Pathfinder

For specialist psychological support in relation to physical health conditions, where NHS Talking Therapies LTC pathways are not appropriate, you may wish to consider referral to Health Psychology.

Health Psychology Pathfinder

Respiratory & Pulmonary Rehabilitation Service (DCHS)

01246 253067
dchst.respiratory@nhs.net

For referrals to pulmonary rehab, please complete the referral form and send via email.
For referrals to secondary care, please refer through e-Referral.

Outpatient Respiratory Physiotherapy (CRH)

CRH Respiratory Advice
crhft.respiratory@nhs.net

Sleep Apnoea: dictate and send letter for CRH referrals.

Confirmed chronic respiratory disease is the primary diagnosis (COPD/Non CF Bronchiectasis/ILD).
On optimum drug treatment.
In the event of a recent admission, the patient's medical condition is sufficiently stable to attend and participate in rehab sessions (to be confirmed on assessment by Pulmonary Rehabilitation Specialist Team).
Suitable to be seen in a group.
The patient is functionally limited either by breathlessness or fatigue.
To be able to walk a minimum of 10 metres with or without a walking aid.
Motivated to attend Pulmonary Rehabilitation and suitable for group work.

De-motivated/lack of compliance.
Mental or physical impairment with inability to exercise e.g. dementia, severe musculoskeletal or neurological problems which limit mobility, falls.
Any serious cardiac event in the last 6 weeks.
Other cardiac pathology including: unstable angina, acute LVF, uncontrolled cardiac arrhythmias, uncontrolled hypertension (either ≥ 180 systolic or ≥ 100 diastolic mmHg). Severe symptomatic stenosis: aortic, left main coronary or stenotic valvular heart disease. Symptomatic heart failure. Suspected or known aneurysm, Hypertrophic obstructive cardiomyopathy. Active or suspected myocarditis or pericarditis.
If the patient is undergoing investigations or is under the care of a cardiologist, permission needs to be sought directly from the specialist as to whether the patient is suitable to attend Pulmonary Rehabilitation.
H/o of Abdominal aortic aneurysm (AAA) with unstable BP.
Patient should not have attended a Pulmonary Rehabilitation Programme within the last two years. However patients can be re-referred within 2 years if their clinical condition deteriorated due to repeated exacerbations or if additional benefits on a shorter timescale would be clinically valuable (for e.g. Preoperative Lung Transplantation).
It is unlikely that if the patient completed the pulmonary rehabilitation course originally and failed to gain a benefit, that they would benefit a second time round; unless circumstances such as an exacerbation/health issues interrupted the initial programme.
Active cancer with evidence of metastasis.
Uncontrolled metabolic disease.
Febrile illness, chronic infectious diseases.
Recent systemic or pulmonary embolism or thrombophlebitis.

Respiratory Services (UHDB)

Lung Line: 01332 788225
Lines are open Monday to Sunday: 8:30am - 4:30pm (Erewash and South Derby only).

ImpACT+ encompasses home oxygen, pulmonary rehabilitation as well as outpatient and domiciliary respiratory services. They do have separate referral forms attached.
Please return all forms to dhft.impact-plus@nhs.net.

ImpACT+ Outpatient and Domiciliary Service

Post-hospital Discharge
- All patients admitted for an AECOPD should have follow up by a specialist service within 72 hours of discharge. Patients referred for Supported Discharge are reviewed within 24 hours of discharge and have appropriate follow up arranged after the initial contact.
New Diagnosis of Respiratory Disease
- All newly diagnosed patients should be referred to ImpACT+ and are seen within 6 weeks for education and support.
Frequent Exacerbations (3 or more in the last 12 months)
- Refer all patients who have had more than 3 exacerbations in the last 12 months for a specialist review.
Respiratory Palliative Clinic (Fatigue and Breathlessness (FAB) Group)
- FAB groups are 3 week MDT (Specialist Nurse, OT, PT and Assistant) group sessions around the county for people who are not suitable for Pulmonary Rehabilitation. Topics discussed are oxygen therapy, chest clearance, and breathlessness management including pacing techniques and breathing control. Patients are offered a ReSPECT form at the end of their 3rd week.
Virtual MDT (vMDT)
- MDT consists of Specialist Nurse and Consultant from ImpACT+ who meet with Primary Care on reoccurring dates to discuss challenging patients and develop treatment plans. Patients referred for discussion are referred using the vMDT referral form 2 weeks before the vMDT date.
Outpatient/Domiciliary Nurse/Physiotherapist/Occupational Therapist Service
- For all patients who need further specialist review to support symptoms management refer as below:
  - Nurse: COPD, asthma or diagnostic uncertainty. Treatments offered: medication review, inhaler technique, Respiratory Action Plan, respiratory review.
  - Physiotherapist: COPD, asthma, bronchiectasis, ILD, chronic cough, breathlessness without diagnosis. Treatments offered: chronic cough control, breathing control, chest clearance, Respiratory Action Plan.
  - Occupational Therapy: COPD, asthma, bronchiectasis and ILD. Treatments offered: Pacing, breathlessness management, mild anxiety management and acceptance therapies.
    All professionals will assess for Pulmonary Rehabilitation as part of the assessment but referrals for Pulmonary Rehabilitation should go direct to the Pulmonary Rehabilitation service and deliver a comprehensive, holistic assessment including assessment for mental health.

Home Oxygen: Use the ImpACT+ referral form.

All referrals must have peripheral SATS results on air showing <92% on 3 separate occasions.

Please refer patients who have a confirmed respiratory diagnosis.
MRC 2 or more and functionally limited by breathlessness.
Motivated and able to walk 10 meters within 20 seconds.
Suitable to be seen in a group.

High falls risk, not suitable to exercise.
Serious cardiac incident in the past 6 weeks.
Resting Heart Rate above 100bpm.
Other cardiac pathology including: unstable angina, acute LVF, uncontrolled cardiac arrhythmias. Severe symptomatic stenosis: aortic, left main coronary or stenotic valvular heart disease. Symptomatic heart failure. Suspected or known aortic aneurysm. Hypertrophic obstructive cardiomyopathy. Active or suspected myocarditis or pericarditis.
Uncontrolled hypertension (either ≥ 200 systolic or ≥ 110 diastolic mmHg.
If diabetic, either ≥ 130 systolic or ≥ 80 diastolic mmHg.