Category: refer

Medical SDEC

Note: If the referrer feels the presentation of a patient is not within the inclusion/exclusion criteria they can still contact the SDEC co-ordinator and check for acceptance into SDEC.

  • ED referrals ONLY 08-18:00
  • Check Capacity prior to sending
  • Investigations: FBC/U&E/Clotting/ECG

Read more

Directory of External Services

Select the area required for further details:

Patients can attend whichever they wish

Calderdale:

  • Walk in Centre – Calder Community Practice Sat & Sun: 8am – 8pm.
  • Park Community Practice Sat & Sun: 8am-8pm

Kirklees:

  • Walk-In Centre – Kirklees, West Yorks (Dewsbury and District Hospital) Mon – Fri: 9am – 8pm, Sat & Sun: 10am – 6pm

Wakefield:

  • King Street Walk in Centre, Wakefield, 7 days a week, 10am – 10pm
Councils
ServiceProviderReferral detailsWhat is the service?
Gateway to CareCalderdalecalderdale.govFirst point of contact for adults social care. Protection of vulnerable adults.
Gateway to CareKirkleeskirklees.govFirst point of contact for adults social care. Protection of vulnerable adults.
Trauma/Abuse
ServiceProviderReferral detailsWhat is the service?
Calderdale – Domestic Abuse SupportWomen Centrecalderdalestaysafe.org.ukFree, confidential support service for anyone affected by domestic abuse; help to explore options including safety advice, help with civil protection orders and court support.
Victim SupportNationalvictim support.org.ukFree confidential service for victims of crime
Men Standing UpBradford Cyreniansbradfordcyrenians.org.ukConfidential free helpline providing advice, information and emotional support to male DA victims
Sanctuary ServiceCalderdale Councilcalderdale.orgSecurity measures and safety advice whether it is the persons own home, housing association or private landlord.
Dogs Trust freedom ProjectDogs Trustdogstrust.org.ukTemp care for pets. Referrals from agencies and/or direct from the owner
KCRASAC – Rape and Sexual assault counselling and helplineCalderdale
Kirklees		kcrasac.co.ukHelpline: We are here to listen, to believe you without judgement and offer support and advice to survivors, family members, friends and partners, as well as signposting and referring to other appropriate services
Counselling: Counselling can help you explore the difficulties you may be experiencing in a non-judgemental, understanding environment.
Embrace Child Victims of Crime Embraceembracecvoc.org.ukOur support is usually delivered weekly for an average of 6 sessions remotely via Video Call or telephone through one of our team trained in trauma informed support. Referrals are accepted from all safeguarding professionals and young people may also self-refer.
EdShift SPOTLIGHTedshift.co.ukA home based outreach independent community interest company, supporting children with ‘Prevention Sessions’ - ‘Act out, Speak out’, using digital resources to advocate healthy relationships.
Respect Young People’s ProgrammeCalderdale Council Calderdale.govSupport for young people & families where young people are abusive to parents, carers and siblings
Mental Health
ServiceProviderReferral detailsWhat is the service?
VITA Health (Talking Therapies)Vita Health Group vitahealthgroup.co.ukFree, confidential talking therapy
Adult Mental Health ServicesSouth West Yorkshire partnership Foundation Trustsingle point of accessA variety of services including crisis, early intervention in psychosis and community mental health support.
Adult/Child Therapeutic servicesNoah’s Arknoahsarkcentre.org.ukCounselling and Psychotherapy (donation/fee applies) 12-24 weekly sessions offered
NorthpointYorkshirenorthpoint.org.ukone of the largest charitable providers of therapeutic services in the region, working with adults, children and young people.
NightowlsWest Yorkshirewww.lslcs.org.ukWest Yorkshire Night OWLS is a confidential support line for children, young people, their parents and carers who live in Bradford, Leeds, Calderdale, Kirklees and Wakefield. This is a pilot scheme funded till March 2022.
Forensic CAMHSYorkshireyorkshireandhumberfcamhs.co.ukA regional Forensic Child and Adolescent Mental Health Service that works with children and young people whose behaviour may be of concern to professionals, their families and/or their communities.
Sexual Health
ServiceProviderReferral detailsWhat is the service?
Calderdale Sexual health ServicesCHTsexualhealth.cht.nhs.ukConfidential treatment and education service to improve sexual health.
Brunswick CentreBrunswickthebrunswickcentre.org.ukConfidential services offering:
HIV support
HIV prevention
LGBT Mental health
Counselling
Housing
ServiceProviderReferral detailsWhat is the service?
Calderdale Housing Options ServiceCalderdale CouncilCalderdale.govTemporary accommodation
Smart MoveCalderdalesmartmove.org.ukIf you are homeless or vulnerably housed or your tenancy is at risk,
The Acorns Domestic Abuse Accommodation Support Calderdale CouncilCalderdale.govProvides a temporary safe house (refuge) and women are supported to move on.
Happy DaysHappy Dayshappydaysuk.orgCommunity support for homelessness
Men Standing UpBradford Cyreniansbradfordcyrenians.org.ukCrash pads and housing support for male’s fleeing domestic abuse
Money
ServiceProviderReferral detailsWhat is the service?
Citizens Advice Citizens Advice Bureaucitizensadvice.org.ukFree, confidential advice with debt, money, benefits, hate crime and work.
BeGAMBLEawareBe Gamble awarebegambleaware.orgWe offer free, confidential help and support to anyone who’s worried about their – or someone else’s – gambling.
Noahs Ark Money adviceNoah’s Arknoahsarkcentre.org.ukBudgeting, debt relief orders, debt management plans, individual voluntary arrangements. As part of our response to the COVID19 pandemic they are also running a food bank.
Drugs/Alcohol
ServiceProviderReferral detailsWhat is the service?
Branching Out Calderdalecalderdalerecoverysteps.org.ukFree, confidential drug, alcohol and tobacco advice and support service
the BaseKirkleeschangegrowlive.orgWe are a free and confidential drug and alcohol service for young people up to the age of 21 in Kirklees.
Stabilisation, Detox, Sober Living, Therapeutic SupportCalderdale in recoverycalderdaleinrecovery.comA range of services to help people get their lives back without the need to abuse drugs or alcohol. Hubs in Halifax and Todmorden.
Stabilisation, Detox, Sober Living, Therapeutic SupportKirklees in recoverykirkleesinrecovery.comA range of services to help people get their lives back without the need to abuse drugs or alcohol.
Hospital – Quick Codes
Airedale General #6 285
Barnsley General Infirmary #6 218
Bradford Royal Infirmary #6 172
Harrogate District #6 196
Hull Royal Infirmary #6 294
Leeds General Infirmary #6 189
Leeds St James #6 188
Manchester Royal #6 279
Mid Yorkshire Hospital 01924 541000
Sheffield Childrens #6 230
Sheffield Hallamshire #6 232
Sheffield Northern #6 231
York District General #6 306

VFC/Orthopedic – Trust Treatment & Follow-Up

Select the appropriate body area for guidance table

No Spinal injuries, back pain, Cauda Equina, foot drop etc to be referred to VFC
 

Patients that will not be suitable & need a “face-to-face” as below

  • Homeless patients
  • Prisoners
  • Non English Speaking Patients
  • Inpatients
  • Patients with Hearing Difficulties
  • Phoneless Patients
  • Injuries Associated with Domestic or Child Abuse
  • Children under 2 Years of Age
Upper Limb

Lower Limb

5th MT zones

Urology Referral Pathways

Referral

The first point of contact for urology advice and referral is the general surgical SHO. This is the on-call surgical SHO carrying the on-call bleep. Some of the on call general surgical SHO have a urology background.

If a time critical emergency such as torsion is presenting, then the first point of contact should be the urology registrar.

In the case of Urological/Surgical emergency

  1. Refer directly to Middle Grade on-call
  2. If Middle Grade unavailable/uncontactable – Contact speciality consultant on-call
  3. If NO senior available – inform ED senior
    • Admit directly (admission rights) to SAU/Ward 4 HRI
    • Attempt to contact surgical SHO (to inform)

(agreed with both surgical and urological leads)

 

Under 3’s go to Leeds

Urologist are happy to operate on patients over the age of 3 years old. Under the age of 3 if this on a urological emergency such as a torsion then this patient should be referred to Leeds paediatric urology services.

Streaming

Any patent with a post op complication for up to 7 days form urological procedure – should be streamed directly to the urology team via the surgical SHO. If the patient is unwell and needs resuscitation and immediate management for example sepsis, then ED team needs to be involved in resuscitation measures and the urological registrar needs to be involved as well

Pyelonephritis

Currently ALL Pyelonephritis should be admitted under the urology team. There is a conversation between urology and medical teams happening currently to see if that requires further rationalisation. However currently the position is all pyelonephritis patients who need admitting are done so under the urology team.

  • Uncomplicated pyelonephritis – does not require CT scanning or ultrasound scanning from the emergency department.
  • Suspicion of an obstructive uropathy –  CT KUB needs to be arranged from the ED

Investigations including:

  • FBC
  • U&E, CRP
  • Blood Cultures
  • Urine cultures

Appropriate Antibiotics should be prescribed using the current antibiotic guidelines.

Renal Colic

CTKUB are now available 24/7.

Patient presenting >50 years old  with a renal colic story, should have a ultrasound scan done at the bedside to ensure that there is no aortic aneurysm before being sent for a CT KUB.

Uncomplicated renal colic needs a non contrast CT scan. This should be organised by the ED

Uncomplicated renal colic patients can wait CT KUB for  results on SDEC. (The case must be to be discussed with the surgical SHO on-call and accepted by them before transfer of the patient. SDEC closes at 6 pm)

Haematuria

All frank hematuria needs investigation

  • Admit + 3-way catheter – those at risk of clot retention and shock 
    • Hb <100
    • Post void bladder scan>250 ml 
  • All those discharged: will need a OPD cystoscopy arranged as well as a USS (the request for flexible cystoscopy on EPR is Urol Cystoscopy  post Wd Dis)
Catheters

New catheters and catheter complications – follow current guidelines. Community nurses follow up for TWOC or other catheter care (HOUDINI team in Kirklees)

Vascular Emergencies (Regional Pathways)

Intro

Vascular surgery has been reconfigured across etc region. The vascular oncall will be based at BRI 24/7.

Multiple pathways have been developed below to help guide appropriate use – full guide HERE

AAA (Symptomatic)
 
AAA (Incidental)
 
Ischaemic Limb (Acute)

Ischaemic Limb (Critical)

Ischaemic Limb (Intermittent Claudication)
 
Uncontrolled Haemorrhage (Interventional Radiology)

Some patients benefit from control of bleeding using embolization techniques, which is a procedure performed by an Interventional Radiologist.

Patients should be treated in their receiving hospital to the maximum of that hospital’s capability, where at all possible. When all local treatment options have been exhausted, the patient should be discussed with one of the Arterial Centres (BRI) with a view to transfer for ongoing management by IR techniques.

Isolated Vascular Trauma

Diabetic Foot

Emergency Transfer

Urgent Vascular Clinic

Access is very limited to this clinic. It is envisioned by WYVas that access to UVAC for ED patients will be arranged through direct (telephone) referral to either:

  • IN hours: Local (HRI) or ON-Call (BRI)Vascular Consultant
  • OUT of hours: ON-Call (BRI) Vascular Consultant

Surgery Referral Pathway

Introduction

The Surgical and ED teams have worked closely to provide an agreed process, to aid patient flow through the ED and help to maintain our acute beds for those patient who need them.

Between 07:00-18:00 SDEC should be utilised as much as possible for those  patient who may not require admission. If you have any doubts contact the SDEC sister

SDEC exclusion criteria
  • Any patients with symptoms of or recent contacts with Covid-19 infection
  • Diarrhoea and/or vomiting
  • NEWS 4+
  • Any patient requiring oxygen treatment
  • Non-ambulant patient
  • Outlying non-surgical patients (Medicine, Orthopaedic referrals from HRI)
  • Acute vascular pathology (suspected AAA, Acute Limb Ischaemia, Diabetic Foot Sepsis)
  • Haemodynamically unstable PR bleed / Large volume witnessed PR bleed
  • Trauma patients with GCS < 15 
  • Patients with head injury or who require neurological observations
  • Suspected cauda equina-refer to CES pathway
Streaming to SDEC
Between 7AM and 6PM, the following groups of patients can be referred directly to the SDEC Nurse-In-Charge (NIC) from the ED Triage Nurse without ED doctor review (if conditions 1-3 fulfilled)
  1. ANY of the following conditions
  2. Do not meet any of the SDEC exclusion criteria
  3. Had relevant bloods and preferably a cannula (see SDEC bloods)

Conditions

  • Upper abdominal pain in Patients with known gallstones
  • Lower abdominal pain in patients aged between 16 and 50
    • With a negative pregnancy test and no PV bleeding (in female patients)
    • No prior history of inflammatory bowel disease or liver disease (in all patients)
  • Small volume red rectal bleeding in a haemodynamically stable patient

    • ‘Small volume’ rectal bleed includes bleeding predominantly on the toilet paper, <200mls, maximum of two bleeds prior to ED attendance, haemodynamically stable, no evidence of collapse/dizziness. If in doubt, speak to the NIC

    • Absence of melaena – a PR examination by ED clinical is required

  • Post-operative wound problem who have had general surgery, breast, urology or plastic surgery operations over the past 4 weeks
    • (triage nurse to have details of name of operation at time of referral to SDEC nurse)
  • Abscesses; Peri-anal, Pilonidal, Back or Chest
    • Limb abscesses should be referred to Orthopaedics
    • Groin abscesses in IVDU patients should be assessed by an ED doctor to ensure correct referral to general or vascular surgery.
    • Patients who are not septic with ‘general surgery’ abscesses who present outside SDEC opening hours can be discussed by the triage nurse with the SAU NIC. If the patient is stable, they can be sent home and asked to return to SDEC at 7AM once all the details have been given to the SAU NIC. The patients should be asked to fast from 2AM but can drink clear water up to 6AM.
  • Patients with known umbilical or groin hernia – presenting with worsening symptoms from their hernia
SDEC Streaming Bloods

Blood test requirements:

  • Abdominal pain: FBC, U+E, LFT, CRP, Amylase, Clotting Screen
  • Rectal bleeding: FBC, U+E, CRP, Clotting Screen
  • Wound problem: FBC, U+E, CRP
  • Abscess: FBC, U+E, CRP
  • Hernia: FBC, U+E, CRP, Clotting Screen
Surgical Referrals – (Non-Streaming Patients)

All other surgical referrals should be referred as normal to the surgical team. For patients who require an in-patient bed:

  • If the surgical team need a CT / Ultrasound to aid decision-making, this may be facilitated or requested in ED. If the surgical registrar feels that the patient may not be suitable for surgical admission, they should contact the on-call surgical consultant before the CT result is obtained to obtain a rapid in-reach surgical consultant review and aid appropriate transfer out of ED
  • If the surgical team feel the referral is inappropriate or unclear (or more likely to need a different specialty), senior surgical review will be delivered within 30 minutes of referral in ED with three possible outcomes (accept onto Surgery, discharge home, Surgical team to make onwards referral as necessary)
  • Criteria for contacting the on-call surgeon include:
    • Delays or difficulties in contacting the surgical team (often due to theatre or other acute pressures)
    • Delay in treatment or surgical review or indecision/disagreement on destination of the patient
    • Consultant surgical opinion should be sought early if needed by the senior ED doctor or sister in charge to avoid delays
    • The first port of call should be the first on consultant (day or night, depending on the time) and if unavailable, the second on-call consultant should be called
    • At CRH the surgical consultant can arrange for review by the “Sub-Acute surgeon”

If patients require urgent surgical assessment and/or treatment at CRH and no bed is available at HRI, the patient must be transferred immediately to HRI ED for surgical assessment