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Respiratory Centralisation @ SJUH
Introduction
As of November 2007 respiratory Care for the City of Leeds centralises at SJUH. There is a transfer phase in which some services remain on both sites before some OPD services are all that remain at LGI.
Referrals to Respiratory Care
Acute referral for admission should be made directly from the LGI ED to SJUH respiratory team in the same manner as has always been used, i.e. via the on call bleep. There is no need for any member of the LGI medical team to pre-clerk the patient before transfer to SJUH. Referral criteria to Respiratory should be continued to based upon the 'ABC' TCI criteria found on the Acute medicine web page (ABC TCI Criteria). An ED related summary of this is shown below.
Please ensure that you utilise CDU for asthma, simple LRTI and ?PE appropriately whenever you can.
Major Principle
If a patient is considered 'too sick' to transfer a senior ED doctor needs to be involved in their care. The patient should be referred (and TCId)to the LGI General Medical SpR plus or minus additional Critical Care support. Any liason with Respiratory should then be the role of the Gen med SpR
Contacting the Respiratory Team
Dr Elliot has produced the following guidance for contacting the Respiratory team.
'ABC' Based TCI Criteria for LGI ED
| Diagnosis | Plan |
| Acute Respiratory Failure | Call ITU & Med Reg |
| Asthma | Treat all cases along BTS guidelines |
| Asthma Acute severe | Transfer |
| Asthma CDU Criteria | CDU Protocol |
| Asthma Life Threatening | Admit to HDU/ITU if does not 'settle' via Med Reg and ITU Team |
| Asthma Moderate | Transfer if not CDU criteria |
| Bronchiectasis exac. of known diagnosis | Transfer |
| COPD | Treat all cases along BTS guidelines |
| COPD on domicillary NIV | Transfer |
| COPD requirng admission but not NIV | Transfer |
| COPD requring NIV | Admit to HDU via Med Reg |
| Haemoptysis major | Transfer if 'stable'. Admit via Med Reg if not 'stable' |
| Interstitial Lung Disease | Transfer |
| Lung Absces s | Transfer |
| Malignancy | |
| Malignancy known case and 'unwell' | Transfer |
| Malignancy on chemotherapy and unwell | Transfer |
| Malignancy supected new diagnosis | Transfer IF cannot be manged as Urgent OPD (d/w Resp team) |
| Pneumonia | |
| Pneumonia failure of community treatment | Transfer |
| Pneumonia in Immunodeficiency | Transfer |
| Pneumonia Mild/Mod severity | Gen Med |
| Pneumonia Severe Community Acquired | Transfer |
| Pneumothorax requiring admission | Transfer |
| Pulmonary Embolism | |
| Pulmonary Embolism CDU Criteria | CDU Protocol |
| Pulmonary Embolism proven-not shocked | Transfer |
| Pulmonary Embolism proven-shocked | Admit Gen Med/HDU via Med Reg |
| Tuberculosis - actual or clinically suspected | d/w Resp Reg-may be managed as OPD or Transfer |
PAC 2.11.07