Transitional Care Unit admission criteria

This information is for health professionals who are making a referral to the Transitional Care Unit (TCU) at Great Ormond Street Hospital (GOSH).

General considerations prior to admission to TCU

  • The parents understand the long-term prognosis, and are willing and capable of meeting the special needs of their child in the home setting with appropriate help.  
  • The family is provided with information about implications of home ventilation on family life.
  • Should the parents not feel able to provide the care for the child in their home, discussions about alternate long-term arrangements (ie foster care) have taken place with social worker and consultant. A summary of discussion is documented in case notes.
  • The child is medically stable and requires only intermittent monitoring of oxygen saturation and CO2 levels.  
  • The child is safe to be nursed in a low dependency environment with a high staffing skill-mix and does not require 1:1 nursing.
  • Documented evidence of parental teaching.
  • The child is able to mix with other children on the unit ie does not require isolation.
  • The child’s resuscitation status has been discussed and agreed with the parents/legal guardian.

Definition of term 'medically stable'

  • The presence of a stable airway (ie tracheostomy)
  • Stable ventilation, without severe episodes of desaturation or apnoea, on a portable respiratory support system / ventilator for at least two weeks.
  • Stable O2 requirement (if required) usually less than 40%, however this should not exclude children admitted for respite care in certain cases.
  • CO2 measurements that can be maintained within safe limits on a respiratory support system / ventilator that is operable by the family in their home.
  • No intravenous medication required unless discussed in individual cases.
  • All other medical conditions are well controlled.

Nutritional considerations

  • Nutritional intake is adequate to maintain expected growth, development and stamina.
  • Nutritional intake is well established via tube feeding/oral feeding/gastrostomy.

Mobility

  • The child can be taken off the ward for at least one hour.  
  • The child is nursed outside the bed, ie sitting in a chair for significant part of the day.

Others

  • The child is well established on oral/nasogastric/gastrostomy or inhaled medications.
  • The child will not need a central line other than in special circumstances. These cases will be discussed and reviewed on an individual basis.

Referral process for the Transitional Care Unit at Great Ormond Street Hospital.

 Referral Process  Rationale
The referring consultant to contact the consultant in charge of the Transitional Care Unit (TCU) as well as the unit manager. To discuss medical suitability. The TCU manager monitors a waiting list of children referred.
The referring unit has discussed the long-term plan of care for the child with the family. To establish family's expectations.
Referral notification form completed. Statement of reasons for referral with expected prognosis (to the best of your knowledge) is sent to TCU manager. To manage waiting list and to inform contracting department for finance approval by local commissioner.
Once referral to TCU is accepted the family therapist as well as the social worker will offer early support to discuss coping strategies, resources, support systems. To provide support and early psycho-social education, e.g. sharing findings from research or experience for children with a chronic illness and their families.
Once referral to TCU is accepted the child will be assessed by multidisciplinary therapy team (physiotherapist, occupational therapist, speech and language therapist, and play therapist) and appropriate programme discussed with the child/family and implemented. To provide relevant support to promote physical, mental and social development of the child.

Please note: Please do not suggest a transfer to TCU with the parents nor encourage a visit to the ward unless the child has been referred and assessed for his/her suitability.

Authors: Dr Ranjan Suri, Consultant for TCU and Nikki Nabney, TCU Ward Manager, June 2010