Description

The South Gippsland Hospital Acute Inpatient Services Referral Form is an essential tool for healthcare professionals aiming to refer patients to acute inpatient services at South Gippsland Hospital. This document, identified as Form 1109, Version 2, December 2024, is meticulously designed to capture comprehensive patient and referral information, ensuring a seamless transition into hospital care.

Key Features

• Referrer and Patient Details: Provides sections to thoroughly document referrer information and essential patient medical details.
• Consent and Risk Assessment: Includes fields for patient consent and assessment of infection risks, crucial for safe and informed care planning.
• Patient Goals and Care Planning: Allows for detailed recording of patient goals, IV access needs, and advanced care planning, alongside anticipated discharge destinations and social supports.

Comprehensive Patient Profile

• Physical and Nutritional Assessment: Gathers information on current physical function, nutrition, and diet to tailor hospital services to individual needs.
• Communication and Cognitive Needs: Addresses communication requirements and cognitive or behavioural considerations, ensuring holistic care.
• Healthcare Needs: Covers elimination, skin integrity, wound care, medication management, and follow-up tests or appointments.

Instructions and Submission

The form includes clear instructions for completion and submission, streamlining the referral process. It highlights important service limitations at South Gippsland Hospital, such as:

• Absence of rehabilitation beds and onsite security
• Limited radiology services
• No onsite pathology or pharmacy
• BMI admission criteria

Supporting Documentation

Healthcare professionals are advised to accompany the referral with relevant supporting documents, including medical summaries, allied health assessments, medication charts, and recent pathology and radiology reports. This comprehensive approach ensures that all necessary information is available for effective patient care planning.

This referral form is a vital component in the coordination of acute inpatient services, facilitating clear communication between referring entities and South Gippsland Hospital, ultimately contributing to improved patient outcomes.