ADMISSION CRITERIA FOR COMMUNITY HOSPITALS

Author

Karen Jefferies, West Kent Community Health

Version

4.0

Date

June 2010

Document Control Sheet Admission Critieria for Community Hospitals

Title Author

Karen Jefferies

File Ref.

Revised admission community hospital criteria v4

Equality Impact Assessment

Initial Screening completed (date)

Full Impact Assessment completed (date) Review completed

Review completed

Approval Sign-off (For formal issue) Owner

Owner

(Organisation)

(Name)

NHS West Kent

Daryl Robertson

Deputy Chief Exec. & Director, Commissioning & Performance

Kent County Council

Margaret Howard

Maidstone & Tunbridge Wells NHS Trust Dartford & Gravesham NHS Trust

Nikki Luffingham

Director, Commissioning & Provision (West) Adults Social Services Chief Operating Officer

Gerard Sammon

Director of Operations

Approver

Role

Name

West Kent Community Heath

Mark Shepperd

Role

Signature

Date

Signature

Date

Managing Director

Change History Version

Date

Author / Editor

Details of Change

2

Admission criteria for Community Hospital beds Final. West Kent Community Health has a total of 131 beds sited within 6 community hospitals. They provide a range of intermediate services: Intermediate care can be defined as: • short stay assessment; • step up for the management of exacerbation of long term conditions; • step down from secondary care and; • palliative care. Intermediate care may be provided within a community hospital, or a nursing home or a social care facility and a team who can rapidly respond to patients with intermediate care needs and provide augmented care at home. Hospital Sites: Livingstone Hospital: East Hill, Dartford, Kent DA2 1SA Tel: 01322 622222 Tonbridge Cottage Hospital: Vauxhall Lane, Tonbridge, Kent TN11 0NE Tel: 01732 353653 Hawkhurst Hospital: High Street, Hawkhurst, Kent TN18 4PU Tel: 01580 753345 Sevenoaks Hospital: Hospital Road, Sevenoaks, Kent TN13 3PG Tel: 01732 470200 Edenbridge Hospital: Mill Hill, Edenbridge, Kent TN8 5DA Tel: 01732 862137 Gravesham Community Hospital, Sapphire Unit (neuro-rehabilitation): Bath Street, Gravesend, Kent DA11 0DG Tel: 01474 360500 Transport from Acute Trusts to Community Hospitals: This should be arranged by the referring hospital and expected time of transfer communicated to the receiving hospital.

3

The criteria for admission to a West Kent community bed covers step up and step down provision. Admission to intermediate care bed should be for a period of treatment, multidisciplinary assessment, rehabilitation” or non-specialist palliative care for patients who are medically stable, having come out of the acute phase of their illness, and whose condition does not require the resources of an acute hospital. This period of admission to a community hospital bed should not exceed 6 weeks in total and should incorporate an expected date of discharge and a clear plan of treatment goals to enable the patient to move forward along the patient pathway to their ultimate destination. These are patients with complex health care needs with a high level of physical dependency requiring 24 hour care therefore they are beyond the capacity of the traditional primary & community care team. Patients are discharged when the assessment or rehabilitation is complete or there is no further benefit from the treatment. Consultant support, from the referring acute trust, will continue to be provided to the patient to ensure that the pathway outcomes are met and the patient is discharged in a timely manner. Patients will be assessed in the acute trust by the acute ward staff and community liaison team using the agreed checklist. This checklist must be completed in full for the patient to be able to transfer safely and effectively to a community hospital bed.

Patients appropriate for admission to Intermediate Care Beds For West Kent Community Health Community Hospital beds these fall into two main categories as identified within the earlier definition: 1. Step up care which will enable patients with a long term condition who experience a crisis, which is beyond the scope of the traditional primary care team, to receive additional support on a short term basis to stabilise their condition. These are patients: • Who would otherwise require acute hospital admission or readmission and • Who do not require the level of medical or technological intervention of an acute hospital. • Who do not require out of hours clinical support services (beyond what can be provided by current GP Out of Hours services). • Who are expected to make sufficient recovery, within a time limited period, to be cared for within existing community resources or • Who are in receipt of some aspects of palliative care e.g. management of intractable pain, carer respite and end of life care (where appropriate and desirable for the patient)

4

2. Step down for patients in a recovery phase following an acute admission. •

• • • •

•

Who are medically stable for transfer from an Acute Hospital, although require a period of on-going 24 hour care in the Intermediate Care Facility. This will, where appropriate, be supported by ongoing Consultant support from the referring acute trust. Who have the ability and motivated to participate in active rehabilitation to improve their level of self-care/functional abilities. Who are expected to achieve rehabilitation goals within a time limited period. This period of time should not exceed 6 weeks or 42 actual days. Who have complex planning needs to deliver a rehabilitation goal which returns the patient to supported living within the community or Who are undergoing a period of assessment prior to decision to discharge either to supported living in the community or to a care home facility. This will be dependent on the full support of the social care team and joint planning for onward timely placement. Who are in receipt of some aspects of palliative care e.g. management of intractable pain and end of life care (where appropriate and desirable for the patient). This will be supported by Hospice providers, where appropriate.This is not appropriate if the patient is on the Liverpool Care Pathway.

Step down care should form part of clear patient pathways. Once the level of dependency is reduced the patient should be discharged to the appropriate community setting e.g. home, supported living etc. If the community hospital episode fails there will be a direct admission back into the referring acute trust under the original consultant, with the admission appropriately prioritised. The rate of patients returning to the relevant acute trust under these circumstances will be kept under review. Exclusions The following exclusions will apply: • Children & young people under the age of 18 years. • Persons with unstable acute medical conditions/ doubt over diagnosis. • Conditions relating to pregnancy. • Patients with diagnosed mental health disorder for which acute psychiatric inpatient admission is appropriate. • Patients with an acute degree of disruptive behaviour which challenges services and which community hospitals, with the support of in-reach specialty teams, may be unable to manage care effectively. • EMI patients. (Currently excluded for review by September 2010). • Patients who are resident in a nursing home. • Patients who are on the Liverpool care Pathway (48hrs).

5

Intermediate care beds are not used for: • Social Respite (except for patients who are in receipt of some aspects of palliative care and require a period of support to enable ongoing care at home in end of life care). • Pathway to long term care (except for a period of ongoing assessment following an acute admission). • Patients resident in a nursing home • Patients who are on the Liverpool care Pathway (48hrs).

References: Our Health, Our Care, Our Say: a new direction for community services (Jan 2006) Department of Health The NHS Operating Framework 2010/11. (Dec 2009). Department of Health. National Service Framework for Older People: supporting implementation-Intermediate Care: moving forward.(2002) Department of Health. A new ambition for old age: next steps in implementing the National Service Framework for Older People. (Apr 2006). Department of Health ‘What is Intermediate Care’ Melis et al (2004) British Medial Journal (329-360)l.

Web sites: www.jitscotland.org.uk www.rcn.org.uk www.kingsfund.org.uk www.nottinghamshirecountyteachingpct.nhs.uk

6