The Leeds Teaching Hospitals NHS Trust


Primary care and hospital discharge


COVID-19: Primary Care and Hospital Discharge (V6)

The following guidance was issued to GPs in Leeds at 3 PM Monday 31st March 2020

Expediting Hospital Discharges

Robust daily planning between LTHT / associated health and care partners and third sector is enabling a significant proactive decrease in hospital bed occupancy in readiness for an anticipated surge in COVID-19 + patients.  This is in line with HM Government Guidance published on 19 March 2020:

https://www.england.nhs.uk/coronavirus/publication/covid-19-hospital-discharge-service-requirements/

 Managing Hospital Referrals for GP Follow-up Post Discharge

  • LTHT will assess all discharges and identify those patients requiring next day follow up by the discharging ward.
  • Some follow-up calls will inevitably lead to the identification of issues that may still be managed in the community, thus avoiding hospital re-admission. In such cases, LTHT will contact GPs, the relevant community service /third sector organisation by telephone for a rapid response.
  • If on assessment at discharge the discharging clinician feels the patient requires rapid follow up at home by their GP this will be indicated via the Electronic Discharge Advice Note (e-DAN) / clinical system (SystmOne /EMIS).
  • All requests for discharge follow up should be triaged within the practice and face to face contact minimised with assessment via remote means e.g. telephone / video consultation in the first instance.
  • More straightforward discharges may still require GP follow-up and will be communicated via a clear request on the e-DAN. Again, patients must be advised that follow up will be remote, either by telephone / video consultation.
  • To achieve a significantly reduced bed occupancy rate in preparation for the surge it is highly likely that some LTHT patients will be discharged following investigations and pending results /plan. We are working with LTHT to ensure a safe and effective process to manage this; further communication is anticipated towards the end of the week.
  • Discharged patients are likely to be anxious and create additional demand by ringing practices for advice. Where a follow up is required, but triage determines it is non-urgent, the practice may choose to utilise appointments via the Extended Access (EA) Service.
  • The Extended Access (EA) Service is currently reviewing opportunities for reconfiguring its service offer at varying points in the surge period and dependent upon its own staffing availability. Plans will be shared in due course.
  • Given that we do not yet fully understand the numbers of patients needing follow up this process will require regular review to ensure GPs can effectively and safely manage increased demand.
  • To help manage patient expectation, LTHT will also advise patients that GP follow up will be delivered remotely via telephone / video consultation.

End of Life / Fast Track Process

  • There have been some changes to the End of Life Fast Track referral form that will be used by LTHT to advise GP’s and the Neighbourhood Teams of a discharge. The referral form is generated by PPM+ and you will continue to receive these via the usual route, there have been no changes to the End of Life Fast Track process.
  • The Association for Palliative Medicine have produced a COVID-19 update on their website at: https://apmonline.org/

Supply of Discharge Medicines during COVID-19 Outbreak

LTHT will discharge patients with:

  • 28 day supply of medicines (TTOs)
  • 14 day supply for those with a compliance aid (an increase of 7 days)

Medicines queries related to the discharged patients

  • If it’s related to amber drugs monitoring in patients who have been on the medication less than 12 months, then contact the specialist overseeing the patients care.
  • If it’s related to amber drug monitoring in patients who have been on the medication for greater than 12 months see new amber drug guidance sent out yesterday.
  • Any general queries can be directed to either LTHT medicines information – information@nhs.net or via the Confed clinical pharmacy team email address leedsccg.medsoptcovidresponse@nhs.net or via the locality lead pharmacist connected to your PCN.

Discharge Lounge Standard Operating Procedure

The St James's Discharge Lounge has now been relocated to the larger Lincoln Wing 1 ground floor Outpatient Clinic ext 67805 with surge capacity into Lincoln 2. At LGI a lounge has been created in Jubilee Wing level E cardio/neuro outpatient’s area ext 25683/25684. The discharge lounges are open 7 days per week on both sites.

Patients exposed to COVID-19 during an inpatient stay

To support clinical teams in the management of inpatients who are exposed to COVID-19, a short letter for patients has been produced based on section 3 of the Government's national guidance that was updated on 23 April - COVID-19: management of exposed healthcare workers and patients in hospital settings.