Referral Process

The Central Intake nurse accepts written physician referrals from the community and all hospitals and residential care homes (including those within Providence Health Care) with supporting collateral information.

Urgent referrals generated from the Emergency Department (ED) or by Over Capacity Protocol (OCP) do not require written physician referrals but do need to be assessed by Psychiatrist or Geriatric Psychiatrist before admission.

Attending Physician

The Geriatric Psychiatrist identified as the Attending Physician is the most responsible physician during the inpatient admission. The referring community physician is invited to attend rounds and discharge planning meetings.

Admission Criteria

The older adult patient population of primary focus are age 65 and older with:

• Late-onset (age 65 and over) mood, psychotic, and severe anxiety disorders.

• Cognitive impairment, including dementia, with co-morbid mood, psychotic, and anxiety disorders.

• Cognitive impairment, including dementia, with related behavioral and psychological symptoms or disturbance. The patient may present with one or many behavioral disturbances that put the patient or others at risk such as suicidal gestures, verbal or physical aggression, self imposed dietary restriction, obsessive/compulsive activities and/or withdrawal.

• Clinical needs that cannot be met safely by available outpatient or outreach resources for assessment and management of the presenting problems.

• Patient remains at serious risk in their current environment (examples include requiring interdisciplinary geriatric psychiatry assessment more than twice weekly or requiring skilled psychiatric nursing assessment and intervention 24 hours per day).

• There is imminence of threat to self or others that require certification under the BC Mental Health Act.

Prioritization of Routine Referrals

Patients from Acute Care within Providence take priority over those from PHC Residential Care if presentation of patient is similar. Patients from Providence Health Care take priority over those from the remainder of VCHA. Patients from the VCHA take priority over those from outside these boundaries. Referrals from outside VCHA will be directed to provincial geriatric psychiatry services at Riverview Hospital.

Referrals outside the criteria outlined above under Admission Criteria will have lower priority.

Referrals from Residential Care who have been through the secondary geriatric psychiatry services and have deteriorated clinically may be redirected to tertiary geriatric psychiatry services at Riverview Hospital if it is assessed that another admission to the secondary level of care would not be beneficial. This may include patients with dementia and behavioral disturbances including aggression.

Safety issues and the length of time waiting for admission and its detrimental effects on the patient's well-being or potential for recovery will be considered. Patients with stable psychiatric illnesses but require management of acute medical conditions are excluded.

Expected length of stay is two to six weeks. Anticipated longer stays may be referred to tertiary geriatric psychiatry services at Riverview Hospital. A "Return to Sender" policy applies to referrals from the community as well as from an acute care unit.

Discharge Criteria and Follow-up Care

Disposition is addressed for the patient prior to admission. It is expected that following the necessary assessment and treatment, the individual will return to their home. Follow-up is organized on an individual basis to include Family Physician, Mental Health Team and/or Geriatric Psychiatry/ Medicine specialist (outpatient or outreach).

Over-Capacity Protocol (OCP) Considerations

Over-Capacity Protocol will be implemented in the following order of priority:

1. Patients in the MSJH or SPH ED who meet admission criteria to GPU, and who have been assessed by a Psychiatrist or Geriatric Psychiatrist will have priority. MSJH ED has priority over SPH ED.

2. Patients at MSJ currently on the wait list for transfer to GPU (usually seen by Geriatric Psychiatry Consultation-Liaison Team) have second priority.

3. All other patients will be admitted to GPU "off-service" and will be followed by the Medical/Surgical Physician and cared for by Medical/Surgical Nursing. It is the responsibility of the Clinical Coordinator (or person responsible for arranging bed access under OCP) to ensure staffing for 24 hours is in place BEFORE patient is admitted to GPU.