1. 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 option 1
Hastings
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 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

2. 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 option 1
Hastings
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

3. 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