Admission criteria for Kent Community Health NHS Trust Community Hospital beds

Effective from 1st September 2014.

Intermediate carewithin community hospitals can provide:

  • Step up from the community for the management of exacerbation of a range of long term conditions to prevent acute hospital admission;
  • Step down from secondary care for short term rehabilitation needs for an average of 21 days.
  • Palliative care including end of life care.
  • A Nurse led multidisciplinary approach for the older patient with complex needs, supported by GP’s and consultants to optimise rehabilitation outcomes.
  1. Step up:

This will enable patients with a long term condition and /or experiencing a sub-acute episode who experience a crisis, which is beyond the scope of the primary and community 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 that which can be provided by current GP Out of Hours services, IC24).
  • Who are expected to make sufficient recovery, within a time limited period, to be cared for at their normal place of residence, within existing community resources or
  • Who are in receipt of some aspects of palliative care e.g. management of intractable pain,or end of life care (where appropriate and desirable for the patient)
  1. Step down:

for patients in a recovery phase and requiring a period of active rehabilitation that cannot happen in their own home,following an acute admission.

  • Who are medically stable for transfer from an acute hospital, but require a period of on-going 24 hour care in a community hospital bed.
  • Who have been assessed, prior to admission, to have the ability and appropriate motivation to participate in active rehabilitation to improve their level of self-care/functional abilities.
  • Who are expected to achieve stated rehabilitation goals within a time limited period. ( target 21 days ) Who have complex planning needs to deliver a rehabilitation goal which returns the patient to supported living within the community or
  • 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).

Step down care should form part of an agreed patient pathway. Once the level of dependency is reduced or the patient reaches their optimal level of function, the patient will be discharged to the appropriate community setting e.g. home or supported living.

Criteria:

  • Admission to a community hospital bed is for a period of treatment, multidisciplinary assessment, active 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 will not normally exceed 3 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.
  • The patients will present with complex health care needs with a high level of physical dependency requiring 24 hour care, therefore beyond the capacity of the primary & community care teams. Patients will be discharged from the community hospital when the assessment or rehabilitation is complete or there is no further benefit to be gained from the treatment.
  • GP input through the multi-disciplinary team approach is provided to the patient to ensure that the pathway outcomes are met and the patient is discharged in a timely manner.
  • Patients for step down will be assessed in the acute trust by the integrated discharge team for appropriate transfer. The discharge process must be completed in full for the patient to be able to transfer safely and effectively to a community hospital bed.
  • Unqualified patients, including those on the inactive phase of the non-weight bearing pathway or continuing care patients will not be admitted into a community hospital bed.
  • Patients with dementia will be admitted if they have been assessed as having rehabilitation potential and the ability to follow an active programme.
  • Patients will be repatriated to their local community hospital as soon as possible, if this is their choice.

Patients not appropriate for community hospital admission:

  • Children & young people under the age of 18 years.
  • Patients with unstable acute medical conditions.
  • Patients with diagnosed mental health disorder for which acute psychiatric in-patient 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 effectively.
  • Patients with no rehabilitation potential
  • 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).
  • Patients awaiting a pathway to long term care
  • Patients resident in a nursing home
  • Patients awaiting discharge to a nursing home
  • Where Rehabilitation is not an outcome of long term care

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.

Strategic and operational planning 2014 to 2019:”everyone counts:planning for patients 2014/15 to 2018/19” ( December 2013). NHS England

Web sites:

Karen Jefferies Community Services Director August 2014

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