Information
For patients with frailty, dementia or delirium, avoidable admission to hospital can be detrimental to both physical and mental health. Patients loose 10% of their body mass per week on bed rest or with minimal activity as is common in hospital. In addition, change of environment can worsen cognitive and behavioural issues in those with dementia or delirium. For some patients admission to hospital is still the most appropriate course of action but this document outlines alternatives sources of support and treatment available to prevent this where possible.
| Patient need/ type of service required: | Team to refer to: | Who can refer: | How to refer: |
| PT and OT requirement where urgent assessment, equipment and support could prevent a hospital admission | Integrated Rehabilitation Team | Any health professional | East Lothian Rehabilitation Service Point of Contact 01620 642834 |
| Acute medical needs +/- therapy needs as an alternative to hospital admissionPriority is given to patients with complex care needs and frailty Patient requires to be safe at home and patient/ family happy for acute medical care under H@H | Hospital@Home(have access to urgent therapy if needed so no need to refer additionally to IRT) | Any health professional who has had training in advanced clinical assessment | Referrals via Patient Flow Centre 0300 013 4000(option 1 and then option 4) For further guidance see our Ref Help Page:https://apps.nhslothian.scot/refhelp/guidelines/HospitalAtHomeEastLothian.aspx |
| Non-acute medical issues, could attend as outpatient | ELCH Geriatric Medicine/ Parkinson’s Clinic | GP practice/ hospital clinicians | Refer via SCI-GatewaySee resources for additional guidance |
| OT assessment only required | Community occupational therapy | Any healthcare professional | East Lothian Council Contact Centre 01875 824309 |
| Physiotherapy assessment only required | Domiciliary Physiotherapy team | Any healthcare professional | Refer via SCI-Gateway for East Lothian Physiotherapy |
| Concerns regarding swallowing or communication issues | Speech and language therapy | Referral accepted from anyone (usually via GP) | SCI Gateway – AHP Speech and Language Therapyhttps://apps.nhslothian.scot/refhelp/SpeechTherapy/SpeechTherapyAdult |
| Community dietetics | Community dietetic team | Any health professional | Refer via SCI Gateway for AHP – Dietetics East Lothianhttps://apps.nhslothian.scot/refhelp/Dietietics |
| Increasing care needs in the community – urgent, at risk of admission to hospital | East Lothian Contact Centre (ECS) | Referral accepted from any healthcare professional or members of the public | Refer via East Lothian Contact Centre 01875 824 309 |
| Increasing care needs in the community – non-urgent | East Lothian Contact Centre (ECS) | Referral accepted from any healthcare professional or members of the public | Refer via East Lothian Contact Centre 01875 824 309 |
| Patient requiring a community bed for end of life care (Ward 1 ELCH, Ward 3 Belhaven, Edington) | East Lothian Patient Flow Team | Any healthcare professional | Referral by telephone01620 642 795/6East Lothian Patient Flow Team Referral Guide.pdf |
| Patients over the age of 65 who require assessment and treatment for mental health conditions, including cognitive impairment. | East Lothian – Psychiatry of Old Age | General and other medical practitioners from other services | Refer via SCI Gateway |
Who to refer:
- Falls and frailty syndromes including dizziness
- Weight loss in frail older patients
- Multiple/complex symptoms in frail
- Single symptom suggestive of malignancy if frail (consider if single organ specialty referral more appropriate especially if clinical frailty score <4)
- Possible Parkinson’s disease (please state this in the referral)
Who not to refer:
- Iron deficiency anaemia (single issue) – should be referred to GI
- Memory loss only – should be referred to Memory Clinic / Old Age Psychiatry in East Lothian
- Polypharmacy reviews – Integrated Care Pharmacists in GPs can help with this
- Incontinence – consider continence nurse / DN referral
- End of life support – palliative care team unless require community bed in which case please refer via East Lothian Patient Flow Team (see above)
- ALL the above do not preclude the referral being appropriate – clinical judgment is required. We are more than happy to discuss referrals/give advice.
We are currently developing specific guidance for conditions affecting older people: https://apps.nhslothian.scot/refhelp/MedicineofElderlyGeriatrics
Osteoporosis guidelines:
https://apps.nhslothian.scot/refhelp/guidelines/Osteoporosis.aspx
Parkinson’s Disease referral guidelines: https://apps.nhslothian.scot/refhelp/guidelines/Parkinsons-(MoE).aspx
TIA and stroke referral guidelines: https://apps.nhslothian.scot/refhelp/Neurology/TransientIschaemicAttackTIAAndStroke
