Paediatric Acute care Guidelines PMH Emergency Department

All Admissions

  • At Princess Margaret Hospital, the decision to admit patients from Emergency Department (ED) is ultimately made by the ED staff
  • The decision to admit patients is made in consultation with the admitting team where appropriate
  • ED staff should communicate with the subspecialty teams about their patients, if the admitting diagnosis is related to the pre‐existing condition
  • Hospital consultant staff are aware that they will be called after hours regarding both sick and private patient admissions. If junior staff encounter any difficulties with this process, or have suggestions please email Dr King or Dr Borland.
  • All admissions must have a bed requested on Enterprise Bed Mangement (EBM) system. Inform the ED Nurse Coordinator as soon as the decision to admit has been made. EBM bed requests must be authorised by the ED Consultant (or most senior Doctor after hours), and all sections filled in accurately (don’t forget isolation status, fasting status).

Private Admissions

  • Clerical staff will ask medical staff to sign a stamped section of the patient notes for a private admission.
  • ED staff may sign this after speaking to the appropriate medical consultant, or once informed by a surgical registrar that they have confirmed with their consultant.
  • Please get back to clerical staff promptly with this information, so that the admission paperwork can be completed. 

Admission of Patients to Inpatient Teams From The Emergency Department 

 General Paediatrics:

  • ED to inform the on call Medical Registrar for all new admissions. Pager 2222. For readmissions, patients previously known to a team and non-metro patients, be guided by the on call Medical Registrar (or the on call Consultant if necessary) with respect to the appropriate team/Consultant for the admission.
  • Sick patients and PICU Admissions: ED to phone the on call General Paediatrics Consultant.

Adolescent Medicine and Eating Disorders (AMED):

  • Must first be discussed with the Consultant on-call for the AMED.  Patients should not be admitted directly to the ward without prior discussion with the on-call Consultant.
  • The following groups of patients (aged 12 years and above) can be admitted under AMED:

    • young people already known to and currently managed by the Adolescent Medicine and Eating Disorders department
    • young people with a likely diagnosis of an eating disorder needing urgent admission for medical instability (i.e. those not already diagnosed with an eating disorder)
    • young people, not already known to another medical team, requiring admission for medical assessment and / or treatment as a result of deliberate self-harm and / or drug ingestion (Note: the process of acute psychiatric assessment by the Acute Response Team remains the same)
    • young people with long-term, complex health and psychosocial issues not already managed by another PMH team

    Further information – Adolescent Medicine & Eating Disorders Admissions

Metro Hospital to PMH Ward Transfer:

  • Must be accepted by admitting General Paediatric Consultant – the patient can go direct to the ward unless clinically unstable.

Hospital In The Home (HITH):

  • Confirm availability of HITH team 0730-2145 (ext 8379) 365 days per year
  • Confirm with admitting Consultant and timing/place of the review appointment. Complete an EBM request.

Medical Specialties:

  • Confirm potential admission with the team Fellow or Consultant according to the on call roster.

General Surgery: 

  • Call ext 8186: ED to confirm all admissions with on call Surgical Registrar.
  • If request private admission, Surgical Registrar must liaise with Surgical Consultant to confirm.

Surgical Specialities:

  • ED to confirm all admissions with on call Surgical Specialty Registrar.
  • If request private admission: Surgical Specialty Registrar must liaise with Subspecialty Surgical Consultant to confirm.

Paediatric Intensive Care Unit (PICU): 

Neonatal Intensive Care Unit (NICU): 

NETS Transfer:

What To Do If Subspecialty Team Gives Advice But Will Not Accept Admission

  • On occasions, patients who are deemed to require admission by ED staff are discussed with a subspecialty team, who after offering advice regarding the investigation and/or management of the patient, then decline admission of the patient under their care and request that the patient be admitted under General Paediatrics
  • Following the decision to admit a patient, the ED Junior doctor must speak with the ED Consultant/most senior ED doctor to determine the most appropriate team to admit the patient under
  • If the decision is made to admit under a subspecialty team and after contacting that team they decline to accept admission of the patient under their care, but offer advice regarding investigations and management, the following approach should be taken
    • Inform ED Consultant/most senior ED doctor of the situation ASAP, prior to organising investigations/management as suggested by the subspecialty team
    • The ED Consultant/most senior ED doctor will then make a decision to either talk directly to the subspecialty Consultant to negotiate admission under that team, OR to talk to the admitting General Paediatrics Consultant
  • If the patient is then admitted under General Paediatrics, decisions regarding further investigation and management of that patient will be made by General Paediatrics staff
  • ED staff should also contact the on call Medical Registrar to advise them of the admission and handover the patient

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