Draft Operational Policy
SINGLETON HOSPITAL ACUTE GP UNIT
Version 2 – 12th June 2012.
SINGLETON HOSPITAL ACUTE GP UNIT OPERATIONAL POLICY
Page1. / Introduction / 3
2. / Purpose / 3
3. / Hours of Service / 3
4. / Service Provision / 3
5. / Accommodation / 3
6. / Eligibility of the Service / 4
7. / Access to Service / 4
8. / Patient Pathway / 4-5
9. / Patient Case Mix for Acute GP Unit / 5
10. / Acute GP Unit Workforce / 6
11. / Key Relationships / 6-7
12. / Support Services / 7-9
13. / Acute GP Unit General Housekeeping / 9
14. / I.T Infrastructure & Telecommunications / 9
15. / Clinical Governance / 10
16. / Nursing Governance / 10
17. / Protection of Vulnerable Adults / 10
18. / Management of Violent/Aggressive Patient / 11
19. / Infection Control / 11
20. / Complaints / 11
21. / Nursing & Medical Records / 11
22. / Untoward Incident Reporting / 12
23. / Transport / 12
24. / Appendix 1 – Flowchart for Referrals / 13
25. / Appendix 2 - Acute GP Unit REFERRAL DIRECTORY / 14-37
SINGLETON HOSPITAL ACUTE GP UNIT
OPERATIONAL POLICY
1. Introduction:
The purpose of this policy is to provide an outline of the Singleton Hospital Acute GP unit and to describe the Units purpose, delivery of the operational service and relationships with the Integrated Medicine service, community resource teams and other support services within the Swansea Locality.
2. Purpose:
The Singleton Hospital Acute GP Unit will form an integral part of the Swansea Unscheduled Care Service. The purpose of the service is to:
· To deliver a GP triage of all GP referrals to the acute medical intake during the hours of service and ‘filter’ patients into appropriate clinical pathways at point of telephone triage or following face to face patient consultation.
· To deliver alternative patient pathways to hospital admission and promote care in the community in line with ‘Setting the Direction’.
3. Acute GP Unit hours of service:
The Singleton Hospital Acute GP Unit will operate on weekdays only, excluding bank holidays between 0900-1700 hrs, the timing will be subject to review as part of the planned evaluation of the pilot.
In addition to, and in parallel with the above, a Minor Injuries Service will operate as follows:
Ø 0800-2000 hours daily, including weekends and bank holidays.
4. Accomodation:
The service will be delivered from the envelope of accommodation that the MIU service is currently based in.
The area is made up of a front reception where patients will register their details on arrival. GP consultation rooms are available for face to face patient consultation and clinical assessment of patients. A resuscitation area that serves the Singleton Assessment Unit, Minor Injuries Service and the Acute GP Service is located within the Minor Injuries service corridor however a planned relocation of this facility will better place the room at the junction of the Minor Injuries Service and Singleton Assessment Unit triage area, directly opposite the main access to both services. The nurses’ station is located at the centre of the Minor Injuries service corridor. External and internal waiting rooms are available.
5. Eligibility of the Service:
The Singleton Hospital Acute GP Unit will triage all requests from Swansea GP’s or others with referral rights, such as Practice Nurse Practitioners who require a medical assessment and potentially admission to hospital. The patient groups include:
· All patients registered with GP practices within the City and County of Swansea
· Patients deemed to be temporary residents
· Patients who are registered within GP practices outside of the Swansea area however if acute admission to Medicine is the outcome of triage then the patient should be directed to the Neath Port Talbot Medical intake.
6. Access to the Service:
GPs requiring advice or admission AFTER June 11 2012 can ring the direct number 01792 200342. The receptionist at Singleton will take the demographic details of the patient and then the call will be transferred to the duty Acute GP.
A brief referral letter and computer generated summary should then be faxed to 01792 298347 or sent with the patient.
7. Patient Pathway:
Referring GP to Acute GP Reception
The referring GP will initially speak to the Reception staff based in the Singleton Acute GP Unit and will provide patient demographic details to enable registry of the patient in Adastra.
Referring GP to acute unit GP
The referring GP will present the clinical details of the patient to the duty Acute GP unit GP and a management plan will be determined as per flowchart attached at Appendix 1.
Patient accepted by Acute GP Unit
Patients who will clearly need admission will be transferred immediately to the medical on call team in the assessment unit.
Patients suitable for the acute GP’s will follow a slightly different path. They will be seen as soon as they can attend the Unit. The patients will get a second opinion (where appropriate); urgent investigations performed (e.g. x-rays, scans, pathology); a working diagnosis made and a formal management plan developed. If possible treatment will be started and the patient discharged home to be followed up by their GP or, if appropriate, to return to the Unit for follow up.
Admission alternatives:
In order for alternatives to admission to be offered to patients where clinically appropriate a range of secondary care support will be available to the Acute Unit GP including:
- Access to specialist hot clinics within 24-48 hrs of patient consultation.
- Access to specialist Consultant advice daily.
- Access to endoscopy via the ward based Gastroenterologist of the day.
- Access to timely domiciliary care and therapies intervention in the community.
- Access to nursing within community networks or Community Resource Team
Communication to referring GP’s:
GPs will receive summary information and outcomes in the same way as they get contacts from the OOH service i.e. faxed back same day (usually within the hour) with a clear management plan and follow up details. FOLLOW UP PTS POST ENDOSCOPY:
8. Patient Casemix for Acute GP Unit:
The service works with other healthcare providers to develop new pathways and ways of working to improve patient care and reduce unnecessary admissions. As new pathways or services evolve and develop they will be publicised to local GPs via a newsletter.
In time, we hope to manage:
Pleuritic chest pain, pulmonary embolism, community acquired pneumonia, pneumothorax
Upper gastro intestinal haemorrhage through risk stratification and OPD management of low risk
Jaundice
Headaches (excluding SAH and meningitis)
Blood tests which need to reach the lab promptly including malaria
Any other clinical scenarios the Acute GP service and GP feel can be managed on an outpatient basis using the resources available.
9. Acute GP Unit workforce:
The Acute GP Unit service will be delivered by a local GP, supported by a qualified nurse and clerical staff. The staffing resource for the service is as follows:
Grade of staff / Hours per day(Mon – Fri) / Comments
General Practitioner / 8
Band 5 nurse / 8
Admin and clerical staff / 8 / No additional resource, attached to MIU clerical team.
In addition to the core workforce, the Acute GP Unit will have access to a full range of support services including:
-unstructured radiology support
-pathology support.
-portering services.
-domestic services.
-acute medical on call team.
10. Key relationships:
The Singleton Hospital Acute GP Assessment Unit will interface with the following primary and secondary care services and departments:
· Acute Medicine on call team
· Integrated Medicine Consultant team, Singleton
· Patient Services
· Community Resource Team
· Swansea Locality Senior Management team
· Singleton Assessment Unit nursing team
· Welsh Ambulance Service Trust
· General Practitioners
· Pathology
· Radiology
· Bed Management team
· Switchboard
11. Support Services:
Acute Integrated Medicine
The Acute GP can access support from secondary care Consultant Physicians in various models as follows:
-Access to specialty clinic hot slots.
-Access to daily specialty Consultant advice
-Access to endoscopy via the ward based Gastroenterologist of the day.
Appendix 2 sets out the referral directory to support the Acute GP Unit.
Bed Management
Where a patient is assessed in the Acute GP Unit and requires admission under the care of the Medical on call team, the patient details will be passed to the SAU staff. It is the responsibility of the SAU Nurse in Charge to liaise with the Bed Management team to advise them of any patients referred from the Acute GP Unit.
Domestic Services
The Domestic Services provides a 7 day a week housekeeping service for the unit and covers the following times,
Monday – Sunday 1X 6.00 am-12.30pm (6 Hour shift) – MIU/Acute GP Unit.
Portering Services
The Portering Department operates a two shift rota system which incorporates four members of the Portering team. The shift patterns worked are,
Monday – Saturday 1X 10.00am -10.00pm (12 Hour shift)
1X 11.00am - 11.00pm (12hour shift)
Sunday 1X 11.00am - 11.00pm (12 Hour shift)
Portering activities undertaken within the Department include:
· Patient movement & assistance
· Blood collections
· Delivery of specimens
· Collection of patients provisions
· Cleaning and restocking of stretcher trolleys
· Checking and restocking of medical gases
· Linen Collection
Security
There is no security currently available within Singleton Hospital. CCTV is in place within the MIU/SAU accommodation. There is a panic alarm in SAU & MIU reception areas which alerts switchboard to contact the Police. However, staff can contact the Police via 999 if they have any concerns with regards to staff or patient safety. The bed/site manager should be notified of any such events.
Pathology Support:
Patients assessed by the duty GP in the Acute GP Unit may require blood investigations to be carried out. The acute GP Unit will have access to the full range of pathology services set out below. The blood request forms should be marked with ‘Acute GP Unit/SMIU’ to enable the acute GP patient group to be differentiated from the MIU attendances. Results will be sent to the Acute GP Unit and will be reviewed and any necessary action taken by the duty acute GP.
Haematology and microbiology provide on site service 08 00-19 00 hrs and an emergency service 19 00-08 00 hrs.
The clinical biochemistry provide on site services between 08 00-00 00 hrs Monday-Friday and 08 00-21 00 hrs on a Saturday and Sunday. Outside of these hours samples will be transported to Morriston Clinical Biochemistry from the Singleton Acute GP Unit using the dedicated laboratory transport.
Access to a blood gas machine for urgent arterial blood gas analysis is available via the SAU.
Radiology Support:
The Singleton Hospital Acute GP Unit will require access to radiology services. The duty GP will access radiology via the request system, however in some cases where diagnostics are required, the duty GP will be required to discuss their request with the duty radiologist. The Radiology resource file is attached at Appendix 2.
Clinical Physiology:
Electrocardiographs can be requested via the Clinical Physiology service Monday - Friday 08.30hrs - 16.30hrs as determined by the duty Acute GP Doctor/supporting Nurse. Out of hours the Acute GP Unit Nurse will undertake this procedure if required.
Pharmacy:
Patients will receive an FP10 prescription for any medication the duty acute GP feels is clinically necessary for the patients’ management. A small stock of medication will be kept on site for periods when community pharmacy provision is unavailable.
The issue of any medications dispensed from the pharmacy stock held within the acute GP unit must be recorded in the ADASTRA system for audit purposes. In addition, any stat medications given to patients must also be recorded in the same way.
Controlled drugs will be available for prescription by the Acute GP Unit and must be administered in line with Health Board policy.
The nursing staff working within the acute GP unit will work in line with current Patient Group Directives for the administration of simple analgesia to patients, in line with Health Board policy and only when the Band 5 nurse has received the appropriate training.
Community Resource Team (CRT)/Therapies:
Access to Therapy Services, domiciliary care support and/or third sector support for patients assessed in the Acute GP Unit will be via the Community Resource Team Nurse Assessor who will be based in the ‘front door’ of Singleton.
Language line:
The Health Board currently has a contract with Language line, an interpretation service that can be accessed to communicate with both patients and relatives where language barriers exist. The MIU and SAU have access codes that can be used for the Acute GP Unit.
12. Acute GP Unit General Housekeeping:
The ordering of stores, CSSD/HSDU will be undertaken by the nurse in charge of the SAU as the Acute GP Unit, SAU and the Minor Injuries service will be managed as an integrated service, with one integrated workforce.
13. IT Infrastructure and Telecommunications
The Acute GP Unit PC’s are connected via the Adastra switch through the Health Board network to the Adastra service - this is a replication of the method used for the previous OOH service.
An independent telephone network is established within the MIU that will serve the Acute GP Unit as well as the Minor Injuries service.
14. Clinical Governance-
Rosemary Fletcher to revise in line with contractual arrangements
The responsibility for meeting minimum quality standards and that a sound clinical governance framework is in place sits with the ?????. The GPOOH service will ensure that a clinical governance system is in operation that complies with the requirement of professional guidance, including standards set down by the Professional Bodies, and other national guidance. A designated Clinical Governance lead for SOS has been appointed and agreed with the commissioner. The Swansea GPOOH service should regularly review its arrangements and provide assurance to the commissioner and the Trust that robust arrangements are in place for audit, appraisal, and significant event review and risk management. Specific reports should be made available on request. The Swansea GPOOH service should ensure that all staff working within the service are made aware of the protocols and systems and are offered a comprehensive induction programme on joining the service, as well as regular training events.