Referrals, Discharge and More
Referrals to inpatient units should be discussed with the ED consultant first. This accelerates decision making, reduces unnecessary referrals and is an opportunity to identify diagnostic and management issues which may not be immediately apparent to you. In many instances the ED Consultant can redirect, trouble shoot or advise about the referral process.
Privately insured patients can be admitted to either St John of God Bendigo or Bendigo Health under the admitting consultant of the day. Some patients may have a long association with a particular doctor and wish to be treated by them- this is subject to availability. See Bendigo Referral options for more details
All referrals to a private consultant must include a brief letter including date, patient name, doctor you are referring to, your name and your provider number. This is so the private consultant can practise legally.
Outpatients - Do not refer from ED
Almost all patients should be referred back to their GPs to coordinate referrals to specialists/clinics rather than from the ED. This is for obvious reasons based on continuity of care. Often GPs know their patients better and can access a more diverse range of follow up options. Outpatient services are limited and waiting times can be months to years depending on the reason for referral. Exceptions are referrals to Fracture Clinic, Early Pregnancy (EPAS) or where circumstances discussed with the ED consultant mean a referral to outpatients directly from the ED is appropriate. Many minor fractures do not need fracture clinic and can be reviewed by GP. Physios, Nurse Practitioners and the Ambulatory Care Consultant can give advice about appropriate follow up. Any other outpatient referrals need to be discussed with the relevant Speciality team prior to making any on-line referrals
Fracture clinic referrals are made through EPR via Add Order - Orthopaedic - Specialisr Clinics. Please ensure that you order an outpatient Repeat X-ray for the patient, so that on the day of review this can occurr prior to been seen in Clinic.
Discharge - General Points
Give your patient a clear understanding of what has happened to them in the ED and what the plan is. Make sure they understand what followup is required. Please give them information - a broad variety of info sheets is available from sources listed under "PATIENTS" in ED Central.
Please dont discharge elderly or vulnerable people late at night alone or without close communication and understanding from family.
As a general rule patients should not be discharged from SSOU overnight once the Afternoon Consultant has gone home, unless the patient has clearly been flagged at hand-over as being safe for discharge home at night. All overnight stay patients need to be reviewed by the morning SSOU consultant prior to discharge.
All patients must have a discharge summary completed.
Discharge summaries are completed on EPR, please ensure that all your patients for the day have a completed Discahrge Summary prior to leaving at the end of your shift.
These Summaries are automatically emailed/faxed to relevant GP through EPR as long as these details are up to date. However if possible it always useful to give the patient a hard copy prior to discharge in case this does not occurr.
Summary notes are your narrative to the GP, your handover of care, one doctor to another. Present your findings from the ED and consultant perspective - not just your own. Imagine you are the GP receiving the correspondence without any knowledge of what happened to their patient in the ED (and that you are time poor - a summary sentence at the top is useful!) Sometimes a summary paragraph at the start may help and your ED documentation to follow.
We do not ask patients to return for follow up in the ED. Every effort should be made to make appropriate follow up arrangements outside the ED. There are of course rare exceptions: eg minor paediatric burn review at 24 hours by Prof Pennington (paed surg) if a clinic time cannot be arranged, returning for imaging (ultrasound) unavailable overnight, paediatric procedural sedation until consultant coverage in hours.
Dont forget to offer patients medical certificates when you are discharging them. It is exceptionally hard for patients to navigate the hospital system to get one from you once they leave, and consultants end up getting asked to complete them when you forget. Use a blue Bendigo Health certificate for a common sense short period of time for standard situations. Dont write one of these for your colleagues unless there is an ED attendance associated with it (the hospital doesn't accept them otherwise).
TAC and Workcover certificates use the same form. Use your common sense and familiarise yourself with these forms. If you sign somebody as unfit for work for a couple of days and you know they will be able to return to work after that then state they will also be fit for work after a certain date (some employers wont let them return to work without this). Some employers occassionally complain that we have given a week off for a minor injury - use your common sense and limit your medical certificates to the shortest possible time or a few days until they can see their GP for review.
There is a TAC claim booklet that is given to the patient to complete before they go home - they need to return it to you/ward clerk for the file. They need to complete this to the best of their ability and leave the bits they cant fill in blank. This is a Victorian wide system, not just Bendigo. If they dont do it in ED they will have to do it at some stage to access benefits including hospital charges.
Transfer Of Patients to Other Hospitals
Please make sure as much information goes with the patient as possible
1) ED Discharge summary
2) Copy ED notes, drug charts and fluid charts
3) Imaging - either on CD or via the hub and spoke system which requires you to sign a form (see previous section.)
4) Print out pathology results
5) Print any previous outpatient letters, discharge summaries or investigations which wil be useful to the reciving hospital.
The ward clerks can help you with the printing but please imagine you are doing the admission at St Elswhere and what you would like to have access to - tell the clerks what you want printed.
Pharmacy Scripts and Drugs
Your prescription for drugs to be administered in the ED are written on the usual hospital drug chart (Through EPR).
Discharge scripts are written on the usual hospital prescriptions pads which can then be taken to external pharmacies.
The Bridge Street Pharmacy at 40 Bridge Street is just around the corner from the hospital. It is open until 9pm 7 days.
The UFS pharmacy on the corner of View and Barnard street is open 24 hours 7 days.
Unsocial hours/socially disadvantaged
The pharmacy department stocks an out of hours pharmacy shelf in the ED main resus drug room. Dispensing these drugs are for patients who cant or wont for social reasons make it to an external pharmacy. A normal hospital script must be written for these items and placed in the box on the shelf in the resus drug room. The small detachable item code sticker from the medication pack you are dispensing must be stuck on the prescription form before you put it in the trolley. The patient will not be sent a bill. Panadeine Forte may also be dispensed in this way but the boxes are locked in the DD cupboard. Please note all drugs of dependence from this safe must be signed out and registered in the log next to the safe. This log is reconciled at the end of every nursing shift to ensure every tablet/ampoule is accounted for.
If discharging a nursing home patient on a new medication, then write a hospital drug chart so the nurses at the nursing home can administer the drug. Then either supply the drugs or write a normal script so the nursing home can obtain the medication. Imagine you are the nurse receiving the patient and then have to organise a Gp to visit some time in the next couple of days to get the script you have said the patient requires!
Other Important Services
All psychiatric risk assessments are done by the psychiatric triage team/ECAT. They also see patients directly and the ED is used as the location for this assessment. These patients may also require a medical assessment.
Patients may be suitable for Hospital In The Home if the are reliable, live in the catchment, have a phone and the HITH unit has space – call them on their mobile via switch to see if they do. HITH have a registrar and the HITH mobile will advise who and when the admission will be done.
Residential In Reach
Bendigo Health have staff that can advise and help treat patient in nursing homes. They can give fluids, IV antibiotics and can also help palliate patient with infusion pumps. They have a mobile that can be contacted via switch and have recently expanded their hours. Please leave a message on their mobile for all patients going back to the nursing home so they can touch base with them.
Purely palliative care patients may be suitable for the Hospice which is in a seprate building – Ring the doctor on for palliative care/hospice.
Adult Retrieval Victoria (ARV) will organize critical care transfers for patients over 15 years of age. It is part of Ambulance Victoria and based at Essendon airport Air Ambulance. They will also assist with bed finding for ICU, urgent cardiac cases unsuitable for Bendigo, and neurosurgical emergencies. 1300 36 86 61. Any questions regarding this service can be directed to Ben McKenzie and Preeti Ramaswamy who all coordinate for ARV.
PIPER - NETS, PETS and PERS have a single contact number 1300 137 650.
Paediatric Emergency Transport Service (PETS) are the paediatric critical care transfer service run out of the RCH ICU. Any patient needing PETS should also have had the Bendigo paediatric consultant called directly.
NETS – Newborn Emergency Transport Service. Any patient needing NETS should also have had the Bendigo paediatric consultant called directly.
PERS - Perinatal Emergency Referral Services - Coordinates NICU beds for patients about to deliver and can assist with advice for mothers in the perinatal period. Bendigo Consultant Obstetricians, Paediatricians and sometimes intensivists should be involved in these cases.