Hospital waiting list criteria (FOI)

Request

It has recently been reported that waiting times for appointments at the hospital have been reduced for 'urgent' cases. 

A

Could you please advise the clinical criteria used to define Urgent, Soon and Routine allocations in Community Physiotherapy, Community Occupational Therapy and Community Social Work?

B

How is this established?

C

Who establishes this?

D

What clinical and national guidelines are used to establish this?

E

How are these services staffed currently?

Response

Community Physiotherapy and Community Occupational Therapy

A

Community Occupational Therapy have two routes that a referral for urgent assessment can be triaged and allocated to:

If an urgent referral is received and the patient requires an immediate response to support discharge from hospital or prevent admission to hospital, as long as they meet the criteria for the Rapid Response and Re-ablement Team (RRRT), the referral is allocated to the RRRT service.

If a referral is received and the patient has no additional needs and is able to function safely within their home environment but needs an urgent response, this is then allocated to the OT Community Service where it is processed within 7 days.

Community Physiotherapy offer ‘Soon’ or ‘Routine’ appointments only. For cases requiring urgent physiotherapy assessment, referrals are forwarded to the RRRT service.

For both Community Physiotherapy and Community Occupational Therapy, referrals allocated as ‘Soon’ have one or more of the following, all of which is determined during a triage telephone assessment (please see link to standardised Triage Questionnaire below).

Community Therapy Triage Questionnaire.pdf

Falling, deteriorating mobility, unsafe, lives alone, recent discharge from Jersey General Hospital with ongoing therapy needs, care package failing due to decreased mobilty, struggling to maintain safety and self at home, if not seen would deteriorate. 

For both Community Physiotherapy and Community Occupational Therapy, referrals allocated as ‘Routine’ are as follows:

Person is in a place of safety (Nursing Home / Residential Home), decreasing mobility but remains safe, reduced outdoor mobility, other issues which aren’t affecting mobility or functional independence.

Please see  link to the Service Criteria document used by Community Physiotherapy and Community Occupational Therapy below.

Community Therapy Service Criteria.pdf

B

Referrals to Community Physiotherapy and Community Occupational Therapy are triaged by a physiotherapist or occupational therapist (OT), as appropriate to the relevant service. Each person referred receives a call from a physiotherapist or OT, who completes a subjective assessment over the phone. The assessment is documented in the Triage Questionnaire and forms part of the person’s clinical record. On the basis of this assessment, the physiotherapist or OT determines whether the person requires a ‘Soon’ or ‘Routine’ assessment according to the criteria above and allocates the referral accordingly.

C

This is a clinical decision, determined by the relevant Allied Health Professional (AHP), as detailed above.

D

There are no guidelines available from The National Institute for Health and Care Excellence (NICE) relating to triage for these areas. Determination of urgency is based on clinical assessment of a patient’s needs against the criteria detailed in answer to Question A, as assessed by the relevant AHP.

E

Community Physiotherapy services staffing:

5.1 Whole Time Equivalent (WTE) physiotherapists, including 1 WTE dedicated to triage within HCS24.

There is also 0.8 WTE physiotherapy support worker allocated to the service.

Community Occupational Therapy staffing:  

6.8 WTE OTs, including 1 WTE dedicated to triage within HCS24.  

There are also 2 WTE support staff.

Community Social Work

A

The Adult Social Care Team does not use the stated definitions of Urgent, Soon and Routine. Instead, a triage system based on a locally developed case weighting tool is used to evaluate the urgency of incoming referrals. Please see link to the case weighting tool below.

Adult Social Care Duty Screening Tool.xlsx

B

The questions in the first column of the triage and screening tool are applied to the information in the referral form to establish case urgency.

C

The Adult Social Care Team Senior Practitioners, who are all registered professionals, apply the triage and screening tool to referrals. They have access to a Team Manager or Senior Manager to discuss individual referrals, should this be necessary.

D

The triage and screening tool and case weighting tool was developed as part of a LEAN Rapid process Improvement Workshop in 2015. Information is not held in recorded form as to which clinical or national guidelines were considered at the time. Article 3 of the Freedom of Information (Jersey) Law 2011 applies.

E

The Adult Social Care Team currently comprises one Team Manager, three Senior Practitioners, twelve full time Social Workers, three Long Term Care Nurses and seven Social Work Assistants.

Article applied

Article 3 - Meaning of “information held by a public authority”

For the purposes of this Law, information is held by a public authority if –

(a)     it is held by the authority, otherwise than on behalf of another person; or

(b)     it is held by another person on behalf of the authority.