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Western Health ED tips for common presentations

introduction

  • ensure you have read the various orientation documents - see Western Health ED medical orientation
  • discuss with senior Dr in ED within 20-30minutes
  • early bed requests and inpatient referrals - if inpatient team do not respond in a timely manner (eg. 30min), d/w senior ED doctor to escalate to inpatient consultant
  • for resus patients likely to need a critical care bed, contact ICU reg EARLY!
  • ensure all patients discharged home have discharge letters and certificates/patient info sheets as indicated
  • if a patient is likely to require > 4hr LOS in ED, consider admitting to EOU if appropriate (eg. a reasonable probability they can be discharged home from there)
  • if there are delays for inpatient unit to review the patient and “admit” whilst in ED, if the patient is stable and safe for transfer to an available ward bed for admission there, complete an “Interim Admission Order” and inform the inpatient unit the patient will be transferred to ward bed (there is generally no need for the patient to remain in ED awaiting CT scan results unless this is likely to result in transfer to another hospital - if there is high probability of discharge home, then an EOU bed should be considered).

aged care residential facility patients / nursing home patients

  • palliative care - how to provide palliative meds on discharge back to NH - complex and not possible once external pharmacies close around 8pm!
    • syringe drivers with Morphine/Midazolam can be started in ED to be continued in the NH
    • Patients who require prn morphine/midazolam need a script with the S8 drugs written up and ampoules dispensed from their local community pharmacy - DO NOT discharge patient from ED with ampoules of S8 drugs!
    • patients may need to be admitted overnight to arrange medications in the morning
    • if there are no palliative care beds available, admit under gen med or aged care

cardiology

drug and alcohol unit / addiction medicine

endocrinology

ENT

facio-maxillary

  • based at Footscray
  • there is no OPG machine at Sunshine - only at Footscray
  • refer patients with dental abscesses, fractured mandibles, etc.
  • see:

gastroenterology

  • patients needing scopes as an outpatient should generally be referred to their LMO to arrange privately as there is a long wait list in the hospital system - exceptions are for those who are too high risk to have a scope in a day procedure centre (eg. morbid obesity, serious co-morbidities)
  • see:

general surgery

general medicine

geriatrics

  • after hours (eg weekends and after 5pm weekdays), aged care patients are admitted by the gen med registrar
  • see:

gynae

Hospital in the Home / HITH

  • there is a HITH registrar who supervises admissions to HITH team
  • once accepted, a HITH nurse will generally assess the patient in ED to ensure suitability, etc.

infectious disease

mental health / psychiatry

neurology

neurosurgery

  • WH has a neurosurgery registrar, however, if not available, may need to contact RMH neurosurg registrar
  • remember to complete the “Hub and Spoke” radiology form (in radiology dept) early so that scans will be sent to destination hospital for review by the receiving unit (eg. RMH)
  • if there is a neurosurgical emergency and RMH is not able to accept, contact ARV to arrange and expedite transfer

oncology

  • oncology unit is based at Sunshine
  • see also:

ophthalmology

  • there is a slit lamp in the procedure room near EOU at Sunshine
  • consider referral to Western Eye Clinic for follow up review of corneal FBs, etc
    • Private clinic at Suite 210, Level 2, 1 Thomas Holmes Rd, Maribyrnong
    • All patients require a referral letter with the patient’s bradma sticker and a provider number (please fax this to the clinic and ask patient to phone clinic for an appointment), and the patient will be billed
    • ph: 9317 8930 fax: 9912 2306

ortho

paediatrics

plastics

renal / nephrology tips

  • all patients on dialysis or with renal transplant who require admission must be admitted under renal unit whatever their presentation is - contact renal reg early!

respiratory medicine

  • Sunshine and Footscray have IRCU beds for higher dependency respiratory patients requiring non-invasive ventilation or adrenaline or salbutamol infusions, if these beds are unavailable, contact ICU consultant to request a HDU bed so that the patient can be moved from ED resus (the ICU reg may be first contact point, but they may not be empowered to accept a patient not fulfilling critical care criteria)
  • see:

stroke / TIA

  • stroke service is only available at Sunshine
  • patients with acute stroke within 4hrs of onset must be escalated to the stroke team for urgent CT brain and consideration for time critical thrombolysis, or transfer to RMH for clot retrieval

thoracics

  • see:
    • pneumothorax - currently patients with intercostal catheters cannot be managed on ward at Sunshine, need transfer to Footscray either under thoracics or under resp. medicine

trauma

urology

  • urology is based at Footscray, if at Sunshine, consider EOU and then transfer to Footscray if indicated
    • patients with ureteric stones and suspected infection require urgent referral to urology and potential intervention within hours!
  • acute urinary retention - the complexities of arranging trial of voids!
  • see also urology

vascular surgery

wh_tips.txt · Last modified: 2017/05/24 15:36 (external edit)