Treatment Escalation plans are available on the wards.

 Patients who may require escalation:

• Patients requiring NIV / Nasal high flow oxygen
• Patients requiring cardiac monitoring – unstable tachy or brady arrhythmia
• Sepsis requiring inotropic / organ support
• Unstable GI bleeds
• Fractures requiring ongoing orthopaedic input
• Low GCS requiring airway support (if accepted for ITU input)
• Stroke requiring consideration of thrombolysis
• Acute surgical / vascular issue requiring specialist intervention
• Renal failure requiring specialist input

Policy for escalation:

• All patients felt to require escalation of care should be discussed and reviewed by DME registrar on call (page 4974) and named Consultant. If out of hours DME registrar +/- DME consultant on call (number via switchboard)
• If agreed that escalation is required the registrar should discuss with the appropriate specialty registrar on call

Transfer policy:

After transfer has been agreed with the Specialty Registrar the DME team should contact the bed manager (page 7702 or Dect phone 82377). Patients should be transferred to either the specialty ward or speciality acute receiving unit area as agreed with the speciality registrar.

Medical HDU admissions:

If a patient is felt to require HDU admission they should be discussed with the HDU registrar. Patients admitted to HDU remain under the transferring Specialty Consultant. Cover should be agreed within Consultant ward teams. If there is a specific sub specialty that the patient needs HDU care for, then this should be discussed with the appropriate specialty.

Transfers from offsite units: 

All patients who are felt to require transfer from offsite beds to the acute site should be discussed with DME registrar on call regarding appropriateness of transfer. If a patient requires transfer this should be discussed with the bed manager in order to find appropriate bed (ARU4, 8A or Langlands) depending on patient’s condition/diagnosis. 

Any uncertainty with regards any transfer should be discussed with on-call consultant.

Transport:

If patients are medically unstable and transferring to ITU/HDU then a 999 ambulance must be called. In other situations internal transport with doctor or nurse escort may suffice depending on patient condition.

Bed manager - page 7702 or DECT phone 82376

DME Consultant on call – contact via switchboard