Current services for Medicine for the Elderly in West Lothian
- SCI gateway single point of contact referral for non-urgent
- REACT for urgent 01506 524149
- Referral should be based on patient’s postcode, not GP Practice
| REACT Hospital at Home (H@H) | Acutely unwell frail, older peopleAlternative to hospital admissionShort term (few days)Comprehensive geriatric assessment at home (inc care home) in the acutely decompensated | Phone call to REACT hub 01506 524149 if urgent (same day/next day) visit required – clinical conversation is usefulNot an alternative to a GP visit.SCI gateway referral if able to wait 2-3 days for assessment. |
| REACT Rehab (AHPs) | AHPs only – physio and OTFull assessment at home (inc care home for physio) | Phone call to REACT hub (01506 524149) if urgent (same day/next day) visit requiredSCI gateway referralSt Johns Hospital > REACTH@H will often refer during/ on discharge from H@H |
| REACT Rapid Access Clinic | We triage to home visits, face to face clinic, and phone/video as appropriate. Please make clear if patient could physically come to clinic.We will refer to AHPs if needed | SCI gateway referralSt Johns Hospital > REACT We aim to see within 2 weeks. |
| Parkinson`s Disease clinic(see Parkinsons RefHelp guidance) | PD patientsNew patients with ?PD / tremor etc.We triage to home visits, face to face clinic, and phone/video as appropriate. | SCI gateway referralSt Johns Hospital > Geriatric Medicine |
| Osteoporosis clinic(see Osteoporosis RefHelp guidance) | No longer based in West Lothian | SCI gateway*All referrals now to Edinburgh rheumatology service* |
| General MOE clinic | We triage to home visits, face to face clinic, and phone/video as appropriate. | SCI gateway referralSt Johns Hospital > Geriatric Medicine |
| Stroke/TIA clinic(see TIA And Stroke RefHelp guidance) | Centralised stroke/ TIA hotline available for GPs to obtain immediate advice and appointments organised- please see the RefHelp page 0131 536 1019 |
| St Michael’s HospitalLinlithgowTippethill House Hospital, Armadale | Hospital Based Complex Clinical Care (HBCCC)Palliative care for West Lothian patients. *Please refer to community hospitals Pathway for referrals to community hospitals/ inclusion criteria (Please discuss with patient / family. Clear anticipatory planning / escalation of care conversation needed before referral.Patient not for transfer to acute sector for diagnostics/interventionNot requiring daily specialist consultant palliative care input) | Weekdays 9am-6pmIf community hospital admission required, please refer to REACT 01506 524149 stating that assessment required for admission.REACT will assess if appropriate. |
- Frail older people in need of secondary care assessment
- Single point of contact – SCI referral for all but urgent (triaged daily)
- Same day / next day urgent assessment should be via REACT H@H and discussed with REACT coordinator (i.e. referral is to avoid hospital admission)
- Geriatrician is available for advice via above
- Please include question to be answered and if possible rockwood_cfs clinical frailty score (or equivalent assessment of frailty) as this helps us to triage to correct service.
Who to refer:
Appropriate referrals for REACT/rapid access/general MOE clinic (equivalent) assessment (excl stroke and PD):
- Falls, 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)
Who not to refer:
- Weight loss in non-frail patients (ie clinical frailty score <4) – should be referred to General Medicine in West Lothian
- Iron deficiency anaemia (single issue) – should be referred to GI in West Lothian
- Memory loss only – should be referred to Memory Clinic / Old Age Psychiatry in West 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 (REACT if considering admission to community hospital)
- Care home support – West Lothian Care Home Liaison Team, WelPAT.
- ALL the above do not preclude the referral being appropriate – clinical judgment is required. We are more than happy to discuss referrals/give advice.
Primary Care Management / Pre-referral work-up / Information needed
- Please see also specific guidance for each condition; Falls, Weight Loss, Dizziness.aspx, Delirium, Parkinsons disease
- Bloods – FBC, U&E, LFTs, calcium, TFTs, B12/folate +/- iron studies and ferritin for all clinic referrals.
- E&S BPs if referring for Falls
- Meds have been reviewed (at least initially)
Information needed:
- Some indication of frailty – functional status/baseline and POC/family support is most helpful. Clinical frailty score also helpful.
- What is the aim of referral and what are the patient and family’s expectations. (i.e. if frail patient not for investigations of possible malignancy – what is it that is hoped the referral will achieve?)
Alternatives to referral / advice
- Email and/or phone advice always available
- Telephone via REACT – coordinator initially – ask for consultant geriatrician if needed
