Ambulatory medicine

AEC Same/Next Day

AEC is an assessment area run by the Acute Medicine department. Patients have to be stable, ambulatory and able to be discharged with the same package of care. They should have a realistic chance of being discharged home.

For same-day assessment:

  • AEC ext. 4453.
  • Patients can be referred between 08:00-22:00 with last referrals from ED at 20:00.
  • If streaming from triage, please use this referral form.

Referrals for next day assessment on AEC:

  • All referrals should be done via the electronic referral platform.
  • If the patient is to return to AEC for further imaging this must be requested by the ED team using the Out of hours imaging requesting SOP.
  • The AEC team will call the patient the next day with a time to return for further assessment. Do not tell them just to turn up.
  • If bridging anticoagulation is being given (ie ?PE) – 7 day supply of apixaban is stocked as a TTO in ED / AEC.
Community DVT

This service is for ambulatory, clinically stable patients that require assessment, diagnosis and management of suspected DVTs.

Patients must live in Walsall.

Availability:

08:30-21:30 7 days a week

Clinical Intervention Team (CIT) contacted via 01922 604920

  • Option 3 – 08:30-18:00
  • Option 2 – 18:00-24.00

Suspected DVTs may be sent home directly from triage. All assessment, investigation and need for anticoagulation will be provided by the CIT team.

The hospital Integrated Front Door team can offer advice/ assistance in referring to community pathways: Bleep 2333.

OPAT

Outpatient Parenteral Antibiotic Therapy (OPAT) is for clinically stable patients that require intravenous antibiotics.
Typically this is ambulatory patients with cellulitis, chest infections or complex UTIs (although other infections may be considered).
Housebound patients may also be considered.

Patients must live in Walsall.

The hospital Integrated Front Door team can offer advice/ assistance in referring to community pathways: Bleep 2333.

Referral Process
Referrals can be made using the e-referral system.
However, between 0830 and 2130, please also call 01922 604920 (option 2), so that an appointment time can be arranged and given to the patient before discharge.

Out of range INR

For follow up for patients with out of range INR refer to the CIT team:

0830- 2130, call 01922 604920 (option 2).

Integrated front door team

Bleep 2333

Monday- Friday 9 – 20.00 ( based out of POD 2 in front of ED 17.00-20.00. Last referral 19.00)

They aim to assess, diagnose and treat to avoid hospital admission. They can assist with referral to community services and pathways

Criteria:

>18yrs with a Walsall GP/ address.

News score < 4 ( not 3 in one area ).

With any of the following:

  • Cellulitis
  • Chest infection / COPD
  • UTI
  • DVT
  • Catheter-related problem ( unless urology intervention required).
  • Elderly fall with no injury.
  • Wallsall residential or nursing home patient.
  • Patient attending with clear hospital avoidance plan.

Anaesthetics

Guidelines

Antibiotic Guidelines

Cardiology

Guidelines

Aortic Dissection

  • Aortic Dissection – RCEM best practice guide (2021)
  • Aortic Dissection – Walsall Speciality Guideline (2021)
    • For confirmed Aortic dissections: Type A please link images and contact NewCross Cardiothroacic team. For type B dissections distal to the left subclavian contact the vascular team at Russels Hall or QE.
    • Involve the cardiology team for difficult referrals.

Arrhythmia Management

Chest Pain

Hypertension

Pulmonary Oedema

Other

Prescribing

  • GTN – Walsall Speciality Guideline (2020)
  • Labetalol – Walsall Speciality Guideline (2020)
  • Isoprenaline – Walsall ED Local Guideline (2020)

TLoC and Syncope

  • Syncope – Walsall ED Local Guideline (2020)
Clinic

Arryhtmia & Chest Pain Clinic

Please use the electronic referral platform.

  • Acceptance criteria:
    • Suspected cardiac chest pain of recent onset
    • Acute heart failure
    • Arrhythmia
    • Syncope:
      • Medium risk – see ED guidelines – suitable for Cardiology Clinic
      • Consider high-risk syncope for same day review in AEC
Community Heart Failure

For patients not requiring admission but do require follow-up in the community, referrals can be completed using the ereferral platform

Coroners

Guidelines

Medical Examiner / Coroners Notification Process

COVID-19

Virtual Ward

This pathway is still active, but inclusion criteria have now been expanded – see “Acute Respiratory Infection Safe at Home Pathway” in the respiratory guidelines.

COVID-19 Safe at Home (Virtual Ward) – Walsall Trust-Wide Guideline (2020)

Referral form for virtual ward.

This is for patients who are at risk of developing complications due to COVID-19. They will receive a phone call three times a day from the acute medical team and will be given home oxygen saturation monitoring.

Referrals are made via phone 08:00-24.00:00 seven days a week. Please give the patients details of any referred patients to reception as they keep a log of referred patients.

Referrals forms out-of-hours should be handed to reception who will refer the patient in the morning. Patients should still be sent home with the information pack and portable oxygen saturation monitor.

Call 01922 604 920 opt. 1 to make a referral. They will go through the list of questions on the referral form.

Patient information packs and portable oxygen saturation monitors are currently located in the ED reception.

Inclusion criteria:

  • Suspected or confirmed COVID-19
  • Patient is displaying signs/symptoms of COVID-19 pneumonie i.e.
    • Shortness of breath
    • CXR changes
    • Significant derrangment in inflammatory markers

OR

  • At risk of complications due to advanced age or high-risk comorbidities

Exclusion criteria:

  • Age under 18 years.
  • Patient with advanced dementia / frailty unless there is someone resident with them and can assist with the monotoring and phone calls for up to 14 days
  • Patient with Chronic lung conditions on home oxygen
  • Those who are not resident in the area

Recovery Trial

Diabetes & Endocrine

Guidelines

Diabetes

DKA

Endocrine

Hyperosmolar Hyperglycaemic State (HHS)

DM Foot Clinic
  • All diabetic foot problems not requiring admission should be followed up
  • Use the eReferral platform to complete referrals.

See Diabetic Foot Pathway for more details

DM Nurse

Available Monday to Saturday 08:00-16:00.

Bleep 8307 for review in ED or AEC.

Please use the electronic referral platform for out of hours follow up.

New Diagnosis of Diabetes

Patients can be reviewed in AEC the next day – see Newly Diagnosed Diabetes Mellitus Pathway for acceptance criteria. Refer to AEC using AEC referral form.

Department Operation & Escalation

Guidelines

Escalation

Referral

Please note the following referral principles:

  • Referral from ED is a one-way process.
  • If the speciality then feels that the patient belongs to another speciality, they need to refer the patient and give feedback to ED either verbally or through an incident form.
  • Response times by specialist registrars to sick patients should be 30 minutes or less. If no response within 30minutes ( or sooner in a time-critical situation ) this should be escalated to the relevant speciality consultant.
  • Referrals cannot be refused over the telephone.

Elderly Care

Guidelines
Care Home Residents
  • All Care Homes ( residential and nursing homes in Walsall) have access to the Enhanced Healthcare in Care Homes team to enable supported discharge from the ED.
  • An ANP or GP does a weekly ward round and will also see urgent referrals to prevent unnecessary hospital admissions.
  • If a patient requires a review after discharge email, please use the electronic referral platform to complete a referral.
  • The Rapid Response Team also cover Care Homes 7 days a week 8am-9.30pm and can be accessed via the Care Navigation centre ( 01922604920 ).
Frailty Service

Availability:
Frailty Nurse 08:00-22:00 Monday to Friday
08:00-20:00 at weekends
Bleep 4047, Ext: 3241, 3242, 3245.

Criteria
Any of

  • >75 years old
  • >65 and from nursing home, residential home or sheltered accomodation
  • Clinical Frailty Score >4
  • Previously labelled as ‘living with frailty’
  • Advanced care plan in place for hospital avoidance.

AND

  • No immediate involvement required from alternative speciality

FES services

Please specify what is required from this list:

  • Frailty Consultant review for clinical input:
    • Delirium or acute chnages in dementia.
    • Falls
    • Polypharmacy
    • Complex Social Circumstances
    • Syncope
    • High frequency ED attender
  • Acute deterioration in mobility requiring assessment or acute social care crisis
  • Frailty team are happy to discuss all patients if there is concern.

Frailty team are happy to see patients following:

  • Assessment and intervention for injuries must be done before referral to frailty
  • Frailty are happy to review outstanding bloods and non-traumatic CXR

Streaming to the FES service from Rapid Assessment (RAT):

Intermediate Care

ICS are a team that provide social support for patients that can potentially be discharged.

08:00-16:00 Monday to Friday (Bleep 2056 at weekends).

Call ICS admin on extension 7333 during the week.

If patient meets FES acceptance criteria then refer to FES.

If <65 but patient needs a package of care, is self-neglecting or requires social care input then contact ICS.

For homeless support – ICS can assist

FES Follow up
  • For patients who are safe for discharge overnight but require Frailty team input.
  • Patient will be followed up, next day, by phone with further review arranged if necessary.
  • Please use the electronic referral platform to complete a referral.

Electrolytes

Guidelines

Emergencies – Resuscitation Council (UK) 2021 Guidelines

Adult

Anaphylaxis

Bradycardia Algorithm – Resuscitation Council (UK) Guideline (2021)

Acute Coronary Syndrome AlgorithmResuscitation Council (UK) Guideline (2021)

Advanced Life Support Algorithm – Resuscitation Council (UK) Guideline (2021)

Basic Life Support Algorithm – Resuscitation Council (UK) Guideline (2021)

Choking Algorithm – Resuscitation Council (UK) Guideline (2021)

In-Hospital Resuscitation – Resuscitation Council (UK) Guideline (2021)

Post Resuscitation Care Algorithm – Resuscitation Council (UK) Guideline (2021)

Reperfusion Therapy STEMI Algorithm – Resuscitation Council (UK) Guideline (2021)

Tachycardia Algorithm – Resuscitation Council (UK) Guideline (2021)

Paediatric

Advanced Life Support Algorithm – Resuscitation Council (UK) Guideline (2021)

Advanced Resuscitation of the Newborn Infant Algorithm – Resuscitation Council (UK) Guideline (2021)

Basic Life Support Algorithm – Resuscitation Council (UK) Guideline (2021)

Cardiac Arrhythmias Algorithm – Resuscitation Council (UK) Guideline (2021)

Choking Algorithm – Resuscitation Council (UK) Guideline (2021)

Emergency Drug Chart – Resuscitation Council (UK) Guideline (2021)

Newborn Life Support Algorithm – Resuscitation Council (UK) Guideline (2021)

Gastroenterology

Guidelines

Endoscopy/Colonoscopy Fast Track

Not to be used for routine referrals

Please use the electronic referral platform to complete a referral.

  • Upper GI inclusion:
    • Dysphagia
    • >55 years AND wight loss AND upper abdo pain OR reflux OR dyspepsia
    • Abnormal radiology suggestive of malignancy
  • Lower GI inclusion:
    • >60 years AND iron deficiency anaemia OR change in bowel habit
    • >50 years with unexplained rectal bleeding
    • Positive faecal occult blood
    • Palpable rectal mass

Endoscopy/Colonscopy Routine

For suspected cancers, use Endoscopy Fast Track Referrals
Please use the electronic referral platform to complete a referral.

For routine referrals –

  • Upper GI inclusion:
    • Treatment resistant dyspepsia
    • Iron deficiency anaemia
    • Barrett’s surveillance
    • Gastric ulcer healing
    • Varices surveillance
    • Query Coeliac Disease / check dietary response
    • Upper abdo pain associated with weight loss, anaemia or nausea and vomiting
  • Lower GI inclusion (colonoscopy):
    • Persistent diarrhoea
    • Colorectal cancer surveillance
    • Polyp surveillance
    • IBD surveillance / assessment
    • Abnormal radiology not suggestive of malignancy (proximal to sigmoid)
  • Lower GI (flexible sigmoidoscopy):
    • <50 years with persistent/recurrent rectal bleeding
    • Abnormal radiology (rectum/sigmoid)
    • Surveillance of pouch or rectal stump

PEG Nurse

Available Monday to Friday 0830 – 1630

Bleep 8121

Extension 5705

Ascites drainage

The Paracentesis Out Patients Pathway for stable patients, with known liver disease, requiring ascitic drain.

  • Available in the Medical Day unit on Monday, Wednesday and Friday. Patients are to arrive at the unit at 8.00am.
  • DIscuss with the Liver specialist nurse to see if a referral is appropriate and to help arrange an appointment.

Inclusion criteria:

  • Patients with established hepatic cirrhosis and tense confirmed transudate ascites, or symptomatic transudate ascites refractory to treatment.
  • The patient has a named gastroenterology consultant over-seeing their care.

Referral

Please note the paracentesis service is for patients with established liver cirrhosis only, they don’t accept patients with ascites from any other aetiology and not for those newly presenting. The wait time is usually 2 weeks, so if the patient is uncomfortable, it is likely they would need to be admitted. 

Gastro HOT clinic

The gastroenterology HOT clinic runs weekly.

Referral criteria:

1.       Abnormal LFTs.

2.       Suspected new IBD.

3.      Low-risk upper GI bleed.

4.       Probable new decompensated liver disease, but not needing immediate admission.

5.       Cyclical vomiting/difficult abdominal pain.

Refer via email:  gastrosecs.walsall@nhs.net

Liver Nurse
  • Please direct queries regarding liver patients presenting to ED to our liver specialist nurse:
  • Louisa Bridgwood ext 7469, mobile 07816084420.
  • Tuesday – Friday 9-5
  • She can help with bridging the gap between the next appointment and presentation to ED with a phone call to the patient. She also facilitates the paracentesis service.

GUM / Needlestick

Guidelines

Haemotology / Blood Products

Guidelines
  • DVT pathway: NICE guidelines summary under Respiratory PE guidelines.
    • 8.30 -21.30 suspected DVT’s should be referred to CIT team from triage (see ambulatory medicine section) for investigation and treatment.
  • Massive Haemorrhage Protocol – Walsall ED Local Guideline (2021)
    • O-neg blood is available immediately at the blood bank fridge (Barcode card is required).
    • FFP must specifically be requested for in the packs.
    • Activate by phoning blood bank NOT SWITCH BOARD.
  • Level One Rapid Infuser – Training Video

Warfarin Reversal – Walsall Speciality Guideline (2016).

  • For follow up for out of range INR – refer to the CIT team- see ambulatory medicine section.

Blood Transfusion Policy – Walsall Trust Wide Policy (2018)

  • This includes Guidelines on the use of Octaplex (pages 43 – 46)

Sickle cell disease regional guidelines (2021). Please note these guidelines are waiting for a local update ( for contact numbers ) but in the meantime, they contain a lot of useful information.

Anticoagulation clinic

For patients commenced on long term anticoagulation.

Referral form to be sent to anti.coag@nhs.net.

Mental Health

Guidelines

Rapid tranquillisation and excited delirium guidelines can be found under the anaesthetic heading.

Psychiatric Liaison

Adult Psychiatric Liaison Services (24 hours) Bleep 8321

Mental health management escalation SOP: When mental health assessment in the ED is delayed or extra support is required.

Older Peoples Mental Health

Service available seven days a week, between 0800 and 1800 daily. Last referrals taken at 1600.

  • Bleep 2037 during service hours.
  • Out of Hours Bleep Adult Psych Liaison 8321

Neurology

Guidelines

Other

Seizures

Stroke

Neuro Clinic

Referral Criteria

Referral Pathway

TIA Clinic

For follow-up of suspected TIAs

Acute Stroke Contact

Please call New Cross acute stroke team on.

07775117096 during the week

07775117309 at weekends

Obs & Gynaecology

Guidelines

Gynaecology

Obstetrics

EPAU Follow Up

Telephone Ward 23 (ext. 6213 / 7283) and ask for the patient to be put in the appointment book

  • Must be haemodynamically stable with no suspicion of ectopic pregnancy with any of the following:
    • Early pregnancy bleeding
    • Pain in early pregnancy
    • Following fall/injury to assess viability
Clinic
  • To arrange to follow up for Obs and Gynae cases please contact the speciality registrar to organise.
  • Postmenopausal bleeding 2-week referral use the e-referral system

Oncology

Guidelines
Acute Oncology Nurse

Acute oncology nurse

  • For ED review or advice for oncology patients or suspected metastatic spinal cord compression.
  • Monday- Friday 9am-5pm.
  • Bleep: 7056, Mobile: 07812 745194.
  • Follow up of oncology patients out of hours:
  • Oncology clinic follow up clinic. Please use the electronic referral platform to complete a referral.

Out of hours advice contact the on-call Oncology registrar at UHB.

Haematology Cancer follow up/ advice

  • Haematology cancer patients not requiring admission can be followed up by the haematology specialist nurse.
  • Monday – Friday 9-5: Bleep 7003 , EXT 7162, MOB: 07929744302.
  • Out of hours: Email: victoria.evans@walsallhealthcare.nhs.uk

2 Week Wait Referrals
  • Follow up for cancers found on imaging:
    • Respiratory 2-week wait referral form for possible new lung cancer on CT: Referral form
    • Cancer of unknown primary. Ie for an incidental finding of metastatic deposits on imaging done in ED. Referral form

  • If it unclear what pathway to use discuss with the acute oncology nurse.

Respiratory 2 week wait referral:

Cancer of Unknown Primary:

Oncology clinic:

  • 1 week fast track referral in patients known to oncology. Referral form.

ED Suspected Cancer Referral (2 week wait):

Orthopaedic & Minor Injuries

Guidelines
ED Clinic

Clinic booked via reception. See criteria and exclusions

Currently, treat this clinic as a soft tissue review clinic including:

  • Animal bites that require secondary closure and review
  • Burns that require 24 hours review
  • Suspected Scaphoid fractures that require 14 day review
  • High risk and dirty wounds
  • Fractures / injuries only identified within the ED fracture management policy
Fracture Clinic

Use, as per the ED fracture management policy.

Reception can give appointment letter

You are not able to refer straight to knee clinic, these patients are referred to knee clinic at the discretion of fracture clinic clinicians

N.B. If you have booked an appointment for a fracture requiring manipulation or one that may require surgical intervention, then bleep the T&O SHO and ask them to discuss it at the morning trauma meeting

HOT Hands Clinic

Clinic is managed by Plastics at the QE

NORSE link (Only works on WMH Computers)

  • Refer open wounds requiring exploration
  • Refer suspected tendon ruptures requiring fixation / assessment
  • Refer open fractures or those that may require surgical fixation
  • Refer suspected or confirmed nerve damage
  • NORSe will provide advice regarding treatment and timeframes for review
Physio

Musculoskeletal physiotherapy is for treating patients with acute or chronic conditions

Patients can self-refer via this number 0121 568 4311

Other

Guidelines

Paediatrics

Guidelines

Asthma

Bronchiolitis: Walsall speciality guideline (2021)

DKA paediatric calculator: (BSPED) To be used in all paediatric DKA patients in Walsall. It will generate a DKA protocol for you to follow.

Fever in under 5s summary– NICE (2019)

Head Injury – Nurse Led Discharge Proforma: Walsall ED local guidelines (2021)

Hyperammonemia and Ammonia Scavenging Medications guideline– Walsall speciality guideline (2021)

Hypoglycaemia pathway- Walsall ED local guideline (2021)

KIDS: The following is available on the KIDS website:

  • KIDS drug calculator: Download via Kids website
  • KIDS clinical guidelines including:
    • Management of the critically ill child.
    • Button battery ingestion.
    • Cardiac disease/ prostaglandin infusion.
    • DKA.
    • Major haemorrhage guidelines.
    • Severe asthma/ bronchiolitis.
    • Status epilepticus.
  • KIDS transfer service. A KIDS NTS consultant is available for advice or to arrange the transfer of any critically unwell paediatric patient. Call 0300 200 1100

Neonatal ANP- For support with neonatal emergencies: Bleep: 4025

Limping child pathway: Walsall ED ( July 2021)

Paediatric Emergency Medicine Guidelines – Paediatric In Partnership (PIP) (2022)

Seizure

Safeguarding

Burns

Midlands Burn Operational Delivery Network (MBODN) Referral Criteria:

  • Total Body Surface Area (TBSA) >5% in patients over 6 months old but younger than 16
  • Children with an inhalation injury defined as visual evidence of suspected upper airway smoke inhalation, laryngoscopic and/or bronchoscopic evidence of tracheal or more distal contamination / injury or suspicion of inhalation of non soluble toxic gases
  • Children over 6 months to 1 year old with up to 1% TBSA Full Thickness Burn (FTB)
  • Children between 1 and 10 years old with FTB of more than 2%TBSA
  • Children between 10 and 16 years old with a FTB of more than 5% TBSA
  • Children with any significant burn to the face, hand, feet or genital area
  • Children with a circumferential burn to a limb
  • Children with high voltage electrical burns
  • Children with severe chemical burns

A burn unit will routinely admit children for the management of both minor and major burn injuries. Guidance on the age and severity of burn injury to be managed within a burns unit:

  • Children between 6 months and 1 year with a burn less than 10% TBSA
  • Children older than 1 year with a burn less than 30% TBSA
  • Children older than 1 year with a FTB of less than 20% TBSA

The full MBODN referral guideline can be found here

Midlands Burn Network Patient Referral Flowchart – MBODN (2015)

Midlands Burn Network Information and Advice for the care of Children with Small Burn Injuries Not requiring admission to a Burns Service – MBODN (2015)

Telephone plastics registrar at Birmingham Childrens Hospital via switchboard on

0121 333 9999

Hot Clinic

Please use the electronic referral platform to complete a referral.

  • Will see any paediatric medical problem that does not require admission
  • For Paediatrician review as an outpatient – usually following discussion with Paeds Reg or Consultant
Plastics and Hand trauma

All referrals to Plastics/ Hand trauma to the Birmingham Women’s and Children’s Hospital and Department of Plastic Surgery will be via their App. The TriVice mobile app can be downloaded from the App Store or Google Play store and is also available as a web-based desktop version.

  • The service will launch on 1st Feb 2022.
  • The app contains lots of information on referral and management pathways.
  • The app can be used to securely upload images.
  • Please click here to view a demo video: https://youtu.be/sM13U-PJ3Dk
  • A guide for referring units can be found here: https://youtu.be/y_sI_h8dbSo

Palliative

Palliative Care Teams

Hospital palliative care nurse:

  • Available Monday to Sunday 09:00-16:30.
  • Ext. 7324 / 7111
  • Bleep:  8063/8030

Fast-track intermediate care service. For imminently dying (within 4 weeks) patients requiring facilitation for discharge.

  • Bleep 5040.

Out of hours Compton Hospice Consultant available via Compton Care switchboard for advice on 0300 323 0250

Community Team

01922 602 620 or ext. 2620.

If patients are going to their own home or a residential home the patient will need a district nurse referral.

Renal

Guidelines
AKI Nurse

AKI Clinical nurse specialist

  • Available for advice/review.
  • Bleep 8160 between 9:00 – 15:00 Mon- Fri.

Respiratory

Guidelines

Non-Invasive Ventillation (NIV)

Pulmonary Embolism

  • DVT/PE Pathway and treatment summary– NICE (2020)
    • 8.30 -21.30 suspected DVT’s should be referred to CIT team from triage (see ambulatory medicine section) for investigation and treatment.
  • Massive PE – Walsall ED Guideline (2022)
  • PE – Walsall Speciality Guideline(2021)

Scoring Systems for PE

  • Well’s Score for PE – MD Calc
    Two-Tier Well’s score endorsed by NICE (2020) as a risk stratification for liklihood of VTE.
  • Age-Adjusted D-Dimer – MD Calc
    Adjusted D-Dimer threshold for DVT/PE for patients ages 50 years or older, as endorsed by NICE (2020).
  • PERC Score – MD Calc
    Used to rule out PE without the need for D-Dimer testing if the diagnosis is clinically considered unlikely. Use if risk of PE is low (i.e Well’s Score 0-1) and no unexplained breathlessness. Endorsed by NICE (2020).
  • PESI Score – MD Calc
    The PESI Score is used to identify low-risk patients with confirmed or suspected PE are suitable for outpatient management. Endorsed by BTS (2018).

Spontaneous Pneumothorax – BTS (2010)

Pleural Clinic

The pleural team provides a wide range of diagnostic tests and treatments for patients with pleural disease including:

  • Thoracic ultrasound
  • Diagnostic or theraputic pleural aspirate
  • Intercostal drain insertion using guide-wire
  • Indwelling pleural catheter insertion, management and removal
  • Surgical Pleural Biopsy and Pleurectomy (via the Thoracic Surgical Service)
  • It can also provide further assessment of patients with pneumothorax, pleural infection, cancer-related pleural effusion, mesothelioma.

Referral:

Pleural team will contact the patient to schedule an appointment. Pleural Clinic occurs every Tuesday morning, route 004 Outpatients procedure room. They aim to see patients within 2 weeks of referral or sooner if urgent.

Use the electronic referral platform for referrals.

Respiratory Clinic

Please use the electronic referral platform for outpatient follow-up.

Review patients in clinic (COPD, Asthma, Bronchiectasis etc.) – see referral criteria for full list of accepted patients.

Will follow-up patients virtually in the community if specified – they will typically call the patient the next working day and arrange review if required.

Referral Criteria

Referral Pathway

Respiratory Nurse

Respiratory nurses are available from Monday to Saturday 08:00-16:00

Bleep 8055 / 2377

Ext. 5218 / 5216

Same Day Review

  • Same day review in ED for supported discharge
Acute Respiratory Infection Safe at Home Pathway

This service is intended to enable early supported discharge for patients with an ARI. Patients will be discharged with a pulse oximeter and will report their readings, temperature and general wellbeing to community nurses 3 times a day. Medical advice is being provided to the community nurses via Rapid Response and the AEC phone line. Patients that may require more specific follow on care will be discussed in a Community Respiratory MDT.

Who can you refer?

Patients with the following clinical features are likely suitable: 

  • Suspected or confirmed respiratory infection including COVID-19 
  • Oxygen saturations of 95-100%, NEWS2 < 3, clinically stable and/or improving
  • No significant respiratory comorbidities.

Patients with the following clinical features may be suitable where clinically appropriate:

  • Saturations of 93-94% and/or NEWS2 of 3-4 with improving clinical trajectories
  • Saturations of 88-94% (or baseline) if known chronic hypoxia e.g. COPD

Exclusion Criteria:

  • Age under 16 years.
  • Patient with advanced dementia / frailty.
  • Those who are not resident in the area
  • Unstable or worsening clinical trajectory 
  • Severe or life threatening pneumonia, asthma or COPD
  • CURB 65: ≥3 (confusion, Urea >8 RR>30 and SBP <100 and age >65)
  • Suspected Sepsis
  • Chest pain of concerning cause
  • Pregnant women with saturations of less than 94%

How can you refer?

To refer ring 01922604920, Option 1 (08:00-24:00, 7 days) with the following information:

  • Patient Personal Details
  • Preferred language
  • Living and care details
  • Symptoms
  • Clinical Observations
  • Comorbidities

The Acute Respiratory Infection Safe at Home pack is available from reception which includes patient information and the SPO2 probe.

Four Important Points to Note

  1. The patient is not on the pathway until accepted by community via the number. Please ensure you refer the patient first. 
  2. Comprehensive records are being kept by the community teams but please document the referral on your clinical notes.
  3. The oximeters will be retrieved by the community team. The paperwork explains this but please help set patient expectations that they are not able to keep the device.
  4. Capacity on the pathway is limited by the amount of patients that can be safely monitored in the community. Please use this pathway for early supported or same-day discharges.

Sepsis

Guidelines

Surgical/ ENT/ Urology

Guidelines

ENT

  • Bell’s palsy: Walsall ED local guideline (2021)
  • Epistaxis management: Walsall ED local guideline (2021)
  • Food bolus obstuction: No formal guidelines. If obstruction is felt to be high up then refer to ENT, otherwise refer to medicine.

Surgery

  • Acute diverticulitis – NICE (2019)
  • Bowel obstruciton: As agreed with radiology:
    • CT abdomen is the invetsigation of choice, in cases of suspected bowel obstcution, rather than AXR .
    • AXR may occasionally be helpful in limited cases of large bowel dilatation such as known sigmoid volvulus or ulcerative colitis with suspected toxic megacolon.
  • Surgical Emergencies – Walsall ED Local Guideline (2020)

Urology

  • Renal Colic – Walsall Speciality Guideline (2014) still in use as of 2020.
    • For out of hours renal colic patients see the ” surgical virtual clinic” section.
  • Urinary Retention – Walsall Speciality Guideline (2018).

Vascular

ENT Clinic
  • Please use the electronic referral platform to complete a referral for the following:
    • Recurrent epistaxis.
    • Vertigo that has not improved with outpatient treatment by the GP. Central causes of vertigo must have been excluded.
    • Bell’s Palsy patients:  Offer ALL patients an ENT virtual telephone appointment (with an otologist – Mr Turner or Mr Desai) within 4 weeks.  
    • Retained foreign body, unable to retrieve in ED – non-urgent. Toxic FB should be discussed with the oncall team.

  • Referrals via reception:
  • Nasal fracture:
    • Book via reception. They will give an appointment letter.
    • Need to be seen approx 7-10 days post injury if deviated septum.
    • If appointment wait >10 days, speak with Surgical SHO to force book it as any deformity actually needs to be corrected before 14 days.
Max Fax Clinic
  • Patients who require review should be discussed with the on-call SHO at New Cross Hospital.
  • The reception team have handouts with the number for the local emergency dentists.
Surgical Virtual Clinic

For stable patients requiring investigation e.g.

  • Biliary colic
  • Renal colic

Discuss with Surgical SHO, and they can request outpatient ultrasound or CT for virtual review within 72 hours.

If SHO requests an ED clinician to book scan, then make sure the patient’s mobile number is included in the request. For further information on how to request OP ultrasound scans see the SOP for requesting USS scans for the surgical OP clinic.

Urology HOT clinic

Urology HOT clinic

  • Reception can give appointment letter
  • Acceptance criteria:
    • Acute/chronic retention that has been catheterised to work towards TWOC.
    • Haematuria that does not require admission
    • Renal colic (stable)
    • Scrotal pain that has been investigated with ultrasound
Vascular clinic
  • For referrals to the vascular clinic, use the e-referral platform.
  • For non-emergency vascular follow up. No specific criteria.
  • Follow up for incidental aortic aneurysms <5.5cm.

Toxicology and Alcohol

Guidelines
Alcohol Liaison Nurse
  • Alcohol Liaison Nurse in avalible to review patients in ED who presented with an alcohol related attendance.
  • Hours: Monday- Friday 8am-4pm.
  • Contact details: Mob: Kelly Albutt 07971 964610 or Mandy Jones 07977 055975 or extension 5911.
CGL Beacon Referal

Referrals to The Beacon drugs and alcohol misuse service:

In hours phone: 01922 669840.

Email: Provide the patients name and DOB along with a brief history: thebeacon.wasall@cgl.org.uk and CC in Kelly Albutt (kelly.albutt@walsallhealthcare.nhs.uk).

For out of area referrals emailKelly Albutt and she will refer on.

CGL Beacon patient referral leaflet

Community Liaison Team

Please use the eReferral platform to make a referral to the community alcohol team (Beacon).

Trauma

Guidelines

Major Trauma

Patients with multiple traumatic injuries or unstable patients should be discussed with the trauma team lead, via WMAS trauma desk on 01384 215695.

For cases where it is felt that the ambulance service should have brought the patient to an MTC instead of Walsall please fill out a TRID form.

Adult Burns

Midlands Burn Operational Delivery Network (MBODN) Referral Criteria:

  • Total Body Surface Area (TBSA) >10% in a patient over the age of 16
  • Patients with an inhalation injury defined as visual evidence of suspected upper airway smoke inhalation, laryngoscopic and/or bronchoscopic evidence of tracheal or more distal contamination / injury or suspicion of inhalation of non soluble toxic gases
  • Patients with compromised immunity
  • Patients that are pregnant and present with complications as a consequence of theburn injury
  • Patients with a non-blanching burn injury greater than 5% TBSA
  • Patients with circumferential burns requiring escharotomy
  • Patients with any significant burn to the face, hand, feet or genital area
  • Patients with a circumferential burn to a limb
  • Patients with high voltage electrical burns
  • Patients with severe chemical burns

The full MBODN referral guideline can be found here

Midlands Burn Network Patient Referral Flowchart – MBODN (2015)

Management of Burn Injuries in the Emergency Department Guideline – Midland Burn Operational Delivery Network (MBODN) (2021)

Advice and follow-up for burns that are not suitable for ED Clinic review
Refer via NORSe (Intranet only)

Midlands Burn Network Minor Burns Dressing Flowchart – MBODN (2015)