Referring Patients for Admission



Always refer to your own EM senior for advice.


How to make a referral

ISBAR

ISBAR

I - Identify yourself

Identify : You, Medic accepting, Patient

S - Situation

Briefly why you are referring for admission

B - Background

Relevant Hx, vital signs, relevant PHx/meds

A - Assessment

What you think the problem is

R - Recommendations

Note clearly that you expect them to admit the patient.
Your signature / time

Please note time / who you bleeped and referring to. Please remember you are referring for admission, not an opinion. If the receiving doctor wishes to admit or discharge, that is up to them to decide once they have seen the patient and made a clinical note. Admitting teams should not be asked for an opinion (ask your EM senior) as this promotes patient ping pong and is detrimental to their care.

In patient teams in CUH.

  • All emergency medical/paediatric/surgical referrals should be admitted to the appropriate ward of the relevant medical/paediatric/surgical service, either directly or via the emergency department, as rapidly and efficiently as possible. Refer to the in-patient SHO for admission.
  • If a patient presents to the emergency department and is deemed to warrant admission to the medical/paediatric/surgical on-call service then contact with and referral to the appropriate on-call team should occur without delay.
  • Refer to the in-patient SHOs for advice - NOT opinion (should refer to your senior or the relevant registrar).
  • If there is a difference of opinion between the Emergency Medicine SHO and the on-call Acute Unselected Medical Take (AUMT) / Surgical / Paediatric SHO as to whether a patient being referred for admission, then the on-call Medical/Surgical / Paediatric Registrar MUST see that patient in the Emergency Department before determining that the patient should be admitted or discharged. (CUH agreed policy)
  • For CDU patients, please complete an interdisciplinary referral form

If there is any dispute between When requesting admission essential to write the request on the ED card and indicate which doctor (e.g. name of Medical Registrar) you wish to come and see your patient.

Mistakes are made if telephone or casual advice occurs when the ED SHO really wanted the patient to be seen by a more experienced doctor for a decision to be made. Record the name and rank of any person from whom you receive advice in the patient’s notes.

"Medical" referrals CUH

ALL referrals from the ED are to be discussed, in advance, with an ED Reg/SpR/Consultant. This will continue to allow senior decision makers the opportunity to identify patients that may be suitable for discharge and/or alternate care pathways, thereby mitigating the need for admission. Additionally, the interaction can be a training opportunity for staff that are new to the ED mindset.

With particular attention to MEDICAL referrals:

  1. Mon-Fri (8am-5pm) referrals are made to the AMAU medical staff. Referrals are made thereafter to the Medical Registrar on Call (MROC). Resuscitation referrals are made directly to MROC from 9am.
  2. EM SHOs can refer to AMAU/MROC provided the referral has been discussed with the duty EM Reg/SpR/Consultant.
  3. MROC will take referrals of all patients in Resuscitation.
  4. MROC can designate ONE specific senior Medical SHO to accept referrals at times when MROC is managing patients in Resuscitation and/or at times when they are not in the ED.
  5. When necessary (eg due to the complexity of the referral), the ED Reg/Spr/Consultant will liaise directly with AMAU/MROC.
  6. The Medical team on call will admit patients for the Cardiology service (out of hours) who present with chest pain only and have a TIMI ≥2 who are not STEMI or NSTEMI. The Cardiology Registrar on Call does NOT need to be contacted out of hours for these patients.
  7. The Cardiology Registrar on Call can be contacted at any time to discuss any cases deemed necessary by the EM or Medical senior.

This update was agreed by the Clinical Director, Dr M O’Connor, EM Consultant Dr C Deasy and the NCHD Co-Leads Dr Liam Healy and Dr Ruth O’Riordanon 01 March 2016.


Referral To patient's Local ED

Note where the patient lives and if we are not the local hospital refer for follow-up to the local Emergency Department or their GP. Provide the patient with a photocopy of the notes. It is important to give relevant X-rays to the patient and to record that fact.

Cystic Fibrosis patients.

All children with CF should be referred immediately to the cystic fibrosis or paediatric doctor on call.

In-hours, the The Paediatric CF nurse can be contacted on 087 9683245.

Dr Muireann Ní Chroinín 17/06/2008.


Referral for Psychiatric opinion - CUH

Referral to Psychiatry service re an ADULT patient

Monday to Friday (08:00 – 16:00)

Print copy details
  • Do not send an electronic referral from the Emergency Department.
  • Discuss the referral face-face with the Liaison Psychiatry Team in the Emergency Department each morning at 08:00. The Liaison Psychiatry team will attend the ED at this time or
  • Contact any member of the Liaison Psychiatry Team by telephone:
  • Self Harm/Suicidal: “Crisis Nurse” CNS. Tel: VPN 65327/65324/92110;
  • Alcohol & Drug Misuse: Liaison CNS. Tel: VPN 61184;
  • All other mental health issues: Liaison Doctor. Tel: VPN 62409/62410
Print copy details

Out of Hours (including weekends and bank holidays)

  • Do not send an electronic referral from the Emergency Department.
  • Contact the Psychiatry NCHD On-Call. Tel: VPN 67103 or
  • For Self-harm/Suicidal, Monday to Sunday (08:00 – 20:00): Contact the Self Harm “Crisis Nurse” CNS. Tel: VPN 65327/65324/92110.

Referral by ED Staff to the Psychiatry service re a CHILD patient

Monday to Friday (09:00 – 17:00)

  • There is no on-site Child and Adolescent Mental Health service at CUH.
  • Contact the relevant sector Child and Adolescent Mental Health team (depending on the child’s address). If you are unable to get hold of anyone or require signposting to the appropriate sector CAMHS team, contact the On-Call Child Psychiatrist (see below).
  • More on CAMHS referrals

Out of Hours (including weekends and bank holidays)

Physiotherapy

In MUH, please complete the Physiotherapy Referral Form.

Please complete a Referral form for patients in the CDU requiring other specialist opinion.


Obs & Gynae

In- and out- of hours, please contact the O&G registrar (covering the labour ward) in CUMH via switchboard

Rapid access cancer OPD referrals

HSE link to referral forms


Care of the Elderly admissions


DVT in Orthopaedic patients with DVT

Patients who are undergoing orthopaedic treatment who present to the ED with ? DVTs will be seen and treated by our orthopaedic colleagues.

They will then refer on to the medical team if necessary. (Mr Mullan letter Sept 2004 Here).

Fragility Fractures

  • Elderly patients who sustain pelvic fragility fractures secondary to an acute medical event (e.g. CVA etc.) should be admitted under the general medical / COTE team on call.
  • Patients with pelvic fractures secondary to a trip or slip with significant social or psychological issues should be admitted, under the orthopaedic team, for appropriate referral to social worker, discharge co-ordinator and occupational therapist.
  • Patients who have fragility fractures without social issues after initial assessment by the orthopaedic team may, following appropriate investigations, be managed in SIVUH or MUH.

Mr. Mark Dolan Orthopaedic Division letter 2011.

ENT

Please contact ENT team in SIVUH to accept referral:
Before 5pm - ENT emergency clinic 021 4926178
After 5pm – on-call mobile – 087 6752981.


Haematology


Paediatric Referrals CUH

  1. All referrals for admissions should be phoned through to Paediatric Registrar. Paediatric SHO may admit patient.
  2. All grey cases should be discussed with EM SpR/Consultant prior to contact with Paediatric Registrar between 8am-5pm.
  3. After hours, PEM SHO to directly discuss all < 1 year old & grey cases directly with Paediatric Registrar on call prior to discharge.
  4. In absence of PEM SHO, *EM senior to review all under 1 year old (>3 months age). Strongly consider Paediatric Registrar review of infants between 3-6 months of age.
  5. ALL infants < 3 months of age presenting to the PED out of hours to be seen by EM SHO and must then be reviewed by Paediatric Registrar on call.
  6. In the absence of PEM SHO, all grey cases to be discussed by EM SHO with *EM senior prior to contact with Paediatric Registrar.
  7. Low threshold for EM Senior to discuss infants > 6 months with Paediatric Registrar on call.

Referrals to in-patient teams MUH

  • Patients referred from EM staff to relevant teams before 08.00 will come under the care of the team who was on-call the night before and all patients referred to relevant teams after 08.00 will come under the care of teams on-call that day. Hard copy.

Surgical referrals CUH

Surgical handover CUh Prof Paul Redmond December 2013

Surgical "handover" is at 07:30. All referrals to the surgical service, made before 07:30 will be seen by the team who were on-call over night. Those referred after 07:30 will be attended by the day team.

ALL general surgical referrals should be made to the on-call surgical team. The on-call team will attend the patient and either admit themselves or transfer care to another (e.g. previous OPD attendance) surgical team.


Content by Dr Íomhar O' Sullivan.   Published 02/03/2004. Reviewed 09/12/2006. Last review Dr IOS 10/04/17.