Effectiveness of referral and counter-referral systems in a high-complexity Speech, Language and Hearing healthcare service in the city of São Paulo

Daniela Regina Molini-Avejonas Thaís Helena Ferreira Santos Sandra Rodrigues de Oliveira Silmara Rondon-Melo Fernanda Parsequian Cartolano About the authors



For optimum quality in Speech, Language and Hearing (SLH) healthcare, it is essential to be aware of the flow of referrals and counter-referrals for high-complexity health services.


To analyze the flow of patients of a high-complexity SLH service in Brazil’s Unified Health System (Sistema Único de Saúde – SUS).


Descriptive study, made at a Speech, language and hearing (SLH) service of a high complexity hospital. Participants were 373 users who underwent SLH screening (consultation of health records). The variables analyzed were: social-demographic profile; SLH profile; origin of referral of users; time between referral and screening being carried out; referrals after screening (counter-referral); time between conclusion of screening and first SLH consultation in the counter-referred service; and degree of satisfaction with the SLH consultation of the counter-referral.


The largest group was the age range zero to 11 years 11 months, male, resident in the city of São Paulo, who had not completed primary education. The most prevalent initial diagnosis in SLH terms was dysphonia. The majority of users were referred to tertiary care. The average waiting time for screening was 56.6 days. Just over half the subjects were referred for tertiary care. The waiting time for care was longest at the secondary level. The majority of users stated their degree of satisfaction with the care to be excellent or good.


A high degree of resolutiveness was observed in the tertiary care service analyzed; and a need was observed in secondary and primary care for reorganization of the systems of referral and counter-referral.

Brazilian Unified Health System; Hospitals, public; Referral and consultations; Patient satisfaction

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