Update Safe for Discharge Status

In order to facilated a timely discharge, the acute trust should notify the parties responsible for supporting the discharge (e.g. Local Authotity and Community Health) as soon as the patient no longer meets any of the clinical criteria to reside in Hospital and any required rehabilitation in the acute hospital has been completed.

Every person on every general ward should be reviewed on a twice daily ward round against the following clinical criteria:

  • Requiring ITU or HDU care?
  • Requiring oxygen therapy/NIV?
  • Requiring intravenous fluids?
  • NEWS2 > 3? (clinical judgement required in persons with AF and/or chronic respiratory disease)
  • Diminished level of consciousness where recovery realistic?
  • Acute functional impairment in excess of home/community care provision?
  • Last hours of life?
  • Requiring intravenous medication > b.d. (including analgesia)?
  • Undergone lower limb surgery within 48hrs?
  • Undergone thorax-abdominal/pelvic surgery with 72 hrs?
  • Within 24hrs of an invasive procedure? (with attendant risk of acute life- threatening deterioration)

Any person not meeting the clinical criteria to reside (see Hospital Discharge Service: Policy and Operating Model (Annex A)) and who has no requirement for further rehabilitation in the acute hospital, will be deemed safe for discharge.

HTTPS Request

Method:

PUT

Request URL:

The request URL will consist of 'https://'+'{Host}'+'{BaseURL}'+'?'+'{QueryString}'

Host Environments:

The Host URLs will determined by the service provider, for example the host URLs for the Nottinghamshire County Council Social Care Data Service are:

Environment Host
Test health-interoperability-test.nottscc.gov.uk
Live health-interoperability.nottscc.gov.uk

Base URL:

/ReferralService/v3/Encounter

Query String /Parameters:

Name Value
identifier The identifier as per Encounter the asscoiated ReferralRequest, in the format {identifier.system |identifier.value}

Example Request Url:

https://health-interoperability-test.nottscc.gov.uk/ReferralService/v3/Encounter?identifier=http://fhir.nottinghamshire.gov.uk/encounter/identifier|6521ea68-e87e-4c80-9ea4-510892d7025f



Request Body:

The Request body should be in either json or xml format

The primary base FHIR resource is a CareConnect-SHD-Encounter-1 with references to other resources as per the Entity Relationship Model below: UpdateEncounterUseCaseDiagram

See Examples for an illustration of the Request body of a typical Referral to Social Care for a Supported Hospital Discharge.

Response

Success

SHALL return a HTTP status code 200 OK on successful execution of the request

Error

An Error SHALL return one of the following HTTP Status Codes and an OperationOutcome with details of the issue:

HTTP Code Display Description
400 Bad Request Poor Syntax or breaks a core FHIR constraint
401 Unauthorized User is not authorised to perform the request.
403 Forbidden The request is forbidden, authorization will not help.
409 Conflict User has requested to create a resource that already exists.
422 Unprocessable Entity The syntax is valid, but cannot be processed, e.g. breaks a business rule.
500 Internal Error The server encountered an unexpected condition which prevented it from fulfilling the request.

JSON example of an OperationOutcome for a Unprocessable Entity

{
    "resourceType": "OperationOutcome",
    "issue":  [
        {
            "severity": "error",
            "code": "processing",
            "diagnostics": "Encounter where medicallyFitStatus = 'Medically Fit' must supply a dateDeemedMedicallyFit extension element with a valid datetime value",
            "location":  [
                "Encounter.extension.where(url = 'https://fhir.nottinghamshire.gov.uk/extensions/SHD-MedicallyFitDetails').extension.where(url = 'dateDeemedMedicallyFit').value.empty()"
            ]
        }
    ]
}


XML example of an OperationOutcome for a 422 Unprocessable Entity

<OperationOutcome xmlns="http://hl7.org/fhir">
    <issue>
        <severity value="error" />
        <code value="processing" />
        <diagnostics value="Encounter where medicallyFitStatus = &#39;Medically Fit&#39; must supply a dateDeemedMedicallyFit extension element with a valid datetime value" />
        <location value="Encounter.extension.where(url = &#39;https://fhir.nottinghamshire.gov.uk/extensions/SHD-MedicallyFitDetails&#39;).extension.where(url = &#39;dateDeemedMedicallyFit&#39;).value.empty()" />
    </issue>
</OperationOutcome>


Profiles

The Refer Patient (to Social Care for Supported Hospital Discharge) Use Care is supported by the following profiles

StructureDefinition Version
CareConnect-SHD-Encounter-1 0.0.1
CareConnect-SHD-Location-1 0.0.1
CareConnect-SHD-Organization-1 0.0.1
CareConnect-SHD-Practitioner-1 0.0.1
Extensions Version
Extension-SHD-MedicallyFitDetails 0.0.1
ValueSets Version
Supported Hospital Discharge Medically Fit Status 0.0.1
CodeSystems Version
Supported Hospital Discharge Medically Fit Status 0.0.1

Rules and Mappings

The generic business context data mappings for the 'Madatory' and 'Must Support' elements are detailed in the Profiles section, however the section below deatils any specific rules or contrains that apply to this use case.

Pre-requisites

The patient MUST have an Active Referral Request

Data Mappings

CareConnect-SHD-Encounter-1

FHIR Element Card. Type Description/Business Context
Encounter.extension[medicallyFitForDischarge] 1..1 Extension-SHD-MedicallyFitDetails Extension to share whether the patient is safe for discharge, i.e. no longer meeting ony of the clinical criteria to reside in hospital.
Encounter.extension[medicallyFitForDischarge].extension[medicallyFitStatus].valueCoding 1..1 Coding Binding Supported Hospital Discharge Medically Fit Status
Encounter.extension[medicallyFitForDischarge].extension[dateDeemedMedicallyFit].valueDateTime 0..1 DateTime Constraint The dateDeemedMedicallyFit SHALL be provided when medicallyFitStatus="Medically Fit".
Encounter.status 1..1 code Encounter.status SHALL be "in-progress"
Encounter.statusHistory 0..0 BackboneElement Status History is Not Required on update where Encounter.status="in-progress"
Encounter.period.end 0..1 dateTime Where Encounter.status="in-progress", the Encounter will be in-progress, the Encounter.period.end will relate to the Target Discharge Date i.e. the Predicted Date that the Patient is expectided to no longer meet any of the criteria to reside in hospital (see Hospital Discharge Service: Policy and Operating Model (Annex A)).

Note: The FHIR dateTime data type supports date and partial date, as well as a full date-time value. Hence the time element is not required if the source system only captures a date.

Examples

Request Body

JSON example of a CareConnect-SHD-Encounter-1

{
    "resourceType": "Encounter",
    "meta": {
        "profile":  [
            "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Encounter-1"
        ]
    },
    "contained":  [
        {
            "resourceType": "Practitioner",
            "id": "shd-lead-clinician",
            "meta": {
                "profile":  [
                    "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Practitioner-1"
                ]
            },
            "name":  [
                {
                    "use": "official",
                    "text": "Ms Laura Clarke"
                }
            ]
        },
        {
            "resourceType": "Location",
            "id": "shd-location",
            "meta": {
                "profile":  [
                    "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Location-1"
                ]
            },
            "name": "Ward 22",
            "managingOrganization": {
                "reference": "#shd-hospital"
            }
        },
        {
            "resourceType": "Organization",
            "id": "shd-hospital",
            "meta": {
                "profile":  [
                    "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Organization-1"
                ]
            },
            "identifier":  [
                {
                    "system": "https://fhir.nhs.uk/Id/ods-site-code",
                    "value": "RK5BC"
                }
            ],
            "name": "King's Mill Hospital"
        }
    ],
    "text": {
        "status": "additional",
        --- We have skipped the narrative for better readability of the resource ---
    },
    "extension":  [
        {
            "url": "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/Extension-SHD-MedicallyFitDetails",
            "extension":  [
                {
                    "url": "medicallyFitStatus",
                    "valueCoding": {
                        "system": "https://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-MedicallyFitStatus",
                        "code": "01",
                        "display": "Medically Fit"
                    }
                },
                {
                    "url": "dateDeemedMedicallyFit",
                    "valueDateTime": "2019-01-30T10:56:00+00:00"
                }
            ]
        }
    ],
    "identifier":  [
        {
            "system": "http://fhir.sfht.nhs.uk/encounter/identifier",
            "value": "11a2d937-39d5-439e-bc6a-d5e586eSteve"
        }
    ],
    "status": "in-progress",
    "type":  [
        {
            "coding":  [
                {
                    "system": "https://fhir.nottinghamshire.gov.uk/encounter/type",
                    "code": "supported-discharge"
                }
            ]
        }
    ],
    "participant":  [
        {
            "individual": {
                "reference": "#shd-lead-clinician"
            }
        }
    ],
    "period": {
        "start": "2019-01-25T00:00:00+00:00",
        "end": "2019-02-03T00:00:00+00:00"
    },
    "reason":  [
        {
            "text": "Description of the reason why the patient was admitted to hospital"
        }
    ],
    "location":  [
        {
            "location": {
                "reference": "#shd-location"
            }
        }
    ]
}


XML example of a CareConnect-SHD-Encounter-1

<Encounter xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Encounter-1" />
    </meta>
    <text>
        <status value="additional" />
        --- We have skipped the narrative for better readability of the resource ---
    </text>
    <contained>
        <Practitioner>
            <id value="shd-lead-clinician" />
            <meta>
                <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Practitioner-1" />
            </meta>
            <name>
                <use value="official" />
                <text value="Ms Laura Clarke" />
            </name>
        </Practitioner>
    </contained>
    <contained>
        <Location>
            <id value="shd-location" />
            <meta>
                <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Location-1" />
            </meta>
            <name value="Ward 22" />
            <managingOrganization>
                <reference value="#shd-hospital" />
            </managingOrganization>
        </Location>
    </contained>
    <contained>
        <Organization>
            <id value="shd-hospital" />
            <meta>
                <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Organization-1" />
            </meta>
            <identifier>
                <system value="https://fhir.nhs.uk/Id/ods-site-code" />
                <value value="RK5BC" />
            </identifier>
            <name value="King&#39;s Mill Hospital" />
        </Organization>
    </contained>
    <extension url="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/Extension-SHD-MedicallyFitDetails">
        <extension url="medicallyFitStatus">
            <valueCoding>
                <system value="https://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-MedicallyFitStatus" />
                <code value="01" />
                <display value="Medically Fit" />
            </valueCoding>
        </extension>
        <extension url="dateDeemedMedicallyFit">
            <valueDateTime value="2019-01-30T10:56:00+00:00" />
        </extension>
    </extension>
    <identifier>
        <system value="http://fhir.sfht.nhs.uk/encounter/identifier" />
        <value value="11a2d937-39d5-439e-bc6a-d5e586eSteve" />
    </identifier>
    <status value="in-progress" />
    <type>
        <coding>
            <system value="https://fhir.nottinghamshire.gov.uk/encounter/type" />
            <code value="supported-discharge" />
        </coding>
    </type>
    <participant>
        <individual>
            <reference value="#shd-lead-clinician" />
        </individual>
    </participant>
    <period>
        <start value="2019-01-25T00:00:00+00:00" />
        <end value="2019-02-03T00:00:00+00:00" />
    </period>
    <reason>
        <text value="Description of the reason why the patient was admitted to hospital" />
    </reason>
    <location>
        <location>
            <reference value="#shd-location" />
        </location>
    </location>
</Encounter>