Referral and counter-referral (referencia y contrarreferencia) and follow-up between levels of care
- Safe practice
Referral sends a person to another provider for care; counter-referral sends back the answer and instructions, so care continues without gaps.
What it is
In Colombia, referral and counter-referral are the technical and administrative processes that let patients receive care with quality, access, timeliness, continuity and comprehensiveness within the provider network of the paying entity (Decree 4747 of 2007). Referral is sending a patient, or diagnostic samples, from one provider to another that can meet the need. Counter-referral is the receiving provider's answer: sending the patient back with instructions, or simply reporting the care given or the test results. The paying entities (such as the EPS) design and operate the system. For the nurse, a referral is only finished when the person has been seen and the answer has come back into the plan.
What it requires
- A clear reason for referral and the right level of care, according to protocol.
- Information and consent of the person and family about where they go and why.
- A complete written summary and a structured verbal handoff.
- Follow-up until the person is seen and the counter-referral is in the record.
How it is applied (and why)
- Confirm the need and the level of care according to protocol — referring too much or too little both harm the person.
- Explain to the person and family where, why and what to bring — informed people arrive and follow through.
- Check the provider network of the person's EPS — the receiving provider must be in the network and available.
- Write the summary: identity, reason, findings, care given, allergies, pending tasks and contact — the receiver should not start from zero.
- Hand over in a structured way (ISBARR) and repeat back orders — structure prevents omissions.
- Keep caring for the person until they enter the receiving institution — responsibility stays with the referring provider.
- Record the referral, time, receiver and agreements — the record supports continuity and protects everyone.
- Track whether the person arrived and was seen — a referral without follow-up is a lost patient.
- When the counter-referral arrives, update the plan, book follow-up and teach the person — the answer only helps if it is acted on.
In nursing practice
- In the community, the basic health team uses a referral (canalización) format and checks each month how many referrals were effective.
- Ambulance transport by a separate entity makes that entity responsible for care during the transfer.
- The paying entities may use the emergency regulation centres (CRUE) to operate referral.
- Possible problems: delays, lost patients, repeated tests and counter-referrals that never return; follow-up detects them.
Common mistakes
- Referring with a vague reason or an incomplete summary.
- Assuming the person went because the order was given.
- Filing the counter-referral without changing the plan.
- Not telling the family what to do while they wait.
Test yourself
Think of the answer, then tap the question to see it.
What is counter-referral?
The answer the receiving provider gives to the referring one: sending the patient back with instructions, or reporting the care given or the test results.
Who is responsible for the patient during a referral until entry to the receiving institution?
The referring provider, unless transport is by a separately enabled ambulance, which is then responsible during the transfer.
Who designs and operates the referral and counter-referral system in Colombia?
The entities responsible for paying for health services, such as the EPS, with a sufficient provider network.
When is a referral finished from the nursing point of view?
When the person has been seen and the counter-referral has been received and acted on in the care plan.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Decreto 4747 de 2007 (art. 3 literal e y art. 17: referencia y contrarreferencia) (Secretaría Distrital de Salud de Bogotá (copia del texto oficial), 2007); Atención Primaria en Salud: componentes y atributos (presentación técnica, 12 de marzo de 2026) (Ministerio de Salud y Protección Social, Colombia, 2026); Nursing Management and Professional Concepts, 7.5 Interprofessional Communication (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2022); Lineamientos para la organización y operación de los Equipos Básicos de Salud (Resolución 2788 de 2022): formato de canalización (Ministerio de Salud y Protección Social, Colombia, 2023).
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Representative model, for educational purposes only.