Acute Medical Receiving - streaming from ED direct to CDU

1. Following satisfactory scoring on a PEWS Chart on arrival in the ED, patients in the following groups will be directly streamed to Medical Paediatrics for assessment in CDU:

• Medical Paediatric patients discharged from CDU/Ward 2C within the past 48 hours re-presenting with the same condition
• Any patient seen in another ED and referred to Medical Paediatrics
• Any patient seen in a remote/distant medical setting and referred to Medical Paediatrics

2. Following initial ED nursing assessment, Triage Category 3, 4 & 5 patients in the following agreed Clinically Extremely Vulnerable (CEV) patient groups will be directly streamed to CDU for appropriate assessment:

• Primary or secondary immune deficiency, including transplant and cancer patients and those on immunosuppressive medication
• Severe respiratory disorder that requires oxygen therapy
• Severe cardiac disease
• Significant neurodisability with recurrent respiratory infections requiring hospital admission

3. Following initial ED nursing assessment, Triage Category 3, 4 & 5 patients in the following groups will be directly streamed to Medical Paediatrics for assessment in CDU:

• Infants under 3 months of age with a confirmed pyrexia ≥ 38°C as measured at triage, or by a GP or a parent/carer
• GP referrals discussed directly over the phone with Medical Paediatrics and specifically asked to attend to see the Medical Paediatric team
• Patients contacted by Medical Paediatrics for urgent same day review through GP outpatient referral vetting process
• Patients requiring further Medical Paediatric assessment/admission from a General Paediatric outpatient clinic
• Diabetic patients
• GP referrals with a history of medical symptoms for more than 1 week

4. To facilitate good communication and team working, the ED Consultant on for Majors will join the Monday-Friday CDU huddle that takes place at 12:15. The Medical Paediatric Consultant(s) on for CDU will join the daily 1600hr ED handover in the ED Seminar Room.