University of Canberra Hospital (UCH) – Patient ...



Canberra Hospital and Health ServicesOperational Procedure UCH – Patient Eligibility and Admission Criteria and Process Contents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc499546412 \h 1Purpose PAGEREF _Toc499546413 \h 2Scope PAGEREF _Toc499546414 \h 2Section 1 – Decision Making and Determining Medical Stability PAGEREF _Toc499546415 \h 3Section 2 – Waiting List PAGEREF _Toc499546416 \h 3Section 3 – Transfer to UCH PAGEREF _Toc499546417 \h 3Section 4 – Eligibility Criteria PAGEREF _Toc499546418 \h 4Section 5 – Admission Criteria PAGEREF _Toc499546419 \h 6Section 6 – Determining Rehabilitation Readiness PAGEREF _Toc499546420 \h 7Section 7 – Brindabella Rehabilitation Centre (Rehabilitation Day Programs) PAGEREF _Toc499546421 \h 8Section 8 – Discharge PAGEREF _Toc499546422 \h 9Section 8 – Transfers of the acutely unwell or emergency patient from UCH PAGEREF _Toc499546423 \h 9Section 9 – Emergency Situations PAGEREF _Toc499546424 \h 10Implementation PAGEREF _Toc499546425 \h 10Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc499546426 \h 10Search Terms PAGEREF _Toc499546427 \h 11PurposeThe aim of this procedure is to:Outline the process for safe and effective admission of patients to the University of Canberra Hospital (UCH) Rehabilitation, Aged and Community Care (RACC) Inpatient Units and Day Programs. Outline the patient eligibility criteria for the RACC Inpatient Units and Day Service.Patients may be admitted from the community or from another hospital. All admissions will be planned unless responding to an ACT Health emergency. Back to Table of ContentsAlertsThe UCH supports a sub-acute rehabilitation model of care. Patients admitted to the UCH are required to meet the criteria for medical stability in order to facilitate safe and effective admission and ongoing care. Back to Table of ContentsScopeThis policy applies to the following staff working within their scope of practice and role:Medical OfficersRegistered NursesUCH Bed ManagementCHHS Bed Management After Hours Hospital ManagersAdministration staffAllied HealthThis policy applies to all admissions to UCH adult rehabilitation from CHHS, Calvary Public Hospital Bruce (CPHB), other hospitals and community facilities. It also applies to all transfers from UCH to CHHS and CPHB. Exclusions:This policy does not apply to admissions or transfers to the UCH Adult Mental Health Rehabilitation Unit.Back to Table of ContentsSection 1 – Decision Making and Determining Medical StabilityAs the UCH is a sub-acute environment, any admission must meet the criteria for medical stability as determined by the rehabilitation team and be accepted by the rehabilitation medical admitting team. Determining Medical StabilityThe patient has a clear diagnosis and co-morbidities have been established.At the time of discharge from acute care, all acute medical issues have been addressed; disease processes and/or impairments are not precluding participation in the rehabilitation program. The patient’s vital signs are stable. The patient has no undetermined medical issues (e.g. excessive shortness of breath, falls, congestive heart failure).The patient’s medication needs have been determined and medication regime is stable.The patient must not have a central line or Hickmanns line inserted. A portacath line may be accepted under consideration by the rehabilitation medical team.If a patient is receiving intravenous medication then consideration should be given to changing to an oral form prior to admission to UCH. For patients who require a Peripheral Intravenous Cannula (PIVC) on admission, the Rehabilitation Medical Officer responsible for the patient’s care must be consulted to ensure that a PIVC is required, alternatives should be considered and the benefits of PIVC should outweigh the risks in the sub acute environment.Back to Table of Contents Section 2 – Waiting ListOnce the patient has been accepted for care under the rehabilitation medical team, their name is placed on the waiting list. The patients are prioritised according to: Date of ReferralClinical indication at the time of initial referralAvailability of appropriate inpatient unit bedAcuity of admitting wards.Back to Table of Contents Section 3 – Transfer to UCHWhen a bed becomes available the UCH Assistant Director of Nursing (ADON) or After Hours Hospital Manager (AHHM) will decide which patient will be transferred to UCH based on the prioritised waiting list. This decision will be made in collaboration with the Bed Management unit at CHHS. The transferring ward will be notified as soon as possible. The transferring patient will be required to have a clinical screen prior to transfer to ensure they still meet the admission criteria and requirements for medical stability. This clinical screen can be undertaken by the RACC Medical Officer, CHASERS team, Rehabilitation Care Coordinator, Clinical Nurse Consultant (CNC) or AHHM. UCH will accept admissions 24 hours a day; however it is preferable for the transferring patient if they arrive prior to 20:00. Admissions after this time will only be accepted if prearranged and unavoidably delayed, for example; due to transport delays. (In an emergency situation admissions will be accepted at any time as directed by the ACT Health Emergency Management Command Centre).If patients are arriving outside of business hours or on a weekend then sufficient medications should be transferred with the patients to provide medications until the next regular business day (24-72hrs of medication).Staff should refer to the CHHS Admission to Discharge Clinical Operations Procedure for General Admission and Discharge information.Staff should refer to CHHS: UCH Patient Escort and Transport Operational Procedure.Back to Table of Contents Section 4 – Eligibility CriteriaRACC services at UCH consists of four adult, sub acute, rehabilitation inpatient units (IPU) and the Day Service Unit. General Considerations for Admission to the IPUsThe patient has a recent impairment of functional ability due to illness or injury.The patient has been assessed by the multi-disciplinary team and will benefit from admission to a rehabilitation unit.The patient has a condition that is likely to be responsive to rehabilitation.The patient has reasonable prospects for functional gain within a benchmarked clinically appropriate time frame.The patient requires the input of a multi-disciplinary rehabilitation program to achieve functional gain.The patient cannot be managed in a more appropriate lower level of care (for example, cannot be safely and effectively managed in a community based rehabilitation program). Additional Considerations for the Slow Stream Unit: The patient has a condition that is likely to be responsive to low level intensity multidisciplinary rehabilitation and does not meet the eligibility criteria for admission to the other UCH IPUs. The target populations for each inpatient unit include but are not limited to people with the following diagnosis: Stromlo Ward (Neurological Rehabilitation Unit) Stroke Acquired brain injuryMotor Neurone DiseaseLate effects of polioMultiple sclerosisCerebral palsySpinal cord disordersEarly symptoms of Parkinson’s Disease.Majura Ward (Older Persons Rehabilitation Unit) for people over 65 years old or Aboriginal and Torres Strait Islander peoples aged 50 years and over with:Falls Medical fractures Orthogeriatric conditions Deconditioning Parkinson’s DiseasePrioritised for people aged 80 and over although admissions outside of the age groups will be considered if the patient has progressive Parkinson’s Disease and/or co-morbidities typically associated with ageing.Namadgi Ward (General Rehabilitation Unit) AmputeesMusculoskeletal disordersPost acute medical hospital admissionPost general surgical and post-orthopaedic surgery patients. For example: Phase II (inpatient) Cardiac/Pulmonary Rehab, orthopaedic/ multi-trauma patients under 65 years of age. Cotter Ward (Slow Stream Rehabilitation Unit) Non-weight bearing restrictions. People who have the potential to be discharged home non-weight bearing or who are able to attain rehabilitation goals during the non weight bearing period.Requiring care whilst awaiting completion of home modifications or placement into residential care People who cannot be treated through traditional rehab due to diminished physical and cognitive toleranceSlow Stream Rehab is suitable for individuals in need of a multidisciplinary rehab approach to address specific rehab goals who also have chronic/complex conditions requiring 24-hour hospital care and who are expected to benefit from a slower-paced rehab program for a longer duration than is offered in dedicated or mixed rehab programs.Back to Table of Contents Section 5 – Admission CriteriaAdmission CriteriaPatient is medically stable, understands what is required of them to participate in rehabilitation and is willing and able to participate in the rehabilitation program in the inpatient care setting. The patient has been assessed by a member of the multi-disciplinary team (e.g. rehabilitation physician, rehabilitation coordinator, Allied Health professional) as requiring rehabilitation in the inpatient care setting/ environment (based on their physical/ medical/ functional, cognitive, psychosocial, social needs). There are clear, achievable rehabilitation goals documented in the clinical record and agreed on by the patient and multi-disciplinary team within a benchmarked clinically appropriate time frame. Discharge destination has been discussed with patient/carer and agreed upon or the multi-disciplinary team is actively working towards a suitable and safe discharge destination with documented actions related to obtaining a suitable discharge destination. The patient and/or carer consents to and is able to participate in the rehabilitation process, including the intensity of therapy required, in the inpatient care setting (i.e. motivation/ active patient participation). Patient and/or carer rehabilitation needs are aligned to service delivery available in the inpatient setting. Special needs are able to be met in the inpatient setting (e.g. non weight bearing patients, bariatric, tracheostomy).The multi-disciplinary team has documented in the clinical record a clear and accurate ongoing management plan and necessary follow-up. The patient falls within the care setting case mix classifications agreed/ able to be accommodated in the inpatient setting. In infrequent circumstances of complex cases of guarded functional prognosis there may be a consideration of a trial of rehabilitation to determine a patient’s ability to participate in and potential to benefit from the program. Where there is agreement for a trial of rehabilitation, clear agreed plans documented in the clinical record regarding the timeframe of the trial and the discharge plan should the trial of rehabilitation be unsuccessful.Additional Criteria for Admission to the Slow Stream unit:The patient has chronic/complex conditions requiring 24-hour hospital care and is expected to benefit from a slower-paced rehab program for a longer duration than is offered in dedicated or mixed rehab programs. Ability and willingness to participate in a multidisciplinary rehab program at a clinically appropriate intensity. Place of Discharge:The patient has a planned and accepted place of discharge (with agreed care supports ready to be put in place) or The patient has a planned transition to an appropriate rehabilitation inpatient program within UCH prior to admission to the unit, and the agreed discharge destination has been discussed with patient/carer and is documented in the clinical record.If appropriate, My Aged Care/National Disability Insurance Agency assessments and plans are in place, plans are documented and ready to be activated on discharge.Rehabilitation Goals:That achieved functional goals are maintained orIf there are clear, achievable remaining rehabilitation goals they are documented. Once goals have been achieved, maintenance programmes will be carried out as independently as agreed to by the patient and/or with the assistance of family/carers. Advance Care PlanningIt is desirable for patients to have an Advance Care Plan in place prior to transfer/admission to UCH. See CHHS Advance Care Planning Procedure for further information.Resuscitation PlanFor appropriate patients it is preferable to have a resuscitation plan in place and clearly identified prior to transfer to UCH. See CHHS Goals of Care and Resuscitation Plan Guideline for further information.Bariatric PatientsBariatric Patients will be admitted to UCH providing their care needs can be met in the unit and within the acuity of the ward. UCH has limited provision for bariatric patients in each inpatient unit. Patients with a TracheostomyPatients with a tracheostomy will be admitted to UCH providing they meet the requirements for medical stability, the eligibility/admission criteria and their care needs can be met within the acuity of the ward. See CHHS Tracheostomy Management Adult Patients Procedure.Back to Table of Contents Section 6 – Determining Rehabilitation ReadinessPatient meets the eligibility and admission criteria as defined in above. Patient meets the criteria of medical stability as defined above. All medical investigations have been completed or a follow-up plan is in place at time of referral and follow-up appointments made by time of discharge. Patient’s special needs have been determined. Patient is able to participate in a rehabilitation programme that may involve several hours of therapy and rehabilitation per day. There are no behavioural issues limiting the patient’s ability to participate at the minimum level required by the rehabilitation program. There are no psychiatric issues limiting the patient’s ability to participate at the minimum level required by the rehabilitation program. Treatment for other co-morbid illnesses/conditions does not interfere with the patient’s ability to participate in the rehabilitation program. Back to Table of Contents Section 7 – Brindabella Rehabilitation Centre (Rehabilitation Day Programs)The Day Programs are designed to accommodate people with rehabilitation goals who:are medically stableno longer require management in the hospital environmentare able to contribute to achieving identified rehabilitation goals within a defined timehave a level of therapy requirement that is not able to be provided within the resources available in the community i.e. are not appropriate for ambulatory/community based rehabilitationhave accommodation and support in the community assessed as safe to support discharge to homeare able to access transport to and from the programrequire the expertise of more than one allied health discipline and are not accessing other allied health services at the same time.The Rehabilitation Day Program is made up of three streams: Neurology StreamProvides care for patients with recently acquired conditions including acquired and traumatic brain injury, stroke, spinal injury and newly diagnosed Parkinson’s disease. Provides care for patients with chronic and progressive conditions including: multiple sclerosis; Huntington’s disease; long term spinal cord injury, traumatic brain injury or stroke management; and motor neurone disease. Care provision may include less intense, long duration services that are more likely to be home based. Relevant community health providers will be involved in assessment, initial goal setting and discharge planning. General StreamProvides care for patients with complex acute and chronic non neurological conditions including upper limb or lower amputation, musculoskeletal pain or injury including multi-trauma, joint replacement and fractures. Geriatric Day Program Provides care for patients with conditions related to the ageing process with a focus upon the treatment of frailty and functional decline. Provides care for patients with conditions that are slowly resolving with changing medical problems and ongoing functional impairment, requiring rehabilitation/restorative care at a less intensive level, but over a longer period of time. Other aspects of care provision specific to geriatric rehabilitation needs may include assessment of nutritional and oral health status, assessment of status of cognition, continence and skin integrity. These would be coordinated within the patient’s rehabilitation program as required. Back to Table of Contents Section 8 – DischargeStaff should refer to the CHHS Admission to Discharge Operational Procedure. Interim Discharge/ Leave PassA patient may take official leave of absence from the inpatient wards for a maximum period of 72 hours if the attending medical officer affirms and consents to such leave.The medical officer and the patient must sign and date the leave of absence section on the General Conditions of Admission Form.The registered nurse is responsible for notifying the ward pharmacist of any medications that may be required during the period of leave.The ward administration officer is notified of the anticipated leave of absence. Back to Table of Contents Section 8 – Transfers of the acutely unwell or emergency patient from UCH If a patient becomes acutely unwell or is deteriorating and it is agreed by the senior medical team that they no longer meet the medical criteria for sub acute care, then the patient will be transferred back to either the Canberra Hospital or CPHB as a priority.It is recommended that acute unwell patients who are dialysis dependent be transferred to the Canberra Hospital to enable continuing treatment in the acute dialysis unit. (At this time CPHB does not provide acute dialysis on site.)In the case of a Code Blue or Emergency the patient will be transferred by ACT Ambulance Services (ACTAS) to an appropriate Emergency Department as per ACTAS triage processes. If there has been a significant change in the patient’s medical condition or functional status then the patient will require a review by the rehabilitation medical team prior to being accepted back to UCH. Back to Table of Contents Section 9 – Emergency SituationsIn the event of a bed crisis at CHHS or an emergency situation, medical approval of discharges may enable urgent admissions from patients already on the UCH waiting list as ready for admission. In an emergency situation if there are no suitable patients on the waiting list then patients who meet the medical criteria for admission to a sub acute hospital may be admitted. This will be done in collaboration with UCH and CHHS Bed Management and with direction from the Executive on call. Back to Table of Contents Implementation This procedure will be implemented on opening of UCH. This procedure will be communicated and outlined to staff, prior to and during commissioning of UCH. New staff will be made aware of the procedure during orientation. The procedure will be available to all staff on the Policy Register.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationProceduresCHHS Healthcare Associated Infections Clinical ProcedureCHHS Peripheral Intravenous Cannula, Adults and ChildrenCHHS Patient Escort and Transfer ProcedureCHHS Admission to Discharge ProcedureCHHS Advance Care Planning Procedure CHHS Goals of Care and Resuscitation Plan Guideline CHHS Tracheostomy Management Adult Patients ProcedureCHHS Family Meetings and/or Goal Setting Meetings and Case Conferences for Rehabilitation Services ProcedureLegislationHealth Records (Privacy and Access) Act 1997Human Rights Act 2004Work Health and Safety Act 2011Back to Table of ContentsSearch Terms RACC, UCH, Admission, Transfer, Rehabilitation, Eligibility Criteria, Sub acute, day programDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 13/12/2018New DocumentLinda Kohlhagen, ED RACCCHHS Policy CommitteeThis document supersedes the following: Document NumberDocument Name ................
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