Coronavirus: Lane Fox Unit update
In response to the coronavirus (COVID-19) outbreak, please read our advice and information before sending any referrals.
The Lane Fox Respiratory Service is a national referral centre for chronic respiratory failure as a consequence of neuromuscular disease, chronic obstructive pulmonary disease, obesity and chest wall disease.
We specialise in the long-term respiratory support, both non-invasive ventilation and invasive ventilation, and in 'weaning' patients from invasive mechanical ventilation.
Outpatient referrals are accepted from general practice and from hospital specialists based mostly in the south of England. We will only accept referrals from consultants and junior doctors.
How to make a referral
Please email Professor Nicholas Hart (clinical and academic director), Dr Joerg Steier, Dr Hina Pattani, Dr Michelle Ramsay, Dr Patrick Murphy or Dr Phil Marino at firstname.lastname@example.org. Please include information about the patient's current issue and the background to their problem as well as any relevant background history, infection status, tracheostomy status or ventilator settings.
Find out how to refer patients with motor neurone disease.
Patients are seen initially in outpatients (parking and disabled access directly into unit is available).
Screening investigations, for example home overnight oxygen monitoring, may be requested before the patient's clinic appointment.
Cough assist referrals
Please complete the cough assist referral form (Word 21Kb).
Inpatient level 2 (non-invasive ventilation) and level 3 (weaning from invasive mechanical ventilation) transfers
Please complete a level 2/level 3 referral form (Word 46Kb) and email this to email@example.com.
Following this, please contact the nurses station and discuss the referral with the nurse in charge on 020 7188 3434 or 020 7188 3435.
Acceptance for admission will be made on a case by case basis dependent on the need of that patient and the urgency of requirement for medical care.
Lane Fox referral and transfer policy
The Lane Fox Respiratory Service will admit patients to the Lane Fox Respiratory Unit at St Thomas’s Hospital or the Lane Fox REMEO Centre at Redhill with an expectation that patient will be transferred to The Lane Fox REMEO Centre after one or two weeks assessment at the Lane Fox Respiratory Unit. We may transfer patients back to the local hospital if weaning is not possible after this one to two week period of assessment.
- All referral forms need to be accompanied by a referral letter. This is required for the acceptance of a patient, as it must be indicated on the top of the referral form.
- The on-call Lane Fox consultant and the nurse in charge will call the transferring centre for weekly updates and to give weaning advice.
- The on-call Lane Fox consultant will liaise with Lane Fox home ventilation service each week to decide which patients on the list can be directly transferred to nursing home (eg high spinal cord injury, traumatic brain injury) to avoid admission to Lane Fox admission.
- Transfer of patients with chronic respiratory (eg chronic obstructive pulmonary disease, bronchiectasis), chest wall deformities and neuromuscular conditions (eg Guillain-Barre syndrome, Duchenne's muscular dystrophy, motor neurone disease and limb girdle muscular dystrophy) will be prioritised.
- Patients with active delirium will not be accepted.
- Patients with post sepsis multi-organ failure and associated muscle weakness without a chronic respiratory condition will receive lower priority.
- Transfer of level 3 patients, who have a 'do not attempt to resuscitate' or a 'not for escalation' order in place at their local hospital, will be carefully considered. This will be discussed in detail with the referring consultant and prioritised accordingly.
- Patients will not be accepted for transfer to the Lane Fox Respiratory Service if the FiO2 is greater than 0.4, unless there is a consultant-to-consultant discussion about the patient.
- The cardiac status of the patient should be documented in the referral letter including the report of a recent electrocardiogram and echocardiogram.
- The infection status of the patient should be clearly documented in the referral letter including multiple drug-resistant infections such as MRSA, Candida Auris, CRO and VRE. The referring clinicians should document if the patient has had previous Clostridium Difficile toxin positive diarrhoea. In addition the stool type should be documented in the referral letter eg type 1 through type 7 stool consistency.
- Patients will not be accepted for transfer if they have untreatable infection, eg pulmonary, pleural and peritoneal infection.
- All parts of the form must be completed and if these are not completed the referral will be rejected. A standard referral letter must be included with the referral form. If there is not a comprehensive referral letter, then the referral will be rejected.
- On transfer of the patient to Lane Fox Unit or Lane Fox REMEO, all images need to be transferred by image exchange portal (IEP).
Referrals from other hospitals must include a completed Inter-Provider Minimum Data Set or ensure that one is sent within 48 hours of referring a patient.