Ward 46

Simple intoxications who are likely to make an uneventful recovery from alcohol
and/or recreational drugs are admitted to ward 46 under Emergency Medicine. The
expectation is that they will require only observation and should be able to “sleep it
off”. They don’t normally require blood tests or other investigations and can have
plans such as “suitable for discharge once recovers and mobilising safely”
documented in the notes and SBAR.

Where patients present to the ED and have a head injury with a positive CT scan not
requiring neurosurgery, they can be admitted under EM in Ward 46. Please discuss
with the consultant or registrar in charge before admission. Where the scan is
negative and if the patient is not suitable for discharge, the patient should not be
admitted under EM, but under the appropriate specialty for the condition that is
preventing their safe discharge. Examples of this are elderly people with frailty and
poor mobility who have head injuries with normal scans, they should be admitted
under General Medicine for DOME review.

The following conditions are appropriate admissions, where the anticipated stay is less than 24 hours with no anticipated discharge delays:

• Low risk chest pain HEART Score </=5, and unable to repeat Troponin in
  ED or ambulatory care area.
• Collapse with normal ECG.
• Seizure if isolated and admitting for observation as post-ictal.
• Neurological symptoms (not CVA/TIA), but requiring medical review.
• Asthma/ COPD with early discharge anticipated.
• Overdoses with expected benign course. This includes admission for
  treatment of paracetamol overdose once the first hour of treatment has elapsed
  in ED. Ask ward nurses to refer to psychiatry liaison if required.
• PTE if low risk and clinically well enough to await further investigation.
• Acute headache with normal CT, usually for LP.
• Hypoglycaemia if not suitable for discharge from ED despite treatment (eg
  long acting hypoglycaemics/other medical issues).

Complete SBAR and request a bed in Ward 46 under GM or EM on Trakcare.
All patients should have a full clerk in type admission (not on the back of the ED
cover sheet) with a clearly documented differential diagnosis and management plan.
It should state that the patient is admitted under GM or EM.

For any medical admissions we are referring these for another assessment by this
specialty and they require appropriate baseline investigations eg ECG, Bloods.
Please carry these out in the ED before the patient is admitted under medicine.

When the hospital is busy you may be asked if your patient (usually a medical
admission) is suitable to board to Ward 46. These patients should be stable with low
likelihood of needing medical input overnight as the ward does not have medical staff
based there out of hours. Again if unsure discuss with senior ED medical staff before
deciding.

Finally for all admissions to ward 46 please ensure a treatment plan to cover the
overnight stay is documented. There are only resident medical staff from 9-17.
Please ensure any medications and fluids are prescribed and be clear in your plan
whether the patient is being admitted under Medicine or Emergency Medicine. The
ward is covered by HaN for simple procedures overnight, but EM staff may be
required for reviews of patients under our care.