Same day emergency care (SDEC)

Medicine

Inclusion criteria

• Aged 16 or older
• General medicine
• "Fit to sit"/mobilising
• Common presentations:
  • Low-risk chest pains (suspected to be ACS, PE or respiratory)
  • Breathlessness (No COVID-19 history)
  • TIA (strokes should go to A&E)
  • DVT
  • Headaches with no neurological deficit
  • Cellulitis
  • Stable anaemia
  • Stable deranged bloods 

Exclusion criteria

• Any patient suspected of either being COVID-positive or having been in contact with COVID-positive cases
• Not "fit to sit"
• High-risk chest pain:
  • STEMI
  • New acute ECG changes such as LBBB
  • Ongoing cardiac chest pain
  • haemodynamically unstable (e.g. hypotensive, tachyarrhythmia)
• NEWS >7/SEWS >2
• Time-critical diagnoses (stroke/sepsis/STEMI) or red flag sepsis
• Trauma – acute/suspected
• Specialty (surgical/renal/oncology etc)
• acute mental health
• Seizures – status or recurrent
• Airway compromise/altered airway
• GCS <15 (at any point leading up to admission)
• Overdose or intoxication with alcohol/drugs
• Hypothermia
• Severe pain (pain score >6/10 despite analgesia)
• Haematemesis/melaena
• T1/T2 respiratory failure
• Requiring O2 therapy
• Asthma with peak flow <75% of best/predicted
• Infection risk – Diarrhoea and vomiting/COVID-19/flu

Surgery

Inclusion criteria

Acute onset:

• severe abdominal pain (requiring admission or definitive surgical review, e.g. suspected diverticulitis, pancreatitis, cholecystitis, appendicitis)
• peri-anal conditions (e.g. abscess)
• right iliac fossa pain (suspected appendicitis, except that caused by gynaecology conditions)
• suspected acutely symptomatic gallstones – cholecystitis, pancreatitis, exacerbation biliary pain (but not chronic biliary colic)
• painful hernia (non-reducible, obstructed, incarcerated, strangulated
• abscesses (on the trunk/axilla/perianal, buttocks), not limb/face/neck
• suspected bowel obstruction
• suspected visceral perforation (stable)
• suspected pancreatitis
• surgical post-operative complications and wound issues
• bariatric surgery complications (Heartlands Hospital only)
• Endoscopic complications
• To QEHB Surgical Assessment Unit (SAU), virtual SAU patients attending ED with condition related to original admission, or any other emergency general surgical complaint

Exclusion criteria

• Trauma patients
• All medical referrals, including melaena and jaundice
• Patients who are critically unwell, requiring level 2 or 3 care, or unstable patients
• Patients requiring immediate (category 1) operations or interventions
• Patients with a potentially compromised airway
• Suspected severe sepsis, generalised peritonitis or massive haemorrhage
• Patients with active diarrhoea and vomiting who are assessed as requiring isolation
• Acutely unwell patients arriving via ambulance
• All gynaecological patients
  • should be directed to GAU, including abdominal pain following prior gynaecology/obstetric intervention and all pregnant patients with lower abdominal pain
• Patients under the age of 16
• Multi-morbid patients with uncertain diagnosis need senior A&E review before decision to transfer
• All chronic conditions should be referred through standard primary care route
• VirtualSAU patients attending ED with a condition unrelated to their original admission, or complaint that is not general surgical in nature
• No vascular patients to Good Hope Hospital or Queen Elizabeth Hospital Birmingham SAUs
• No urology patients to Good Hope Hospital SAU

Paediatrics

Inclusion criteria

All acute medical referrals of children and young people up to the age of 16 years will be considered for referral apart from the exceptions below. If uncertain whether a patient is suitable for referral, discuss the case via the contact numbers provided for advice.

Exclusion criteria

• Any patient presenting with a time-critical condition, requiring immediate treatment upon arrival at hospital, must continue to be pre-alerted to the Emergency Department
• Babies under 10 days of age with feeding difficulties or jaundice who are usually seen on post-natal ward

Gynaecology

Inclusion criteria

• Pregnant patient:
  • Hyperemesis
  • Abdominal pain
  • Vaginal bleeding
• Non-pregnant:
  • Menstrual problems
  • Low abdominal pain (could be colorectal problems/appendicitis)
  • Previous gynae problems, now presenting with similar symptoms
• Post-gynae operation re-attendance
• Post-miscarriage/delivery problems like fever, vaginal bleeding or discharge
• Vulval vaginal symptoms
• IUCD, vaginal pessaries related problems (comes under previous gynae problems)