Criteria for Referral to Allied Health Professionals within NHS Tayside

For the over 65 year olds

Caroline McKenzie

Nutrition Standards

November 2009

Copyright © 2012. Tayside Nutrition Managed Clinical Network, NHS Tayside. This publication can be used or reproduced including photocopying, for non-commercial purposes. We request that the source and Copyright owners be acknowledged and that the material is not substantially altered in any way. Applications for use outwith these terms should be forwarded in writing to the Tayside Nutrition MCN Manager (Food, Fluid and Nutritional Care), Directorate of Public Health, NHS Tayside, Kings Cross, Clepington Road, Dundee, DD3 8EA.

Referral Criteria to Dietetics

How to refer to dietetics

Referrals should be fully completed, signed and sent to the Nutrition & Dietetic Department. Although verbal referrals can be made, action will only be taken once a written referral has been received.

The following patients may be referred and will be seen according to priority.

URGENT (seen within 1 working day)

Enteral Nutrition

Please note that an emergency regimen is available on your ward for use at the weekend/public holidays

SOON (seen within 2 working days)

  • Texture Modification
  • Nutritional Support
  • Mineral Modification
  • Newly Diagnosed Coeliac Disease
  • Newly Diagnosed Inflammatory Bowel Disease e.g. Crohns Disease and Ulcerative Colitis
  • Food allergy that has been clinically diagnosed and affects nutritional status or is not catered for by the hospital menu
  • Newly diagnosed Diabetes – type 1 and type 2

ROUTINE * (seen within 4 weeks)

  • Long standing Diabetes with poor control
  • Weight reduction (BMI > 30 with one or more co- morbidities/BMI > 35)
  • Lipid lowering
  • General Nutrition

* In some cases patients may need to be seen as an outpatient.

Referral Criteria to Speech and Language Therapy

How to refer to speech and language therapy

  • Referrals for assessment and management of swallowing disorders may only be made by medical practitioners.

High priority

  • New or deteriorating swallowing difficulties that place the patients life at risk.
  • Loss of communication due to terminal illness.
  • As identified by the Dysphagia Screening Tool (stroke).

Medium priority

  • Deteriorating neurological disorder affecting communication
  • Longstanding or improving swallowing problems and those with alternative feeding in situ
  • Patients with previously issued AACS (augmentative and alternative communication system), whether due to mechanical problems or altered ability
Low priority
  • Any long standing communication problems
  • Mild to moderate communication problems
Timescales (Angus & Dundee)

Inpatients with new dysphagia should be seen within 2 working days of receiving referral.

Patients in the community with dysphagia will be seen within 2 working weeks.

All other patients will be seen within 6 weeks.

Timescales (Perth & Kinross)

Standard times for - receipt of referral to initial assessment:

Dysphagia / Communication Diffs. / Voice Clinic
(PRI)
Perth Royal Infirmary In-Pts / 2 working days / 3 working days
Community Hospitals In-Pts / 5 working days / 2 weeks
Community OP/Doms / 2 weeks / 6 weeks / 12 weeks

Referral Criteria to Occupational Therapy

How to refer to occupational therapy

Areas should contact their local OT services to determine mode of referral

The following patients will be considered for OT assessment

Those with any physical difficulties requiring feeding aids, cognitive, sensory, perceptual, behavioural or social/environmental problems that potentially impact on safety and ability to prepare hot drinks, light snacks or meals within their own environment.

Priority Levels

  • All patients referred to OT services will be prioritised in conjunction with priority bandings.
  • Priority will be given to maintaining patients within the community or to facilitate discharge to a patients own home.

The information above relates to OT services within Perth. Criteria have yet to be agreed within Angus and Dundee. When this information is available it will be made available to wards.

Referral Criteria to Physiotherapy

How to refer to physiotherapy

Referrals will be accepted from Medical Practitioners and other Healthcare Professionals.

Priority Levels

  • Referrals are triaged as they are received and prioritised according to their level of need and likelihood of deteriation.
  • All in patients in an acute setting are assessed within 24 working hours on receipt of referral
  • Those patients in a community hospital setting will have a locally agreed level of service and method of contacting Physiotherapy staff in a more urgent situation

PERTH AND KINROSS
PHYSIOTHERAPY SERVICE /

PERTH ROYAL INFIRMARY

PRIORITY BANDINGS

  1. PRIORITY 1

Patients to whom physiotherapy intervention may contribute to avoiding deterioration of their condition to a life-threatening status.

  • Emergency respiratory on-call.
  • Acute Respiratory Care – ICU/HDU/Medical/Surgical.
  1. PRIORITY 2

Patients whose condition may be affected by physiotherapy to the extent of avoiding a potentially long-term debility or who could be discharged with minimal input.

  • Assess new referrals.
  • Trauma -Inpatients – Neurosurgical/Orthopaedic.

-Outpatients – Upper and/or lower limb trauma.

  • ESDS.
  1. PRIORITY 3

Patients whose condition and quality of life is likely to be improved by physiotherapy.

  • All in-patient referrals.
  • All urgent acute out-patient referrals (urgent waiting list).
  1. PRIORITY 4

Patients whose condition and quality of life may be improved by physiotherapy.

  • In and outpatient.
  • General out-patients (non-urgent waiting list).

Referral Criteria to Dental Services

How to refer to the Dental Services

  1. If the patient has a general dental practitioner then the patient should be referred to them in the first instance
  2. If the patient does not have a general dental practitioner then the patient should be referred to Tayside Community Dental Service[1]. This is done by completing the referral form available on all wards and sending it to the address at the top of the form (each hospital will send the forms to a designated CDS clinic). Verbal referrals will be accepted for urgent cases but a completed form must be available at the initial examination. No patients will be seen without a completed referral form. The medical questions on the referral form must be completed by a doctor. Do not send the form to the dental surgery in the hospital unless specifically asked to do so.

Urgent cases

These will be seen within 2 working days. Out-of-hours and over weekends and public holidays please contact the numbers below and follow the advice given.

  1. Perth and Kinross 01592 740230
  2. Dundee and Angus 07740 937557

Urgent cases include severe pain not controlled by simple analgesics, swelling and haemorrhage.

Unless a patient is confined to bed or has severe mobility problems, it is likely that the patient will be asked to attend a CDS clinic outwith the hospital for any urgent care.

Patients who have oral ulcers do not require to be seen urgently, but should be referred immediately.

Routine cases

These will be seen within 3 weeks.

Routine cases include lost and loose dentures, broken teeth/lost fillings with no pain.

NinewellsHospital

From August 2005 contact the A&E department at DDH (Monday – Friday.)

1

[1] For patients who are in NinewellsHospital please see specific paragraph.