Acute Medicine
Access Criteria
Standard Operating Procedures for Acute Patient Care
Appendix 1: Services for Consult per Diagnosis/Presenting Problem
- This table guides referral to specialties based on diagnosis or most likely diagnosis. It is not exhaustive, and does not override clinical judgement or other clinical agreements.
- Site dependent differences for admissions do exist.
-
- Tauranga - patients will be admitted under the relevant sub-specialty.
- Whakatane - Dental, ENT, Ophthalmology, Plastics, Cardiology and Urology patients will be admitted under the General Surgery or Medicine Team and a discussion with the relevant specialty team must occur by 0900 hours the next day.
| Diagnosis / Presenting Problem | Modifying Factors | Service |
|---|---|---|
|
Abdominal Pain |
Pyelonephritis or UTI |
General Medicine |
|
Suspected renal or obstructing ureteric stone |
Urology /at Whk GS with F/U consult |
|
|
All other patients (without an obvious gynaecological cause) |
General Surgery |
|
|
Alcohol withdrawal |
If severe acute symptoms |
General Medicine |
|
Ambulation |
Non orthopaedic causes |
General Medicine |
|
Gastrointestinal Bleeding |
Gastrointestinal Bleeding from Upper GIT with or without medical Co-morbidities |
General Medicine admission with Surgical consultation |
|
Gastrointestinal Bleeding from Lower GIT |
General Surgery |
|
|
If suspected occult GIT blood loss or unknown cause and requiring admission for management |
General Medicine |
|
|
Abdominal Aortic Aneurysm (AAA) / Dissection |
Suspected or proven abdominal aortic aneurysm dissection. |
Surgery / Vascular |
|
Thoracic Aortic Dissection |
Suspected or proven non-traumatic thoracic aortic dissection. Distal to left subclavian artery ("Type B") for medical management |
Type A General Surgery Type B Medicine / Cardiology |
|
Back pain |
Related to trauma, infection or possible disc pathology. |
Orthopaedics |
|
Osteoporotic collapse |
Orthopaedics |
|
|
Chronic Lower Back pain requiring admission for pain control and physio (i.e. failed trial of adequate pain medications and ambulation) |
Orthopaedics |
|
|
Signs of cord compression |
Orthopaedics |
|
|
Secondary to malignancy unless there are features of cord compression. |
General Medicine if patient not known to another Service |
|
|
Cellulitis / Gangrene |
Cellulitis over a joint or evidence/suspicion of osteomyelitis or septic arthritis Associated with wound (no joint / osteomyelitis involvement) |
Orthopaedics General Surgery |
|
Diabetic foot ulcer with cellulitis or suspected necrotising fasciitis |
General Surgery |
|
|
Infection requiring surgical debridement or amputation |
General Surgery |
|
|
Facial or odontogenic |
Dental/or at Whk GS with F/U consult |
|
|
Periorbital or Orbital |
Ophthalmology /or at Whk GS with F/U consult |
|
|
Perineum involved |
General Surgery |
|
|
All others |
General Medicine |
|
|
Diverticulitis |
General Surgery |
|
|
Epistaxis |
Medical causes e.g. HT / coagulopathy / platelet disorders etc |
General Medicine |
|
Local nasal pathology e.g. trauma / tumour etc |
ENT (in WHK - general surgery) |
|
|
Uncontrollable bleeding (any cause) |
Consult ENT for assistance (in WHK - general surgery) |
|
|
Facial Fractures |
Requiring Admission |
Maxillo-facial / or at Whk GS with F/U consult |
|
With dental Issues |
||
|
Foreign Body ENT |
Non-corrosive |
ENT outpatients (both sites) |
|
Corrosive |
ENT (in WHK - general surgery) |
|
|
Hepatitis / Liver Failure |
Gastroenterology |
|
|
Hypertensive Emergency |
General Medicine |
|
|
Ischemic Limb |
General Surgery/Vascular |
|
|
Ischemic Colitis |
General Surgery |
|
|
Oncology Problem |
Patient currently known to the oncology service and with a related problem |
Oncology /or at Whk GS with F/U consult(working hours) otherwise General Medical |
|
All other oncology related problems |
General Medicine |
|
|
Paediatrics |
Of surgical nature (especially if adult equivalent problem) |
General Surgery with Paediatrics consult |
|
Of medical nature |
Paediatrics |
|
|
Pancreatitis |
Obstructive cause (e.g., gallstones), Alcoholic |
General Surgery |
|
Post ERCP, discuss with consultant who performed procedure |
General Surgery |
|
|
Psychosis / Delirium |
Presumptive organic cause requiring ongoing medical treatment |
General Medicine |
|
Exacerbation of chronic psychiatric condition and no complicating organic causes identified |
Psychiatry |
|
|
No organic cause identified, no previous history |
Psychiatry |
|
|
Pyelonephritis |
Obstructing ureteric stone |
Urology/at Whk GS with F/U consult |
|
Pregnant Patient |
O+G |
|
|
All other UTIs requiring admission |
General Medicine |
|
|
Renal Failure, Acute |
Due to obstructive uropathy including urinary retention |
Urology |
|
Underlying surgical cause |
General Surgery |
|
|
All others |
Renal |
|
|
Sore Throat |
+ Quinsy (Peritonsillar Abscess) |
ENT in consulting working hours, general medicine outside working hours with ENT consult next morning / at Whk Med with F/U |
|
- Quinsy |
General Medicine |
|
|
Stroke |
Ischemic Stroke or Haemorrhagic stroke for conservative management |
Stroke Team |
|
Transient Ischemic Attack (TIA) |
Refer to TIA protocol |
|
|
Syncope / Seizures |
General Medicine |
|
|
Trauma |
Thoracic injury (penetrating, blunt) or abdominal injury (penetrating, blunt) requiring admission |
General Surgery |
|
Head Injury requiring observation or transfer |
General Surgery |
|
|
Extremity fracture or ligamentous injury requiring surgical consult |
Orthopaedics |
|
|
Pelvic fracture of any type caused by significant trauma in any age group |
Orthopaedics |
|
|
Facial or mandibular fractures requiring surgical consults |
Maxillo-facial/ENT/or at Whk GS with F/U consult |
|
|
Vascular injury |
General Surgery |
|
|
Intracranial Haemorrhage not requiring neurosurgical intervention |
General Surgery |
|
|
Vertebral Fracture |
Orthopaedics |
|
|
Spinal Injury with neurological compromise |
Orthopaedics |