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Table 3 Effective referral systems

From: A realist review of the partograph: when and how does it work for labour monitoring?

Question No of studies Evidence synthesis Quality
Which methods of working ensure effective referral? n = 2 There is confusion between healthcare worker roles, particularly between midwives and physicians, which may impact on the effectiveness of referral.
The partograph is not always used as a communication tool between health workers at handover of care or referral.
Partograph findings are not always acted upon.
*V low [29, 32]
What are the issues or barriers related to effective referral? n = 10 The partograph is a trigger for referral. However, there is some inconsistency in referrals based on partograph findings.
It is unclear if referrals made as a result of partograph use are appropriate.
There was little evidence of additional barriers to transfer, e.g., transport, cost etc.
**Low [23, 36, 38]
*V low [20, 28, 29, 31, 32, 37, 39]