Clinical Referral Guidelines

Shepton Mallet NHS Treatment Centre (SMTC) is able to accept patients with stable co-morbidities corresponding to anaesthetic assessment status ASA-3 (i.e. patients with severe systemic disease that limits their activities).

Ultimately it will be the decision of the SMTC Medical Director or Lead Anaesthetist as to whether a patient is accepted for a procedure.

The decision to accept a patient will depend on accurate and comprehensive clinical information being provided by the patient's GP as well as an anaesthetic assessment at the SMTC.

If you have any questions about the possible suitability of a patient for treatment at SMTC - please call SMTC on 01749 333 600 and ask to speak to the Medical Director.

The following conditions are accepted (as long as the condition is controlled and the patient asymptomatic if on treatment):

CARDIOVASCULAR	RESPIRATORY	OTHER
Hypertension (systolic <160 mmHg,  diastolic < 100 mmHg)	Asthma (peak flow above 200 l/min)	Diabetes
Angina	COPD    (FEV1 > 50% predicted, O2 sats >92% on room air)	Epilepsy
Heart failure (NYC I and II)
Dysrhythmia
Patients with valve disease
Patients taking warfarin due to longstanding Atrial Fibrillation with no history of thromboembolism.

   Note - this list is not exhaustive but illustrative of some frequently encountered conditions.

   The following conditions are not accepted: 

Cardiovascular
Myocardial infarction, angioplasty or coronary stenting -  within the last 6 months
CVA / Recurrent TIAs within the last 12 months
Implanted ventricular defibrilator or past history of ventricular dysrrhythmia
Patients taking Clopidogrel
Respiratory
Severe COPD FEV1 < 50% predicted.  O2 Sats < 92% on room air
SOB at rest / minor exertion.
Bronchiectasis (severe)
Other
Myleodysplasia, Haemophilia, Thrombocytopenia
Presence of infected skin lesions or any ongoing infection
Chronic ulceration with cellulitis
Active or severe liver disease
Immunocompromised HIV or active Hepatitis B or C
Unstable mental health
Significant cognitive impairments
Current MRSA positive (or negative eradication swabs in excess of 1 month from due admission date)

The following table indicates clinical conditions that are suitable for some procedures at SMTC:
 

	PROCEDURE
Cardiovascular	MAJOR	MINOR	DIAGNOSTIC ENDOSCOPY & Cataracts
Patients with valve replacements	No	No	Yes
Pacemaker in situ - functional	No	No	Yes
Renal
Renal failure or impairment (creatinine > 200 umol/L)	No	Yes*	Yes
Endocrine
Rare Endocrine disorders e.g. Addison's Disease, Cushing's syndrome	No	Yes*	Yes*
Blood disorders
Sickle cell disease	No	Yes	Yes
Known Anaemia  (g/dl)	Hb>12	Hb>10	Hb>10
Other
Age under 18 years	No	No	No
BMI of 40+  or weight > 150kg	No	No	No

Yes*  -  GP to discuss referral with SMTC lead anaesthetist before accepted)

MAJOR PROCEDURE = inpatient treatment    
(joint replacement, cholecystectomy)

MINOR PROCEDURE = daycase treatment     
(other orthopaedic procedures + general surgery eg hernias)