1. health and fitness

SESLHD MHS PROCEDURE
COVER SHEET
NAME OF DOCUMENT
Patient Flow Operational Framework for Mental Health
Service
TYPE OF DOCUMENT
Procedure
DOCUMENT NUMBER
SESLHDPR/245
DATE OF PUBLICATION
March 2013
RISK RATING
Medium
LEVEL OF EVIDENCE
N/A
REVIEW DATE
March 2016
FORMER REFERENCE(S)
SESIMHS Patient Flow Operational Framework 015_10
EXECUTIVE SPONSOR or
Dr Murray Wright, Director, SESLHD Mental Health
Service
EXECUTIVE CLINICAL SPONSOR
AUTHOR
Gayle Jones, A/ SESLHD MHS Access & Service
Integration Manager
POSITION RESPONSIBLE FOR THE
DOCUMENT
Gayle Jones, A/ SESLHD MHS Access & Service
Integration Manager
KEY TERMS
Patient flow; access management; demand
management; mental health access
SUMMARY
This document provides a framework for standardised
patient flow operations in SESLHDMHS. Standardised
operations aim to enhance mental health patients‟
experience and outcomes and as such this
document should be used a s a reference tool by
mental health staff.
Feedback about this document can be sent to [email protected]
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Table of Contents
Introduction and Background…………………….…………………………………
2
SESLHD MHS Geography……………………………………………………………. 3
SESLHD MHS Inpatient Facilities……………………………………………………. 4
Patient Flow Coordination
The Role of the Patient Flow Coordinator…………………………………………..
6
PFC Communications Schedule…………………………………………………….
7
Capacity/Demand Profile Reports……………………………………………………. 8
LLOS Meetings, Second Opinion Policy, Demand Planning………..……………
9
Weekend Demand Planning………………………………………………………….. 10
Collaborative Patient Flow Operations
The three R‟s of Patient Flow……………………………………………………….
11
Over Census / Over Numbers………………………………………………………
12
Collaborative Patient Flow, After Hours Patient Flow ……………………………
13
Accepting Referrals of Patients for Mental Health Admission…………………….
13
Transfer of Care ……………………………………………………………………....
15
Repatriation of Out of District Patients – Establishing Catchment Area………….. 16
Repatriation Negotiation / Requesting Transfer to Alternate Facility..………..….. 17
Repatriation within SES LHD MHS, within NSW, Interstate and International……. 17,18
Inter-hospital Transfer Algorithm……………………………………………………
19
Transport……………………………………………………………………………….
20
SESLHD MHS Priority Transport Options……………………………………………. 21
Referral to/from Private Hospitals…………………………………………………….. 22
Referral to Rehabilitation Services………………………………………………….
23
Referral to Bloomfield Rehabilitation Services, Drug and Alcohol Services……
24
Special Needs Referrals……………………..…………..………………………..….. 25
Appendix 1 - Useful Numbers………………………………………………………..
26
Appendix 2 – Escalation Algorithm………….…………..…………………………..
27
Appendix 3 – Referral to IPCU/ MHICU Facilities Algorithm……………………..... 28
References and version control ……………………………………………………… 29
Revision 0 Trim No. T13/5626
Date: March 2013
page 1 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Introduction and Background
This document provides a framework for standardised, district-wide, patient flow operations
in South Eastern Sydney Local Health District Mental Health Services (SESLHD MHS). The
framework applies to the management of operational patient flow for patients in SESLHD MHS
and for patients who are being transferred to or from SESLHD MHS.
Aims
Standardised patient flow operations aim to enhance mental health patients‟ experience and
outcomes and as such this document should be used a reference tool by all mental health 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 the NSW Health Mental Health for Emergency
Departments – A Reference Guide 2009.
Target Audience
The framework is aimed at Sector Service Directors (SD), Clinical Operations Managers (COM),
Inpatient Service Managers (ISM), Nursing Unit Managers (NUM), Patient Flow Coordinators
(PFC), Nurses in Charge (NIC), Registrars and Consultant Psychiatrists and all other mental
health staff involved in the patient flow process.
Patient Flow Philosophy
The Garling Report (2008) identified the link between efficient use of inpatient beds and
improvement in the quality of care provided to patients.* Persons requiring mental health
inpatient care should receive timely and efficient access to the best possible care available.
The core principle of patient flow is to provide sustainable access to inpatient beds 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.
What is Patient Flow?
„Patient Flow‟ refers to the patient journey through a health service, in this instance the SESLHD
MHS and predictable. SESLHD MHS operates at or near 100% bed occupancy most of the
time therefore daily transfers of care out of mental health inpatient services must be planned
to accommodate predicted daily admissions. Most admissions occur via the Emergency
Department (ED).
To achieve this KPI 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 (POW) Mental Health
Service have points of admission that may bypass ED. For example Police / Community
Mental Health Team (CMHT) presentations and patients sent directly from courts or prison for
assessment can be transported directly to the Kiloh Centre. Multiple points of admission make
patient flow coordination more complex and heighten the need for predictive and collaborative
transfer of care planning around the clock.
*
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)
Revision 0 Trim No. T13/5626
Date: March 2013
page 2 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
SESLHD Geography
hern Network
Central Network
SESLHD Hospital and Health Service Sectors
(*Mental Health Inpatient unit/s on site)
(+Mental Health assessment service in ED)
Northern Sector
Prince of Wales Hospital*+
Royal Hospital for Women
Sydney Hospital
Sydney Eye Hospital
Southern Sector
St George Hospital*+
The Sutherland Hospital*+
The Garrawarra Centre
Southern Network
Revision 0 Trim No. T13/5626
Date: March 2013
page 3 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
SESLHD MHS Inpatient Facilities
Site
Prince of Wales
Hospital
St George Hospital
Sutherland Hospital
Acute Mental Health Inpatient Units (MHU)
Name
Total beds
Bed Configuration
Kiloh Centre
50
20 x observation, 30 x general acute
MHU
28
Mental
Health
Inpatient Unit
28
9 x observation, 19 x general acute
including 6 SMHSOP beds
10 x observation, 18 x general acute
Most MHU‟s provide both high-level acute (observation) and general acute care when
community treatment is not possible due the patient‟s clinical condition. MHU‟s are declared
under the NSW Mental Health Act 2007 (MHA) to accommodate people who are acutely unwell
and require involuntarily treatment and care.
Psychiatric Emergency Care Centres (PECC’s)
St George
6 PECC beds
Prince of Wales
4 PECC beds
PECCs provide rapid access to mental health assessment and short stay admissions up to 72
hours. Patients referred to PECC must have a clearly defined admission / transfer of care
pathway documented including the plan and expected date of discharge from hospital (EDD).
Patients must have a manageable level of risk in all domains including suicide, self harm,
aggression, sexual safety and absent without leave. 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 direct from the community to
PECC.
Site
Prince of Wales
Sutherland
Mental Health Rehabilitation Units (MHRUs)
Name
Beds + Configuration
MHRU
14 non acute beds - non-declared
MHRU
20 non acute beds - declared
Several Mental Health Rehabilitation Units (MHRUs) are also available in SESLHD. These
non-acute facilities provide a range of programs to support 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 venue for completion of
Clozapine titration for suitable patients.
Revision 0
Trim No.
Date: February 2013
page 4 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
Site
Prince of Wales
St George
Sutherland
SESLHDPR/245
Specialist Mental Health Service for Older People
(SMHSOP)
– acute Configuration
Name
Total beds
Euroa
6 (declared)beds + 2 Neuro-Psychiatry beds (non declared)
MHU
6 allocated within the MHU (declared)
MHU
6 allocated within the MHU (declared)
SMHSOP provides 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 SMHSOP. Where capacity
exists SMSHOP beds may be considered during periods of peak bed demand as temporary
venue for limited number of „transition‟ patients from an adult acute 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)
Hornsby MHICU
Northern Sydney Central Coast Area Health Service
Cumberland IPCU
Sydney West Area Health Service
Concord IPCU
Sydney South West Area Health Service
SESLHD MHS does not currently have an IPCU/MHICU planning has commenced for a 12 bed
facility to be commissioned January 2013. SES shares access to tertiary IPCU / MHICU beds
in the facilities above with all other Local Health Districts in NSW. See Appendix 3 for Referral
Algorithm.
Tertiary Child & Adolescent MHS Inpatient Units (CAMHS)
– acute
Shellharbour
Acute
Shellharbour Hospital
beds
Gna Ka Lun
Acute
Campbelltown Hospital
Redbank House
Acute, incl Child & Family
Westmead Hospital
Nexus Unit
Acute
John Hunter Hospital
Sydney Children’s Acute - non declared
Randwick Hospital Campus
The 8 beds available at Sydney Children‟s Hospital are not declared under the Mental Health
Act 2007(MHA) so are unable to accommodate patients detained involuntarily. SESLHD MHS
can make referrals to the declared tertiary CAMHS beds listed above.
Revision 0
Trim No.
Date: February 2013
page 5 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Patient Flow Coordination
The Role of the Patient Flow Coordinator (PFC)
The PFC is the central point of contact for information and access to Site/Sector 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 is provided on page 13.
Northern Sector
Southern Sector
PFC Contact
Numbers
Prince of Wales
St George / Sutherland
Ph: 0411 653 463
Ph: 0411 658 967
The core responsibility of the PFC is to be aware of current capacity and demand within their
sector at all times. Capacity refers to the number of mental health inpatient beds physically
available to accommodate patients requiring admission. 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 point in time. To remain abreast
the PFC must review relevant databases, attend clinical meetings and liaise continuously with
NUMs, ED clinicians, inpatient clinicians, Community Mental Health Teams (CMHT) and peer
PFCs (general and MH) to collect information such as:
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
The PFC records capacity/demand details in twice-daily Profile Reports (see page 8). Updates
are sent to clinical teams, District MH Access & Service Integration Team, Site/Sector MH
Executives and other relevant stakeholders as required.
PFC’s should be especially alert
for:
Avoidable admissions – ensuring admissions are consistent with the principle of
least restrictive care as outlined in the MHA, 2007.
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, inpatient drug and alcohol
services, NGO supported accommodation (such as NEAMI) or general aged care
services.
Revision 0
Trim No.
Date: February 2013
page 6 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Patients awaiting 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 and multidisciplinary team (MDT) clinical 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.
Patient Flow Coordinator Communication Schedule
The aim of this PFC communication schedule is to ensure timely and regular exchange of
information between the Sector PFC and the District Access & Service Integration Team.
Ad hoc communications includes challenges to patient flow as they occur, e.g. access
blocked patients in the ED, other issues enquiring escalation.
Time
0830
0930
1100
1200
1400
Monday
Tuesday
Wednesday
Thursday
Friday
Sat/Sun
Email AM Profile Report to District Access & Service Integration Manager
Verbal, email or SMS update of ED Demand and placement plans
1100
MH Site Manager on-call
Telco
with District Executive
on-call
Verbal, email or SMS update - pt flow challenges
Email
Weekend
Demand Plan
1500
1530
1550
1630
District MH Access & Service Integration Manager provides briefing & service overview
to District Risk Manager and District Director SES LHD MHS on request
Email PM Profile Report to District Access Team Manager
Verbal, email or SMS update of any significant variance from 1530 report
Close of Business
0830
0930
Verbal, email or SMS update from morning meetings
District MH Access Manager Telco with District Patient Access team: Provide specific
overview of Site Self Sufficiency / Placement Plans for ED Admissions
Time
1200
1400
1500
1500
1530
1550
1630
Revision 0
Trim No.
Date: February 2013
page 7 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Site/Network Capacity/Demand (Profile) Reports
Sector profile reports are collated by PFCs and published at 0830hrs and 1530hrs daily via
email to: Site Registrars, Consultant Psychiatrists, Team Leaders, MH Executives, NUM‟s, Allied
Health, General Hospital Executives, District Risk Manager, District Access & Service
Integration Team.
The reports are a summary of current Site/Sector 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.
Revision 0
Trim No.
Date: February 2013
page 8 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Long Length of Stay (LLOS) meetings
Long Length of Stay (LLOS) meetings are held weekly or fortnightly to discuss patients with
length of stay in the MHU of greater than 28 days and in MHRU for patients reaching length of
stay thresholds of 100, 150 and 180 days. 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. Representatives from the District
MH Rehabilitation Team attend the MHRU LLOS meetings. Patients are discussed from a MDT
and holistic perspective, aiming to remove any barriers to transfer of care or leave.
Second Opinion Policy
The SESLHD MHS Policy Obtaining a Second Opinion from a Consultant Psychiatrist
2007/06 v5, outlines the length of stay thresholds for obtaining a second opinion:
LOS >28 Days
LOS >49 Days
LOS >75 Days
Thresholds for Obtaining a Second Opinion
Flexible format, may seek opinion from another Consultant
Psychiatrist within the unit or within the service
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
Automatic referral to Complex Care Committee
The thresholds should be routinely reviewed during LLOS meetings and action to obtain a
second opinion initiated if required.
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. The District MHS Access & Service
Integration Manager is using historical data to generate Demand Prediction figures. Data is
based on previous three month discharges and EDD as entered into the NSW Health Patient
Flow Portal.
The figures should guide Site/Sector planning to enable mental health beds to be available as
required. Proactive and predictive planning ensures site self sufficiency and reduces waiting
time for patients in ED.
Revision 0
Trim No.
Date: February 2013
page 9 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Weekend Demand Planning
As with patient flow and demand planning in general, 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 below to ensure sufficient capacity in line with predicted weekend demand.
Venue
PECC
Planned
D/C
JB
Saturday/SundayMonday
Planned
Possibility
for D/C or
Leave &
Leave
Return
Date
Planned
D/C
Planned
Leave &
Return
Date
Possibility
for D/C or
Leave
Total
Obs
Unit
Issues
Possible
Suitable
for Sub
Acute,
PECC,
MHRU,
OPU
transfer?
M S – to
PECC
OOA's /
Outliers for
repatriation
FM 6/7
4
JB awaiting crisis accommodation
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
Distributed to: Weekend CNCs, On call Execs, On call Registrars and Consultants
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
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 their care is being transferred or they are going on leave. If going on leave the WDP
identifies when they are 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 SMHSOP Units should capacity be available. The WDP also
identifies patients who may be considered for transfer to alternate SES MHUs, MHRU‟s, PECC‟s
or SMHSOP 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
mental health 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 & Service Integration Team Manager.
Revision 0
Trim No.
Date: February 2013
page 10 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Collaborative Patient Flow Operations
Patient flow is a collaborative process incorporating both operational and clinical bed
management. Effective patient flow entails collaboration and co-operation between the PFC
and MDT. The role of PFC is to „coordinate‟ patient flow in partnership with the MDT.
The Three R’s of Patient Flow
Remember the Three R‟s before recommending placement of a patient:
Right Patient
Consider the patient‟s 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, are 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 hand over for example. Mitigation strategies should
be implemented to ensure patient‟s transfer is not delayed other than for safety reasons.
Revision 0
Trim No.
Date: February 2013
page 11 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
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 and additional staffing resources 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 ECT.
Patients commencing Clozapine who are undergoing initial dose monitoring.
Patients on the unit awaiting CTO hearing.
Patients brought directly to the unit (eg Kiloh) by Police or 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
& 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, SMHSOP Unit.
Identify patients who may be supported by CMHT whilst 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 patient. 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 management 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.
Revision 0
Trim No.
Date: February 2013
page 12 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
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 sector 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 co-ordinate patient flow after hours (evenings and overnight
including weekends). At times of peak demand t h e 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:
Accepting Patients for Mental Health Admission
Revision 0
Trim No.
Date: February 2013
page 13 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
From ED
Acceptance of patients for admission is a collaborative process between the Mental Health
clinician assessing the patient in the ED, 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 or
drug and alcohol rehabilitation centre, be transferred to CMHT follow up, are they
suitable for a brief PECC admission?
Is there a documented admission plan?
Has the patient had a physical health assessment clearing them for a MH admission?
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. Prior to patients being
transferred from ED the patient must be de-cannulated, ECG leads removed (ligature risk)
and extubated at least 24 hours previously.
Is the medical record complete? MH-OAT Assessment module (A1), treatment plan for
admission, medication chart including PRN‟s and depots, MHA original papers, blood
pathology forms for example.
Acceptance of patients for admission is also a collaborative process between the PFC and the
MHU or PECC NUM or NIC. A patient may have been assessed as suitable for a sub acute
unit for example 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 Police / Ambulance / CMHT presentations, unit acuity and
staffing, AWOL‟s, transfers of care and leaves.
Direct Presentations
When patients present directly to the unit with Police, 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 evidence of other intoxication such as
illicit or prescribed substances e.g. pinpoint or dilated pupils, high pulse / respirations. If a
patient is found to be intoxicated they must be transferred to the ED immediately for monitoring
and medical assessment.
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 all
medical investigations and treatments have been completed and the patient has been reviewed
Revision 0
Trim No.
Date: February 2013
page 14 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
by CL team for the least restrictive care option prior to transfer to 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 Clinical
Operations Manager 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” is a term adopted by NSW
Ministry of Health to demonstrate that care continues beyond the hospita l setting.
In the context of Mental Health, transfer of care ensures the safe, effective and efficient
movement of people with mental health problems between inpatient settings to the community or
alternative care settings. T he decision to transfer c a r e o f a patient should be made by the
MDT in consultation with the patient and carers wherever possible.
Planning for transfer of care optimises the patient journey and ensures timely service. The
section below is consistent with PD2011_015 Care Co-ordination: 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.
The Registrar under whom the patient is admitted should allocate and verify the EDD within
48 hours of admission, wherever possible.
Within 48hrs 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 48hrs 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.
Prior to Transfer of care
On the EDD the departure time from the ward should be no later than 1000hrs.
Transfer of care medications should be ordered and stored in the clinical area at least 12hrs
prior to 1000hrs on the EDD.
Transportation bookings and arrangements should be confirmed within 24-48hrs prior to
transfer of care. It is usually the patient‟s / carer‟s responsibility to arrange their
transportation home, however exceptions can be made in consultation with the NUM / MH
Executive, particularly if EDD will be unduly compromised.
Revision 0
Trim No.
Date: February 2013
page 15 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
All items on the transfer of care checklist should be completed prior to transfer of care,
including notification of NGO‟s, case managers, GP‟s etc.
Repatriation of Out of District Patients
Establishing Catchment Area
Establishing catchment area usually comes down to 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 has an AVO preventing them returning to their accommodation.
The patient has a breakdown of relationship preventing them returning to their
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 Negotiation
Repatriation negotiation occurs between Site/Sector PFCs in the first instance. This can be
escalated to Site/Sector Registrars, Consultant Psychiatrists and/or Service Dirceors if there is
uncertainty about suitability of a patient for repatriation. If the issue remains unresolved and
is impacting on patient flow, escalation to the District Access & 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 fax copies of the
following to the receiving venue:
MH-OAT Assessment module (A1) or A4 plus another recent A1 if available (usually in medical
record). 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.
Revision 0
Trim No.
Date: February 2013
page 16 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
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 PFC to PFC (weekdays 0800-1630hrs), or between afterhours
Site/Sector patient flow delegate roles and/or on call Registrars to discuss request for
placement.
Faxing of MH-OAT assessment, risk assessment and additional modules where
necessary, medication charts, MHA papers, progress notes and any transfer of care
summaries from previous admissions.
Once paperwork has been received and thoroughly reviewed the referring Duty Registrar
is required to discuss the referral with the accepting Duty Registrar.
Should the patient provisionally be accepted for transfer this should be discussed with the
Consultant Psychiatrist or on call MH Executive to ensure that the transfer is appropriate.
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 the patient is clinically appropriate and if appropriate satisfying themselves
that the patient is a resident of their catchment area. Where transfer request cannot be
resolved at local level, escalation to Service Director or On-call Executive may be required (see
Appendix 2).
Repatriating within SESLHD MHS
Where a patient is from within SESLHD catchment area negotiations for inter-Site/Sector
transfers are undertaken by the relevant PFCs. District Access & Service Integration Team
is 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 PFC, NUM, NIC or on call Registrar / Consultant Psychiatrist
dependent on local practices.
NSW Metro PFC Contact Numbers
South Western Sydney LHD
Ph: 0425 237 499
Central Coast & 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 in terms of risk and clinical presentation for example? Logistically how will the
patient be transferred e.g. air, train, relative/carer assistance, hospital vehicle and escort. Mental
Revision 0
Trim No.
Date: February 2013
page 17 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Health Act status – each jurisdiction has its own MHA and patient‟s status may become
altered once over the border. The issue is complex and requires direct involvement of the site
Chief Psychiatrist, sector Director of Operations and/or SESLHD MHS Director.
International Repatriation
A patient may require transfer to their 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. For example Switzerland has an excellent
retrieval process where a team will be sent to escort the patient back to Switzerland. Retrieval
agencies generally quote tens of thousands of dollars to assist in the repatriation of a patient to
their place of origin. Such an agency is SOS International, Ph: 9372 2400.
International repatriation requires a MDT approach to consider risk factors and clinical
presentation. Airlines require an assessment form confirming suitability of the patient to fly,
usually obtainable via their websites.
Revision 0
Trim No.
Date: February 2013
page 18 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Inter-hospital Transfer Algorithm



Team identifies the need to transfer a
patient to another venue following
comprehensive clinical assessment,
medical review & detailed risk
assessment.
Business Hours
After Hours
Referring team contacts Patient Flow
Coordinator (PFC) via routine process to
communicate requirement for transfer of
patient & provides all paperwork.
Requesting site PFC alerts Duty Registrar /
Consultant, site Executive & District Access
Team of transfer requirement, faxes all
relevant documentation to receiving venue &
checks receiving venue has received the fax.
Duty Registrar at receiving venue reviews
relevant paperwork in consultation with PFC /
NUM / site Mental Health Executive.
Current documentation to be compiled at
this stage:
 Complete MH-OAT assessment
 Risk assessment & additional modules
 Care plans
 Management plans etc
 Historical information
 Medication / PRN charts
 7 days progress notes
 Original legal papers plus S78, 80 & 81
where required.
On-Call Registrar / CNC alerts NIC, On-Call
Consultant, On-Call Executive of transfer
requirement. NIC/ CNC faxes paperwork
and phones to confirm receipt of fax.
Registrar at receiving venue reviews relevant
paperwork.
Clinical discussion occurs between referring
venue & receiving venue Registrars & On- Call
Consultant Psychiatrist where necessary.
Clinical discussion occurs between referring
venue & receiving venue Registrars & Duty
Consultant Psychiatrist where necessary.
After clinical discussion the decision to transfer
a patient to another venue is made in
consultation with the Medical Officers, Nurse
in Charge / CNC, On-Call Executive and after
hours Nurse Manager.
After clinical discussion the decision to
transfer a patient to another venue is made in
consultation with Medical Officers, NUM‟s,
PFC & Executive. A clinical handover must
precede or coincide with the patient‟s arrival
at the receiving venue.
Once the decision to transfer has been made,
appropriate transport can be booked and it is
imperative the original Mental Health Act
paperwork accompanies patient and nursing
clinical handover takes place. A clinical
handover must precede or coincide with the
patient‟s arrival at the receiving venue
Ref: Inter-hospital Transfer of Mental Health
Inpatients including ED, PECC, MHRU, OPU and
MHU facilities Document No: 002_10
Revision 0
Trim No.
Date: February 2013
page 19 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Transport
When transferring a patient to another unit the following should be collated prior to transfer:
Original MHA papers must accompany the patient. Photocopies should be kept in the
patient medical record.
A current Section 78 form for transfer should be completed and original to accompany
patient.
Copies of the recent clinical notes from the medical record, MH-OAT assessment, 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.
Scheduled patients must be risk assessed by the attending medical officer and a collaborative
transport and escort plan formulated. Clinical handover must be given at the receiving
destination.
SESLHD MHS Priority Transport Options
The patient‟s risk status will determine the most suitable means of transport. Risk status should
include risk of AWOL, self harm, harm to others, sexual safety, patient‟s current mental state,
willingness to be transported and historical risk factors. The following is a repertoire of
transport options in escalating order for consideration and collaborative discussion in line with
risk assessment:
1.
2.
3.
4.
5.
6.
7.
8.
Hospital Transport with nurse escort
Hospital transport driver (overtime) and hospital car with nurse escort
Hospital car with Health and Safety Assistant (HASA) as the driver with nurse escort
Hospital car with two nurse escorts (one driving)
Networked hospital transport service with nurse escort
Networked hospital transport driver and hospital car with nurse escort
If the transfer is a repatriation arrange to use the donor site transport service
Consider admitting a high risk patient to the local MHU and transferring a low risk patient via
hospital car with ward staff or taxi and ward staff to another sector hospital
9. Consider delaying transport until acuity settles in 24 hrs
10. Consider temporarily placing a stable low risk patient in a transitional PECC bed to facilitate
high risk MHU admission
11. Consider assertive CMHT engagement to expedite low risk MHU patient transfer of care to
community to facilitate capacity to accept high risk admission
12. Contact Consultant Psychiatrists to review Mental Health inpatients to create capacity
13. Consider occupying medical / surgical bed for low risk voluntary patient to facilitate high risk
patient admission to MHU
14. Consider buying a private hospital bed for low risk admission to facilitate capacity
15. NSW Ambulance / Hospital Security Officer with nurse escort
16. NSW Ambulance / Overtime Hospital Security Officer with nurse escort
17. NSW Ambulance / Casual Pool Hospital Security Officer with nurse escort
18. NSW Ambulance / Sector Security Officer with nurse escort
19. NSW Ambulance / NSW Police where a public safety issue is identified in consultation with Site/
District Mental Health Executives, Security Manager and / or Corporate Service Manager
Revision 0
Trim No.
Date: February 2013
page 20 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Hospital Vehicle/ Taxi
Based on risk and following discussions with 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
nurse escort 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
NSW Ambulance Bookings
NSW Ambulance Liaison Officer
NSW Ambulance Senior Operations Manager
Medical Retrieval Unit
Ph: 8382 2141
Ph: 131 233
Ph: 0407 296 254
Ph: 8396 5150
Ph: 9553 2222
*St Vincent‟s Transport can transfer patients within New South Wales and interstate.
To organise transfer contact ph:8382 2238.
Aero-medical Transport of Patients
Where distance prohibits the use of a motor vehicle, aero-medical transport may be
considered. 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 Transport (above) will organise transport with
Wing-away. Patients who are Involuntary under the MHA can be transported but must be
adequately settled. Wing-away have 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 Sector Service Director and Chief
Psychiatrist prior to organising the transfer.
Revision 0
Trim No.
Date: February 2013
page 21 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Referral to Private Hospitals
Private psychiatric hospitals‟ admission criteria may vary slightly. In general these hospitals do
not accept patients who are Involuntary under the MHA or have high levels of risk.
Therefore patients must be voluntary prior to transfer and have 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. Essentially the same information is
required as when negotiating repatriation:
MH-OAT assessment and risk modules (A1& A4).
Private Health Fund provider and number.
Evidence of address and phone number of patient.
Recent clinical notes from medical record / Current risk assessment / Psychiatric / Physical
history / Plan for admission.
GP / Private Psychiatrist / Psychologist contact details / Next of kin / carer contact details.
Patients may not know their health fund reference numbers and it may be necessary to contact
the health fund with the patient‟s name, date of birth, address so they can supply the health
fund 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 put in financial difficulty.
Private Hospitals
Wandene (Kogarah)
Wesley Private (Ashfield)
St John of God (Richmond)
St John of God (Burwood)
Sydney Clinic (Bronte)
Northside Clinic (Greenwich)
Northside West Clinic (Wentworthville)
The Park Central Clinic (Campbelltown)
Southwest Clinic (Liverpool)
Ph: 8197 5800
Ph: 9716 1400
Ph: 024570 6100
Ph: 9715 9200
Ph: 9389 8888
Ph: 9433 3555
Ph: 8833 2222
Ph: 024621 9111
Ph: 9600 4000
Accepting Referrals from Private Hospitals
Patients who experience a significant deterioration in their clinical condition while in a private
psychiatric hospital may be Scheduled under the MHA, 2007 and require transfer to a public
hospital. When this occurs the private hospital will contact the nearest declared MHU and notify
them of the patient‟s pending transfer. Most often the patient is taken to ED for assessment prior
to transfer to MHU. The same principle applies as for accepting patients from ED or the
general hospital (see page 14).
Revision 0
Trim No.
Date: February 2013
page 22 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Referral to Rehabilitation Services
SESLHD MHS MHRU Clinical Access Pathway
1. Consumer identified by treating team for MHRU Referral from acute inpatient setting
(priority) or community. Informal visit to MHRU may occur at this point. *Referral to Bloomfield
or other SESLHD MHS MHRU may occur at this point*
2. Referral completed by referring clinician and
sent to MHRU NUM
Referral incomplete or consumer needs
do not match Rehabilitation service.
Referral complete and contains sufficient information
for assessment of urgency, risk, relevance and
processing of referral in a timely manner.
Referrer contacted by MHRU to provide
additional information and /or discuss
possible alternative options.
*Bloomfield most
suitable for
consumer
Contact
Bloomfield PFC
MHRU assesses person within 2 weeks
*Other SESLHD MHS MHRU
more suitable for consumer
Referral negotiated
directly between
Sectors
Place available
MHRU NUM facilitates admission processes in
consultation with referrer/treating team, priority list adjusted
accordingly.
Local MHRU suitable for
consumer
Place not available
Consumer prioritised on waiting list:
bed list + waiting list circulated
weekly by Sectors
MHRU NUM commences engagement process in consultation
with referrer/treating team – includes consumer visit(s) to MHRU
POW
SESIMHS
MHRU’s
Ph: 9382 3798
Fax: 9382 4237
TSH
Ph: 9540 8200
Fax: 9540 8237
Revision 0
Trim No.
Date: February 2013
page 23 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED BY
LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Referral to Bloomfield Rehabilitation Services
Bloomfield is a specialist psychiatric facility based in Orange, NSW and includes several
locked and declared rehabilitation units. The rehabilitation units at Bloomfield offer single
gender accommodation for men and women and a limited number of long stay beds
for patients deemed unsuitable for rehabilitation but for who all other placement options
have been exhausted. The model at Bloomfield targets patients with higher acuity and
more complex presentations than standard rehabilitation services. Beds are also available
for patients undergoing Clozapine titration.
Once a patient has been assessed as suitable for referral to Bloomfield a referral form
must be completed. This is a collaborative process between the MDT and PFC. The
following documents are required for referral to Bloomfield:
Completed referral form, MH-OAT documentation, OT assessment / 7 days
progress notes, medication chart.
Transfer of care summaries from previous non-acute admissions, clinical handover
/ referral letter and site ownership letter.
Bloomfield‟s allocation meetings take place on a Wednesday and the referral is
processed within approximately a week. Once a patient has been accepted it may take
a few more weeks before a bed comes 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, St Vincent‟s 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 0700hrs. The NUM
must be informed so that extra staff can be arranged if needed to cover the escort. All
original MHA paperwork must accompany patient, along with a completed Section 78. Due
to the remote location of Bloomfield Hospital it is essential patients have a supply of
personal 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 SESLHD to provide support and education to patients with addiction issues.
Clinical Nurse Consultants specialising in Alcohol and Other Drugs can attend ED‟s and MHUs to
assess and support patients with co-morbid mental health and drug and alcohol issues. There
are various facilities for Drug and Alcohol rehabilitation in NSW. Alcohol and Other Drugs
rehabilitation facilities in SES LHD include:
Sydney Hospital offers two inpatient rehabilitation beds for patients at risk of
seizure during alcohol withdrawal: 9382 7111.
The Langton Centre is a community based Drug and Alcohol service: 9332 8777.
Revision 0
Trim No.
Date: February 2013
Page 24 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS
REGISTERED BY LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Special Needs Referrals
„Special Needs‟ refers to patients who may be 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 Police, Security or 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 / Sector 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 Area Access &
Service Integration Team should be advised of the situation and the following information
provided via email:
Name / MRN / Date of Birth / Address.
Special needs requirement, eg. Patient is RN working in the local hospital or
patient a Police Officer working in local Area Command.
Patients‟ current mental state/ diagnosis / prognosis / history.
Patients MHA status.
Revision 0
Trim No.
Date: February 2013
Page 25 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS
REGISTERED BY LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Appendix 1
Useful Numbers
Services and Contacts
Numbers
District Access & Service Integration
9113 2468 / 0404 033596
0404 ED
033 596
SHH Eloura East
4295 2546
SHH
SHH Eloura West
4249 2549
Shoalhaven ED
SHH Mirrabook
4295 2310
Milton ED
TWH MHU
4253 4304
TWH ED
TSH MHU
9540 7506 / 7485
TSH ED
STG MHU
9113 2559
STG ED
STG PECC
9113 1419
STG PECC Fax
POW General
9382 4319 / 4357
POW ED
POW Obs
9382 4333 / 4356
Kiloh Reception Fax
POW PECC
9382 7772 / 7770
POW Euroa (SMHSOP)
SVH Caritas
8382 1590
SVH ED
SVH PECC
8382 4090
SVH PECC fax
POW MHRU
9382 3798
NUM
TSH MHRU
9540 8200
NUM
SHH MHRU
4295 2357
NUM
Sydney Children‟s Child and Adolescent Ward (CAMHs)
TWH SMSOP Unit
4296 6666/switch
4421 3111/switch
4454 9133/switch
4222 5000/switch
9540 7115
9113 1516
9113 1499
9382 8400
9382 4399
9382 3796
8382 2473
8382 4091
9382 3495
9540 8231
4295 2352
9382 8283
4253 4465
Revision 0
Trim No.
Date: February 2013
Page 26 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS
REGISTERED BY LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Appendix 2:
SESLHD MHS Patient Flow Escalation Algorithm
Revision 0
Trim No.
Date: February 2013
Page 27 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS
REGISTERED BY LOCAL DOCUMENT CONTROL PROCEDURES
SESLHD MHS PROCEDURE
Patient Flow Operational Framework
SESLHDPR/245
Appendix 3:
Referral to IPCU / MHICU Facilities Algorithm




Patient presents with associated
loss of capacity for self-control,
with a corresponding increase in
risk, which does not enable their
safe, therapeutic management and
treatment in an acute ward.
Treating team notifies PFC of need
to refer patient for mental health
intensive care.
PFC notifies site Executive and
MHS Access & Service Integration
Manager
PFC faxes all documentation to
receiving venue.
Documentation to be compiled at
this stage:
 Comprehensive Consultant
psychiatrist assessment
 Risk assessment
 Care plans
 Details of containment strategies
trialled: management plans etc
 Historical information
 Medication / PRN charts
 7 days progress notes
 Appropriate legal papers
SES LHD MHS PFC contacts
corresponding PFC to establish
IPCU / MHICU bed availability and
makes referral. PFC informs
referring team of outcome.
Referring Consultant Psychiatrist
contacts Chief Consultant of
receiving venue to support request
for higher level care and clinical /
therapeutic / pharmaceutical
discussion.
Bed available
PFC to arrange appropriate
transport and escort, ensure
original MHA paper work and
copies of notes etc accompany
patient and escort is able to
provide full clinical hand over.
Bed unavailable
If no bed available, referring site
Service Director to contact site
Service Director of Intensive Care
Venue to ascertain if bed can be
made available.
Bed available
Bed unavailable
The referring venue has an obligation to
ensure repatriation of the patient within
24hrs of notification by IPCU / MHICU of
criteria for admission no longer applying
Where no bed available, site
Service Director to prepare brief of
action so far for SES LHD MHS
Director
IPCU/MHICU Venues & Contacts
Sydney/ Sydney West (Concord)
Sydney West (Cumberland)
North Shore Central Coast (Hornsby)
PFC 0425 237 499
PFC 984 0386
PFC 0404 830 169
Revision 0
Trim No.
Date: February 2013
Page 28 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS
REGISTERED BY LOCAL DOCUMENT CONTROL PROCEDURES
References
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)
NSW Health Mental Health for Emergency Departments – A Reference Guide 2009
NSW Health Sustainable Access Plan 2004
Referral to Intensive Psychiatric Care Unit (IPCU) or Mental Health Intensive Care Unit
(MHICU) Business Rule Document No: 004_10. April 2010
SESLHD Acute Patient Flow and Sustainable Access Management for Mental Health
January 2013
Discharge/Transfer Planning For Adults & Children in Acute Facilities, SESLHD PD 107 August
2009
Inter-hospital Transfer of Mental Health Inpatients including ED, PECC, MHRU, OPU and MHU
facilities SESLHD Document No: 002_10
Obtaining a Second Opinion from a Consultant Psychiatrist SESLHD PD 2007/07 v5 Revised
April 2012
8. Revision and Approval History
Date
22/11/2012
Revision no:
0
Author and approval
Updated and changed from previous SESIAHS Procedure. Gayle Jones,
A/Access & Service Integration Manager, SESLHD MHS. Approved by
SESLHDMHS Clinical Council.
Revision 0
Trim No.
Date: March 2013
Page 29 of 29
THIS DISTRICT DOCUMENT BECOMES UNCONTROLLED WHEN PRINTED OR DOWNLOADED UNLESS REGISTERED
BY LOCAL DOCUMENT CONTROL PROCEDURES