Referring to Hospital Care

Referring to Hospital Care

Triggers for moving patient to hospital or palliative care

Escalate care if the patient develops:

• rapid deterioration. • worsening fatigue, profound exhaustion. • fainting, falls. • coughing up blood. • fever greater than 40°C. • severe shortness of breath at rest

• Clues to respiratory compromise. Include: Talking with single words or short sentences; Pausing between sentences to catch their breath; Noisy breathing; Blue face or lips; Respiratory rate greater than 20 breaths per minute. • chest pain on breathing in or tightness/pressure in the chest • new onset of confusion or becoming drowsy • change in oxygen saturation (SaO2): • Pre-COVID-19 SaO2 was greater than 94% or was unknown, then SaO2 trigger is less than 92%, or a drop of 3% or more from baseline, or a drop of 3% from resting to after exercise. • Pre-COVID-19 SaO2 was 94% or less, then SaO2 trigger is less than 88%, or a drop of 3% from baseline, or a drop of 3% from resting to after exercise. • Note that the safety of formal exertional desaturation tests such as the 1 minute sit-to-stand test have not been evaluated for COVID-19 and should not be performed routinely. Asking the patient to walk around the room may suffice. • unexplained heart rate greater than 100 beats per minute • dehydration – reduced oral intake and minimal urinary output in 12 hours. • cold, clammy, mottled, or pale skin. • other factors indicating need for management in hospital • If unsure about management, seek COVID-19 advice. If escalation to hospital care is required call on call medical SMO via switchboard WBOP 07 579 8044 and submit ereferral as per usual referral but mark as Covid Positive. Inform the patient that they are to wear a mask when arriving at the hospital.