Community Respiratory Team

Who to refer to HAH:

• Any patient with confirmed diagnosis of COPD by spirometry with an acute exacerbation of COPD.
• In particular patients in whom emergency admission to hospital could potentially be avoided by timely assessments and on-going management at home.

How to refer to HAH:

• Liverpool patients to be referred via UCD 0845 345 0878
• CRT nurse will visit patient within 2 hours of referral

This 7 day service accepts referrals between 8am - 6pm Monday to Friday.

The Team are based at Croxteth Health Centre.

Service aims to:

• Manage acute exacerbations of COPD at home
• Exacerbation COPD NICE guidelines
• Avoid unnecessary admission of COPD patients
• Support early discharge from hospital
• Initiate timely interventions, including non-medical prescribing and nebulised therapy
• North mersey prescribing guide
• Referral for tests/investigations
• Provide education/support/advice to healthcare professionals regarding the management of patients with COPD in the community
• Implement individualised evidenced based care plan
• Example of exacerbation care plan
• Provide anticipatory care e.g. prevention advice, education and support to carers
• Work in partnership with secondary care colleagues and specialists
• Involve AHPs as appropriate

HAH contact details:

Croxteth Health Centre
40 Altcross Road
Liverpool
L11 OBS
Tel : 0151 295 9192
Fax: 0151 234 5139

Service overview:

Patients who have been admitted to hospital or who have attended the Accident and Emergency Department or Medical Assessment Unit with an Exacerbation of COPD can be assessed by a Nurse Practitioner to determine whether with suitable medication, nursing and social support they can be safely cared for at home and have their discharge expedited.

The team is based in 2 hospitals:

• Royal Liverpool University and Broadgreen Hospital Trust (RLUBHT)
• Aintree University Hospital (UHA)
• The team will also accept referrals from Whiston Hospital for patients with a Liverpool GP

Who to refer for ESD:

This service is for patients registered with a Liverpool with an acute exacerbation of COPD.

This 7 day service operates 8am - 8pm, accepting referrals from colleagues within secondary and primary care setting at any time during the patients stay aiming to avoid hospital admission or reduce length of stay.

Service Aims to:

• Manage acute exacerbations of COPD at home
• Exacerbation of COPD NICE guideline
• Avoid unnecessary admission of COPD patients
• Support early discharge from hospital
• Initiate timely interventions, including non-medical prescribing and nebulised therapy
• North Mersey prescribing guide
• Referral for tests/investigations
• Provide education/support/advice to healthcare professionals regarding the management of patients with COPD in the community
• Implement individualised evidenced based care plan
• Example of exacerbation care plan
• Provide anticipatory care e.g. prevention advice, education and support to carers
• Work in partnership with secondary care colleagues and specialists
• Involve AHPs as appropriate

The contact details for CRT team in each acute hospital are:

Aintree University Hospital (UHA)
Longmoor lane
Fazakerly
L9 7AL
Tel: 0151 529 2514
Fax: 0151 529 2915 

Royal Liverpool University and Broadgreen Hospital Trust (RLUBHT)
Prescot Street
Liverpool
L7 8XP
Tel: 0151 706 2047
Fax:0151 706 2017

Conforming to national guidelines the team will provide COPD Optimisation to all patients who have been under the HAH or ESD service following an exacerbation of COPD.

Complex patients can also be referred for appointments within community clinics with one of the Advanced Respiratory Nurse Practitioners or with one of the Chest Consultants covering the service.

The team also provides a two week follow up Optimisation appointment to complex patients who have been discharged from University Hospital Aintree or Royal Liverpool Hospital following a COPD exacerbation admission.

This Optimisation is primarily to maximise the patients understanding of their condition, what COPD means to them and how it affects their day to day life. By identifying a patients level of understanding the practitioner can steer a productive session with the ultimate aim of inducing positive changes in behavior to improve quality of life and outcomes. The Optimisation strives to develop patients self-management skills and empower patients and carers to make informed decisions about their care.

We help patients identify individual goals and discuss possible strategies to help them achieve these. 

 The Optimisation offers numerous services including:

• Medication concordance
• Inhaler technique
• Ensuring individuals are on the appropriate therapy for the severity of obstruction and symptoms described
• Dietetic assessment
• Identification of anxiety and its treatment

The Optimisation generates appropriate and timely referrals including:

• Arrangement of case conferences/MTD meetings
• Pulmonary rehabilitation
• Spirometry and reversibility testing
• Oxygen assessments
• CXRs
• CT scans
• Secondary care respiratory consultant review
• Social services

The team also provides education and training to other allied health professionals and colleagues caring for patients with COPD, this can be provided on an individual or group basis.