Guideline for arranging an inpatient admission

St Peter’s Hospice is a specialist palliative care service, committed to supporting the needs of the wider Bristol community.

Admission to the inpatient unit at Brentry is one component of a range of services offered by the multidisciplinary team.

Procedure for arranging admission

Patients are normally nominated for admission by Hospice Community Nurse Specialists, the Day Hospice team, or the medical team based on their own and/or the Primary Health Care Team’s up-to-date assessment of need. Inpatients in any of the Bristol hospitals may also be nominated for admission by Specialist Palliative Care colleagues in the local hospital teams, if they determine that these patients have specialist palliative care needs that would best be met by transfer to the hospice.
 
If a GP/DN/hospital palliative care team would like a current patient to be considered for admission they should contact the patient’s Hospice Community Nurse Specialist or Day Hospice team to request this. Patients who are not known to the hospice can be referred for admission by sending a referral form and discussing the case with one of the senior doctors.
 
Non-urgent requests for admission are discussed at the next Admissions Meeting on each of the inpatient units (Daily: Mon-Fri), and if appropriate admissions for the same or the next day are agreed depending on bed availability. Cases are prioritised, with a clear emphasis on giving top priority to patients facing crisis in the community. Following multi-disciplinary discussion at the admissions meeting we aim to:-

a) Place the patient’s name on the waiting list for admission or;

b) Place the patient’s name on the Safety Net as not yet clearly requiring admission, with an agreed plan to review the patient’s progress with the referrer within a specified period of time or;

c) Decline to offer admission based on an assessment of all the circumstances at that time.

Emergency admissions can be arranged for the same day or out of hours if appropriate, depending on bed availability. Requests for emergency admission must be discussed with a senior hospice doctor who is available 24 hours for urgent advice. These can occur at any time of the day or night for patients with urgent need for specialist palliative care providing it is appropriate to admit to an isolated hospice inpatient unit. For patients with acute reversible conditions requiring urgent investigation or intensive medical management, hospital admission should be considered, depending on the informed choice of the patient or patients advocate. For patients not known to the hospice a full referral form and relevant letters will be required.

Reasons for admission

The needs of each patient on the waiting list for admission are categorised as follows:

1. Symptom Control – this term is used to cover all aspects of physical and psychological symptoms, which require some form of specialist palliative care intervention on an inpatient basis.

2. Psycho-social Support – this covers situations where patients with specific palliative care needs or their carers require respite from a difficult psycho-social environment.

3. Assessment – this term refers to patients whose changing condition/needs require specialist monitoring/assessment. There may be considerable uncertainty about the prognosis of these patients and they may well require terminal care.

4. Terminal Care – this term refers to patients who have been assessed by a member of the St Peter’s team, primary health care team or hospital palliative care team and are considered to be actively dying in the near future and who are specifically in need of specialist palliative inpatient care. 

Standards for Admission

Based on the above categories, we aim to admit:

• patients requiring admission for symptom control within 5 days
• patients requiring admission for psychosocial support within 8 days
• patients requiring admission for terminal care within 3 days
• patients requiring admission for assessment within 5 days

Transport for Admissions

It is the responsibility of the professional requesting admission to arrange transport. Please note that if the ambulance service are informed that it is an urgent palliative care case they will prioritise transport to pick up within 1 or 2 hours (depending on urgency). If an emergency admission is expected out of hours, please request that ambulance control contact the inpatient unit on receiving confirmation of the ambulance’s arrival at the house. Alternatively request that the family inform the unit by telephone.

For information about our referral guidelines and our referral form please click here...>