Page 262 - Registrar Orientation Manual 2016

Type:
Guideline
Document reference:
5295
Manual Classification:
Service Specific Emergency Medicine Administration
Title: Speciality Referral Guidelines
Effective date:
14 October 2014
Facilitator sign/date
Facilitator sign/date
Authorised sign/date
Version:
05
Page:
1 of 9
Paul Reeve
Head of Medicine
John Bonning
Clinical Director Emergency Department
Tom Watson
Chief Medical Advisor
Document expiry date:
14 October 2017
1. Purpose of Guideline
To give guidance to RMOs on the appropriate speciality for referrals, for assessments and admission to help avoid debates and disputes about which speciality should see a patient
2. Background
The following rules have been adapted from the Waikato Hospital Emergency Department Standard Operating Procedure, signed off by the Waikato Hospital Management Executive Group in 2009.
These guidelines have been developed to ensure patients are referred to the most appropriate service for ongoing management of their identified diagnoses, or presenting problems.
These guidelines recognize the areas of expertise of each of the services, but are not meant as a substitute for clinical judgment. Individual circumstances may alter referral choices.
The guidelines focus on diagnoses in which expertise may overlap, or where there are subspecialty divisions specific to Waikato, so the appropriate service may be unclear. If there is still uncertainty about the most appropriate service the ED consultant should make the recommendation.
Because of the subspecialty split in Medicine it can be particularly confusing about which medical speciality takes which patients in Waikato. See the Appendix for more details.
To improve continuity of care, “failed discharges”, or patients who have recently been discharged, should normally be referred back to the service they were under, unless they clearly have a new problem that is best managed by another service.
Direct GP to ED Referrals
The same guidelines also indicate which services GPs and Accident and Medical Practitioners should refer to, but note that the ED also accepts direct GP referrals of patients with the following conditions:
• uncomplicated cellulitis suitable for outpatient treatment
• uncomplicated DVT suitable for outpatient treatment
• fractures and dislocations suitable for reduction in ED
• simple abscesses suitable for I&D in ED
• head injury with concussion
• headache and migraine
• suspected cardiac chest pain for chest pain pathway
• suspected renal colic for diagnostic workup
• toxicology, poisoning and overdose
However, if the patient is not suitable for ED or outpatient management or does not respond and needs admission, then the patients should be referred on to the appropriate speciality listed.
Disagreements and Disputes
A memo from the Chief Medical Advisor and the Group Manager on “The Transfer of Care from ED to Inpatient Specialities” outlines the protocol that governs all referrals. This notes:
• Inpatient speciality registrars are expected to make a timely assessment of any patient referred.
• A speciality registrar cannot decline to see a referral. Patients must not be kept waiting in the ED.
• If, after seeing a patient, the inpatient speciality team then believe another service is more appropriate it is their (not ED’s) responsibility to refer on to the appropriate team.
• Any arguments should be immediately escalated to the Consultant and/or CD level to resolve.