North Somerset Rapid Response and Rehabilitation Referral Pathway

1. North Somerset Rapid Response and Rehabilitation Referral Pathway Receive referrals from GP’s, DN’s, social services, DCLN (based at WGH), Bristol hospitals REACT, specialist nurses trust-wide, Community Matron, Carelink, self-referrals, non-stat support groups, OOH, ECP, paramedics, RH/NH, hospices Discharge referral in RIO With ‘Inapproriate Referral’ as reason given Report Generated in RIO and Available/sent to PCT monthly Fill out referral form Create referral on RIO into New Referral caseload Referrer advised during phone conversation and signposted to appropriate services Review and triage referral Follow-up & Discharge Signpost to Appropriate service Referral appropriate? No Signposted on to other Services and/or discharged from care Recorded on referral Form and in Progress Notes in RIO Rapid Response care should be delivered within 14 day target. Longer input may be appropriate for specialist Services, or as a result of a delay in other services. Care plan agreed with Patient, depending on mental capacity, recorded in progress notes in RIO. Assessment undertaken Referral appropriate for service? Identify priority patient need, document on referral form All appropriate professionals with RR&R assess patient needs