Alternatives to acute admission to RCH
The individualised management of our acutely unwell or unsafe frail community in Cornwall has been redesigned given the risks of acquiring Covid-19 at the acute site, and the poor prognosis if they have Covid-19, the main aim to manage them at home or away from Treliske site. This hinges on identifying the very frail and considering end of life can planning early on in this care episode.
Community Assessment & Treatment Units (CATUs)
For patients (both covid and non-covid) who:
1) Need urgent escalation of care from the community
2) This escalation can't be done in the home (ie ACAH/DNs/community bloods not appropriate, if they are, complete SERF form - this is the 'Community Coordination Centre' route)
3) Are not appropriate for RCH acute admission (ie poor prognosis or high risk if nosocomial Covid infection, eg Rockwood 5 or more, multiple comorbidities, clear advance directive documented, etc)
4) Who may benefit from some POC diagnostics +/- witnessed response to initial treatment (eg iv fluid)
5a) Are likely to go home after CATU care
---- OR ----
5b) Would not benefit from care escalation to RCH admission but may from ongoing bedded care (in a community hospital or step down to residential care of some description)
Who they are
CATUs are staffed by a ward doctor with GP oversight during the day, with band 6 nurses overnight and 111 cover.
Where they are
CRCH
Bodmin
WCH
St Austell
Where they are
POC diagnostics (Troponin T must be >12hrs post chest pain)
X-ray available 8am-8pm (St Austell tbc)
How to refer - in hours
Please discuss CATU referrals with the Acute GP service in hours (0800 - 2000hrs)
[AGPs click here for contact details]
Please ensure an accompanying TEP & patient profile (+/- expected death form where appropriate)
WCH may still take admission in the same way - via bed manager on-call
How to refer - out of hours
Please discuss CATU referrals with 111 out of hours (2000hrs - 0800hrs)
Please ensure an accompanying TEP & patient profile (+/- expected death form where appropriate)
Glossary
SERF single e referral form: for all community referral eg ACAH, community beds, CATU, …, idea is to co-ordinate community services to avoid admissions
OPAL Older People's Assessment & Liaison Services (read more)- 4 localities in Cornwall being set up with allocated geriatricians, these are assessment services stemming from the CATUs and referral is through the same route
CCC Community Coordination Centre- reviews SERFs 8-8, have two pathways behind the scenes to use:
a 'bed bureau' to coordinate county-wide inpatient community care (including health & social funded hotel beds) and
a 'therapy' stream to coordinate Acute Care at Home, DNs, Community matrons, palliative care
GotD geriatrician of the day/Silverline 01872 252161 - lead the decision making regarding frailty and stroke/TIA admissions