readiness during transport, and anxiety reduction. Following implementation, healthcare providers reported increased confidence in emergency referral management. Patient and family satisfaction remained at the highest level throughout the evaluation period (mean scores = 4.93 ± 0.10, 4.95 ± 0.09, and 4.97 ± 0.06, respectively). The developed system improved the quality, safety, and standardization of emergency patient referrals. However, the study was conducted in a single community hospital, which may limit the generalizability of the findings. Hospitals should therefore adapt referral standards to their specific contexts to ensure timely, safe, and high-quality patient transfers.

Keywords: Action Research, Quality Improvement, Emergency Patient Referral System, Community Hospital