EMed

CUH EM to AMAU Streaming policy

CUH EM SHO/Registrar to MAU

Assumptions

  • Based on EM 'best working diagnosis'
  • Do not require diagnostic results nor specialty consults as a condition of acceptance
  • Refusal of suitable redirect requests should result in immediate escalation to both EM & AMAU Consultant
  • Where AMAU capacity exists, suitable EM Redirect patients should not be kept in ED (particularly during hours of AMAU operation, 0800 1700)
  • Redirection can only happen once patients are seen by EM Clinicians - this can be any point from triage

Examples 1

  • CVS 2: Undifferentiated Chest Pain (troponin -ve ), CCF 3, AF 3 (in patients with ICD /Pacemaker in-situ, Patients presenting with ICD in-situ may be referred to MAU if ICD is not the primary reason for patient attendance)
  • Resp: Premorbid conditions requiring medical optimisation 4 (Asthma, COPD, Fibrosis, PHTN) [+ PE (Where no CDU capacity available
  • GIT: PUD, stable UGIB , stable lower GIB , IBD, Non specific D& Refractory Nausea & Vomiting
  • Neuro 5: Perceived deterioration in (or complications with) pre existing neurological conditions (not requiring resuscitation); e.g. . UTI in MS, Stoma complications]; Note: Moderate/High Risk TIA go directly to Stroke Team
  • ID 6: Limb / Facial Cellulitis [where CDU bed not available]. [Exclusion: Breast Cellulitis (Breast Team )/ Abdominal Wall cellulitis (Gen Surg ) + Nec Fasc (Plastics)]
  • Endocrine 5: Diabetics requiring medical optimisation (therapeutics, diagnostics or access to CNS)
  • Syncope: All cases of Non Vasovagal Syncope to be accepted by MAU Team, if requested by EM Team
  • Social: Unsafe discharges ( e.g. Social vulnerability / failed FITT or OT/PT assessment) [where CDU / GEMS bed is not available]
  • Other: Non emergent cases (such as Unintentional Weight Loss , Altered LFTs, refractory emesis etc ) i.e. . unlikely to require admission) but requiring optimisation of therapeutics / requiring additional diagnostics [where CDU bed is not available]

Key

  1. Non comprehensive list
  2. Cardiology : Cardiology Direct Referrals: (a) Primary AF (b) Primary CCF (c) Likely Cardiogenic Syncope (d) Presentations likely related to ICD / Pacemaker dysfunction (e) NSTEMI
  3. MAU referral appropriate if requirement is medical / pharmaceutical optimisation (and presentation not in clinical context of in-situ ICD / Pacemaker)
  4. Medical optimisation: non emergent management of polypharmacy or downstream diagnostics
  5. every effort will be made to contact CNS where available
  6. ID Consults are not a mandatory condition of referral
Redirect to AMU

Out-of-Hours / Overnight Referrals

Where possible, referrals to AMAU should occur before 20:00 and may be made either face-to-face or by telephone discussion with the AMAU team.

If a patient remains suitable for AMAU referral after 20:00:

  • Patients referred following a night shift may be discussed directly with the AMAU team the following morning.
  • For referrals arising after 20:00 on late shifts, referrals may be sent via email to:AMAU.CUH@hse.ie.
  • Please also cc the duty EM consultant and UVC South-West.

Prior to referral, clinicians should consider whether the patient may be more appropriately managed by their own GP rather than requiring AMAU review.

Content by Dr Jonathan Costello. Last review Dr Amy Brennan 19/05/26.