Possible Indications for ED Short Stay Unit (4E) Admission:
Undifferentiated conditions (such as abdominal pain) being observed by ED doctors with a well developed management plan and only after discussion with the ED Consultant (at any hour of the day). These do not include patients that the surgical service wish to review the next day – they should be admitted under the General Surgical Team or even a joint admission under General Surgical and General Paediatric Teams.
Uncomplicated ward overflows (e.g. under the General Paediatric Team) in a stable condition may go into the ED Observation Ward until a bed becomes available – but remain the responsibility of the admitting team rather than ED. This is limited to two patients at a time.
Conditions Excluded from ED Short Stay Unit (4E) Admission:
Undifferentiated diagnosis without clear management plan
Children with significant social issues (includes intoxicated adolescents)
Babies < 8 months
Requiring isolation as per the hospital isolation policy
Any child requiring spinal immobilisation/Philadelphia collars
Preschool children with no parent available to stay with them at all times
Complex medical issues requiring extensive nursing care (e.g. cerebral palsy, tracheostomy)
Mental Health patients (due to safety issues and length of stay whilst awaiting review)
All ED Short Stay Unit (4E) Admissions must have a bed requested on Enterprise Bed Management (EBM) and authorised by the ED consultant.
There are Criteria Led Discharge (CLD) Pathways for the following conditions which may allow patients to be discharged by the experienced ED Short Stay Unit (4E) nurse having met the pre-defined criteria:
Minor Head Injuries
Asthma and Viral Induced Wheeze
Allergic Reaction, Anaphylaxis
Post Ketamine Sedation
Please complete the CLD paperwork for this process on admission if the patient is suitable.
Medical Doctor’s Responsibility:
The ED Doctor admitting the patient to the ED Short Stay Unit will continue to manage them during their current shift
The designated 4E ED Registrar will take handover of all the current 4E patients at handover time, and be familiar with patients being admitted during their shift
All patients must be reviewed regularly during the shift and these reviews documented in the inpatient notes
Discharge decisions can occur at any time when appropriate
Care should be taken to ensure that patients are reviewed prior to shift handover to ensure iSoBAR handover is completed. 4E medical staff should seek advice and/or review by the ED Consultant on an as required basis and at the 4E ward round by the Support consultant on weekdays and the Floor Consultant on weekends following the morning handover at 0800.
4E patients admitted after midnight should not routinely be discharged without ED consultant review at 0800. Patients seen by the ED consultant prior to midnight who will be suitable for discharge prior to 0800 must have a clear handwritten plan endorsed by the ED consultant.
Cases that are complicated or where the Registrar is not happy about the management should be discussed with and/or reviewed by the ED Consultant at handover at 0800
All patients discharged from the ED Short Stay Unit (4E), require a formal discharge summary (for coding and General Practitioner communication) using the TEDS (The Electronic Discharge Summary) System to be done at the time of discharge. To facilitate this in a timely fashion, please complete a draft TEDS summary at the time of admission, which can be finalised and submitted on discharge.
Children who deteriorate or are deemed unfit for discharge within 24 hours should be transferred to the ward with admission arranged under the admitting Consultant of the day (e.g. General Paediatric Team). The change over time for admitting Consultants is 0800 – call the appropriate team based on when the decision to transfer was made. The Registrar of the unit needs to be contacted for the admission as usual. Please inform the ED nursing patient flow coordinator to arrange the ward admission.
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