Overnight SDEC referral guide by Jess Moxon

sdecmu — 2022-02-22 15:33:38 UTC

Patients to accept:

2022-03-08 13:53:52 UTC

- DVT
- PE*
- HTN
- Cellulitis
- IDA
- Chest pain*
- SOB*
- UGIB*
- Self harm* e.g. paracetamol overdose
- Undifferentiated medical presentations that are not more suited to another speciality and not clearly requiring admission.

*Only if low risk presentations
(see next column)

Who takes the referrals?

2022-03-08 13:54:38 UTC

- Day: SDEC ACP (60974) 8am-10pm Mon-Fri, 8am-6pm Sat-Sun
- Night: Chancellor's Med reg (#4687) who then hands over any overnight referrals in person to the SDEC ACP at 8am

Patients to decline:

2022-03-09 10:40:06 UTC

- Age <16 or >80 (>80 go to SDEC: Older people's unit)
- Age >70 with frailty >6 (Go to SDEC Older peoples unit)
- NEWS 5 or above (unless normal baseline for the patient)
- Patients who will clearly require admission
- Alcohol or drug intoxication/withdrawal
- Reduced GCS, disturbed behaviour or delirium
- Patients requiring a hoist.
- Require speciality review (Go to that speciality's OP clinic/admit to speciality)
- Chronic issues better managed by GP

PE

Andy_Ditchfield — 2022-03-11 15:00:11 UTC

- Calculate the PESI score to determine risk category
- Always take into account the clinical and social context outwith the scope of the PESI score to decide SDEC suitability

Chest pain

Andy_Ditchfield — 2022-03-11 15:00:20 UTC

To be low risk must not have on ECG:
- ST segment changes
- New LBBB
- New TWI

Must not have:
- Severe HTN
- Raised troponin

UGIB

Andy_Ditchfield — 2022-03-11 15:00:29 UTC

- Calculate the Blatchford score to determine risk category
- Do not accept anyone with previous ALD or oesophageal varices
- Always take into account the clinical and social context outwith the scope of the Blatchford score to decide SDEC suitability

Self harm

Andy_Ditchfield — 2022-03-11 15:00:36 UTC

Can be accepted if treatment/ observation period can be completed with the day.

To be low risk must not have:
- wounds (beyond superficial wounds).
- Ingested cardio-toxic substances requiring telemetry
- Recommended period of observation on Toxbase beyond SDEC opening hours
- Safeguarding issues requiring admission
- Behavioural disturbance or lack of capacity
- ALPS advice to invoke MHA or complex psychiatric management.

SOB

Andy_Ditchfield — 2022-03-11 15:00:42 UTC

Low risk if:
- Not requiring supplementary 02 or likely to be weaned quickly.
- Not ACS
- No acute haemorrhage
- Not covid positive

DVT/PE

Andy_Ditchfield — 2022-03-18 13:32:29 UTC

- The A&E doctor should:
1. Give the first dose of LMWH
2. Book the USS or CTPA
3. Ensure all CTPA patients have had CXR first - and consider VQ for young patients (if the patient require VQ they must be anticoagulated until the next working day eg if requested Friday give enoxaparin until Monday)
4. Record the patient's phone number on PPM
5. Ask patients to expect a phone call with appointment time by 9:30am - they should also provide number for patient to call if needed: 01132065057.

Self-harm

Andy_Ditchfield — 2022-03-18 14:19:00 UTC

The A&E doctor should:
- Take the patient's consent to refer to ALPS prior to transfer (#1091)
- Document time of referral and advice in notes
- Ensure an escort to SDEC

HTN

Andy_Ditchfield — 2022-03-18 14:38:20 UTC

- Follow the SDEC HTN pathway

Cellulitis

Andy_Ditchfield — 2022-03-18 14:38:38 UTC

- Follow the SDEC Cellulitis pathway

IDA

Andy_Ditchfield — 2022-03-18 14:38:55 UTC

- Follow the SDEC IDA pathway

Lists

sdecmu — 2023-12-10 22:12:11 UTC