Access to Care has a pivotal role helping to ensure that patients are treated in the most appropriate location. Although the term ’admission avoidance’ is often used it is important to remember that saving money is only one reason behind this process. All of us have a duty to try and make sure that wherever possible, patients are treated within their own homes or as near to them as practicable.
In addition, AtC has the ability to monitor capacity within acute trusts, community hospitals and Neighbourhood Teams, a task aided by eCMS
These two factors mean than AtC is able to assist clinicians wishing to find the most suitable referral option for their patient.
The challenge we face is trying to ensure that AtC is available to assist where it is worthwhile but does not hinder the admission process when there is no tangible benefit.
With this in mind, the following key points represent the current advice:
- If clinicians feel that an acute admission is absolutely unavoidable they should continue to admit patients directly to the acute unit of their choice
- They should, however, bear in mind that alternatives are sometimes available even in quite challenging circumstances
- Therefore, if a clinician feels that there may be a chance, however remote, of avoiding admission to an acute unit; they are asked to contact Access to Care.
Examples include:
- Treatment at home (Neighbourhood Team)
- Community Hospital admission
- Same day out patient appointment
- Same day investigation
- Whilst referral information can be submitted via the website, email or fax, we would prefer clinicians to phone AtC when trying to arrange possible admissions. This will allow detailed information to be collected via a clinician to clinician conversation.
- The clinical information collated will form the referral letter and will be submitted by AtC to the accepting organisation
- Using the information collected, AtC will organise the most appropriate outcome for the patient, bearing in mind the resources available.
- If a suitable alternative to acute admission is not available, AtC will, as a last resort, arrange admission to an acute trust.
- In most circumstances, there will be no necessity for the referring clinician to speak to the admitting clinician or to AtC again. Clearly, there will be occasions when this is requested in order to clarify information. In this event, the onus will be on AtC or the accepting clinician to contact the referring clinician.
- If admission is required, AtC will organise appropriate transport.
The majority of cases in which alternatives to acute admission exist tend to fall into certain predictable groups. As a guide only, we would encourage clinicians to contact AtC if patients fall into the following groups:
- Possible medical admissions
- Possible care of the elderly
- Possible Community Hospital admissions
- Possible palliative care admissions
- Neighbourhood Team care
- Retention of urine
AtC is prepared to assist whenever the referring clinician feels alternatives to acute admission may exist. Many situations, in a wide variety of clinical specialities can be managed if a ’same day’ outpatient appointment can be arranged. Sometimes, clinicians are not sure if this option is available and often, they have insufficient time to access it – Access to Care is able to assist in such cases.
