Referral criteria and referral process

Criteria:

1. The service is available to people living within the catchment area that have incurable, life-limiting malignant or non-malignant disease. Most patients will have advanced progressive disease and the focus of care will have changed from curative to palliative.  Some patients, who have complex specialist needs, may be referred at an earlier stage of their disease.
 
2. The patients will have complex problems associated with their disease, such as difficult physical symptoms and/or psychological, social or spiritual issues requiring Specialist Palliative Care Services.
 
3. The patients (or their advocate) and the patients’ GP must consent to the referral.
 
4. Patients may be referred for an urgent assessment by a Community Nurse Specialist or a Hospice Doctor, and contact will be made with them within 2 working days. These patients must have been assessed by a health care professional in the previous 48hrs, and meet 1 or both of the following criteria:

• Particularly severe symptoms not readily responding to current management
• A rapidly deteriorating condition requiring specialist palliative care input

The Referral Process:

1. A request for assessment can be made by any professional, but it must be made with the consent of the patient (or their advocate) and their GP.
 
2. Referrals should always be accompanied by a fully completed referral form and must include copies of recent hospital letters, scans and blood results and any other relevant information. Insufficient information will delay the initial assessment. If the referral is for Hospice at Home to provide 24 hour nursing care at the end of life please return the specific referral form for this service - Hospice at Home referral form
 
3. It is essential that the referrer identifies the reason for the referral and current problems requiring specialist palliative care input.
 
4. Urgency of the referral should be specified according to the above criteria.
 
5. Referrals indicated as ‘urgent’ should be faxed to the hospice and at the same time be accompanied by a telephone call from the referrer to a member of the Community Clinical Nurse Specialist Team (who will be working as the triage nurse) or the Senior Medical team.  This is in order to provide immediate advice to the referrer.  Following this telephone discussion with the referrer, if it is still deemed as urgent the patient will be contacted within 2 working days.
 
6. For referrals marked as routine patients will be contacted within 2 weeks.
 
7. Once a patient has been accepted by the hospice services they will be contacted to let them know how the referral will be processed.
 
8. If, following assessment/management the patient no longer requires input from the hospice they will be discharged from the service. Re-referral is welcomed but further information or another referral form may be requested, particularly if there has been no hospice involvement for longer than 9 months.

Hospice Services

Patients can be referred for one of the following services:

• Home Visit Community Nurse Specialist
  For the majority of patients at home, the initial holistic assessment will be made by the community nurse specialists. If a joint visit with GP and/or DN would be helpful, please indicate on the referral form.
  
  
• Home Visit Doctor/Outpatient appointment
  If a patient has particularly complex medical problems a senior doctor can make the initial assessment either at the patients’ home or as an outpatient at the hospice.
  
  
• Day Hospice
  A patient can be referred to attend a therapeutic programme; one day a week for twelve weeks. Patients will be in a group environment with access to a specialist multidisciplinary team. The day will include relaxation as well as gentle physical exercise, and the opportunity to join in informal education sessions on relevant topics such as oral care, medicine management, and planning for the future. Patients who do not have their own transport but are able to get in and out of the car independently can have access to a volunteer driver. It is the referrer’s responsibility to sort transport for those who may need more assistance. Patients will normally be discharged from Day Hospice after 12 weeks: back to the care of the referring Health Care Professional.
  
  To download a Day Hospice transport form click here
  
  Patients can also be referred to the Fatigue and Breathlessness (FAB) Management Programme run by the physiotherapy, occupational therapy and nursing team within Day Hospice. It runs over a 6 week period. Click here to see dates for the next course
  
  For either service; if the patient is using oxygen, a HOOF will need to be completed by the GP to ensure oxygen is delivered to St Peter’s for use by the patient on their day of attendance at the Day Hospice.
  
  
• Inpatient Unit
  The hospice inpatient beds at Brentry are used to offer short-term admission (usually up to 14 days), with the aim of supporting patients at times of acute and/or complex specialist palliative care needs. For patients with acute reversible conditions requiring urgent investigation or intensive medical management, hospital admission should be considered, depending on the informed choice of the patient or patient’s advocate.
  
  If a GP/DN/hospital palliative care team would like a current patient to be considered for admission they should contact the patient’s Hospice Community Nurse Specialist or Day Hospice team to request this. If the patient concerned is not already known to the hospice it is essential to fax a full referral form and discuss the case with one of the senior doctors.
  
  Routine requests for admission will be discussed at the next admission meeting (Daily: Monday to Friday). Emergency admissions can be arranged for the same day or out of hours if appropriate, depending on bed availability. Requests for urgent admission must be discussed with a senior hospice doctor who is available 24 hours for urgent advice.
  
  For planned admissions if patients are using oxygen, a HOOF will need to be completed by the GP or referring hospital team to ensure oxygen is delivered to St Peter’s for use by the patient during their inpatient stay.
  
  For more information see guideline for arranging admission
  
  
• Hospice at Home
  This is a service available to enable patients with high levels of nursing need to be in their own home for terminal care. It is intended for patients in the last week of life. A nurse from St Peter’s stays with the patient for a full eight hour shift, providing up to 24 hour cover if required. There is limited availability for this service, which means that provision is usually limited to one patient at any one time. There is a separate referral form to access this service. Please complete the form and fax it to the medical secretary. The Hospice at Home team leader or the hospice CNS on call will contact the referrer to discuss whether Hospice at Home is available/appropriate for the patient.

It is not possible to make a direct referral for bereavement/FLAGS, occupational therapy, physiotherapy, chaplaincy, psychologist or respite admission.

Completed referral forms

Completed referral forms should be faxed to: 0117 915 9473

Or posted to:

Clinical Administration Team
St Peter's Hospice
Charlton Road
Brentry
Bristol BS10 6NL