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Home | Articles | Admission | Transfer from Galloway Community Hospital

Transfer from Galloway Community Hospital

Last updated 4th March 2024

Introduction

  1. This document outlines the categories of patients who should usually be transferred to DGRI for medical management.
  2. The decision to transfer must be made on an individual patient basis, and will include factors such as patient preference and appropriateness of escalation. 
  3. The On-call Medical consultant in DGRI is available to discuss transfer if the decision is not clear-cut.
  4. All patients must be assessed for their fitness to transfer.  This should involve the GCH anaesthetist when appropriate. 

Critical Care

  1. All patients requiring level 2 or 3 care (Critical Care) should be considered for transfer, regardless of the underlying pathology.
  2. The remainder of this document lists specific patient groups who should additionally be considered for transfer even when there is no immediate need for Critical Care.

Cardiology

  1. Acute coronary syndrome – this may need discussion with tertiary centre or DGRI Cardiologists first, as below:
    • STEMI  patients should be discussed as per protocol with University Hospital Hairmyres
    • High risk NSTEMI patients should be discussed with on call cardiologist at GJHN to avoid transfer to DGRI and subsequent transfer to GJNH
    • Patient with significant co morbidities who have had NSTEMI should be discussed with on call cardiologist before transfer- not every NSTEMI patient needs to be in DGRI if they are not for intervention
    • Cardiology patients already listed for invasive investigation / surgery   should be discussed with on call team at GJNH before transferring to DGRI as it may be more appropriate to transfer directly to GJNH
  2. Symptomatic bradycardia (including Complete Heart Block, 2:1 block, Wenckebach, slow atrial fibrillation, and prolonged pauses).  If patient requires urgent pacing, they should be discussed with on call team at QEUH to discuss direct transfer to QEUH
  3. Ventricular tachycardia
  4. Any dysrhythmia causing haemodynamic compromise
  5. Infective endocarditis
  6. Pericarditis – discuss with Cardiology. Some may be able to remain in GCH if Echocardiogram can be done quickly and patient is stable

Renal

  1. Unexplained Acute Kidney Injury (AKI) after initial assessment
  2. AKI worsening despite treatment or requiring dialysis
  3. Acute illness or infection requiring hospitalisation in a dialysis or renal transplant patient – this should first be discussed with renal doctor on call (32177), Monday to Friday 9am to 5pm and on call renal consultant out-of-hours, as it will be possible to manage some patients in GCH.
  4. Some patients with new diagnosis of Nephrotic Syndrome after discussing with renal team, ideally in-hours.

NB Patients with AKI secondary to obstruction should be referred to Urology/Surgery, not to Renal/Medicine

Diabetes and Endocrine

  1. Diabetic Ketoacidosis (DKA)
  2. New diagnosis of pituitary failure
  3. Hyperglycaemia hyperosmolar state
  4. Severe hyponatraemia (<125mmol/l)

Neurology

  1. Undiagnosed acute or deteriorating neurology
  2. Guillain Barre syndrome
  3. Recurrent seizures (ie not settling with initial treatment)
  4. Patients needing LP (for exclusion of sub-arachnoid haemorrhage or other acute pathology)

Respiratory

  1. Pneumonia
    • Covid pneumonia with any persistent supplementary oxygen requirement, if suitable for escalation to invasive ventilation.  Note that only a few patients are suitable for CPAP/HFNO2 if not for invasive ventilation – discuss with Acute Medicine or Respiratory if unsure.
    • Non Covid pneumonia with oxygen requirements ≥ 35% venturi or if static or deteriorating despite treatment
  2. Respiratory Failure
    • Hypoxaemic Respiratory failure of any cause with oxygen requirements  ≥ 35%, despite initial treatment for underlying cause, if suitable for escalation to CCU. 
    • Exacerbations of COPD with Acute Hypercapnic Respiratory Failure (paCO2 >6.5 kPa) ± hypoxaemia (“Type 2 Respiratory Failure”) where patient is acidotic pH 7.25-7.35 / H+ 44-56 and paCO2 >6.5 kPa and is suitable for acute bi-level non-invasive ventilation.
    • Caution in patients with acute hypercapnic respiratory failure without COPD.  Discuss with Respiratory or acute medicine on call.
    • Home ventilation patients (Nocturnal NIV) with respiratory acidosis or worsening of respiratory symptoms/status.  Transfer is preferable even if not acidotic.
  3. Pleural and lung cancer
    • New unilateral pleural effusion or significant worsening of known unilateral effusion, requiring drainage due to symptoms.  If small or clinically stable consider outpatient referral or discuss with Respiratory.
    • Pneumothorax – If unstable must drain prior to transfer.  If chest drain remains in situ, then transfer for further management. 
    • Lung cancer with immediate oncological emergency eg Cord compression, SVCO.  Suggest discuss with acute medical team or Respiratory, prior to transfer as some circumstances might require immediate transfer to tertiary centre. 
  4. Airways disease
    • Asthma – Acute severe asthma or life-threatening asthma presentation, once stabilised and safe for transfer.  
    • Cystic fibrosis – Discuss with the Cystic Fibrosis team in Glasgow or Edinburgh depending on who normally looks after them.  Out of hours will be respiratory on-call in that hospital.  
  5. Other
    • Complex respiratory infection eg – empyema, lung abscess etc.  Patients with probable or confirmed TB should be managed as an outpatient where possible. 
    • Massive haemoptysis (> 100ml blood in 24 hours) – Out of hours discuss with Glasgow Respiratory team.  Hb not relevant but hypoxia and dyspnoea important.  Discuss with respiratory during working hours.  May need transfer to CCU or directly to tertiary centre. 
    • Pulmonary embolism – see respiratory failure.  Post thrombolysis should be transferred directly to CCU for observation once stable.
      Any one you are concerned about – suggest discuss if respiratory issue not encompassed above. 

Gastroenterology

  1. Acute liver failure/Fulminant hepatitis
  2. Upper GI bleed, especially if haemodynamically unstable, ongoing bleeding.  Patient with Glasgow Blatchford Score ≤1 may remain in GCH.
  3. Suspected variceal bleed
  4. Acute exacerbation of Inflammatory Bowel Disease (discuss with Gastro team in DGRI – some patients will be able to remain in GCH)
  5. Delirium Tremens (or otherwise difficult to manage alcohol withdrawal eg psychosis)

Infectious Diseases

  1. Meningoencephalitis
  2. Cerebral abscess
  3. Infection in a returning traveller
  4. Malaria
  5. Infection in a patient living with HIV
  6. Pyrexia of unknown origin (if initial investigation is unrevealing)
  7. Complex infection including collections requiring surgical/radiological drainage (consider if Surgical referral is more appropriate)

Haematology/Oncology

  1. Febrile neutropenia (if clinically stable, discuss with DGRI – some may be able to stay in GCH)
  2. Other issues to be discussed with Haematology consultant or Cancer Specialist nurse (or Oncology at WGH, Edinburgh, out of hours) if there is uncertainty about transfer.

Content by Dr Sian Finlay