Articles
Vaccination Referrals from ED Paediatric Antimicrobial Guidance Children’s Services Resolution and Escalation Protocol Blunt Chest Wall Trauma/Rib Fractures Information for Parents Carers of Children Having Investigations in Relation to Unexplained Injuries + Consent form Bruising and Injuries in Babies and Children – Parents Leaflet Multi-Agency Protocol for Injuries to Non-Mobile Children Flowchart for children attending Galloway Community Hospital (GCH) for NAI Follow Up Skeletal Survey Flowchart for children attending DGRI for NAI Follow-Up Skeletal Survey Cognitive Function Conscious Level Kidney Biopsy Complications Parenteral Iron for Non-HD CKD Patients Fracture Management Guidelines (Paediatric) Fracture Management Guidelines (Adult) Management of Hypertension in Acute Stroke Prescribing for CAU Patients Still in ED Hypothermia Deactivation of Implantable Cardioverter Defibrillator Myeloma Croup Care Of Burns In Scotland (COBIS) Paediatric Guidance Management of Epistaxis Sore Throat Differential Diagnosis Dizziness Differential Diagnosis Peritonsillar Abscess/Quinsy Acute Tonsillitis Acute Mastoiditis Otitis Media Otitis Externa Extravasation of IV Amiodarone WoS Paediatric Drooling and Aspiration Guideline Palliative Care – How to Refer Eating Disorders Stroke Care Warfarin Anticoagulation for AF, DVT and PE Molnupiravir MyPsych Foundation Doctors Toolkit Paediatric Febrile Neutropenia Guidance PAEDIATRIC HYPOGLYCAEMIA MANAGEMENT in NON DIABETIC CHILDREN   Paediatric Diabetic Ketoacidosis (DKA) Guideline Child Protection Policies and Procedures (D&G) Management of Acute Behavioural Challenges in Adolescents and Young People presenting to Secondary Care Cancer of Unknown Primary Patients Returning from Interventional Cardiac Procedure Treatment of Malaria Discharging Patients on High Dose Steroids Sotrovimab Paediatric Ketone Correction Guideline Insulin Correction Factor Table (Paediatrics) Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s Management of Hypoglycaemia in Children with Type 1 Diabetes Newly diagnosed diabetic – not in DKA (Walking wounded) Proton Pump Inhibitor Guideline for Neonatal and Paediatrics Stroke – Post Thrombolysis Neonatal Guidelines Gentamicin Prescribing (Paediatrics) Management of Anaphylaxis (Paediatrics) Management of Prolonged Seizures (Convulsive Status Epilepticus) in Children Bronchiolitis Acute Wheeze or Asthma in Paediatrics Conscious Proning Covid-19 Basics Remdesivir Thromboprophylaxis Identifying Patients in the Highest Risk Groups Steroids for Patients with Covid-19 Infection IL-6 Inhibitors – Tocilizumab or Sarilumab Baricitinib Paxlovid (Nirmatrelvir/Ritonavir) Influenza A Inhalers for Adults with Asthma Standard Operating Procedure for AMU Trigger Finger/Thumb Osteoarthritis of the Hand/Thumb Mallet Finger Ganglion Dupuytren’s Contracture De Quervain’s Tenosynovitis Carpal Tunnel Syndrome Prescribing Advice on Admission – Clozapine Prescribing Advice on Admission – Methadone/Buprenorphine Prescribing Advice on Admission – Corticosteroids Prescribing Advice on Admission – Items Not Prescribed by GP Prescribing Advice on Admission – Patients on Chemotherapy Regimes Prescribing Advice on Admission – Medication for Parkinson’s Disease Prescribing Advice on Admission – Insulin Prescribing Advice on Admission Medical Emergencies in Eating Disorders (MEED) Gentamicin & Vancomycin HIV Testing Guidelines Metabolic Syndrome Associated Fatty Liver Disease (MAFLD) Greener Inhaler Prescribing C4 Predischarge Beds Handover Safe and Secure Handling of Medicines Blood Glucose & Steroids IV Fentanyl & Morphine for Acute Pain in Adults Assessment & Management of Acute Pain Hospitalised and Has Coronavirus19 Infection (No suspected Viral Pneumonia Syndrome) Hospitalised Due to Coronavirus19 with Likely Viral Pneumonia Bi-Level NIV S/T Guidelines for CCU Phase Bi-Level NIV S/T Guidelines for ED Phase Adults With Incapacity Premenstrual Syndrome Pelvic USS Boarding Coeliac diagnosis pathway (Adults) Voice clinic Ear Wax Dermatology Squamous Cell Carcinoma (SCC) Malignant Melanoma Basal Cell Carcinoma (BCC) Nipple Discharge Early Cancer Diagnostic Clinic (ECDC) Genetics Referrals Breast Infections Breast Pain Primary Care Prescribing Guidelines Emergency Department Anaesthetics and Chronic Pain Team Respiratory Referrals Chronic Cough Pathway GP Clinical Handbook Test Paediatric Bronchiolitis Early Cancer Diagnosis Clinic (ECDC) Obstetrics & Gynaecology/Medicine Admission Agreement Idiopathic Intrancranial Hypertension Urology Out of Hours Urology Out of Hours Sengstaken/Minnesota Tube for Bleeding Varices Eradication of Helicobacter pylori Transfer from Galloway Community Hospital Repatriation of Patients from Tertiary Hospitals THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 1, Risk factors THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 3, Postnatal assessment & management THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 4 THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 2, Management of women with previous VTE THROMBOPROPHYLAXIS IN PREGNANCY, LABOUR AND THE PUERPERIUM Orthopaedic VTE Risk Assessment Sodium Glucose Transporter 2 Inhibitors (SGLT2i) Cardiology Referrals Vascular Referrals ‘Watershed’ Conditions Myasthenia Gravis Gentamicin in Renal Replacement Therapy Vancomycin in Renal Replacement Therapy REDMAP Poster Realistic Conversations Summary Plan for Deteriorating Health Treatment Escalation Plans Ambulatory Care for Blood and/or Iron Infusion Principles for Light Touch Patients – B2 Clostridiodes difficile Infection Post Astra Zeneca Vaccine Headache Blood Culture Rhabdomyolysis Analgesia Acute Appendicitis Small Bowel Obstruction Elective Admission – Colorectal Surgery Trauma Admissions Post-operative Care Gallstone Disease Vasopressors and Inotropes/Chronotropes Shock Elective Admission – ERCP Elective Admission – Orthopaedics Laxatives Fat Embolism Compartment Syndrome Surgical Post-operative Complications Stoma Diverticular Disease High Dose Steroid Pre-Treatment Checklist Acute Surgical Admissions Level 1 CCU Medical Area Acute Oncology STEMI Thrombolysis Protocol Haemolytic Anaemia Conversion Charts Anticipatory ‘As Required’ Medications Syringe Driver Chart Scottish Palliative Care Guidelines Covid-19 Sick Day Rules for Patients with Primary Adrenal Insufficiency Diabetic Retinopathy Coming Off Benzodiazepines and “Z” Drugs Dental Abscess Facial Trauma – Mandibular Fractures Facial Trauma – Orbital Fractures Facial Trauma – Zygoma Platelet Transfusion Death Certification Parenteral Iron in Adults >18 Years OPAT SBAR (Complex Infections) Mental Health Liaison Team Referrals STEMI Admitting Patients with Tracheostomy/Laryngectomy to DGRI Emergency Laryngectomy Management Emergency Tracheostomy Management Safe Transfer of Patients with Tracheostomy/Laryngectomy within DGRI Other Tracheostomy Documents Systemic Anticancer Therapy Toxicity Haemodialysis Medication Prescribing Breaking Bad News by Telephone End of Life Diabetes Care Adrenal Insufficiency Serotonin Syndrome DGRI Referrals Confirmation of Death Neuroleptic Malignant Syndrome Pulmonary Embolism Deep Vein Thrombosis of Lower Extremities Exacerbation of COPD Contrast Associated AKI Acute Kidney Injury – Introduction Paracetamol Hypertensive Emergencies Staphylococcus aureus Bacteraemia (SAB) Rate Control in AF Common Scenarios Acute Severe Ulcerative Colitis IV Fluid Prescription in Adults Chronic Obstructive Pulmonary Disease Legionnaires Disease Septic Arthritis Guillain-Barré Syndrome Back Pain Anaesthetics – Unscheduled Procedures Requests Hyperglycaemia & Steroids Variable Rate Insulin Infusion Decompensated Liver Disease Fast Atrial Fibrillation – ACP Hyperkalaemia Contraindications to MRI Magnetic Resonance Imaging Bleeding with Other Antithrombotics In-patient Hyperglycaemia Management Anaemia (Management) – ACP Suspected NSTEMI – ACP Guidance on Chaperones Compulsory Admission and Treatment Radiology Immediate Discharge Letter Alcohol Withdrawal Fentanyl Patches in the Last Days of Life Care in the Last Days of Life Low Molecular Weight Heparin Interstitial Lung Disease Haematinic Testing Thromboprophylaxis for Non-Covid Patients Lung Cancer Osteoporosis Heart Failure Fluid Replacement in AKI Death & The Procurator Fiscal Thrombophilia Screening Neutropenic Sepsis Acute Vertigo Aortic Dissection Antithrombotics in Hip Fracture Transient Global Amnesia Hypomagnesaemia Hypophosphataemia Oxygen Therapy Falls – ACP Falls Acute Asthma Oncology Contact Details & General Advice Reversal of Warfarin Lumbar Puncture, Antiplatelet & Anticoagulant Drugs Antithrombotics & Surgery Non ST Elevation MI (NSTEMI) Suspected Acute Coronary Syndrome Antibiotics and the Kidney Acute Upper GI Bleeding (AUGIB) Pericardiocentesis Pleural Effusion Spontaneous Pneumothorax Acute Diarrhoea Iron Deficiency Anaemia Hyperthyroidism Gout Giant Cell Arteritis Pacemakers Clinical Suspicion PE – ACP Community Acquired Pneumonia (CAP) Management of Urinary Symptoms Management of Acute Kidney Injury SSRI Poisoning Immobility Autopsies Indications for Echocardiography Bradycardia Suspected Meningitis Hypernatraemia Diarrhoea – ACP Suspected Meningitis – ACP Blood Transfusion Brain Tumours Newer Antidiabetic Drugs Parkinson’s Disease Major Haemorrhage Protocols (DGRI & GCH) Major Haemorrhage Stroke Thrombolysis Heart Failure – ACP Suspected Anaphylaxis Anaphylaxis – ACP The AMB Score – ACP Transient Loss of Consciousness (TLOC) – ACP Bell’s Palsy – ACP Suspected Sepsis Lumbar Puncture Hypokalaemia Gentamicin Dosing Transient Loss of Consciousness Urinary Tract Infection Urethral Catheterisation Vancomycin Dosing Hyponatraemia Narrow Complex Tachycardia Hypocalcaemia New Onset Type 1 Diabetes – ACP Paracentesis for Tense Ascites – ACP Idiopathic Intracranial Hypertension – ACP Other Funny Turns Hypoglycaemia Hypoglycaemia – ACP Management of Transfusion Reactions Hypercalcaemia Haematemesis – ACP Anti-Platelet Therapy in Coronary Heart Disease Unfractionated Heparin Infusion Anaemia (Investigation) – ACP Delirium Suspected Seizure – ACP Headache – ACP Community Acquired Pneumonia – ACP Cellulitis Dyspepsia Management of Acute AF Rhythm Control in AF Atrial Fibrillation Renal Transplants Massive Pulmonary Embolism Head and Neck Injury Diabetic Ketoacidosis Switching from VRII Insulin Pumps Diabetes Mellitus Aspirin Digoxin Poisoning Tricyclic Antidepressants Opiates Benzodiazepines Gut Decontamination Deliberate Self Harm Acute Liver Failure Asymptomatic Raised Transaminases (ALT & AST) Nutritional Support in Adults Refeeding Syndrome Parenteral Nutrition Crohn’s Disease Acute Pancreatitis Abdominal Aortic Aneurysms Malignant Spinal Cord Compression Post Splenectomy Sepsis Ascites in Cirrhosis Alcohol Related Liver Disease Hepatitis C Symptom Control Suspected Variceal Bleeding Severe Headache Status Epilepsy in Adults Lower Gastrointestinal Bleeding Functional & Social Assessment Breathlessness with Abnormal CXR Polymyalgia Rheumatica Rheumatoid Arthritis Ureteric Colic & Renal Stones Intravascular Catheter Related Blood Stream Infection Care of Vascular Access Urinary Incontinence Peritoneal Dialysis Related Peritonitis The First Seizure Hypertension Ventricular Tachycardia Cardiogenic Shock Complicating Acute Coronary Syndrome Telemetry The Diabetic Foot Subcutaneous Insulin Diabetes and Acute Coronary Syndrome Hyperosmolar Hyperglycaemic State Multiple Sclerosis Coma
 
 
In this section Close
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