Adult ED to LUCS redirection protocol

The decision process should be:

1. Is the patient suitable for signposting? e.g.
   1. common GP issue
   2. already seen GP
   3. had complaint for more than 3 days
   4. NEWS less than 2
2. if yes, is it in hours for primary care (Mon-Fri 1800-0800), or out of hours (Mon-Fri 1800-0800, 24/7 Sat & Sun, and NHS holidays)
   1. if in hours signpost back to primary care
3. if out-of-hours, do they fulfil LUCS criteria?
4. if yes, make LUCS appointment; otherwise signpost back to GP/NHS 24 as first point of contact.

Remember if you encounter any difficulty in the signposting process:

1. tell the patient a senior doctor will come and discuss the matter
2. place the patient back in the waiting room
3. place the notes in the tray with other patients waiting to be seen
4. place the patient virtually in the Signposting box on TRAK
5. the senior doctor will then make the ultimate decision as to whether the patient needs ED assessment or is signposted elsewhere

As of December 2022 the ED can directly book patients a LUCS appointment. See the Adastra LUCS booking guide on how the front desk staff can do this.

If, in the OOH period (Mon-Fri 18:00-08:00, 24/7 Sat & Sun, and NHS holidays) the patient fulfils the LUCs adult or paeds criteria then the triage sheet is returned to reception with observation and brief triage history an reception can make either a ‘within 2 or 4 hour time slot’. 

This appointment can be made at any of the LUCs sites and not restricted to SJH and they have asked us to try and use other clinics where possible and appropriate. 

If there are no '2 or 4 hour time-slots' then it comes to the EPIC to decide the best outcome, whether:

1. whether the person can wait longer (within 6 hours)
2. clinical call-back from OOHGP
3. can contact NHS 24/GP independently
4. should be seen in the ED.

For all patients for whom we make a LUCS appointment, on the TRAK discharge screen the destination should be selected as ‘Transferred to out of hours (triaged in A&E) – code: OOHT’. This will allow easier monitoring of how many people are referred to LUCS.

• 2022-09-12 version: Please see the attached protocol and the flowchart for a summary of the process.