This Standard Operating Procedure (SOP) sets out how referrals will be managed in Strata for people waiting for P1 service capacity and are discharge from acute hospital setting to be transferred to a Community Hospital.
The process of transferring P1 waiters to community hospitals only applies in exceptional circumstances to support system flow pressures.
Key Principles:
1. Referral remains open for Pathway 1 receiver service(s) – they admit when the person has been discharged home and care / support commences.
2. When the transfer details are confirmed (where the person will be transferred to), the discharging ward (acute) is responsible for changing the new location in the Client Details tab in Strata.
3. Once the person has arrived at the community hospital ward, the receiving ward is responsible for changing the location in the Client Demographics tab.
See illustration below.
Strata Service Provider Training Guides CITS training portal - Strata
Each day, CFT flow leads review acute hospital data (pathway list) to identify appropriate people who do not meet the criteria to reside and who could be transferred to a community hospital while waiting for capacity in the community to go home.
If a person becomes unwell or has a fall in the community hospital ward, and needs to be assessed in ED or re-admitted to the acute ward – the following applies:
1. Person transferred to:
a. Community Hospital ward will hold the bed for 24hrs.
b. If not returning to Community Hospital and admitted to Acute ward, the Community Hospital Cancels the referral.
The referral only remains open if the person returns to the Community Hospital within 24 hours - If the person is not medically optimised for discharge back to the Community Hospital or home:
1. Community Hospital Cancels the referral for the IToCH and receiver service(s) by clicking on the Red X – in the Cancel Reason box – select ‘Other’ and add text ‘No longer Medically Optimised for Discharge’
2. IToCH / Receiver Service(s) see that referral is cancelled (Grey colour with CAN text – see below illustration).
a. Select ‘Reviewed’ tab
b. Then select ‘Refresh’ tab – this will remove referral from list
If IToCH has sent referral to email receiver service (PDF) outside of Strata pathways – make sure they have been notified that the referral has been cancelled.
Article ID: 354
Created: July 3, 2023
Last Updated: August 25, 2023
Author: Eve Adams
Online URL: https://elearning.cornwall.nhs.uk/site/kb/article.php?id=354