Management of inter-hospital transfers by RHC Emergency Department

Definition: These are patients already admitted to an in-patient hospital bed elsewhere being transferred for specialist input at RHC. The accepting specialty should ascertain whether that patient fulfils the red or green pathway in terms of their COVID-19 risk and organise an appropriate inpatient bed at RHCG before the child is transferred.

The ED co-ordinator must be contacted on 0141 452 (8)4585 and informed of any transfer that will need to come through ED as per the guidance below.

Ward bed ready (majority of cases):

The patient will be greeted at triage in the ED and a set of observations recorded on a CEWS chart (or last transfer observations if taken within the last 10 minutes).

If stable during transfer, with no significant change in observations and no concerns raised by the ED nurse/transfer staff, the patient should proceed directly to the ward for handover to take place there.

Ward bed not ready (exceptional cases):

The patient will be triaged in the ED and allocated to a space in the Clinical Decision Unit (CDU) or ED accordingly, with hand over to the responsible CDU/ED staff.

The accepting specialty will be paged from triage and should attend promptly to review their patient.

Resuscitation required:

If there has been an unforeseen complication or deterioration during transfer, the patient will be taken immediately into resus and attended by ED staff.

The accepting specialty will be contacted and expected to attend.

Definition: These are patients coming directly from another ED or Assessment Unit at any time, irrespective of receiving specialty.

For all transfers from an ED or Assessment Unit out with RHC accepted for specialty review the ED co-ordinator must be contacted on 0141 452 (8)4585 by the accepting specialty. 

The following information should be provided to the ED Co-ordinator:

• Patient’s name, DOB, CHI (if known)
• The service expecting the patient including a contact name and contact number of the accepting service. 
• If there is any specific planned action expected for when patient arrives in ED then this should also be communicated.

On arrival, they will be triaged and COVID-19 risk assessed in the ED and allocated a space in the ED or CDU accordingly.

The accepting specialty will be informed of their arrival. These patients (excluding head injuries) will be seen by the accepting specialty staff either in ED or CDU.

However, they will be attended by ED staff if any immediate concerns are identified at triage.

Any patient being brought to RHC by a retrieval team, including ScotSTAR MUST have been discussed with and accepted by the admitting consultant from the relevant accepting specialty, at which time an appropriate venue for specialty review in RHC should be agreed.  A COVID-19 risk assessment should be done at the point of referral to advise admission to an appropriate area within RHC.

Patients arriving with a retrieval team to an identified inpatient bed, including CDU and PICU, should proceed directly to that bed and DO NOT require to stop or be triaged in the ED.

If the child is to be reviewed in the ED (guidance above applies) the ED co-ordinator should be informed by the accepting consultant and given details of which clinician will review them on arrival and how they can be contacted.

In the event of an unforeseen complication or deterioration during transfer, the ED should be notified as soon as possible and the patient will be taken immediately into resus and attended by ED staff. The accepting specialty will be contacted and expected to attend.

Any patient being transferred by the Retrieval Team for trauma please see section 3. ‘Paediatric Major Trauma Team Activation’ of RHCG Major Trauma Team Emergency Department Activation and Response - Standard Operating Procedure” for guidance on those who require RHC ED involvement.