SESLHD GUIDELINE COVER SHEET · Older Persons Mental Health Units (OPMHUs) provide specialist...

SESLHD GUIDELINE COVER SHEET

NAME OF DOCUMENT

Access and Patient Flow Operational Framework for Mental Health Service

TYPE OF DOCUMENT GUIDELINE

DOCUMENT NUMBER SESLHDGL/051

DATE OF PUBLICATION March 2017

RISK RATING Medium

LEVEL OF EVIDENCE NSW Mental Health Act 2007 The Garling Report (2008) National Standards for Mental Health Services (2010): 10.2.1 Delivery of Care National Safety and Quality Health Service Standard: 6.2 Clinical Handover

REVIEW DATE March 2020

FORMER REFERENCE(S)

SESLHDPR/245 Patient Flow Operational Framework for Mental Health Service SESLHDGL/022 Acute Patient Flow and Sustainable Access Management for Mental Health Guidelines

EXECUTIVE SPONSOR or EXECUTIVE CLINICAL SPONSOR

Peter Young A/Chief Psychiatrist SESLHD Mental Health Service

AUTHOR

Danielle Coppleson and Daniella Taylor Access and Service Integration Managers SESLHD Mental Health Service

POSITION RESPONSIBLE FOR DOCUMENT

SESLHD MHS Access and Service Integration Managers.

KEY TERMS

Patient flow; access management; demand management; mental health access.

SUMMARY

This document provides a framework for standardised patient flow operations in SESLHD MHS. Standardised operations aim to enhance mental health consumers’ experiences and outcomes and the document should be used as a reference tool by mental health staff.

THIS DOCUMENT IS A GUIDE FOR BEST PRACTICE This Guideline is intellectual property of South Eastern Sydney Local Health District.

Guideline content cannot be duplicated. Feedback about this document can be sent to [email protected]

mailto:[email protected]

REVISION: 1 TRIM No: T16/56738 Date: March 2017 of 34 THIS DOCUMENT IS A GUIDE FOR BEST PRACTICE

This Guideline is intellectual property of South Eastern Sydney Local Health District. Guideline content cannot be duplicated.

Access and Patient Flow Operational Framework for

Mental Health Service Section 1 - Background ............................................................................................................................... 3 Section 2 - Principles ................................................................................................................................... 4 Section 3 - Definitions and Scope ............................................................................................................... 5 Section 4 - Responsibilities........................................................................................................................ 10 Section 5 - Patient Flow Coordinator Communication and Reporting Schedule........................................12 Section 6 - Mental Health Inpatient Length of Stay…………………………………………………………… 15 Section 7 - Collaborative Patient Flow Operations, including Over Census/Over Numbers ..................... 16 Section 8 - Mental Health Admission and Transfer of Care ...................................................................... 19 Section 9 - Repatriation of Out of District Patients .................................................................................... 22 Section 10 - Transport ................................................................................................................................. 25 References……………………………………………………………………………………………………………. 32 Revision and Approval History ....................................................................................................................... 33 Appendix A: SESLHD MHS Inpatient and Emergency Department Contacts ............................................. 34

Section 1 Background



Section 1 – Background This document provides a framework for standardised access and patient flow for consumers within SESLHD Mental Health Service (MHS) – and for consumers who are being transferred to or from SESLHD MHS. Aims Standardised access and patient flow aims to enhance mental health consumers’ experiences and outcomes, and as such this document should be used as a reference tool by all MHS staff. Patient flow is a dynamic process not limited to business hours and this framework provides consistency of patient flow operations within and outside of business hours. This framework complements the processes outlined in Mental Health for Emergency Departments - A Reference Guide. Target Audience The framework is aimed at Site Service Directors (SDs), Clinical Operations Managers (COMs), Inpatient Service Managers (IPSMs), Community Service Managers (CSMs), Nurse Managers (NMs), Nursing Unit Managers (NUMs), Access and Service Integration Managers, Patient Flow Coordinators (PFCs), Clinical Coordinators (CCs), Nurses in Charge (NICs), Psychiatric Registrars and Consultant Psychiatrists and all other mental health staff involved in the patient flow process.

http://www.health.nsw.gov.au/mentalhealth/publications/Pages/mental-health-ed-guide.aspx

http://www.health.nsw.gov.au/mentalhealth/publications/Pages/mental-health-ed-guide.aspx

Section 2 Principles



Section 2 – Principles Patient Flow Philosophy The Garling Report (2008)1 identified the link between efficient use of inpatient beds and improvement in the quality of care provided to patients. People requiring mental health inpatient care should receive timely and efficient access to the best possible care available at the best possible time. The core principle of patient flow is to provide sustainable access to inpatient beds and community treatment and is identified as a State-wide standard. Consideration must be given at all times to ensure that people with a mental illness or mental health disorder “receive the best possible care and treatment in the least restrictive environment enabling the care and treatment to be effectively given" (NSW Mental Health Act 2007). Standard 8.1 (Governance and Leadership) of the National Standards for Mental Health Services (2010) states: “The governance of the MHS ensures that its services are integrated and coordinated with other services to optimise continuity of effective care for its consumers and carers”, while Standard 10.2 (Access) requires that a mental health service is “accessible to the individual and meets the needs of its community in a timely manner”.

1 Final Report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals Overview, Peter Garling SC 27 November 2008, Pg. 30 (1.193)

Section 3 Definitions and Scope



Section 3 – Definitions and Scope What is Patient Flow? ‘Patient Flow’ refers to the patient journey through a health service (in this instance the SESLHD MHS). SESLHD MHS strives to ensure that all Mental Health Unit inpatient beds are accessible to consumers requiring care. Daily transfers of care out of Mental Health Units must be coordinated, predicted and planned to reduce harm and effect safe patient care and timely daily admissions. Admissions can occur via the Emergency Department (ED) or directly to Mental Health Units from the community. To achieve safe patient care, all patients requiring mental health admission should be transferred to an appropriate facility as soon as assessment and/or treatment processes are completed. It should be noted that some venues, such as Prince of Wales Hospital, have points of admission that may bypass the ED. e.g. NSW Police / Community Mental Health Team (CMHT) presentations and patients sent directly from courts or prison for assessment can be transported directly to the Acute Inpatient Unit. Multiple points of admission can make patient flow coordination more complex and heighten the need for predictive and collaborative transfer of care planning around the clock. All patients admitted to a mental health facility must have a clearly defined admission / transfer of care pathway documented, including the plan and expected date of discharge (EDD) from hospital.

SESLHD Geography




SESLHD Hospitals and Health Services (*Mental Health Inpatient Unit/s on site)

(+Mental Health assessment service in ED)

Northern Southern Prince of Wales Hospital*+ St George Hospital*+ Royal Hospital for Women The Sutherland Hospital*+ Sydney Hospital The Garrawarra Centre Sydney Eye Hospital

SESLHD MHS Facilities

Acute Mental Health Inpatient Units (MHU)

Site Name Total Beds Bed Configuration

Prince of Wales Hospital Kiloh Centre 46 16 x observation, 30 x general acute

St George Hospital MHU 28 9 x observation, 19 x general acute

Sutherland Hospital IPU 28 10 x observation, 18 x general acute

Most Mental Health Units provide both high-level acute (observation) and general acute care when community treatment is not possible due the patient’s clinical condition. MHUs are ‘declared facilities’ under the NSW Mental Health Act 2007, to accommodate people who are acutely unwell and require involuntary treatment and care.

Psychiatric Emergency Care Centres (PECCs)

St George 6 PECC beds

Prince of Wales 4 PECC beds

Psychiatric Emergency Care Centres (PECCs) provide rapid access to mental health assessment and short stay admissions up to 72 hours. PECC ultra short admissions are designed to reduce patient harm in the ED and can be used when complex ED discharge planning is required. Patients must have a manageable level of risk in all domains including suicide, self-harm, aggression, sexual safety and absconding. Admissions are direct from the ED following mental health assessment and authorisation by the Medical Superintendent or delegate. Appropriate patients may be transferred from an acute mental health inpatient facility to PECC and, on occasion at some facilities, may be admitted directly from the community to PECC.

Mental Health Rehabilitation Units (MHRUs)

Site Name Beds + Configuration Prince of Wales MHRU 14 non acute beds - non-declared Sutherland MHRU 20 non acute beds - declared




Two Mental Health Rehabilitation Units (MHRUs) are also available in SESLHD. These non-acute facilities provide a range of programs supporting patients to develop or regain skills for living independently or in supported accommodation. Where capacity exists during times of peak bed demand, a MHRU bed may be considered as a temporary venue for limited number of ‘transition’ patients from an acute facility. Careful consideration should be given to the use of MHRU beds for this purpose due to the disruption to patients involved. Wherever possible, patients who have already been referred to and/or are awaiting a MHRU bed and who have minimal risk factors should be considered. MHRUs may also provide a venue for completion of Clozapine titration for suitable patients.

Specialist Mental Health Service for Older People (SMHSOP) Site Name Total Beds Configuration

Prince of Wales Euroa 6 (declared) + 2 neuro-psychiatry beds

St George OPMHU 16 sub-acute (declared) Older Persons Mental Health Units (OPMHUs) provide specialist mental health assessment and treatment for older people with acute mental illness. Patients with a primary organic or physical health condition leading to disturbed behaviour are generally outside the referral criteria for OPMHUs. Where capacity exists, beds may be considered during periods of peak bed demand as a temporary venue for limited number of ‘transition’ patients from an acute adult facility. This strategy should only be used at times of peak demand and after all other strategies to increase acute bed capacity have been exhausted. In general only patients who are close to the admission age and with minimal risk factors should be considered for transition placement.

Tertiary Intensive Psychiatric Care Units (IPCU or MHICU) Prince of Wales MHICU South Eastern Sydney Local Health District Ph: 9382 0977

Hornsby MHICU Northern Sydney Local Health District Ph: 9477 9500 Cumberland IPCU Western Sydney Local Health District Ph: 9840 3864 Concord IPCU Sydney Local Health District Ph: 9767 8852

SESLHD MHS has a 12 bed Mental Health Intensive Care Unit (MHICU) based at the Randwick Hospital Campus, which provides acute treatment for patients with complex mental health issues. PFCs need to facilitate admission to a MHICU within their own District. Where this is not possible due to lack of available beds, an out of district MHICU can be contacted to discuss a swap and or placement. For referrals to SESLHD MHICU please see SESLHDBR/017 - Referral to SESLHD Mental Health Intensive Care Unit (MHICU)

For referrals out of SESLHD please see SESLHDBR/019 - Referral to Intensive Psychiatric Care Unit (IPCU) or Mental Health Intensive Care Unit (MHICU) External to SESLHD Mental Health Service

http://www.seslhd.health.nsw.gov.au/Policies_Procedures_Guidelines/Clinical/Mental_Health/BR/Default.asp








Tertiary Child and Adolescent MHS Inpatient Units (CAMHS) – Acute

Shellharbour Ph: 4295 2820 Shellharbour Hospital

Gna Ka Lun Ph: 4634 4444 Campbelltown Hospital Redbank House Ph: 9845 7950 Westmead Hospital Hall Ward Ph: 9845 2009 Children’s Hospital, Westmead

Nexus Unit Ph: 4985 5800 John Hunter Hospital Saunders Unit Ph: 9382 0097 Sydney Children’s Hospital, Randwick

The eight beds available at Sydney Children’s Hospital are gazetted beds. SESLHD MHS can make referrals to the declared tertiary CAMHS beds listed above. The Access and Service Integration Manager should be informed of all tertiary Child and Adolescent MHS (CAHMS) Inpatient transfer requests within business hours. Consultation Liaison SESLHD provides a Consultation Liaison service at each site for people in medical wards requiring mental health assessment and/or review, with the exception of persons under the care of a geriatrician. These patients are to be referred to Older Persons Mental Health, and young people admitted to the paediatric ward under a paediatrician.

Child, Youth and Adolescent MH Community Services (CAMHS)

Child , Youth and Adolescent Services

Community All sites, (Sutherland, St George, Eastern Suburbs)

Children Of People with a Mental Illness – COPMI

Community All sites

School Link Community All sites

SESLHD MHS provides services to people and their carers in the community. Teams are structured to provide treatment and rehabilitation across the population spectrum to include older adults, children, youth and adults. *NB. (At the time of the development of this Guideline, a redesign of Community Mental Health teams was under way. This Guideline will be reviewed and adjusted accordingly when this redesign has been completed.)




Community Mental Health Services

SMHS Community

2 x Adult Non-Acute Teams, including rehabilitation (Maroubra, Bondi). 1 x Acute Care Team 1 x Mobile Community Team

Sutherland Community 2 x Adult Non-Acute Teams, including rehabilitation (START and CONNECT) 1 x Acute Care Team (ACT)

St George Community 3 x Adult Non-Acute Teams (Directions, Connections and Outlook) 1 x Acute Care Team

Family and Carer Program

Community and Inpatient All sites

Perinatal Community All sites

Older Persons Community All sites

Aboriginal and Torres Strait Islander MH Services

Community

All sites

Section 4 Responsibilities



Section 4 – Responsibilities PATIENT FLOW COORDINATION The Role of the Access and Service Integration (ASI) Manager/s The ASI Manager/s provide leadership, derive and interpret data and information to inform strategic direction across the District in relation to capacity and patient flow. The ASI Manager/s work collaboratively with Patient Flow Coordinators and site managers to make changes and increase their ability to meet the needs of the population within an appropriate time frame. The ASI Manager/s need to be aware of current capacity and demand across the District and develop networks with other SESLHD disciplines, other LHDs across the State, and Ministry of Health staff to develop, advocate and share resources related to patient flow and capacity. The Role of the Patient Flow Coordinator (PFC) The PFC is the central point of contact for information and access to site mental health beds in SESLHD during business hours Mondays to Fridays. After hours and on weekends, the role is delegated at each site for continuity of patient flow coordination. More details about after hours coverage are provided on pages 14, 17 and 18.

PFC Contact

Prince of Wales Ph: 0411 653 463

St George / Sutherland Ph: 0411 658 967 The core responsibility of the PFC is centred on the care coordination of patient services as per the NUM 1 Award. This includes the orchestration of services to meet patients’ needs after discharge, liaison with all health care disciplines for the provision of services to meet patients’ needs and the operational requirements of synchronising capacity and demand. Demand refers to the number of patients from all sources (including ED, Police, Community Mental Health, other inpatient services and other MHS) that require admission at any given time. To remain in touch the PFC must review relevant databases including the Electronic Patient Journey Board within the NSW Health patient flow portal, attend clinical meetings and liaise routinely with NUMs, ED clinicians, inpatient clinicians, Community Mental Health Teams (CMHT) and peer PFCs (general and MH) regarding: • Number of patients physically present on the unit(s) • Number of patients on leave and for how long • Patients absent without leave (AWOL) and whether they are expected to return and, if not,

when the bed will be confirmed as available • Patients in ED awaiting assessment and/or likely to require admission • CMHT patients being assessed and likely to require admission • Out of District patients requiring repatriation to their local MHS • MH Patients on a medical ward potentially requiring transfer of care. The PFC records capacity/demand details in twice-daily Profile Reports (see page 11). Updates are sent to site stakeholders and the MHS Access and Service Integration Team.

Section 4 Responsibilities



PFCs should be especially alert for: • Avoidable admissions – ensuring admissions are consistent with the principle of least

restrictive care as outlined in the Mental Health Act • Out of District patients requiring repatriation to their local MHS • Patients with private health insurance who may be transferred to a private facility • Barriers to transfer of care or leave for a patient who is otherwise clinically ready • Patients suitable for referral to Acute CMHT, MHRU, transitional care teams, inpatient drug

and alcohol services, Community Managed Organisation (CMO) supported accommodation (such as NEAMI) or general aged care services

• Frequent presentations to EDs of MH consumers • Facilitation of case review with relevant stakeholders and participation in care coordination

planning documents (management plans) that are integrated with CMH plans. Escalation points for the site PFC: At times the site PFC will need to escalate issues to their site Service Managers and the ASI Manager for a faster resolution, and for communication to relevant stakeholders and data systems. These circumstances include: • Decommissioned beds/building works within inpatient settings affecting capacity status • High risk AWOL patients and high risk admissions (children/pregnant women/forensic

patients etc.) • Clients unplaced in the ED (i.e. awaiting MH admission and no allocated bed identified. The

ASI Manager is to be informed as per the routine PFC communication schedule below, and escalated if required following local site escalation)

• High MH presentations in the ED (>4 patients). The ASI Manager is to be informed as per the routine PFC communication schedule below, and escalated if required following local site escalation

• Patients requiring the Housing and Accommodation Support Initiative (HASI PLUS)/ Integrated Services Program (ISP) etc., following local site endorsement

• Requests for District case conferences following local site escalation and endorsement • Out of LHD MH requests for incoming transfers • Out Of LHD repatriations, after seven working days of site involvement/local site escalation • Potential upcoming 24 hours ED breaches following local site escalation • Patients awaiting Community Treatment Order (CTO) hearings that could be placed on leave

pending the hearing. Planning for discharge and transfer of care is initiated as soon as possible after admission, including the allocation of an estimated date of discharge (EDD). The PFC has a key role in tracking the patient journey. By attending daily ward, multi-disciplinary team (MDT) clinical meetings and length of stay meetings, the PFC maintains awareness of all patients’ progress and can facilitate the removal of any non-clinical barriers to transfer of care such as accommodation, transport or social issues in collaboration with the NUM, MDT and others.

Section 5 Patient Flow Coordinator Communication and Reporting Schedule



Section 5 – Patient Flow Coordinator Communication and Reporting Schedule, including Demand Planning Patient Flow Coordinator Communication Schedule The aim of this PFC communication schedule is to ensure timely and regular exchange of information between the site PFC and the District ASI Team. Ad-hoc communications includes challenges to patient flow as they occur, e.g. consumers held up in the ED as a result of access block, and other issues requiring escalation.

PFC Communication Schedule

8:30 am E-mail AM Profile Report to all relevant site stakeholders, including Access and Service Integration Manager

11:30 am E-mail, verbal or SMS update of ED demand and inpatient capacity status. Report to Access and Service Integration Manager, site Executives

2:00 pm Verbal, email or SMS update patient flow challenges to Access and Service Integration Manager

3:00 pm E-mail Weekend Demand Plan (Friday)

3:30 pm E-mail AM Profile Report to all relevant site stakeholders, including Access and Service Integration Manager

Site/Network Capacity/Demand (Profile) Reports Site Profile Reports are collated by PFCs and published at 8:30 am and 3:30 pm daily via email to: Site Registrars, Consultant Psychiatrists, Team Leaders, MH Executives, NUMs, Allied Health, General Hospital Executives, District Risk Manager, District Access and Service Integration Team, and other relevant demand management stakeholders. The reports are a summary of current site capacity and demand. In line with NSW Ministry of Health protocols, the Profile Reports also indicate predictive patient flow for the next 24 and 48 hours. See sample Profile Report below.




Demand Planning The aim of demand planning is to maximise the use of mental health inpatient beds using a non-reactive, predictive approach to patient flow. EDDs are to be entered into the NSW Health patient flow portal and should be reviewed daily, with local systems in place to review expired EDDs. Proactive and predictive planning ensures site self-sufficiency and reduces waiting time for patients in the ED.

Venu

e

ED T

otal

War

d

Beds

Patie

nts

Leav

e 24 hr Prediction 48hr Prediction

CL1

OO

DS

Cap

acity

D/C

Adm

D/C

Adm

Security CL1

STG ED 0 Nil patients

TSH ED 3

31/8 1308hrs Invol 28y M. Psychosis = for imminent admission to MHU and placed. 31/8 1418hrs Vol 52y M. Depression = MHA in progress, disposition pending. 31/8 1421hrs Vol 45y M. Depression = MHA in progress, disposition pending.

STG

MHU 27 27 4

1 3 3 6

0 0 1 0 MHU AH Bed 1 0 0 0 0 0 1

OPU 16 16 0 0 0 0 0

PECC 6 6 0 0 0 0 0

TSH

MHU 27 27 3

1 2 3 3

0 0 2 0 MHU AH Bed 1 1 0 0 0 0 0

MHRU 20 20 0 0 0 0 0 SGH Med

Bed

TSH Med Bed

Bed Status

1 x MHU beds STG Outliers Nil

0 x OPU bed STG Out of District 1 x Broken Hill 0 x PECC bed STG

0 x MHU beds TSH Outliers Nil

0 x MHRU bed TSH Out of District 1 x Nepean, 1 x WSLHD

STG Duty Consultant Dr Duke STG Site Executive Ms Nikki Dimichiel TSH Duty Consultant Dr Menon TSH Site Executive Ms Beth Tovey

Venu

e

ED's

Tot

al

War

d

Beds

Pt's

Leav

e 24 hr Prediction 48hr Prediction

CL1

OO

D'S

Cap

acit

y

D/C

Adm

D/C

Adm

Totals 3 98 98 7 2 5 6 9 0

0 3 1

Key Leave= Patient out on overnight or extended leave, CL=Care Level, Med Bed=patient in a general hospital medical bed either awaiting mental health bed or receiving consultation psychiatry input, OOD= out of LHD patient, Vol/Invol=Voluntary/Involuntary patient, MHU=Mental Health Unit, MHA=mental health assessment, SW=Social Work, D&A=drug & alcohol, O/D=overdose




Weekend Demand Planning Weekend demand planning strengthens site capacity, maintains self-sufficiency and minimises reliance on neighbouring services over the weekends. Local site sufficiency plans are documented on the Weekend Demand Plan (WDP) template to ensure sufficient capacity in line with predicted weekend demand. See sample WDP report below.

The WDP flags those patients confirmed for leave or transfer of care over the weekend and identifies their expected day/time of departure. The WDP records the patient’s full name, whether his/her care is being transferred or he/she is going on leave. If going on leave the WDP identifies when he/she is due to return. Any issues that may impede leave or transfer of care such as accommodation or transport issues are also highlighted. Site self-sufficiency is essential for efficient patient flow on weekends. The WDP identifies patients who can be temporarily and safely transferred at times of peak demand to venues such as MHRU, PECC or OPMH Units, should capacity be available. The WDP also identifies patients who may be considered for transfer to alternate SESLHD MHUs, MHRUs, PECCs or OPMH Units, should local capacity be unavailable. The PFC prepares the WDP in collaboration with the NUM and MDT and has it signed off by a representative of the site MH Executive. The WDP provides a reference tool and enhances communication for weekend staff, including after hours clinical teams. The WDP is displayed in each MHU and is emailed to the weekend site on call MH Executive, on-call Registrar and Consultant Psychiatrist and the District MHS Weekend Access and Service Integration Team Manager. Increased extended demand and Extended holiday periods At times of increased demand or extended holiday periods, such as Christmas and Easter, the Access and Service Integration Team and Patient Flow Coordinators can arrange demand planning meetings to discuss projected capacity and develop contingency plans with strategies to meet predicted demand.

Possible Saturday / Sunday / Monday

Venue Suitable transfer?

Planned D/C

Planned Leave & Return Date

Poss. for D/C or Leave

Planned D/C

Planned Leave & Return Date

Poss. for D/C or Leave

Total

OOA / Outliers for repatriation

Obs Unit

M S - to PECC

JB FM 6/7 4

Issues JB awaiting crisis accommodation

PECC ME to OPU

JC 2

Issues

Endorsement Endorsed by: Site Executive or delegate and Medical Superintendent or delegate Additional resources to be accessed in cases of surge demand Distribution List

Weekend CNCs, on call Execs, on call Registrars/Consultants, Access and Service Integration Mgr

Deployment of additional ward staff Consultant on notice to attend facility in person to assist in reviewing patients on ward and/or in ED

ACT/CMHT on notice to attend facility to assist in identifying ward patients for potential leave/DC with intensive community support

Section 6 Mental Health Inpatient Length of Stay



Section 6 – Mental Health Inpatient Length of Stay Long Length of Stay (LLOS) meetings Long Length of Stay (LLOS) meetings are held weekly or fortnightly to discuss patients with a length of stay in the MHU of greater than 28 days and in the MHRU for patients reaching length of stay thresholds of 100, 150 and 180 days. PECC patients with actual or upcoming LOS >72 hours should also be discussed, as well as identification of any patients – regardless of LOS – who have identified barriers to discharge. Meetings should be attended by the Chief Psychiatrist, Social Workers, CMHT Team Leaders, NUM, ISM, Clinical Operations Manager, PFC and District Access and Service Integration Manager (upon request). Representatives from the District MHS Rehabilitation Team are invited to attend the MHRU LLOS meetings when required. Patients are discussed from a MDT and holistic perspective, aiming to remove any barriers to transfer of care or leave. See also the District Terms of Reference for the LLOS meeting. ‘Obtaining a Second Opinion’ Policy SESLHDPD/269 - Obtaining a second opinion from a Consultant Psychiatrist within Acute Inpatient Mental Health Units outlines the length of stay thresholds for obtaining a second opinion:

Thresholds for Obtaining a Second Opinion

LOS >28 Days

Flexible format, may seek opinion from another Consultant Psychiatrist within the unit or within the service

LOS >49 Days Second opinion and face-to-face review to be sought from the Chief Psychiatrist/ Medical Superintendent. Review may be conducted by the Chief Psychiatrist/ Medical Superintendent of the treating facility or another facility

LOS >75 Days Automatic referral to site Complex Care Committee

Referral to the District Complex Care Review Committee is to be made via the Access and Service Integration Manager after the site Complex Care Committee meeting and local escalation to the site Mental Health Executive. This is detailed in SESLHDBR/029 - Referral to the Mental Health Service (MHS) Complex Care Review Committee (under review).

The thresholds should be routinely reviewed during LLOS meetings and action to obtain a second opinion initiated if required.

http://www.seslhd.health.nsw.gov.au/Policies_Procedures_Guidelines/Clinical/Mental_Health/Policies/default.asp




Section 7 Collaborative Patient Flow Operations, including Over Census/Over Numbers



Section 7 – Collaborative Patient Flow Operations, including Over Census/Over Numbers COLLABORATIVE PATIENT FLOW OPERATIONS Patient flow is a collaborative process incorporating both operational and clinical bed management. Effective patient flow entails collaboration and cooperation between the Access and Integration Manager, PFC and MDT. The role of the PFC is to coordinate patient flow in partnership with the MDT. The Three Rs of Patient Flow Remember the Three Rs before recommending placement of a patient: Right Patient Consider the patient presenting issues, age, risk factors, illness, physical health, gender, history and social supports – Do they need admission? What is the purpose of admission? Is the admission planned? What is the expected date of discharge from the inpatient facility (EDD)? Right Bed Consider the environment you are recommending placement into: ward acuity/patient mix, sexual safety risks, staffing resource issues, clinical skill mix, specialist medical and multidisciplinary services, relationships or history with other patients or staff, physical security of the environment (e.g. risk of absconding, falls risk).

Right Time Consider whether the patient has any physical complaint which requires investigation and resolution prior to transfer. How does the patient feel about going to a particular ward? Is there staff available to admit the patient? Is transport available or additional escort staff available? Has the bed become physically vacant (even if the bed is not yet physically available, the patient may, in an emergency, be moved to the unit while the bed is being prepared)? It is important to note that admission or transfer should not be delayed for the sake of staff convenience (e.g. meal breaks, clinical handover). Mitigation strategies should be implemented to ensure patient transfer is not delayed other than for safety reasons. Over Census / Over Numbers Over Census refers to the census report taken at midnight every night. There may be, at times, more patients listed as admitted to the unit than there are formal beds. As such the report seeks to capture the actual head count of patients at midnight and excludes patients on overnight or extended leave. In extreme and rare circumstances where SESLHD MHUs surge to over census capacity, the situation must be approved by the Service Director or delegate or the on-call MH Executive after hours, additional staffing must be sourced. Over Numbers refers to circumstances where there are physically more patients than beds on




a unit at a particular point in time. This can include: • Patients returning from leave whose beds have been used • Day patients awaiting or recovering from Electroconvulsive Therapy (ECT) • Patients commencing Clozapine who are undergoing initial dose monitoring • Patients on the unit awaiting a CTO hearing • Patients brought directly to the unit (e.g. Kiloh) by NSW Police or the CMHT, awaiting

assessment. Over numbers or over census admission can compromise patient care and place undue pressure on staff. The aim of efficient patient flow is to avoid over numbers and over census by anticipating demand and ensuring there is sufficient capacity to accommodate actual or predicted admissions. In the event that a MHU goes over numbers or over census, the following actions should occur without delay: • Inform the Duty Consultant Psychiatrist/Registrar as soon as it is known that the unit will be

over numbers or over census • Inform the site Executive or on-call MH Executive after hours and District MH Access and

Service Integration Team (within office hours) • Discuss with the site Nurse in Charge (NIC) any patients who may be suitable for review for

leave, transfer or discharge • Identify any patients who may be suitable for temporary transition placement in MHRU,

PECC or the SMHSOP Unit • Identify patients who may be supported by the CMHT while on leave from the unit • Contact peer PFCs during business hours to establish alternate site bed capacity and seek

assistance with alternate placement for suitable patients. After hours this may require direct contact with each facility.

Over numbers/over census situations can be stressful and place teams under significant pressure. It is imperative for all parties to remain open and supportive and communicate transparently to preserve goodwill. Operational patient flow is the administrative tasks associated with accessing a mental health inpatient bed and includes: • Bed finding and/or negotiations within and between services regarding bed availability • Repatriation and identifying suitable patients for clinical review, leave, transfer or admission

to a private facility. Clinical patient flow and bed management involves the clinical review and decision making process to determine whether any additional acute beds can be made available including: • Review of out of District patients/out of site patients for repatriation • Review of patients who may be considered for transfer and admission to a private mental

health facility • Review of patients on leave for extension of leave • Review of appropriate patients for early transfer of care with additional supports or overnight

leave with acute CMHT follow-up. This includes reviewing bed allocations and transfer of care status of patients, status of patients on leave, voluntary patients requesting to have care transferred or patients who have supportive family and/ or community networks.




After Hours Patient Flow Each site has a role designated to coordinate patient flow after hours (evenings and overnight, including weekends). At times of peak demand the on-call Consultant Psychiatrists can support the patient flow process by advocating for access to alternate venues if needed e.g. by discussing assessment and management of an individual patient with the Consultant Psychiatrists on-call at another hospital. Where site bed capacity is nil and Consultant Psychiatrist to Consultant Psychiatrist negotiation for alternate site placement has been unsuccessful, negotiations may be escalated to the on-call MH Executive for peer discussion and resolution. The hospital after hours Nurse Manager is another valuable resource for advocating and facilitating strategies to generate additional bed capacity after hours. The SESLHD MHS after hours Patient Flow Coordination Contact List is below.

Section 8 Mental Health Admission and Transfer of Care



Section 8 – Mental Health Admission and Transfer of Care ACCEPTING PATIENTS FOR MENTAL HEALTH ADMISSION

Acceptance of patients for admission is a collaborative process between the Mental Health clinician assessing the patient in the ED, the duty Consultant Psychiatrist/ED Consultant Psychiatrist or Registrar and the PFC or after hours delegate. Important factors to consider include: • Is there a less restrictive alternative to admission? • Can the patient go to a private hospital, a drug and alcohol rehabilitation centre, or be

transferred for CMHT follow up? • Is the patient suitable for a brief PECC admission? • Is there a documented admission plan? • Has the medical assessment and treatment in ED been completed? • To minimise the risk of medically compromised patients being transferred to a MH bed, the

ED medical staff are required to document in the medical record that there are no further investigations or treatments pending, subsequent to a thorough physical examination.

Network / Site MHS Mon – Fri (8:00am – 4:30pm) Patient Flow Coordinators

Mon – Fri (after hours) Sat – Sun (all hours) Overnight (7 days)

Northern Hospital Network

Prince of Wales Hospital Ph: 0411 653 463

POWH EDMH CNC Ph: 9382 2222, pager #45260 (Weekdays: 4:30pm – 9:45pm; Weekends: 8:00am – 9:45pm)

POWH Kiloh Observation Ward

Nurse-in-Charge Ph: 9382 4333

Southern Hospital Network

St George Hospital

Ph: 0411 658 967

STG ED MH CNC (7:00am - 11:00pm) Ph: 9113 1111, pager #833

STG ED MH Registrar on call (11:00pm – 7.00am)

Sutherland Hospital TSH MHU Nurse-in-Charge (24 hrs) Ph: 9540 7506

SESLHD Mental Health – Access and Service Integration Team Monday – Friday (8:30am – 5:00pm)

Ph: 0404 033 596

• Maintains District-wide oversight of mental health bed capacity and demand. This information is communicated twice daily

• Provides advocacy in relation to accessing beds at other sites in circumstances where a patient cannot be accommodated locally

• Supports SESLHD site PFCs to access out of District beds as required

• Provides an escalation pathway for circumstances where a bed outside the District is sought due to complex clinical or contextual issues (e.g. special needs patients)

• Promotes cooperative and transparent communications to enable timely access to available MHS beds.

• Outside business hours (M-F) – If a patient flow matter is unable to be resolved the matter may be escalated by the MH Registrar, CNC or other relevant stakeholders to the on-call MH Executive

• Site on-call MH Executives can be contacted via local hospital switchboard

• If an inpatient bed is unable to be acquired for a patient requiring a MH admission after-hours, the site on-call MH Executive must be notified.




• Prior to patients being transferred from ED the patient must have had cannulae removed, ECG leads removed (ligature risk) and have been extubated at least 24 hours before transfer.

• Is the medical record complete? (i.e. assessment module, care plan for admission, medication chart including PRNs and depots, Mental Health Act original paperwork, blood pathology forms).

• Acceptance of patients for admission is also a collaborative process between the PFC and the MHU or PECC NUM or NIC. e.g. A patient may have been assessed as suitable for a sub-acute unit, but following clinical handover it may be apparent the patient requires placement on an acute unit. Negotiation must take place with the NIC to establish the time for transfer into the MH bed. There may be times when it is necessary for the NUM or NIC to defer transfer at a particular time due to acuity. Other factors include staffing resources.

It is therefore essential for the PFC to maintain regular contact with the NUM or NIC to communicate information about NSW Police/NSW Ambulance/CMHT presentations, unit acuity and staffing, AWOLs, transfers of care and leave.

Direct Presentations When patients present directly to the unit with NSW Police, NSW Ambulance or CMHT, it is imperative to assess whether they are intoxicated. An Alcolmeter is available on each acute unit to measure alcohol intoxication. Patients should be observed for other evidence of intoxication from illicit or prescribed substances (e.g. pinpoint or dilated pupils, rapid pulse/ respirations). If patients are believed to be intoxicated they must be transferred to the ED immediately for monitoring and medical assessment. Direct to ward presentations currently only occur at Prince of Wales Hospital, although direct MH admissions can and do occur across the LHD as per SESLHDBR/059 - Admissions to Acute Mental Health Inpatient Units (including Direct Admissions for Community Managed Consumers) From General Hospital The Consultation Liaison (CL) teams will inform the PFC of any patients in a general hospital bed awaiting mental health admission. The same criteria as per ED apply. It is imperative that all medical investigations and treatments have been completed and the patient has been reviewed by the CL team for the least restrictive care option prior to transfer to a MHU. Prioritisation for Admission When there are patients in the ED and General Hospital awaiting mental health placement at the same time, especially when bed capacity is limited, priority for placement should be negotiated with the hospital Patient Flow Manager in consultation with the Mental Health Patient Flow Coordinator, Mental Health Inpatient Services Managers and Duty Consultant (or delegate). TRANSFER OF CARE Discharge from an acute care facility is not the end point in the continuum of care for most people accessing acute care services; hence, ‘transfer of care’ demonstrates that care continues beyond the hospital inpatient setting.

http://www.seslhd.health.nsw.gov.au/Policies_Procedures_Guidelines/Clinical/Mental_Health/BR/default.asp





In the context of Mental Health, transfer of care ensures the safe, effective and efficient movement of people with mental health issues between inpatient settings, to the community or to alternative care settings. The decision to transfer care of a patient should be made by the MDT in consultation with the patient and his/her carers wherever possible. Planning for transfer of care optimises the patient journey and ensures timely service. The section below is consistent with NSW Ministry of Health Policy - PD2011_015 Care Coordination: Planning from Admission to Transfer of Care in NSW Public Hospitals. On Arrival to the Inpatient Unit • On arrival to the unit (or as soon as practicable) each patient should receive information on

the Expected Date of Discharge (EDD), outlining expected date and time of departure from the unit/clinical area and the expectations around transportation. This information should be entered into the Electronic Patient Journey Board.

• The Registrar under whom the patient is admitted should allocate and verify the EDD within 48 hours of admission, wherever possible.

• Within 48 hours of admission the EDD should be communicated to the MDT. The EDD should be based on the patient’s presenting clinical signs and symptoms, historical length of stay, psychosocial and non-clinical factors that may influence length of stay where known.

• A transfer of care risk assessment should be conducted and the admission/transfer of care checklist commenced within 48 hours of admission.

• The EDD should be verified by the Consultant Psychiatrist at the patient’s first MDT clinical review and the date relayed to the patient and family/carer as soon as is practicable.

• Each patient should be actively involved in their own transfer of care planning wherever possible.

• The EDD needs to be reviewed on a daily basis, updated accordingly on the patient bed board and any changes to the EDD need to be communicated to the patient immediately.

• The Electronic Patient Journey Board should be updated regularly by the NUM in conjunction with site teams and the PFC.

Prior to Transfer of Care • On the EDD the departure time from the ward should be no later than 10:00 am. • Transfer of care medications should be ordered and stored in the clinical area at least 12

hours prior to 10:00 am on the EDD. • Transportation bookings and arrangements should be confirmed within 24 - 48 hours prior to

transfer of care. It is usually the patient’s/carer’s responsibility to arrange transportation home. However, exceptions can be made in consultation with the NUM/MH Executive, particularly if the EDD will be unduly compromised.

• All items on the transfer of care checklist should be completed prior to transfer of care, including notification of CMOs, Case Managers, GPs etc.

http://www0.health.nsw.gov.au/policies/pd/2011/PD2011_015.html


Section 9 Repatriation of Out of District Patients



Section 9 – Repatriation of Out of District Patients Establishing Catchment Area The consumer’s catchment area is determined by their confirmed residential address. However, this can be unclear for a variety of reasons including: • The patient has just been released from prison • The patient has been admitted directly from the airport • The patient is homeless • The patient is the subject of an Apprehended Violence Order (AVO), preventing him or her

from returning to his/her accommodation • The patient’s relationship has broken down, preventing him/her from returning to his/her

accommodation. When the address is unclear, other factors may be taken into consideration to determine which catchment area the patient is best serviced by such as: • Has the patient had any previous psychiatric treatment? If so, where and how recently? • Does the patient have relatives or support networks? If so, where? • Where does the patient want to live? • Does the patient have an identified care provider or a Case Manager? • Does the patient have a complex medical condition requiring local specialist care? Repatriation Repatriation discussions occur between site PFCs in the first instance. This can be escalated to Consultant Psychiatrists and/or Service Directors if there is uncertainty about the suitability of a patient for repatriation. If the issue remains unresolved after seven working days and is impacting on patient flow, escalation to the District Access and Service Integration Manager may be required. It is useful to confirm all negotiations via email with relevant parties to avoid misunderstandings. When negotiating repatriation, the requesting service must email copies of the following documents to the receiving venue or have access to review via the electronic Medical Record [eMR] (where available): • Assessment module and/or another recent assessment if available (usually in the medical

record). Include confirmation of address of relatives/carers, or most recent residential address

• Mental Health Act papers/recent clinical nursing notes/current risk assessment/plan for admission/medication chart

• Details of Case Manager (if available) and whether the patient is known to the Acute Care Team.

Requesting Transfer to Alternate Facility When requesting temporary transition placement (e.g. to PECC or SMHSOP Unit) to enable capacity for acute patient flow, or when repatriating a patient, the following process is required: • Telephone contact from PFC to PFC (weekdays 8:00 am - 4:30 pm), or between after hours

site patient flow delegate roles and/or on-call Registrars to discuss request for placement




• Email of assessment, eMR risk assessment and additional modules where necessary, medication charts, Mental Health Act paperwork, progress notes and any transfer of care summaries from previous admissions

• Once the paperwork has been received and thoroughly reviewed, the referring Duty Consultant is required to discuss the referral with the accepting Duty Consultant.

The referring venue is responsible for ensuring all required information is forwarded (see page 20). The receiving venue is responsible for reviewing the paperwork prior to accepting the patient, ensuring that the patient is clinically appropriate and; if appropriate, satisfying themselves that the patient is a resident of the catchment area. Where the transfer request cannot be resolved at a local level, escalation to the District Access and Service Integration Manager, then Service Director or on-call Executive may be required. Repatriating within SESLHD MHS Where a patient is from within the SESLHD catchment area, negotiations for inter-site transfers are undertaken by the relevant PFCs. The District Access and Service Integration Team are to be kept informed of progress. Repatriating within NSW Negotiations for repatriation of patients who are from outside of SESLHD MHS are between local PFC and other receiving MHS PFCs, NUMs, NICs or on-call Registrars/Consultant Psychiatrists, dependent on local practices.

NSW Metropolitan PFC Contact Numbers South Western Sydney LHD Ph: 0425 237 499 Central Coast and Northern Sydney LHDs Ph: 0404 830 169 Sydney West LHD Ph: 9840 3864 Illawarra Shoalhaven LHD Ph: 0403 571 299 St Vincent’s Hospital Ph: 0416 141 026 Nepean Blue Mountains LHD Ph: 0434 396 111 Repatriating Interstate There are various factors to be considered when transferring a patient interstate. • Is the patient suitable for transfer, e.g. in terms of risk and clinical presentation? Logistically

how will the patient be transferred (e.g. air, train, relative/carer assistance, hospital vehicle and escort).

• Mental Health Act status – each State has its own Mental Health Act, and the patient’s status may become altered once over the border. The Access and Service Integration Manager must be informed of the request for interstate repatriation by the PFC. The issue is complex and requires the direct involvement of the site Chief Psychiatrist, site Director of Operations and/or SESLHD MHS Director.




International Repatriation A SESLHD MHS inpatient may require transfer to his/her residence overseas. Where relevant, the patient’s travel insurance may cover the cost of repatriation. Alternatively the family/carers may be able to escort the patient. Where unclear, it is useful to contact the relevant Embassy/Consulate to advise what repatriation options can be provided. If the initial repatriation costs need to be paid by SESLHD, then a travel quote and invoice must be obtained through the MHS Finance Department (the current travel agent for SESLHD MHS is Helloworld in the Illawarra), from the sending site’s local MH Executive in writing via email. The Access and Service Integration Manager must be informed of the request for international repatriation by the PFC. Following SESLHD MHS Director of Operations approval it will then require approval from the SESLHD Chief Executive. International repatriation requires a MDT approach to consider risk factors and clinical presentation. Most airlines require an assessment form confirming suitability of the patient to fly, usually obtainable via their websites.

Section 10 Transport



Section 10 – Transport Transport All patients requiring patient transport must have a comprehensive assessment undertaken by an appropriate clinician to determine that the patient is at low risk of deterioration during transportation. Transport arrangements and escort level will depend on the outcome of the assessment. In the case that the sending facility has no Mental Health clinicians, the level of escort required should be determined by the sending Medical Officer. Patient transport needs to be booked via the Non-Emergency Patient Transport Service (NEPT) online booking form. (Please refer to the NEPT Web User Guide for further assistance if required) Patients deemed as high risk are out of the scope of NEPT. Medium risk patients will require Mental Health escort and may also require an additional security escort. Mental Health escorts are staff who accompany the patient during transfer to provide specialist heath care to minimise patient distress and/or provide management strategies for responding to patient agitation during transport. This could include Nursing staff, Health and Security Assistants (HASAs)/ Patient Safety Assistants (PSAs) or hospital Security Officers. These escorts will be supplied by the sending facility. When transferring an involuntary patient to another unit the following should be collated prior to transfer: • Original Mental Health Act paperwork must accompany the patient. Photocopies should be

kept in the patient medical record • A current Section 78 form for transfer should be completed, with the original to accompany

the patient • Copies of the recent clinical notes from the medical record, assessment module, risk

assessments and additional modules where necessary, medication chart, investigations and other relevant assessments or correspondence

• Any medications or belongings such as money, cards, cigarettes and lighters. Patients under the Mental Health Act must be assessed for risk by the attending Medical Officer and a collaborative transport and escort plan formulated. Clinical handover must be given at the receiving destination at the time the patient arrives.

https://neptbookings.health.nsw.gov.au/Account/LogOn

http://www.health.nsw.gov.au/nept/Pages/Information-training-materials.aspx




SESLHD MHS Priority Transport Options The following is taken from NSW Ministry of Health Policy - PD2014_013 Service Specifications for Transport Providers – NEPT and the NSW Healthshare Guideline ‘Non-Emergency Patient Transport (NEPT) Escort Guideline’ NEPT_003.



http://intranet.hss.health.nsw.gov.au/__data/assets/word_doc/0007/690874/NEPT_003-NEPT-Escort-Guidelines.docx





The following table is taken from the NSW Healthshare Guideline ‘Non-Emergency Patient Transport (NEPT) Escort Guideline’ NEPT_003 (page 9).

When a patient who requires transport is high risk and/or Class A: • Consider admitting a high risk patient to the local MHU and transferring a low risk patient to

another SESLHD hospital • Consider delaying transport until acuity settles in 24 hours • Consider temporarily placing a stable low risk patient in a transitional PECC bed to facilitate

high risk MHU admission • Consider assertive CMHT engagement to expedite low risk MHU patient transfer of care to

community to facilitate capacity to accept high risk admission • Contact Consultant Psychiatrists to review Mental Health inpatients to create capacity • Consider involvement of NSW Ambulance/NSW Police where a public safety issue is

identified in consultation with Site/District Mental Health Executives, Security Manager and/ or Corporate Services Manager.

When a high risk patient requires transfer to or from a facility such as MHICU When a SESLHD high risk patient requires transport, potentially requiring mechanical restraint, St Vincent’s Hospital will provide transport and is to be contacted via the SESLHD MHICU, which is to be the central point of contact. Transport can be provided by St Vincent’s Hospital

Level of Risk Transport Class

Transport Options

High risk patient • Requires Mechanical Restraint Device (MRD) or any other restraint • IV sedation • Serious risk of physical harm to self or others • Uncooperative • Sedation not clinically appropriate or oral sedation given with minimal effect • Physical or verbal aggression

Class A Out of scope for NEPT

NSW Ambulance May also require Mental Health escort

Medium risk patient • Involuntary patient • Some agitation or restlessness • Some bizarre or disorganised behaviour • Confused • Withdrawn or uncommunicative • Medium risk of physical harm to self or others • Oral sedation administered

Class B NEPT provider Mental Health escort

Low risk patient • Voluntary patient • Low risk of danger to self or others • No acute distress • Uncomplicated physiological state • Cooperative, communicative, amendable to instruction • No reported suicidal ideation • No oral sedation administered

Class C NEPT provider with RN/EN escort






Transport between 6:00 am to 8:00 pm and on weekends 8:00 am to 6:00 pm. The Access and Service Integration Manager is also to be notified in business hours, and the MH Executive after hours. This is also the case for patients in the MHICU requiring transfer to another facility or venue for treatment, such as ECT. Hospital Vehicle / Taxi Based on risk and following discussions with a Consultant Psychiatrist and Clinical Operations Manager, voluntary patients may be transferred in the ward car driven by nursing staff. Taxi vouchers can also be obtained from the NUM to transfer a patient to another hospital or home if a nurse escort is not required. If the patient requires an escort in the taxi, a return taxi voucher for the nursing staff will be required. The destination of the taxi voucher must be completed in advance to prevent misuse of the vouchers.

Ambulance

St Vincent’s Hospital Transport – MHICU transfers only Ph: 8382 2238 NSW Ambulance Bookings Ph: 131 233 SESLHD Ambulance Health Relationship Officer / Liaison Officer Ph: 0407 296 254 SLHD Ambulance Health Relationship Officer Ph: 0409 669 644

NSW Ambulance Senior Operations Manager Ph: 8396 5150 NSW Ambulance Medical Retrieval Unit/ Aero-Medical Control Centre Ph: 9553 2222

Aero-Medical Transport of Patients Where distance prohibits the use of a motor vehicle, aero-medical transport may be considered. The Medical Retrieval Unit (ph: 9553 2222) is the central booking point for medical retrieval or long distance patient transport (for patients requiring air transport). However if Air Ambulance declines the transport, St Vincent’s Hospital Transport (above) will organise transport with Wing-away. Patients who are involuntary under the Mental Health Act can be transported but must be adequately settled. Wing-away has nurses who conduct a transport risk assessment prior to accompanying the patient on the flight. The accepting hospital will usually arrange to collect the patient from the destination airport. In exceptional circumstances Wing-away will also transfer from the airport to the destination hospital. In appropriate circumstances, provision may be made for a relative to accompany the patient on the flight. Authorisation must be obtained from the site Service Director and Chief Psychiatrist prior to organising the transfer.

Referral to Private Hospitals Private psychiatric hospital admission criteria may vary slightly. In general these hospitals do not accept patients who are involuntary under the Mental Health Act or have high levels of risk. Therefore patients must be voluntary prior to transfer and have a current risk assessment demonstrating low-moderate levels of risk. Consideration must be given to risks such as suicidality, deliberate self-harm, aggression, AWOL, sexual safety and self-neglect. Private psychiatric hospitals also vary in their referral requirements.




The same information is required as when negotiating repatriation: • Assessment Modules and risk modules (A1) • Private Health Fund provider and number • Evidence of address and phone number of patient • Recent clinical notes from the medical record/current risk assessment/psychiatric history/

physical history/plan for admission • GP/Private Psychiatrist/Psychologist contact details/next of kin/carer contact details.

Patients may not know their Private Health Fund reference numbers and it may be necessary to contact the health fund with the patient’s name, date of birth and address so the health fund can provide the reference number. Patients who have health insurance may be required to pay an excess before they can be transferred to a private psychiatric hospital. This must be established before transfer takes place to ensure the patient is not placed in financial difficulty.

Private Hospitals

Wesley Private (Kogarah) Ph: 8197 5800

Wesley Private (Ashfield) Ph: 9716 1400

St John of God (Richmond) Ph: 02 4570 6100

St John of God (Burwood) Ph: 9715 9200

Sydney Clinic (Bronte) Ph: 9389 8888

Northside Clinic (Greenwich) Ph: 9433 3555

Northside West Clinic (Wentworthville) Ph: 8833 2222

The Park Central Clinic (Campbelltown) Ph: 02 4621 9111

Southwest Clinic (Liverpool) Ph: 9600 4000

Northside Macarthur Ph: 4640 5555

Referral to SESLHD MHS Rehabilitation Services

SESMHS Prince of Wales Ph: 9382 3798 Fax: 9382 4237

Sutherland Ph: 9540 8200 Fax: 9540 8237 Referral to Bloomfield Rehabilitation Services Bloomfield Mental Health Services offers a comprehensive range of services on its campus in Orange, NSW. All of these facilities offer care for people in Western NSW; many also provide services to Sydney and for all of NSW. Bloomfield has specialist psychiatric facilities and includes several locked and declared rehabilitation units.




The rehabilitation units at Bloomfield include:

Bloomfield Canobolas Clinic Rehabilitation

All referrals for Bloomfield Rehabilitation go through the Western Sydney Patient Flow Coordinator on 02 6369 7542 via the SESLHD MHS Access and Service Integration Manager

Manara Clinic – male gender – 16 beds Rehabilitation

Turon House – female gender – 16 beds Rehabilitation

Castlereagh Unit Longer Term Rehabilitation

The units listed above offer single gender inpatient rehabilitation for men and women, and a limited number of longer stay beds. Inpatient rehabilitation at Bloomfield is for patients requiring medium to long term rehabilitation with an enduring mental illness. The model at Bloomfield targets patients with higher acuity and complex presentations. Once a patient has been assessed as suitable for referral to Bloomfield, a referral form must be completed as part of a collaborative process between the MDT and PFC. The following documents are required for referral to Bloomfield, and must be sent electronically to the SESLHD Access and Service Integration Manager, who will then forward them to the Western Sydney Patient Flow Coordinator (with confirmation of receipt sent to the treating team): • Completed referral form, eMR documentation, Occupational Therapy (OT) assessment/

seven days of progress notes, medication chart. • Transfer of care summaries from previous non-acute admissions, clinical handover/referral

letter and site ownership letter. When/if a patient has been accepted, it may take a few more weeks before a bed becomes available. However, the date for transfer is generally indicated in advance to enable the patient and MHU to prepare. Following acceptance by Bloomfield, if transport is required, NEPT Transport should be contacted at least 48 hours in advance. It is approximately a 10 hour round trip to Orange so the patient and escort are usually collected by Transport at 7:00 am. The NUM must be informed so that extra staff can be arranged if needed to cover the escort. All original Mental Health Act paperwork must accompany the patient, along with a completed Section 78. Due to the remote location of Bloomfield Hospital, it is essential that patients have sufficient money, personal items and clothing upon transfer. The patient’s family/carers should be given the contact details and address for Bloomfield. Drug and Alcohol Services There are drug and alcohol teams based at every hospital and at various community services throughout the SESLHD to provide support, education and collaborative treatment to patients with addiction issues. Clinical Nurse Consultants (CNCs) specialising in alcohol and other drugs




can attend EDs and MHUs to assess and treat patients with co-morbid mental health and drug and alcohol issues. There are various facilities for Drug and Alcohol rehabilitation in NSW and access to these is usually via an intake line. Contact numbers for intake and Drug and Alcohol services can be found on the relevant hospital intranet site under Drug and Alcohol in the Clinical Services section. Special Needs Referrals ‘Special Needs’ refers to patients who are unable to be treated in their local catchment due to actual or potential risk or conflict of interest. This can include patients who are employed within the hospital, a member of the local NSW Police, Security or NSW Ambulance Officers or relatives of patients or staff employed within the hospital. It can also relate to patients who have a clinical presentation that precludes admission to the local hospital, such as delusional thoughts regarding a member of staff or past threats of harm toward a staff member. When this situation occurs, the issue should be escalated to the site Service Director to confirm whether transfer to another venue is required and to negotiate with another venue where appropriate. Should the matter not be resolved locally, the District Access and Service Integration Team should be advised of the situation and the following information provided via email: • Name/Medical Record Number (MRN)/Date of Birth/Address • Any special needs requirement (e.g. the patient is a staff member working in the local

hospital or a NSW Police Officer working in Local Area Command) • Patient’s current mental state/diagnosis/prognosis/history • Patient’s Mental Health Act status.

References



References NSW Ministry of Health • NSW Health Mental Health for Emergency Departments – A Reference Guide 2015 • NSW Ministry of Health Policy - PD2011_015 Care Coordination: Planning from Admission

to Transfer of Care in NSW Public Hospitals • NSW Health Non-Emergency Patient Transport (NEPT) • NSW Ministry of Health Whole of Health Program 'Winter 2015 – Maintaining Performance'

Background Paper

SESLHD • SESLHDBR/051 - Transfer of Mental Health Patients to other Public Mental Health Facilities

and Private Hospitals • SESLHDPD/269 - Obtaining a second opinion from a Consultant Psychiatrist within Acute

Inpatient Mental Health Units • SESLHDBR/015 - Psychiatric Emergency Care Centre (PECC) Escalation Process for

Mental Health Patients with a Length of Stay (LOS) >48 Hours • SESLHDBR/059 - Admissions to Acute Mental Health Inpatient Units (including Direct

Admissions for Community Managed Consumers) • SESLHDBR/029 - Referral to the Mental Health Service (MHS) Complex Care Review

Committee • SESLHDBR/017 - Referral to SESLHD Mental Health Intensive Care Unit (MHICU) • Extraordinary Event Management and Demand Plan for Acute Inpatient Bed: SESLHD

Mental Health Service • Mental Health Intensive Care Unit (MHICU) Referral Form Others • Garling, P. Final Report of the Special Commission of Inquiry. Acute Care Services in NSW

Public Hospitals Overview 27 November 2008, pp. 30 (1.193) • NEPT Web User Guide • National Safety and Quality Health Service (NSQHS): Standard 6. Clinical Handover (6.2) • National Standards for Mental Health Services 2010: Standard 10. Delivery of Care (10.2.1)

http://www.health.nsw.gov.au/mhdao/publications/Pages/mental-health-ed-guide.aspx



https://neptbookings.health.nsw.gov.au/Account/LogOn

http://www.health.nsw.gov.au/wohp/Documents/maintaining-performance-paper.pdf

http://www.health.nsw.gov.au/wohp/Documents/maintaining-performance-paper.pdf












http://seslhnintranet/Mental_Health/Projects_Strategic_Planning/Bed_Management/default.asp


http://sesinet/sites/Forms/Approved_Forms/Forms/AllItems1.aspx?View=%7bc2d0b7c2-7374-4f94-975e-ddfca12100dd%7d&SortField=Title&SortDir=Asc

http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0003/34194/Overview_-_Special_Commission_Of_Inquiry_Into_Acute_Care_Services_In_New_South_Wales_Public_Hospitals.pdf

http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0003/34194/Overview_-_Special_Commission_Of_Inquiry_Into_Acute_Care_Services_In_New_South_Wales_Public_Hospitals.pdf

http://www.health.nsw.gov.au/nept/Pages/Information-training-materials.aspx

https://safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf

http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-servst10

Revision and Approval History



Revision and Approval History

Date Revision no: Author and approval

Nov 2012 0 Updated and changed from previous SESIAHS Procedure. Gayle Jones, Acting Access and Service Integration Manager, SESLHD MHS. Approved by SESLHD MHS Clinical Council.

May 2016 0v1

Scheduled review. Converted to Guideline. Updated by Access and Service Integration Managers, SESLHD MHS. Multiple changes made to reflect the contemporary patient flow framework, including revision of strategic and operational responsibilities. Multiple contacts updated; services added; referral forms added; profile sample reports updated; bed capacity updated; acronyms updated; references to ensure the framework encompasses effective, safe, patient care delivery. Circulated to MHS Service Directors, Clinical Operations Managers, Inpatient Service Mangers, Chief Psychiatrists, Patient Flow Coordinators, Nursing Unit Managers and District Clinical Nurse Manager.

July 2016 0v2 Feedback from Clinical Nurse Manager and STG Clinical Operations Manager incorporated, including addition of phone numbers, rewording of content/language plus format changes.

Aug 2016 0v3 Feedback from Service Directors, District and site Quality Managers, Intellectual Disabilities Clinical Coordinator and STG Clinical Operations incorporated. Changes include addition of phone numbers, rewording of content/language plus format and grammatical changes.

Oct 2016 0v3 Approved by SESLHD MHS District Document Development and Control Committee (DDDCC).

Nov 2016 0v4 Reformatted by MHS Access and Service Integration Team from a Procedure to a Guideline. Endorsed by SESLHD MHS Clinical Council.

March 2017 0v4 Endorsed by SESLHD Clinical and Quality Council for publishing.

September 2017

0v4 Executive Services updated links to the Mental Health Intensive Care Unit (MHICU) Referral Form.

January 2018 1 Unscheduled review. Included Extraordinary Event Management and Demand Plan for Acute Inpatient Bed: SESLHD Mental Health Service within reference list.

April 2018 1 Endorsed by DDDCC. Updated reference list. May 2018 1 Endorsed by SESLHD MHS Clinical Council with no further amendment. This

document will replace SESLHDGL/022.



Appendices



Appendix A:

SESLHD MHS Inpatient and Emergency Department Contacts TSH MHU 9540 7506 / 7485 TSH ED 9540 7115

TSH MHRU 9540 8200 TSH MHRU NUM 9540 8231

STG MHU 9113 2559 STG ED 9113 1516

STG PECC 9113 1419 STG PECC Fax 9113 1499

STG OPMHU 9113 4859 STG OPU NUM 9113 4870

POWH General 9382 4319 / 4357 POWH ED 9382 8400

POWH Obs 9382 4333 / 4356 Kiloh Reception Fax 9382 4399

POWH PECC 9382 7772 / 7770 POWH Euroa (SMHSOP) 9382 3796

POWH MHRU 9382 3798 POWH MHRU NUM 9382 3495

SVH Caritas 8382 1590 SVH ED 8382 2473

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