EMed

Referring Patients for Admission

Always refer to your own EM senior for advice

How to make a referral

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 PMHx/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.

Referring patients for admission - CUH

If looking for advice on the management of a patient please ask the most senior Emergency Medicine (EM) doctor present or discuss with the EM consultant by phone if needed after-hours.
All efforts are made by the EM staff to make the most appropriate referral. Where it is felt by an admitting team that the referral runs contrary to agreed practices this must be discussed with the most senior EM doctor on the floor immediately. The EM consultant group is keen to receive feedback from in house specialty consultants regarding Emergency medicine referrals.

The practice of referral to inpatient teams should follow these rules:

  1. Referrals are one way. Once a referral has been made, it is the responsibility of that named specialty to determine the further disposition of the patient. If an inpatient team decides a patient needs discharge or will have their care best provided under a different specialty, the responsibility is on this team to refer the patient onward or discharge the patient
  2. This (one-way referral) policy has been approved by all CUH clinical directors and the EMB
  3. Clinical Escalation within 30 minutes. In the event of a disputed referral of a patient, record the details of the involved doctors and reason for dispute in the clinical notes. Discuss this immediately with the most senior EM doctor who will review the patient. If the disposition plan of the patient remains uncertain after 30 minutes, the EM consultant on call must be involved, if not already aware. The EM consultant will then resolve the issue with the relevant consultant
  4. Disputed Admission Specialty. Where there is disagreement as to which specialty a patient should be admitted under, in the first instance efforts should be made by the Registrars on call for the involved specialties to resolve the issue. Where the involved Specialty Registrars are unable to reach agreement on which Specialty the patient is admitted under, the issue needs to be escalated to the involved Consultants on call to reach an agreement
  5. Disposition Decision. In the event of more than one specialty refusing to admit a patient. A process for resolving this issue has been agreed by the Executive Management Board of the hospital (ref: Consultant Memo Dated Dec 2023). The EM consultant has delegated Executive authority, to arbitrate on disposition disagreements between specialties. In this capacity, the EM consultant will decide under which specialty the patient's care needs will best be met, and the patient will be admitted under that specialty as the primary team. This does not mean that the other specialty does not continue to see and consult on the patient. Where disagreement remains, this can be escalated to the relevant Clinical Directors of the specialties during normal working hours

Print version this CUH EMB agreed policy.

CUH Referral Pathway

"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 (e.g. 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’Riordan on 01 March 2016.

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)

  • 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

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
  • 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)

Out of Hours (including weekends and bank holidays)

Physiotherapy

Obs & Gynae

  • In- and out- of hours, please contact the O&G registrar (covering the labour ward) in CUMH via switchboard
  • The agreed policy is that if suggested imaging is not available within 2 hours, any patient, with suspected Obs/Gynae pathology, should be transferred to CUMH ED

Rapid access cancer OPD referrals

  • Please complete an iCM referral

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:

Content by Dr Íomhar O' Sullivan. Please see contributors above. Last review Dr ÍOS 29/06/24.