The referral process for accessing services at St Catherine’s Hospice varies slightly depending on the nature of a person’s condition and the type of care needed. Broadly speaking, however, people must always be referred to St Catherine’s by a healthcare professional.
We prioritise referrals on the basis of need, and the type of service that may best meet that need. We do not operate a first come, first served system.
In-patient referrals are made by a person’s GP, hospital doctor, district nursing sister/charge nurse, ward sister, community matron or a Clinical Nurse Specialist (CNS).
It is important that a person is informed and agreeable to the referral and we always check that this is the case.
We review all current referrals each morning, contacting the relevant professional for further information if we do not think we have a complete picture. We always prioritise admissions depending on a person’s clinical and social needs. In some cases community care may be a more appropriate choice or option, and often we will refer a person on to these services – sometimes as an interim measure while they wait for an in-patient unit bed to become available.
When a bed becomes available, we contact the referring professional to arrange admission. The length of a person’s stay varies depending on their individual need. It is always our intention to help people manage their symptoms and feel comfortable enough to be able to return home if possible. However, some patients will die at the Hospice under the care of our highly experienced staff.
Referrals to our community team of Clinical Nurse Specialists are made by referrals are made by a person’s GP, hospital doctor, district nursing sister/charge nurse, ward sister, community matron or a Clinical Nurse Specialist (CNS).
The Hospice community team manages each referral – ensuring they have the information required to fully-assess a patient’s level of need, allowing them to prioritise an appointment effectively. An appointment is then made with the team and visits managed and co-ordinated from then on, working in conjunction with other health and social professionals such as district nurses.
Referrals from a person’s GP, hospital doctor, district nursing sister/charge nurse or CNS team member are sent directly to our Lymphoedema team who then assess clinical need and gather any additional information they may require.
The Lymphoedema Service then makes an appointment directly with the patient, ensuring that any other healthcare professionals involved are kept informed.
We aim to ensure co-ordinated, safe and timely discharge of patients from Hospice care, ensuring that the appropriate arrangements are in place for on-going care that continues to meet the needs of our patients and their families.
Some people will require very little support from other services after discharge, whereas others may need a full range of provision.
The discharge process is triggered either:
We work together with patients and families to provide personalised care which respects personal wishes – including where a patient wants to be cared for. For example, if someone is being cared for at the Hospice but would like to be at home at the end of life, we will work hard to achieve this.
It is appreciated that sometimes people would, ideally, prefer to stay in the Hospice, or continue to be seen by the Hospice team indefinitely. Unfortunately due to limited resources and high demand for our services, we are unable to provide on-going care if a patient’s condition is stable.
This means that if a person’s condition improves enough for care to be safely provided and monitored elsewhere, discharge is planned – allowing other people with specialised palliative care needs to access our services.
During discharge planning, the personal circumstances, needs and wishes of each individual are carefully considered, including any recent changes in condition that may influence the level of care and type of follow-up required.
We use the information gained from our assessments to make suggestions about what might help the person to manage their condition/situation effectively in their preferred place of on-going care. We might suggest, for example, that carers or district nurses visit regularly after discharge, or that certain equipment might be needed, or that a residential or nursing home may be able to more appropriately meet a person’s specific needs.
If extra care is needed at home, or if residential or nursing home care is required, the Hospice team can advise on how this might be funded.
In more complex situations, community – and sometimes hospital – teams may be invited to a planning meeting to discuss options and agree discharge plans with the person, their family/carer and hospice staff.
If a person’s situation changes during discharge planning, then the decision to discharge may be discussed again and deferred if appropriate.
The Hospice team provide support and information to enable the person – and where appropriate their family or carer – to be closely involved with any decision-making throughout care and at the time of discharge. We work together to provide arrangements that are suitable for each individual.
Several members of the Hospice team may be involved in supporting discharge planning, such as the nurse, doctor, physiotherapist, occupational therapist and the family support team.
The Hospice team also works closely with other teams in the community and in local hospitals. They often need to be involved in the discharge planning process and can become further involved with a patient after discharge. For example, district nurses may continue to monitor a person’s condition alongside the GP, or may continue to offer specific interventions for problems such as lymphoedema, catheter care or wound care.
Any person discharged from Hospice services is given information about who to contact if there are any problems, including a contact number for the Hospice team.
Information is also provided about follow-up arrangements and a discharge letter is sent to update other involved professionals, such as the hospital consultant or specialist nurse, GP, District Nurses and Out of Hours services.
Everyone discharged from the inpatient unit is given a week’s supply of medication – to allow enough time to order a repeat prescription from their GP – as well as an information sheet about the medication.
Patients discharged from lymphoedema services are given a supply of hosiery, and the GP is given information about ordering further supplies when needed.
By working together we hope to meet the needs of each individual, whilst ensuring our services are opened to as many people as possible.
However, we also know that sometimes people need us again at a future date. If the need arises, a professional (such as the GP, district nursing sister/charge nurse or consultant) can refer a person back to Hospice services.