“小病在社区、大病进医院、康复回社区”，按照卫生部门的规划，大医院与社区卫生机构之间有一条双向转诊通道，为患者提供整体性、连续性医疗服务。然而，这条通道却一直存在“肠梗阻”，转上容易转下难，病人们愿意从社区转上大医院就诊，转回社区进行康复或后续治疗的人却少之又少。8月21日，广西医科大一附院请来南宁市60多家社区卫生机构的负责人，就双向转诊问题进行座谈。

“Slight illness in the community、Serious illness into hospital、Rehabilitation back to the community”，According to the health department of planning，Big hospitals and community health organizations have between a two-way referral channel，For patients with integrity、Continuity medical service。however，This passage has been exist“ileus”，To the easy is difficult to turn，The patients are willing to turn from community big hospital，Turn back to the community rehabilitation or subsequent treatment are rare。August 21，Guangxi nanning YiKeDa YiFuYuan invited more than 60 community health officials，Is two-way referral problems in discussion。

大部分病人“转不回去” Most of the patients“Turn back”

　　事实上，双向转诊已推行多年，但相当一部分居民都不知道这回事。家住江南区亭洪路的市民覃女士告诉记者，平时家人有个头疼脑热，都会到附近的南宁市第二人民医院去，没想过在社区卫生机构看，“社区的条件跟大医院肯定没法比，看病这事不比买件衣服，医疗质量是要首先考虑的”。

In fact，Two-way referral for many years has been carrying out，But quite a number of people don't know it。Live in jiangnan area pavilion flood road citizens tain lady told reporters，At ordinary times family has a headache and fever，Will to nearby nanning second people's hospital，Haven't thought about it in the community health institutions to see，“The condition of community with large hospital affirmation can't ratio，The doctor this thing than to buy clothes，Medical quality is to first take into consideration”。

　　听记者描述了双向转诊的概念后，覃女士表达了自己的想法：“如果凭着社区卫生机构的转诊单可以到大医院优先就诊，那我当然愿意先到社区看。但是如果在社区看不好，转到大医院还得跟其他病人一样排长队，还不如直接到大医院看，省得在社区多折腾一次。”

Listen to reporter describes the two-way referral after the concept of，Tain lady expressed their ideas：“If with community health institutions referral single can go to large hospital see a doctor first，That of course I would prefer to go to the community to see。But if in the community look bad，Turn to big hospitals have to with other patients as long lines，As the direct to the hospital to see，In the community so as to save more than a flounder。”

　　“还是有很大一部分病人愿意转上大医院治疗的，现在的问题不是‘转不上去’，而是‘转不回来’。”座谈会上，不少社区卫生机构的负责人都说起了这个问题。

“There are still a large part of the patients would be willing to turn on the big hospital treatment，The question now is not‘Turn not up’，but‘Turn not to come back’。”symposium，A lot of community health officials are about the problem。

　　西乡塘区百会社区卫生服务站的负责人张女士说，通过社区向上转诊的病人很多，像心脏病、肿瘤等处理不了的情况，他们都会安排病人就近转到南宁市第三人民医院，或按病人意愿转到医疗条件更好的医院。一般情况下，在大医院治疗后稳定了，病人就可以回到社区进行后续治疗或康复，如脑梗病人，度过危险期后，回到社区进行康复更方便也更经济，但实际上，转回来的病人少之又少。

Xixiang pond area hundred will be in charge of the community health service station to ms. Zhang said，Through the community upward referral of patients a lot，Like heart disease、Tumor unmanageable situation，They can arrange the patient came near to turn to nanning the third people's hospital，Or by the patient will turn to medical conditions better hospital。generally，In large hospitals after treatment was stable，The patient may be able to return to the community to conduct the follow-up treatment or rehabilitation，Such as cerebral infarction patients，Through crisis after，Back to the community rehabilitation more convenient and more economical，But in fact，Return of patients less and less。

“回路通畅”等于多出一家医院 “Loop unobstructed”Equal to more than a hospital

　　广西医科大一附院是全区接收转诊病人最多的医院之一，80%以上的就诊病人是区内外转来的。今年上半年，该院接收的南宁市各社区服务中心(站)的转诊病人中，门诊慢性病6115人次，住院361人次。

Guangxi YiKeDa YiFuYuan is the receiving referral hospital, one of the most，More than 80% of the clinic patients is to turn the region。In the first half of this year，The hospital received nanning the community service center(station)The referral of patients，Chronic disease outpatient service 6115 people，361 people in hospital。

　　该院领导跟社区卫生机构有着同样的困扰：转来的病人不愿转回去。该院院长曾志羽告诉记者，医院非常支持符合条件的病人转回社区。可不少病人手术完拆线了还不愿出院，总觉得自己还没完全康复，千方百计找关系要再住几天。与此同时，医院每天都有病人在排队等床位，却住不进来。

The hospital leadership with community health agencies have the same problem：Return of the patients would not turn back。Hospital director CengZhiYu told reporters，The hospital very support eligible patients turn back to the community。But many patients after operation take out stitches still is not willing to discharge，Always thought that I haven't fully recover，Leave no stone unturned to find relationship again for a few days。meanwhile，The hospital every day there are patient queue up in bed，Were living in。

　　曾志羽说，出现这样的问题，优质医疗资源有限是一个主要原因。为了让有限的优质医疗资源服务更多人，双向转诊的理念是解决之道：大医院病床周转率提高，让更多人能享受到优质医疗资源，社区卫生机构能更好地发挥作用，患者“看病难”问题得到缓解。

CengZhiYu said，Such a problem，High quality medical resources co., LTD., is one of the main reasons。In order to let the limited high quality medical resource service more people，Two-way referral concept is the solution：Big hospital bed turnover increase，Let more people can enjoy the high quality medical resources，Community health agencies can play a better role，patients“See a doctor difficult”Problem ease。

　　曾志羽还给记者算了一笔账：在双向转诊制度非常成熟的美国等发达国家，医院的平均住院天数在7~8天，我国则是10~12天。以该院接近3000张床位的规模计算，如果能把平均住院天数缩短1/3，就能多出1000张床位，相当于多出一家医院。

CengZhiYu back to reporter calculate a bill：In the two-way referral system very mature the United States and other developed countries，The average hospitalization days hospital in 7 ~ 8 days，Our country it is 10 to 12 days。With close to 3000 hospital beds scale calculation，If the average hospitalization days shorten 1/3，Can more than 1000 beds，The equivalent of a hospital。

完善双向转诊还需多方努力 Perfect bidirectional referral to various efforts

　　双向转诊“转回难”并不完全是患者的就医观念问题，社区卫生机构的服务能力有限也是重要原因。东葛社区卫生服务中心副主任梁佩兰坦言，在有的情况下，病人即使转回来，社区卫生机构也“接不住”。以康复为例，简单的针灸、推拿等治疗没问题，但是中风后肢体、语言功能的康复等需要专业康复师的指导，很多社区卫生机构都没法提供。该中心此前也一直没有专业康复师，直到今年才选派一名人员去参加培训。

Two-way referral“Return difficult”Do not fully is the patient's medical concept，Community health service is also important limited ability to reason。East ge community health service center, deputy director of the LiangPeiLan said，In some cases，The patient even turn back，Community health agencies also“Joint not”。Behind in order to recover as an example，Simple acupuncture and moxibustion、The massage treatment such as no problem，But after a stroke body、Language function rehabilitation and so on KangFuShi need professional guidance，A lot of community health institutions can not provide。The center had also had not been professional KangFuShi，Until this year designation a personnel to attend training。

　　参会人员都认为，疏通双向转诊通道，还需要多方努力。卫生行政部门应出台相关的细则，如转诊指南，什么情况该转，往那里转，以及相应的奖惩办法。通过政府投入、大医院技术帮扶等多种手段提高社区卫生机构的服务能力。同时，群众的就医观念也有待转变。

The conference participants all think，Dredge two-way referral channel，Still need to various efforts。The public health administrative department shall be issued relevant rules，Such as referral guide，What circumstance this turn，Turn where，And the corresponding rewards and punishments measures。Through the government investment、Big hospital technical supporting and so on the many kinds of methods to improve community health service ability。At the same time，The concept of medical needs to change。

名词解释 Nouns explain

　　双向转诊：由于社区卫生服务机构在设备和技术条件方面的限制，对一些无法确诊及危重的病人，转移到上一级的医疗机构进行治疗。上一级医院对诊断明确、经过治疗病情稳定转入恢复期的病人，返回所在辖区社区卫生机构进行继续治疗和康复。其目标是为建立“小病在社区、大病进医院、康复回社区”的就医新格局，缓解大医院就医难问题的同时，充分利用各社区医院的服务功能和网点资源。(记者 张若凡)

Two-way referral：Due to the community health service organization in terms of equipment and technology of limit，For some unable to diagnose and critically ill patients，Transferred to the level of medical institution for treatment。Hospital at the next higher level in the diagnosis of clear、After treatment in stable condition into the recovery of the patients，Return to your area of community health institutions continue to treatment and rehabilitation。The goal is to build“Slight illness in the community、Serious illness into hospital、Rehabilitation back to the community”A new pattern of medical treatment，Ease the large hospital difficult problem at the same time，Make full use of the community hospital service function and network resources。(Reporter ZhangRe all)