General Medical Admissions Information for Weekday Professional Line

GENERAL INFORMATION ON ADMISSIONS

Before speaking with the caller, double check where they are calling from and which hospital they are likely to be referring into.

In general, patients should use the hospital for their geographical catchment areas. There may be times when this is not in the patient’s best interests, eg. relevant/recent previous care at another hospital, patient’s feelings/choice, etc. If referring to a hospital outside their usual catchment area, please consider discussing with the chosen hospital’s Acute Medics before transfer (see numbers in telephone directory).

Hospitals in BNSSG can now see EMIS notes (and our CLEOentry within 1 hour of closing) via connecting care. For WGH admissions, please ask referrer to send with a summary print out/letter (but if not possible then WGH can see notes on connecting care, state “notes on CC” in narrative).

Pathology results from BRI/WGH/NBT can viewed via your NBT ICE login by finding the patient, reporting, view report by patient, and then selecting “ICE OPENNET REPORTS” or via connecting care.

THINGS THAT DON’T COME UNDER MEDICINE

Abdo pain/diverticulitis/pancreatitis/biliary pathology/abscess/obstructive jaundice -> General surgeons

Anaemia secondary to non medical causes-( for example menorrhagia, which should be directed to Gynae in the first instance)

Acute diabetic foot ulcers -> vascular SpR via switch Diabetic Foot Ulcer 

Hand cellulitis -> plastics SpR via switch (NBT), Orthopaedics on STAU (BRI)

Cellulitis over a joint/?septic arthritis  -> orthopaedics SpR via switch

Mastitis/breast abscess -> see Cellulitis

Orbital/pre-septal cellulitis -> Bristol Eye Hospital

Some facial cellulitis -> see Cellulitis

?PE in pregnancy or post partum . Varied destinations depending on gestation / hospital: see Pulmonary Embolism (PE). 

Sacral/pressure ulcer (as main reason for admission) ->plastics

?Renal colic -> ED for scan if ongoing pain

?Cauda equina ->ED (ask HCP to speak with ED consultant first)Cauda Equina Syndrome CES

Gynaecology problems -> Gynae SpR via switch

Head injury ? Subdural  -> see Head Injury (subdural haematoma)

Trauma eg. ?bony injury/fracture/laceration/head injury -> ED

Confirmed urinary retention ->  ED or Sirona (via SPA number)

?VP shunt problems -> ED for shunt series

Undergoing active cancer treatment  eg. neutropenic sepsis  -> Oncology SpR (or consultant) via BRI switch or can try 0117342 2011 Oncology SDEC (busy line that patients use too).

Known renal (eg. transplant) patient/patient needing emergency dialysis -> discuss with Renal SpR first via Southmead switch

Poisoning ->  ED at BRI.  NBT  will accept poisonings if related to a known agent that is likely  to require prolonged monitoring / Treatment ( eg paracetamol OD needing NAC). Otherwise to NBT ED.

Discitis -> This differs according to hospital of referral. At NBT - if no neurology and no confirmed radiological diagnosis , then the medical team will accept these patients (and potentially refer to ID if proven). If there is focal neurology, NBT recommend referral to the neurosurgical team direct. Neurosurgery should also be the first point of contact if, for example, this diagnosis is made on imaging for any reason.

The BRI medical team would prefer any possible or proven discitis to be referred to the Orthopaedic team in the first instance. They have good links with the Neurosurgical and ID teams at NBT should this subsequently be proven.

Complete heart block  -> medics (NBT),  D/W cardiology SpR and send to ED (BRI), at Weston - if patient is identified to be in CHB in the community and is stable needs to be transferred directly to cardiology at the BRI (call them to discuss). Arrhythmia page has more information.

Current or recent chemotherapy -> BHOC (via oncology SpR (or consultant) through BRI switchboard)

?Necrotising fasciitis → Refer patient to nearest ED, patient will then be assessed and triaged to appropriate surgical speciality

Acute Stroke if < 6 hours -> 999 to ED (but please ask referrer to inform stroke team too). see Stroke

SPECIALITIES AT SPECIFIC SITES

BRI: Max Fax, ENT, Eye hospital, Bristol Haematology and Oncology Centre, Bristol Heart Institute (for STEMIs but all other acute cardiology presentations can generally be dealt with at their local hospital).

NBT: Stroke, Neurosurgery, Renal, Plastics, Urology, Breast Surgeons, Vascular Surgery, Neurology

ADMISSION AVOIDANCE

Please see Hot clinics and admission avoidance

PATIENTS FROM PRISON

We may get calls from medical professionals at local prisons about patients requiring admission (eg. HMP Bristol, HMP Ashfield). If adding a patient from prison to the medical take list please highlight which facility they are coming from,  that they will be coming with prison escort and include an ETA at the hospital.

PARAMEDIC-ON-SCENE

At the BRI, paramedics are able to call the BRI Acute Physician 01173426860 who may add the patient to the medical take list directly (if appropriate).

PATIENT FOR ADMISSION

For any patient that needs admission under Medicine- complete a succinct summary of the case (see below) in the CLEO “history” box and then press “Finish for Non-clinical”  on completion of case select 'yes' to 'NON-CLINCIAL SUPPORT TO COMPLETE CASE REQUIRED' and select the 'type required'.

• Relevant background medical history
• Presenting symptoms
• Recent relevant treatment/investigations/admissions
• Referrer’s query/concern
• Clinical Frailty Score ( Rockwood Score) (only if over 65) & NEWS score
• Gate/ward/department the patient has been directed to
• Highlight any infection control issues by adding 'IPC+' to your 2 line summary at the end. Please also indicate what the concern is in your 2 line summary  eg. D&V /CV19/ TB. If there are no infection control concerns you do not need to use the IPC terminology
• Highlight any significant mental health or safeguarding concerns (and verbally inform admitting teams, see contact numbers below)
• Mode of transport (eg. “own transport” or “999 ambulance”)

Example:   54F, background of T1DM. 2/7 left pleuritic chest pain. CXR yesterday NAD.  No cough/fever/covid sx.  PCR negative.  Sats99%, P120. NEWS2.  ?PE.  31A AEC. own transport ETA 14:00

NBT

DIRECTING TO THE APPROPRIATE LOCATION

• Gate 36 medical SDEC
  •  All patients likely to be discharged same day
  • Ask to arrive ASAP (arrive before 18:00). 
  • SDEC (Same Day Emergency Care) at NBT
• Gate 31A SS
  • All patients likely to require an admission
  • Patient initially triaged in the ‘patient assessment area’
  • Apart from airway concerns/compromise 31A can manage all levels of unwell patients
  • Infection control restrictions (ie Covid, D+V) no longer apply, the staff will isolate patients as required  
  • Please be clear in your summary regarding any infection considerations, Covid status required
  • AMU Operation Policy FINAL 2020Aug12
• Gate 32A
  • Acute Frailty Unit, RW≥5 AND over 75 
  • Possibly very frail over 60s but discuss with geriatrician of the day or AMU consultant first
  • Patients with News score 7 or above should be considered to go to 31A (32A have a limited bed base to manage unstable patients)
  • Patients requiring continuous monitoring or rapid resuscitation (for electrolyte imbalance, cardiac arrhythmia and uncontrolled seizures) should also be directed to 31A
  •  Apart from the above caveats refer all frail elderly patients here.
  • The COTE consultant is happy to take calls about any cases where admission destination is not clear. (8am - 8pm 0117 414 0141)
  • The NBT medics call 31A the 'acute medical triage' area and 32A 'acute frailty unit'.
  • Gate 32A can take infectious patients, whether Covid or D+V,  inform them in your summary
  • AFU Operational Policy FINAL 2020Aug12
    

NBT clinical streaming tool

Combined EZ Acute Medicine and Frailty Medical Take Operational Policy FINAL 2020Aug13

KEY CONTACTS

• Switchboard  01174143999
• SDEC Consultant (08:00-19:00) 01174149217
• AMU Consultant (08:00-22:00) 01174149216
• Geriatrician of the day (08:00-20:00) 07738859048
• ED 01174143021
• Neurology consultant 0117 414 1917
• Stroke consultant (until 1600) 0117 414 5619 (and then stroke SpR via switch after that time)

DIRECTING TO THE APPROPRIATE LOCATION

All patients present via WGH ED but you can highlight for specific teams in your take list summary. Advise pts to explain they are medically expected on arrival at ED.

If a patient is self conveying to WGH with a NEWS of 6 or above OR has a concerningly unstable presentation please ring Med SPR on bleep 219 when referring the patient to inform them  This does not apply if the patient is arriving via ambulance.

• WGH SDEC Criteria can be found here
• Opening times: 08:00 - 22:00, last arrival time 19:00
• Write “SUITABLE FOR SDEC” in your 2 line summary.
  
  
• GEMS – non covid, Age >75, NEWS ≤3, RW 4-8, presenting with frailty related problem eg. falls, new/worsening confusion, reduction in mobility. Must arrive before 2.30pm (mon/tues) and 5pm (weds/thursday/friday). Write “SUITABLE FOR GEMS “.  Click here for full details: Acute Frailty Unit (GEMS unit) at WGH

OTHER WGH INFORMATION

Cardiology:  There is no cardiology SpR at WGH so if you need cardiology advice, bleep the Med SpR at WGH or Cardiology SpR at BHI.

Neurosurgery: If a case is obviously neurosurgical (eg. abnormal scan, patient known to neurosurgery) and needs “on the day advice”, ask the GP to use Referapatient (https://www.referapatient.org/Home/Index).     ?cauda equina → WGH ED (not medical take list).

Headache:   Symptoms very suggestive of ?SAH →  direct to the medical take (not SDEC). More non-specific headache which requires same-day assessment → SDEC

Respiratory: There is no respiratory hot clinic

Medical Day Case Unit – for blood transfusions, iron infusions (SDEC will take these if no capacity on medical day case unit and it is urgent), IV antibiotics

Renal: If known to renal (eg. renal transplant patient) and/or requiring emergency dialysis → discuss with renal SpR at NBT. General AKI (not needing dialysis) → WGH medical take.

Procedures: Needing pleural tap/chest drain → medical take,  Needing ascitic drain → may be suitable for SDEC

Endocrine diagnostic testing: eg. short synacthen test → SDEC

KEY CONTACTS

• Switchboard   01934 636363
• ED Reception 01934 647101
• ED Consultant 07393 268850
• SDEC doctors 01934 881023 or 647191
• Med SpR on-call  bleep 219
• GEMS (frailty service) bleep 343