Paediatric Acute care Guidelines PMH Emergency Department

Conditions for Criteria Led Discharge (CLD) for the Emergency Department Short Stay Unit (4E) include:

  • Allergic Reaction and Anaphylaxis
  • Asthma and Viral Induced Wheeze
  • Croup
  • Gastroenteritis Rehydration
  • Toxic Ingestions, Poisonings
  • Minor Head Injuries
  • Post Ketamine Sedation

The appropriate CLD forms can be printed from the Emergency Department Doctor Office computers. The forms with instructions to print are located on the Desktop. 

Policy or procedure

The treating ED Doctor must fill in in the appropriate paperwork at the time of the patient’s admission to the ED Short Stay Unit (4E):

Parents should be advised by medical staff that CLD is taking place, and that their child may be discharged by senior nursing staff if they meet appropriate set criteria. If the parent declines, CLD should be ceased, and medically led discharge re-instated.

4E Nursing Staff Responsibility:

  • CLD can be done by nurses with more than 2 years paediatric nursing experience, and with more that 6 months experience in the ED at PMH, and you must have completed CLD specific training
  • If you are rostered as the 4E nurse and do not meet the above points – the Nursing Coordinator or Patient Flow Nurse must review the patient and complete the CLD paperwork
  • Follow the criteria on the CLD form – once all have been met, discuss the patient with the Nursing Coordinator re discharge
  • At discharge also complete the CLD data log for all patients
  • If the patient cannot meet all the criteria, or if you feel discharge is inappropriate (despite meeting the criteria), discuss with the Nursing Coordinator – a medical review can be requested
  • Patients who clinically deteriorate should have a medical review and the CLD ceased (document this in the variances section of the form)
  • Inform the 4E Registrar that the patient has been discharged (so that the Discharge Summary can be finalised)

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