ADMISSION OR NOT?

On a home visit?  Complex case?  Not sure whether to admit or not?  Could possibly avoid admission if there was extra support or coordinated care at home? Obviously acute serious things like an acute MI need admission. We're not questioning that. We're questioning those grey cases where you're not quite sure but you know that if extra support was at the patient's home, they'd do fine being managed there.

Unnecessary hospital admissions are a big drain on resources. Remember, it's public money that we're spending here and so we must use it responsibly.

In House

Some practices have a case manager who can help you review cases to see if admission can be avoided if extra help was placed at home. They are qualified nurse and are very experienced and will know about services that you might not.

At Ashcroft Surgery, the case manager is Pat Hartley.

Remember, a lot of elderly patients prefer to be at home than in hospital. In fact, the hospital environment (with its unfamiliarity) can induce an acute confusional state.

So think!

Alternatives to Admission

Notes

Urgent Care team : 

Aims: to provide assistance to practices with late visits, reduce unnecessary admissions to acute hospitals, establish better alternative pathways - including:  possible admission, support etc, to help establish the requirements for a trust wide unscheduled care service

examples of patients to refer

1. chronic disease with acute exacerbation; "off legs"; patients with complex needs - nursing/social as well as medical

2. patients who might benefit from a dual ambulance and medical response, example, patients with chest pain or cardiac arrest for whom the GP might currently call only the ambulance service.  It is hoped that this dual response will help provide the best care for individual patients as well as fostering closer working ties with the ambulance service

3. patients whom the GP feels may be able to stay in the community (home or hospital) but needs more assistance/imput/review then would be normally given

examples of patients not to be included

1. patients well known to the practice that the GP feels would be inappropriate to involve a further team in their care, example, palliative care patients; patients who can be seen at the surgery example children and young adults;

2. patients who would be better managed by a planned consultation at a later date example relating to ongoing issues with which GP/practice already involved with;

3. acute mental health crisis for whom the crisis intervention team would be more appropriate

4.  

	currently only available to Ashcroft and Moorside surgeries
	as only one doctor will be on duty at any one time there may have to decline visit request depending on the workload