Clinical Pathways: Women s Services. September 2014

Transcription

1 Clinical Pathways: Women s Services September

2 Contents 1. Known Pregnant Female with Likely Non-Pregnancy Related Illness <16 weeks 2. Known Pregnant female with Likely Pregnancy Related Illness < 16 weeks 3. Non-pregnant Female (Adult) with likely Pathology (No pain) 4a. Non-pregnant Female (Adult) with Low Abdominal Pain (part 1) 4b Non-pregnant Female (Adult) with Low Abdominal Pain (part 2) 5. Patients treated with Methotrexate 6. RSH day case patients not fit for discharge 7. Patient presenting to EPAS with Suspected Ectopic pregnancy and High Likelihood Suggested by USS 8. Patient presenting to EPAS that has developed a heavy bleed

3 1. Known Pregnant Female with likely Non-Pregnancy Related Illness < 16 weeks Ambulance Service triage pt/ self referral to PRH CCC GP Self-referral to RSH ED PRH EM doctor +/- Junior/Middle/Senior Speciality Doctor + Senior OOH: Middle /Obs PRH Junior/Middle Specialty Doctor + Senior OOH: Middle /Obs EM RSH ED Doctor +/- Junior/ Middle/Senior Speciality Senior telephone advice (with attendance in extremis) OOH: Senior or resident mid grade O and G for telephone advice with Senior in attendance if in extremis Admit to speciality ward e.g. medicine Conversation with /Obs On call at RSH GATU Admit to PRH speciality ward (via RSH: with telephone advice from Senior Via PRH: Junior/ Middle/ Senior Specialty Doctor + Senior ) (OOH: Middle /Obs) Discharge

4 2. Known Pregnant female with likely Pregnancy Related Illness < 16 weeks Ambulance/self referral to PRH CCC GP Self-referral to RSH EM PRH EM doctor +/- Junior/Senior OOH: Junior/Middle PRH GATU Junior/Senior OOH: Junior/Middle/ Senior ED RSH EM Doctor +/- Senior Doctor (telephone advice) OOH: Middle For telephone advice GP Discharge Nearest EPAS Admit onto Ward (PRH) Junior/Middle/Senior Patient unstable in ED ED Doctor + (Middle/ Senior Surgical only in extremis) + Senior Transfer to PRH

5 3. Non-pregnant female (Adult) with likely Pathology (No pain) PRH ED CCC GP ( negative) RSH ED Negative Positive Negative EM PRH EM Doctor +/- Junior/Senior OOH: Junior/Middle PRH GATU Junior/Senior OOH: Junior/Middle EM RSH EM Doctor +/- telephone advice Senior (+/-attendance) OOH: Middle for telephone advice +/-senior gyne in attendance Ward (PRH) Junior/Middle/Senior Discharge

6 4a. Non-pregnant female (Adult) with Low Abdominal Pain (part 1) GP triage base on most likely diagnosis Surgical SAU (RSH) Positive GATU (PRH) Negative Investigations Negative Set sequence of investigations Surgical Pathology Pathology Pathology Surgical Pathology Surgical Ward (RSH) Surgical Junior/Middle/Senior Senior on-call telephone advice/ attendance Surgical Opinion (surgical senior) Ward (PRH) Junior/Middle/ Senior Discharge and OPD FU

7 4b. Non-pregnant female (Adult) with Low Abdominal Pain (part 2) Self referral RSH EM ED (RSH) ( Negative) ED Doctor, Surgical Middle/Senior. Telephone advice Senior +/- attendance Positive Self Referral PRH EM ED (PRH) ( negative) ED Doctor, discussion with RSH Middle/ Senior Surgery +/- Junior/Senior Clear Surgical Pathology Non specific/specific abdo pain Clear pathology Senior telephone review or arranged attendance Clear pathology Non specific/specific abdo pain Clear Surgical Pathology Transfer If well discharge home with meds/advice. Come back next day In hours PRH GATU Out of hours PRH ward Junior/middle/Senior Set sequence of investigations- ultrasound SAU (RSH) Junior/Middle/Senior Surgery Set sequence of investigationsultrasound to be organised by team in GATU not by A&E Surgical Pathology Transfer Surgical Ward (RSH) Surgical Junior/Middle/Senior

8 5. Patients treated with Methotrexate Patients seen at PRH EPAS / Emergency Assessment Bloods taken (day 0) and patient given information leaflet Inform CDU & Pharmacy RSH of potential patient for the next day. Blood results received (day 0) Prescription signed by Consultant. Next day (day 1) prescription sent to PRH Pharmacy by for them to send onto RSH Pharmacy. Methotrexate held on Chemotherapy day unit. Patient to attend the CDU at RSH by 2.30pm for Administration of the Methotrexate. Patient observed for 1 hour post treatment on the Chemotherapy day unit. EPAS to be informed of any problems/questions Paperwork to be returned to EPAS (PRH/RSH) and patient to be FU as per the protocol at EPAS (RSH/PRH). If patient unwell they must attend PRH EPAS

9 6. RSH day case patients not fit for discharge Complex day surgery to take place at beginning of the theatre list Patient assessed and decided not fit for discharge home. cological surgical complications Recovery from anaesthetic or general surgical complications Transfer patient to PRH ward Transfer patient into Surgical bed

10 7. Patient presenting to EPAS with Suspected Ectopic pregnancy and High Likelihood Suggested by USS PRH RSH Patient arrives at EPAS Patient arrives at EPAS Patient scanned and assessed by Nurse ectopic pregnancy suspected Refer patient to assessment unit Yes Patient scanned and assessed by Nurse ectopic pregnancy suspected Yes Is the patient fit to transfer to PRH independently? Discuss with patient Patient stable No No Inform and transfer patient to the emergency department and Contact GOD (PRH) Theatre at RSH Discharge patient home with EPAS open access Admit onto ward Advise patient to attend assessment unit at PRH immediately Transfer patient via ambulance to Assessment Unit at PRH Transfer patient to ward at PRH

11 7a. Patient presenting at RSH (out of hours) with Suspected Ectopic pregnancy Patient arrives at RSH ED Assessed by ED clinician BHCG refer/book appointment to nearest EPAS for the next day Transfer to ED Resus Contact GOD Theatre at RSH Transfer to ward at PRH Discharge from surgical bed

12 8. Patient presenting to EPAS that has developed a heavy bleed PRH RSH Patient arrives at EPAS Patient arrives at EPAS Assessed in EPAS by nurse Assessed in EPAS by nurse Yes Refer patient to assessment unit Patient stable? No Yes Yes Is the patient fit to transfer to PRH independently? Discuss with patient Patient stable? No No Inform and transfer patient to the emergency department and Contact GOD (PRH) Discharge patient home with EPAS open access Admit patient onto ward Advise patient to attend assessment unit at PRH immediately Transfer patient via ambulance to Assessment Unit at PRH