HIV acutely unwell pathway Sussex HIV Network This pathway applies to all patients other than those listed in non-acute pathway All HIV+ patients with signs and/or symptoms potentially attributable to HIV infections must be referred for urgent specialist assessment within 24 hours at local HIV unit. If admission required for HIV related condition refer to HIV ward team (see below) HIV+ patient unwell in OPA/GP/A&E Unwell HIV+ patient admitted by non HIV Medical Team to hospital other than BSUH D/W local HIV Consultant / team Eastbourne 01323 416100 option 1 Hastings 01424 464750 If unavailable liaise direct with HIV centre BSUH Referral Criteria (HIV related / other pathways) Fever/sepsis of any source Respiratory Tract Infection (LRTI, PCP,TB) Neurological signs or symptoms (unless suspect CVA) Suspected TB – any site Suspected or proven cancer Haematological disorder (low plts, anaemia, neutropenia) Renal failure/stones/pyelonephritis Hepatic decompensation/hepatitis/obstructive jaundice Shingles/Measles/Mumps Significant D&V requiring admission For HIV related admission (see referral criteria) contact BSUH HIV Ward Registrar immediately via switchboard On 01273 696955 Spr Bleep 8075, out of hours aircall Spr via switchboard BSUH review X-rays of patients awaiting transfer BSUH Bed Manager Informed of admission to BSUH Follow surgical pathway if surgical admission Inform E Sussex HIV team within 24 hours of discharge 10/7 Post discharge clinic at BSUH Discharge letter to GP / local clinic When treatment has finished Refer back to Local centre with management plan Letter to GP

HIV local inpatient pathway All HIV + patients with signs and/or symptoms potentially related to HIV must be referred for urgent specialist assessment within 24 hours at local HIV unit. If admission required for suspected HIV related condition refer to HIV ward team (see HIV acutely unwell pathway) This pathway applies to HIV positive patients who require admission for the following diagnoses Emergency treatment for MI/CVA/PE/cardiac failure/GI bleeding Neutropenic sepsis - first dose ABX then transfer Assessment and management of DVT/Acute joint inflammation/Diabetes/Cushings Elective and emergency surgery (including acute abdomen/PID/cholelithiasis) Minor trauma and fractures not requiring surgery, Overdose and Uncomplicated pregnancy Radiology review available from HIV Centre by request on a case by case basis All elective surgery patients should be notified to HIV pharmacy and HIV nurse Eastbourne 01323 416100 option 1 Hastings 01424 464750 Surgical proformas should be completed when date of surgery known Pharmacy to communicate with Anaesthetist to avoid drug-drug interaction HIV Nurse to contact nursing staff on admitting ward to advise on care, esp importance of ARVs

Notes on Inpatient pathways for patients in Sussex with HIV Only BSUH provides 24 hour on call/referral advice to local Accident and Emergency (A&E) departments with ring-fenced HIV inpatient beds on Howard 2 ward, and a dedicated HIV daycare In BSUH is the care of HIV positive inpatients the responsibility of either a HIV Consultant or joint HIV Consultant, with the other services managing HIV patients under General/Other Consultants BSUH Consultants have at least two dedicated Programmed Activities (PAs, i.e. one working day) dedicated to inpatient care per week Prompt transfer of HIV positive patients to BSUH has not always occurred because of bed pressure in BSUH, the patient has been too unstable to transfer or BSUH have not been notified of the patient The HIV Network would require all patients (apart from a limited number of specified elective and acute admissions) to be admitted directly to BSUH The pathway for admission starts at the initial assessment of the patient, and includes the ambulance service transferring to BSUH directly (not the local hospital) and is predicated on an assurance from BSUH that HIV admissions will be prioritized to support the HIV network (2011). Relevant documents: HIV acute inpatient pathway HIV non-acute and elective inpatient pathway