Procedural implementation of the hospital integrated referral system (Sistem Rujukan Terintegrasi/ SISRUTE) in Indonesia: A systematic review
https://doi.org/10.52235/lp.v7i1.713
Keywords:
health care, hospital, Indonesia, patient transfer, referralAbstract
Background: The Integrated Referral System (Sistem Rujukan Terintegrasi or SISRUTE) has been introduced in Indonesia to strengthen coordination, timeliness, and continuity of patient referrals across health care facilities. However, the available evidence remains dispersed across local studies and broader referral system literature.
Objective: This review aimed to examine the procedural implementation of SISRUTE in hospitals in Indonesia and to identify the factors that influence its effectiveness, supporting conditions, and implementation barriers within referral service procedures.
Methods: This study employed a systematic review design. Literature searches were conducted in Google Scholar, PubMed, ProQuest, and ScienceDirect using combinations of terms related to SISRUTE, patient referral, emergency referral, and hospitals. Studies published between 2021 and 2025, available in full text, and relevant to SISRUTE implementation in Indonesian health care settings were considered. Data from the included studies were extracted systematically and synthesized using a narrative approach.
Results: Ten studies were included in the final review. The findings showed that SISRUTE and other digital referral systems generally improved referral efficiency, accelerated response time, and strengthened coordination between health facilities. Hospital-based evidence indicated that referral response commonly occurred within a short time frame, while digital referral implementation also contributed to improved workflow efficiency and user satisfaction. However, implementation remained constrained by limited bed capacity, inadequate infrastructure, uneven system integration, information quality issues, and variations in staff readiness. The review also found that performance expectancy, effort expectancy, and facilitating conditions influenced system use, whereas broader evidence emphasized the importance of interoperability, training, and organizational support.
Conclusion: The procedural implementation of SISRUTE in hospitals in Indonesia shows substantial potential to improve referral management and service coordination. Nevertheless, the effectiveness of the system depends on technological readiness, institutional capacity, and sustained support for health workers. Strengthening infrastructure, integrating referral platforms with hospital service systems, and improving workforce preparedness are essential to optimize the contribution of SISRUTE to hospital referral quality in Indonesia.
Downloads
References
Ahkam, Z. A. (2023). Implementasi Sistem Rujukan Terintegrasi (SISRUTE) di RSUD Labuang Baji Kota Makassar.
Ahmed, S. K., Mohammed, R. A., Nashwan, A. J., Ibrahim, R. H., Abdalla, A. Q., Ameen, B. M. M., & Khdhir, R. M. (2025). Using thematic analysis in qualitative research. Journal of Medicine, Surgery, and Public Health, 6, 100198.
Alabbasi, K. H., Kruger, E., & Tennant, M. (2022). Strengthening Saudi Arabia’s primary health care through an e-referral system: A case study. Clinical Practice, 12, 374–382. https://doi.org/10.3390/clinpract12030039
Aljerian, N. A., Alharbi, A. A., AlOmar, R. S., Binhotan, M. S., Alghamdi, H. A., Arafat, M. S., Aldhabib, A., & Alabdulaali, M. K. (2024). Showcasing the Saudi e-referral system experience: The epidemiology and pattern of referrals utilising nationwide secondary data. Frontiers in Medicine, 11, 1–11.
Anderson, J. K., Newlove-Delgado, T., & Ford, T. J. (2021). Annual research review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage. Journal of Child Psychology and Psychiatry, 63, 447–462.
Aristian, M. T., Murni, N. S., & Zaman, C. (2025). Analysis of patient satisfaction with electronic medical record services at general hospital: A cross-sectional study. Lentera Perawat, 6(3), 522–530. https://doi.org/10.52235/lp.v6i3.536
Astiti, N. K. A. (2023). Analisis Data Sistem Rujukan Terintegrasi (SISRUTE) di Instalasi Gawat Darurat (IGD) Infeksi RSUP Dr. Sardjito.
Avoka, C. K., McArthur, E., & Banke-Thomas, A. (2022). Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review. Tropical Medicine & International Health, 27, 494–509.
Azhar, F., Khan, R. A., Fatima, T., Yasmin, R., & Mehboob, U. (2021). Referral writing: Consensus building on a tool for writing structured referrals. Journal of the Pakistan Medical Association, 71, 2794–2798.
Bai, L., Cheng, Y., Tao, Z., Feng, L., Wang, S., & Zeng, Y. (2022). Research on maternal service area and referral system in Hubei Province, China. International Journal of Environmental Research and Public Health, 19, 1–14.
Bordbar, N., Shojaei, P., Ravangard, R., Bastani, P., Joulaei, H., & Kavosi, Z. (2022). Evaluation of the World Countries Health Referral System Performance Based on World Health Organization Indicators Using Hybrid Multi-Criteria Decision-Making Model. Value in Health Regional Issues, 28, 19–28. https://doi.org/10.1016/j.vhri.2
Bordbar, N., Shojaei, P., Ravangard, R., Bastani, P., Joulaei, H., & Kavosi, Z. (2022). Evaluation of the world countries health referral system performance based on World Health Organization indicators using hybrid multi-criteria decision-making model. Value in Health Regional Issues, 28, 19–28.
Bruxvoort, K. J., Schumacher, C. M., Towner, W., Jones, J., Contreras, R., Ling Grant, D., & Hechter, R. C. (2021). Referral linkage to preexposure prophylaxis care and persistence on preexposure prophylaxis in an integrated health care system. Journal of Acquired Immune Deficiency Syndromes, 87, 918–927.
Chou, A., Johnson, J. K., Jones, D. B., Euloth, T., Matcho, B. A., Bilderback, A., & Freburger, J. K. (2023). Effects of an electronic health record‐based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi‐experimental study. Health Services Research, 58(S1), 51–62. https://doi.org/10.1111/1475-6773.14087
Chukwu, E., Garg, L., Obande-Ogbuinya, N., & Chattu, V. K. (2022). Standardizing primary health care referral data sets in Nigeria: Practitioners’ survey, form reviews, and profiling of Fast Healthcare Interoperability Resources (FHIR). JMIR Formative Research, 6, e28510.
Constantine, A., Condliffe, R., Clift, P., Tulloh, R., & Dimopoulos, K. (2021). Palliative care in pulmonary hypertension associated with congenital heart disease: Systematic review and expert opinion. ESC Heart Failure, 8, 1901–1914.
Cunningham, E. B., Wheeler, A., Hajarizadeh, B., French, C. E., Roche, R., Marshall, A. D., Fontaine, G., Conway, A., Valencia, B. M., Bajis, S., Presseau, J., Ward, J. W., Degenhardt, L., Dore, G. J., Hickman, M., Vickerman, P., & Grebely, J. (2022). Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 7, 426–445.
Dominico, S., Serbanescu, F., Mwakatundu, N., Kasanga, M. G., Chaote, P., Subi, L., Maro, G., Prasad, N., Ruiz, A., Mongo, W., Schmidt, K., & Lobis, S. (2022). A comprehensive approach to improving emergency obstetric and newborn care in Kigoma, Tanzania. Global Health: Science and Practice, 10, 1–24.
Drewry, M. B., Yanguela, J., Khanna, A., O’Brien, S., Phillips, E., Bevel, M. S., McKinley, M. W., Corbie, G., & Dave, G. (2023). A systematic review of electronic community resource referral systems. American Journal of Preventive Medicine, 65, 1142–1152.
Duffy, M., Ghosh, A., Geltman, A., Mahaniah, G. K., Higgins-Biddle, M., & Clark, M. (2021). Coordinating systems of care for HIV and opioid use disorder: A systematic review of enablers and barriers to integrated service access, and systems and tools required for implementation. Medical Care Research and Review, 79, 10775587211051182.
Eksteen, S., Eikelboom, R. H., Launer, S., Kuper, H., & Swanepoel, W. (2021). Referral criteria for preschool hearing screening in resource-constrained settings: A comparison of protocols. Language, Speech, and Hearing Services in Schools, 52, 868–876.
Ema Arisandi, Arlin Adam, Andi Alim. (2023). Transformasi Budaya dalam Pelayanan Kesehatan: Studi Kualitatif atas Penerimaan Masyarakat terhadap Sistem Rujukan Online (SISRUTE) di Kabupaten Luwu Timur.
Fathoni, M., Syafrudin, S., & Setyawan, A. (2023). Analisis Kesiapan Infrastruktur Teknologi Informasi dalam Implementasi SISRUTE di Rumah Sakit Umum Daerah. Jurnal Manajemen Informasi Kesehatan Indonesia, 11(1), 45-56.
Gadenz, S. D., Basso, J., de Oliviera, P. R. B. P., Sperling, S., Zuanazzi, M. V. D., Oliveira, G. G., da Silva, I. M., Motta, R. M., Gehres, L. G., de Brito Mallmann, É., Rodrigues, Á. S., Pachito, D. V., & de Faria Leao, B. (2021). Telehealth to support referral management in a universal health system: a before-and-after study. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-07028-5
Kementerian Kesehatan Republik Indonesia (Kemenkes RI). (2019). Laporan Nasional RKTM 2018: Tantangan Sistem Rujukan di Indonesia. Jakarta: Kemenkes RI.
Kementerian Kesehatan Republik Indonesia (Kemenkes RI). (2020). Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 Tahun 2020 tentang Sistem Rujukan Terintegrasi. Jakarta: Kemenkes RI.
Kusuma, M. I. A., Palupi, E. R. R., & Wirawan, N. (2025). Relationship between workload and nurses response time in the emergency room: A literature review. Lentera Perawat, 6(3), 419–426. https://doi.org/10.52235/lp.v6i3.483
Marlangen, R., Murni, N. S., & Gustina, E. (2025). Correlation of various risk management factors for risk control at general hospital: A cross-sectional study. Lentera Perawat, 6(3), 570–577. https://doi.org/10.52235/lp.v6i3.541
Maryono, K., Hermansyah, A., & Wijaya, I. N. (2025). Evaluation of the Use, Storage, and Administration of Narcotic Drugs in Pharmacies, Hospitals, and Community Health Centers: Literature Review. Indonesian Journal of Health Services, 2(2), 40-50. https://doi.org/10.63202/ijhs.v2i2.95
Ni Kadek Ari Astiti, Happy Indah Kusumawati, Sutono. (2023). Analisis Data Sistem Rujukan Terintegrasi (SISRUTE) di Instalasi Gawat Darurat (IGD) Infeksi RSUP Dr. Sardjito.
Plummer, M. L., Calvello Hynes, E., Fogarty, J., Toro Polanco, N., & Reynolds, T. (2025). Optimizing people’s movement across the health system: a scoping review of referral systems within a primary health care approach. In Primary Health Care Research and Development (Vol. 26). Cambridge University Press. https://doi.org/10.1017/S1463423625100546
Prasetyo, B., & Utami, R. D. (2021). Dampak Implementasi SISRUTE terhadap Waktu Tunggu Pelayanan Pasien Rujukan di Rumah Sakit. Jurnal Kesehatan Masyarakat Nasional, 16(2), 112-120.
Putra, R. W., & Umar, Z. U. B. (2024). Nurses’ experience in providing continuity of care for people with mental disorders after hospitalization in primary health care: A qualitative study. Journal of Community Nursing and Primary Care, 1(1), 1-8. https://doi.org/10.63202/jcnpc.v1i1.27
Rachmawati, R., & Chalidyanto, D. (2021). Tantangan Digitalisasi Kesehatan: Studi Kasus Adopsi SISRUTE di Tiga Rumah Sakit di Jawa Timur. Media Kesehatan Masyarakat Indonesia, 20(3), 201-210.
Safi, M., Clay-Williams, R., Thude, B. R., Vaisman, J., & Brandt, F. (2022). Today’s referral is tomorrow’s repeat patient: referrals to and between medical outpatient clinics in a hospital. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07633-y
Sari, D. P., Hidayat, B., & Wahyuni, C. (2022). Faktor Penghambat Implementasi SISRUTE dari Perspektif Tenaga Kesehatan: Studi Fenomenologi. Jurnal Manajemen Pelayanan Kesehatan, 25(1), 33-42.
Zahrawi Astrie Ahkam, Nurmiati Muchlis, Samsualam. (2023). Implementasi Sistem Rujukan Terintegrasi (SISRUTE) di RSUD Labuang Baji Kota Makassar.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Septi Anggraini, Akhmad Ikhlasul Amal, Erna Melastuti
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
