Download Operational Document

Draft Operational Policy
SINGLETON HOSPITAL ACUTE GP UNIT
Version 2 – 12th June 2012.
1
SINGLETON HOSPITAL ACUTE GP UNIT
OPERATIONAL POLICY
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Introduction
Purpose
Hours of Service
Service Provision
Accommodation
Eligibility of the Service
Access to Service
Patient Pathway
Patient Case Mix for Acute GP Unit
Acute GP Unit Workforce
Key Relationships
Support Services
Acute GP Unit General Housekeeping
I.T Infrastructure & Telecommunications
Clinical Governance
Nursing Governance
Protection of Vulnerable Adults
Management of Violent/Aggressive Patient
Infection Control
Complaints
Nursing & Medical Records
Untoward Incident Reporting
Transport
Appendix 1 – Flowchart for Referrals
Appendix 2 - Acute GP Unit REFERRAL DIRECTORY
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SINGLETON HOSPITAL ACUTE GP UNIT
OPERATIONAL POLICY
1.
Introduction:
The purpose of this policy is to provide an outline of the Singleton
Hospital Acute GP unit and to describe the Units purpose, delivery of
the operational service and relationships with the Integrated Medicine
service, community resource teams and other support services within
the Swansea Locality.
2.
Purpose:
The Singleton Hospital Acute GP Unit will form an integral part of the
Swansea Unscheduled Care Service. The purpose of the service is to:


3.
To deliver a GP triage of all GP referrals to the acute medical intake
during the hours of service and ‘filter’ patients into appropriate
clinical pathways at point of telephone triage or following face to
face patient consultation.
To deliver alternative patient pathways to hospital admission and
promote care in the community in line with ‘Setting the Direction’.
Acute GP Unit hours of service:
The Singleton Hospital Acute GP Unit will operate on weekdays only,
excluding bank holidays between 0900-1700 hrs, the timing will be
subject to review as part of the planned evaluation of the pilot.
In addition to, and in parallel with the above, a Minor Injuries Service
will operate as follows:
 0800-2000 hours daily, including weekends and bank holidays.
4.
Accomodation:
The service will be delivered from the envelope of accommodation that
the MIU service is currently based in.
The area is made up of a front reception where patients will register
their details on arrival. GP consultation rooms are available for face to
face patient consultation and clinical assessment of patients. A
resuscitation area that serves the Singleton Assessment Unit, Minor
Injuries Service and the Acute GP Service is located within the Minor
Injuries service corridor however a planned relocation of this facility will
3
better place the room at the junction of the Minor Injuries Service and
Singleton Assessment Unit triage area, directly opposite the main
access to both services. The nurses’ station is located at the centre of
the Minor Injuries service corridor. External and internal waiting rooms
are available.
5.
Eligibility of the Service:
The Singleton Hospital Acute GP Unit will triage all requests from
Swansea GP’s or others with referral rights, such as Practice Nurse
Practitioners who require a medical assessment and potentially
admission to hospital. The patient groups include:



6.
All patients registered with GP practices within the City and County
of Swansea
Patients deemed to be temporary residents
Patients who are registered within GP practices outside of the
Swansea area however if acute admission to Medicine is the
outcome of triage then the patient should be directed to the Neath
Port Talbot Medical intake.
Access to the Service:
GPs requiring advice or admission AFTER June 11 2012 can ring the
direct number 01792 200342. The receptionist at Singleton will take the
demographic details of the patient and then the call will be transferred
to the duty Acute GP.
A brief referral letter and computer generated summary should then be
faxed to 01792 298347 or sent with the patient.
7.
Patient Pathway:
Referring GP to Acute GP Reception
The referring GP will initially speak to the Reception staff based in the
Singleton Acute GP Unit and will provide patient demographic details to
enable registry of the patient in Adastra.
Referring GP to acute unit GP
The referring GP will present the clinical details of the patient to the
duty Acute GP unit GP and a management plan will be determined as
per flowchart attached at Appendix 1.
4
Patient accepted by Acute GP Unit
Patients who will clearly need admission will be transferred immediately
to the medical on call team in the assessment unit.
Patients suitable for the acute GP’s will follow a slightly different path.
They will be seen as soon as they can attend the Unit. The patients will
get a second opinion (where appropriate); urgent investigations
performed (e.g. x-rays, scans, pathology); a working diagnosis made
and a formal management plan developed. If possible treatment will be
started and the patient discharged home to be followed up by their GP
or, if appropriate, to return to the Unit for follow up.
Admission alternatives:
In order for alternatives to admission to be offered to patients where
clinically appropriate a range of secondary care support will be
available to the Acute Unit GP including:
- Access to specialist hot clinics within 24-48 hrs of patient consultation.
- Access to specialist Consultant advice daily.
- Access to endoscopy via the ward based Gastroenterologist of the
day.
- Access to timely domiciliary care and therapies intervention in the
community.
- Access to nursing within community networks or Community
Resource Team
Communication to referring GP’s:
GPs will receive summary information and outcomes in the same way
as they get contacts from the OOH service i.e. faxed back same day
(usually within the hour) with a clear management plan and follow up
details. FOLLOW UP PTS POST ENDOSCOPY:
8.
Patient Casemix for Acute GP Unit:
The service works with other healthcare providers to develop new
pathways and ways of working to improve patient care and reduce
unnecessary admissions. As new pathways or services evolve and
develop they will be publicised to local GPs via a newsletter.
In time, we hope to manage:
 Pleuritic chest pain, pulmonary embolism, community acquired
pneumonia, pneumothorax
5
 Upper gastro intestinal haemorrhage through risk stratification
and OPD management of low risk
 Jaundice
 Headaches (excluding SAH and meningitis)
 Blood tests which need to reach the lab promptly including
malaria
 Any other clinical scenarios the Acute GP service and GP feel
can be managed on an outpatient basis using the resources
available.
9.
Acute GP Unit workforce:
The Acute GP Unit service will be delivered by a local GP, supported
by a qualified nurse and clerical staff. The staffing resource for the
service is as follows:
Grade of staff
Hours per day
General Practitioner
Band 5 nurse
Admin and clerical staff
(Mon – Fri)
8
8
8
Comments
No additional resource,
attached to MIU clerical
team.
In addition to the core workforce, the Acute GP Unit will have access to
a full range of support services including:
-unstructured radiology support
-pathology support.
-portering services.
-domestic services.
-acute medical on call team.
10.
Key relationships:
The Singleton Hospital Acute GP Assessment Unit will interface with
the following primary and secondary care services and departments:





Acute Medicine on call team
Integrated Medicine Consultant team, Singleton
Patient Services
Community Resource Team
Swansea Locality Senior Management team
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






11.
Singleton Assessment Unit nursing team
Welsh Ambulance Service Trust
General Practitioners
Pathology
Radiology
Bed Management team
Switchboard
Support Services:
Acute Integrated Medicine
The Acute GP can access support from secondary care Consultant
Physicians in various models as follows:
-Access to specialty clinic hot slots.
-Access to daily specialty Consultant advice
-Access to endoscopy via the ward based Gastroenterologist of the
day.
Appendix 2 sets out the referral directory to support the Acute GP Unit.
Bed Management
Where a patient is assessed in the Acute GP Unit and requires
admission under the care of the Medical on call team, the patient
details will be passed to the SAU staff. It is the responsibility of the
SAU Nurse in Charge to liaise with the Bed Management team to
advise them of any patients referred from the Acute GP Unit.
Domestic Services
The Domestic Services provides a 7 day a week housekeeping service
for the unit and covers the following times,
Monday – Sunday 1X 6.00 am-12.30pm (6 Hour shift) – MIU/Acute
GP Unit.
Portering Services
The Portering Department operates a two shift rota system which
incorporates four members of the Portering team. The shift patterns
worked are,
Monday – Saturday 1X 10.00am -10.00pm (12 Hour shift)
1X 11.00am - 11.00pm (12hour shift)
Sunday
1X 11.00am - 11.00pm (12 Hour shift)
7
Portering activities undertaken within the Department include:







Patient movement & assistance
Blood collections
Delivery of specimens
Collection of patients provisions
Cleaning and restocking of stretcher trolleys
Checking and restocking of medical gases
Linen Collection
Security
There is no security currently available within Singleton Hospital. CCTV
is in place within the MIU/SAU accommodation. There is a panic alarm
in SAU & MIU reception areas which alerts switchboard to contact the
Police. However, staff can contact the Police via 999 if they have any
concerns with regards to staff or patient safety. The bed/site manager
should be notified of any such events.
Pathology Support:
Patients assessed by the duty GP in the Acute GP Unit may require
blood investigations to be carried out. The acute GP Unit will have
access to the full range of pathology services set out below. The blood
request forms should be marked with ‘Acute GP Unit/SMIU’ to enable
the acute GP patient group to be differentiated from the MIU
attendances. Results will be sent to the Acute GP Unit and will be
reviewed and any necessary action taken by the duty acute GP.
Haematology and microbiology provide on site service 08 00-19 00 hrs
and an emergency service 19 00-08 00 hrs.
The clinical biochemistry provide on site services between 08 00-00 00
hrs Monday-Friday and 08 00-21 00 hrs on a Saturday and Sunday.
Outside of these hours samples will be transported to Morriston Clinical
Biochemistry from the Singleton Acute GP Unit using the dedicated
laboratory transport.
Access to a blood gas machine for urgent arterial blood gas analysis is
available via the SAU.
Radiology Support:
The Singleton Hospital Acute GP Unit will require access to radiology
services. The duty GP will access radiology via the request system,
however in some cases where diagnostics are required, the duty GP
will be required to discuss their request with the duty radiologist. The
Radiology resource file is attached at Appendix 2.
8
Clinical Physiology:
Electrocardiographs can be requested via the Clinical Physiology
service Monday - Friday 08.30hrs - 16.30hrs as determined by the duty
Acute GP Doctor/supporting Nurse. Out of hours the Acute GP Unit
Nurse will undertake this procedure if required.
Pharmacy:
Patients will receive an FP10 prescription for any medication the duty
acute GP feels is clinically necessary for the patients’ management. A
small stock of medication will be kept on site for periods when
community pharmacy provision is unavailable.
The issue of any medications dispensed from the pharmacy stock held
within the acute GP unit must be recorded in the ADASTRA system for
audit purposes. In addition, any stat medications given to patients must
also be recorded in the same way.
Controlled drugs will be available for prescription by the Acute GP Unit
and must be administered in line with Health Board policy.
The nursing staff working within the acute GP unit will work in line with
current Patient Group Directives for the administration of simple
analgesia to patients, in line with Health Board policy and only when
the Band 5 nurse has received the appropriate training.
Community Resource Team (CRT)/Therapies:
Access to Therapy Services, domiciliary care support and/or third
sector support for patients assessed in the Acute GP Unit will be via
the Community Resource Team Nurse Assessor who will be based in
the ‘front door’ of Singleton.
Language line:
The Health Board currently has a contract with Language line, an
interpretation service that can be accessed to communicate with both
patients and relatives where language barriers exist. The MIU and SAU
have access codes that can be used for the Acute GP Unit.
12.
Acute GP Unit General Housekeeping:
The ordering of stores, CSSD/HSDU will be undertaken by the nurse in
charge of the SAU as the Acute GP Unit, SAU and the Minor Injuries
service will be managed as an integrated service, with one integrated
workforce.
9
13.
IT Infrastructure and Telecommunications
The Acute GP Unit PC’s are connected via the Adastra switch through
the Health Board network to the Adastra service - this is a replication of
the method used for the previous OOH service.
An independent telephone network is established within the MIU that
will serve the Acute GP Unit as well as the Minor Injuries service.
14.
Clinical Governance-
Rosemary Fletcher to revise in line with contractual arrangements
The responsibility for meeting minimum quality standards and that a
sound clinical governance framework is in place sits with the ?????.
The GPOOH service will ensure that a clinical governance system is in
operation that complies with the requirement of professional guidance,
including standards set down by the Professional Bodies, and other
national guidance. A designated Clinical Governance lead for SOS has
been appointed and agreed with the commissioner. The Swansea
GPOOH service should regularly review its arrangements and provide
assurance to the commissioner and the Trust that robust arrangements
are in place for audit, appraisal, and significant event review and risk
management. Specific reports should be made available on request.
The Swansea GPOOH service should ensure that all staff working
within the service are made aware of the protocols and systems and
are offered a comprehensive induction programme on joining the
service, as well as regular training events.
15.
Nursing Governance
The Singleton Hospital Acute GP Nurse will operate in accordance with
Health Board policies and procedures. The operational line
management is via the SAU Ward Manager to Lead Nurse to Senior
Nurse Medicine. Professional issues will be escalated to the Head of
Nursing & Community Services as lead for governance. Operational
management concerns will be escalated to the Head of Operational
Services and the Head of Nursing and Community Services as the
governance lead.
16.
Protection of Vulnerable Adults:
Adult patients deemed as vulnerable in accordance with the definition
set out in the Protection of Vulnerable Adults Inter-Agency Policy and
Procedures 2004 (Chapter 5) must be managed in accordance with
Health Board and Welsh Government Policy.
10
17.
Management of the violent/aggressive patient:
Patients who pose a risk of violence or are verbally or physically
aggressive should be managed in accordance with Health Board
policy.
18.
Infection Control:
Management of potentially infective patients presenting with
diarrhoea and/or vomiting to the Singleton Hospital Acute GP Unit
must be managed in line with Health Board policy.


If a patient in the Acute GP Unit develops symptoms of diarrhoea
and / or vomiting they should be isolated immediately into a side
room. Enhanced environmental cleaning should be instigated once
the room is vacated (Infection Control Manual, Section 9).
If a patient requires admission to the SAU, the infection issue must
be notified to the Nurse in Charge of the SAU in order that isolation
facilities can be made available.
Management of the Potentially Infective Patient:
The potentially infective patient will be managed in accordance with the
Health Board Infection Control Policy.
Notifiable Infectious Diseases:
It is the responsibility of the duty GP in the Acute GP Unit to report any
notifiable diseases to the Health Protection Team for the Mid and West
Wales region as part of the Notifiable Diseases Public Health (Control
of Disease) Act, 1984 and Notifiable Diseases Public Health (Infectious
Health) Regulations, 1988.
19.
Complaints
Complaints raised by patients/relatives regarding the actions of the
Nurse or the duty GP in the Acute GP Unit doctor must be managed in
line with the NHS complaints procedure and the Health Board
complaints procedure.
20.
Nursing and Medical Records
All of the nursing and medical records will be entered electronically into
the ADASTRA system. Clinical records for patients who attend the
Acute GP Unit will be forwarded to the patient’s host practice in line
with the agreed protocol by facsimile or Data Transfer Service [DTS].
11
21.
Untoward Incident Reporting
The reporting of untoward incidents must be undertaken in line with
Health Board policy via the Datix system.
22.
Transport:
Non-emergency patient transport service: The Ambulance service
operates a comprehensive patient transport service for the Health
Board. This encompasses transport home and inter-hospital transfers.
For Transport Home the following number must be used: (9) 01792
561999 or (9) 01267 222555.
Taxi service: The Health Board now operates a strict policy on the use
of Taxi’s
to transport patients home or between hospitals where other avenues
of transportation have failed. All staff ordering a Taxi service should
contact the Bed Manager for authorisation before contacting the
transport hub on Ext: 4053 or 4054.
Bus Services: The Bus service provision at Singleton and Morriston
hospitals is available every 15 minutes on site from 8am until 6pm.
After 6 pm service provision reduces but there are still regular buses
every half an hour up until 11 pm on both sites.
12
Appendix 1
Flowchart for referrals
GP IDENTIFIES NEED TO REFER PATIENT
TO SINGLETON
GP Rings 01792 200342
Receptionist takes patient demographic details then passes call straight
onto GP on duty
Discussion between referring GP and acute unit GP
Patient clearly needs
admission to hospital
GP accepts referral on behalf
of medical on call team
(acute unit GP completes call
record and this is faxed back
to surgery
GP faxes referral letter to
01792 298347 or gives
letter to patient
Patient suitable for
alternative pathway of care
Patient suitable for:
Urgent outpatient
assessment by
specialist services; OR
Admission to a
community nursing
home; OR
Care at home by the
acute Community
Resource Team; OR
Short term support at
home using social
services / Community
Resource Team
GP faxes referral letter
to 01792 298347 or
gives letter to patient
Acute GP sees
patient, investigates
as appropriate,
develops
management plan
Patient arrives at
Singleton and transferred
around direct to medical
on-call team
Patient admitted to
hospital
Patient suitable for
management by
acute unit GP
Acute unit GP
facilitates access to
alternative pathway &
record faxed to GP to
confirm
Patient
discharged
home
Patient
commences on
ambulatory
pathway
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APPENDIX 2
REFERRAL DIRECTORY
ACUTE G.P UNIT
14
Singleton Hospital
ACUTE G.P UNIT
Singleton Hospital
ACCESS TO:HOT SLOTS/BOOKING PROCESS
15
HOT CLINIC SLOTS
Mon
AM
Diabetes/Endocrinology
PM
Tue
AM
Dr K Jones
(Clinic
ID: 711) Singleton
08:30
Wed
PM
AM
Gastroenterology
(Jaundice)
PM
Prof S Bain (Clinic
ID: SI-DIA-SB-WEPM-NEW)
Singleton
13:00
Thu
AM
PM
Dr K Jones
(Clinic ID: 386)
Singleton
13:30
Dr J Kingham
(Clinic ID: 2116)
Singleton
08:30
Medicine for the Elderly
Dr A Treseder
Dr D Leopold (Clinic
(Clinic ID: A06)
ID: L10-GORS-TUMorriston
09:30
PM)
Goreseinon 14:00
Dr W Harris
(Clinic ID: 2107)
Singleton
09:00
Dr P Pathmanaban
(Clinic ID: 2358)
Singleton
10:30
Respiratory Medicine
Dr S Packham
(Clinic ID: 2097)
Singleton
09:15
Dr P Ebden
(Clinic ID: SI-WEAM-NEW Ebden)
Singleton
09:00
16
HOT CLINICS SLOT BOOKING PROCESS
TO MAKE BOOKING PLEASE CALL 7419
17
ACUTE G.P UNIT
Singleton Hospital
ACCESS TO:ENDOSCOPY
 Access to Endoscopy can be achieved via a discussion with the Gastroenterology
Consultant of the day – please refer to rotas attached
18
ACUTE G.P UNIT
Singleton Hospital
ACCESS TO:SPECIALITY CONSULTANT ADVICE
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CONSULTANT CONTACT INFORMATION
Consultant
Secretary
Extension Number
Prof Stephen Bain
Dr Balwinder Bajaj
Dr Chin Lye Ch'ng
Jill Darney
Jill Davies
Ruth Phillips
7715
6337
5009
Dr
Dr
Dr
Dr
Dr
Dr
Richard Chudleigh
Gwyneth Davies
Claire Dinsdale
Adrienne Edwards
Rhian Finn
Wyn Harris
Jill Darney for out-patient work /
Wendy Johnson for in-patient
Deborah Lewis
Hannah Ayling
Emma Williams
Emma Williams
Hannah Ayling
7715/5359
7751
5870
6306
6306
5870
Martyn Heatley
Sophie Henson
Chris Hudson
Stuart Packham
Jill Davies or Linda Alexander
(depending on which consultant he
is working for)
Jan Webb
Patricia Seagull
Deborah Lewis
6337/5354
5619
5910
7751
Dr
Dr
Dr
Dr
Personal Mobile
Anna Davies - due to start in post
Dr Praveen Pathmanaban
on 11.6.12.
Dr Kate Speed
Emma Williams
6306
Dr Linzi Thomas
Delyth Pughsley
5506
Dr Andrew Treseder
Pat Joseph (based in Morriston)
3384
Dr Clive Weston
Linda Alexander
5354
Dr Lisa Williams
Jan Webb
5619
NB: Consultants can also be contacted via switchboard on ext 100 if the personal mobile number is currently
unavailable.
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Day
Date
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
11th June
12th June
13th June
14th June
15th June
18th June
19th June
20th June
21st June
22nd June
25th June
26th June
27th June
28th June
29th June
2nd July
3rd July
4th July
5th July
6th July
9th July
10th July
11th July
12th July
13th July
16th July
17th July
18th July
19th July
20th July
23rd July
24th July
25th July
26th July
27th July
30th July
31st July
1st Aug
2nd Aug
3rd Aug
6th Aug
7th Aug
8th Aug
9th Aug
10th Aug
13th Aug
14th Aug
15th Aug
16th Aug
17th Aug
20th Aug
21st Aug
22nd Aug
23rd Aug
24th Aug
27th Aug
28th Aug
29th Aug
30th Aug
31st Aug
WARD 3
Geriatrics
WARD 5
WARD 6
Diabetes
WARD 7
Stroke/TIA
WARD 8
Respiratory
WARD 9
Cardiology
WARD 10
Gastroenterology
Consultant of Day
Consultant of Day
Consultant of Day
Consultant of Day
Consultant of Day
Consultant of Day
Consultant of Day
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
Hudson
BANK HOLIDAY
Hudson
Hudson
Hudson
Hudson
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Packham
Packham
Packham
Packham
Packham
Packham
Packham
Packham
Packham
Packham
Davies
Davies
Davies
Davies
Davies
Davies
Davies
Davies
Davies
Davies
Baja
Baja
Baja
Baja
Baja
Heatley
Heatley
Heatley
Heatley
Heatley
Heatley
Heatley
Heatley
Heatley
Heatley
Weston
Weston
Weston
Weston
Weston
Heatley
Heatley
Heatley
Heatley
Heatley
Baja
Baja
Baja
Baja
Baja
Weston
Weston
Weston
Weston
Weston
Thomas
Williams
Thomas
Ch'ng
Thomas
Ch'ng
Thomas
Thomas
Ch'ng
Thomas
Thomas
Williams
Henson
Thomas
Ch'ng
Ch'ng
Williams
Henson
Ch'ng
Thomas
BANK HOLIDAY
BANK HOLIDAY
Harris
Treseder
Dinsdale
Dinsdale
Treseder
Harris
Dinsdale
Treseder
Harris
Treseder/ Dr Harris
Harris
Treseder
Dinsdale
Harris
Treseder
Dinsdale
Dinsdale
Treseder
Harris
Dinsdale
Treseder
Harris
BANK HOLIDAY
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Pathmanaban
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban/Chudleigh
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
BANK HOLIDAY
Pathmanaban/Chudleigh
Chudleigh
Pathmanaban
Pathmanaban/Chudleigh
BANK HOLIDAY
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
Speed/Edwards
BANK HOLIDAY
Packham
Packham
Packham
Packham
21
ACUTE G.P UNIT
Singleton Hospital
ACCESS TO:COMMUNITY RESOURCE TEAM (CRT)
22
23
24
25
26
ACUTE G.P UNIT
Singleton Hospital
ACCESS TO:RADIOLOGY RESOURCE FILE
SINGLETON HOSPITAL RADIOLOGY RESOURCES FILE
This file aims to provide a comprehensive description of the preparation that patients require for all examinations that take place
here within the Radiology Department, Singleton.
27
The radiology department will issue the ward a preparation sheet with details appropriate for individual patients requiring
examination. Please refer to this, as it may have specific instructions for that individual patient. If you have any queries, please ring
the relevant department quoting the patients hospital number.
Contact phone numbers within Radiology
AREA
Plain films (Portables/GP’s)
In patient X- rays
Radiographer On-call Bleep
(5pm – 9am)
Main Radiology Reception
XR Appointment queries
Fluroscopy Room 3
Room 5
Radiology Nurse Bleep
TELEPHONE NO.
5268
5437
Bleep 5722
5927
5211
5221
5261
Bleep 5723
AREA
CT/US Reception
CT Scanner
Antenatal US
(West Ward Block)
MRI Reception
MRI Scanner
XR Porters
TELEPHONE NO.
5467
5552
5660
Radiology FAX
285436
8857
8871
5973
When patients visit the Radiology Department, can you please ensure that they are wearing an ID wristband, are
dressed in a hospital gown, and have no valuables such as jewellery, mobile phones etc. on their person as we cannot
accept responsibility for any loss or damage.
LMP (- Last Menstrual Period). Please record on forms/notes of patients between the ages of 12 and
55 yrs.
Plain Films:
* Please ensure all allergies are written clearly in the patients notes.
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IVU
Chest and Abdominal films
for ‘? Perforation’
OPT (Orthopantomogram radiograph of the dental
arches and their associated
structures)
Cannulated and recent renal function blood test. Low residue diet the day before examination.
LMP where applicable
Patients need to be sitting upright for approx 15 minutes before XR in order to demonstrate a
perforation. LMP where applicable
Patients need to be able to stand upright, or sit unsupported on a stool.
Please ensure that all in patient Radiology requests are completed on the following request form:
(Please see over leaf)
Fluroscopy procedures:
* Please ensure all allergies are written clearly in the
patients
notes.
Upper GI
Barium Follow through
Barium Meal
Barium swallow
Barium video swallow
NBM (Nil By Mouth) 8hrs prior to exam. Patient dressed in hospital gown. LMP where
applicable.
LMP where applicable. NBM 8hrs prior to exam.
LMP where applicable. NBM 8hrs prior to exam.
In conjunction with Speech Therapy. LMP where applicable.
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Gastrograffin Swallow
EUS (-Endoscopic
Ultrasound)
PEG (- Percutaneous
Endoscopic Gastrostomy)
RIG – Radiology Insertion
of Gastrostomy
LMP where applicable. NBM 8hrs prior to exam.
- Clerked, bloods, cannulated, drug chart, consent form. (Antibiotic requirement pre
EUS will be instructed by the Consultant) NBM 6hrs prior to exam. If patient is on
Warfarin, please stop medication as instructed by the Radiologist.
- Well hydrated, clerked, bloods, cannulated, drug chart, signed consent form. LMP
where applicable. NBM 8hrs prior to procedure, NG tube in situ.
- Well hydrated, NG tube inserted, clerked, bloods, cannulated, drug chart, consent
form. LMP where applicable. Antibiotic cover 1hr before examination.
Lower GI
Barium Enema
Colonic Stent
ERUS (- Endo rectal
Ultrasound)
Proctogram
Sinogram
Small bowel intubation
Urograffin
Enema/Pouchogram*
Picolax preparation the day before examination. Patient dressed in a hospital gown
only. LMP where applicable.
Clerked, bloods, cannulated, drug chart, signed consent form. LMP where applicable.
Hospital gown and Laxative preparation (Picolax x 1 sachet).
Hospital gown, LMP where applicable.
Please inform us of what type of tube is in situ. LMP where applicable.
NBM from 10pm the night before. LMP where applicable.
Patient dressed in a hospital gown only. * Please ensure patient brings spare
Colostomy/Iliostomy bags if required. LMP where applicable.
Biliary System
ERCP
Clerked, signed consent form, hospital gown, Recent clotting screen, drug chart, Cannulated
Right hand/arm. NBM minimum of 6hrs and a maximum of 12 hrs pre procedure. Prescribed
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PTC (-Percutaneos
Transhepatic Cholangiogram)
T-Tube Cholangiogram
prophylactic antibiotic given approx. 1hr prior to ERCP. Antibiotic cover/Vitamin K injection only
if requested by Radiologist. LMP where applicable.
Clerked, signed consent form, hospital gown, drug chart, Prescribed prophylactic antibiotic
given approx. 1hr pre procedure. Pre-op BP/Bloods/Sats results sheet. LMP where applicable.
Recent blood results, cannulated Right hand/arm.
Usually day case procedure, clerked, signed consent form, drug chart, LMP where applicable.
Urinary System
Antegrade Pyelogram
Conduitogram
IVU *
Micturating
Cystogram/Cystogram
Signed consent form, LMP where applicable, recent blood results,
LMP where applicable.
Cannulated and recent renal function blood test. Low residue diet for 2 days pre IVU. LMP
where applicable. If morning appt. NBM 8pm previous night. If afternoon appt. – light
breakfast, nil orally after. * N.B If Diabetic patient please inform Radiology for a morning appt.
Urinary Catheter in situ. LMP where applicable.
Nephrostomy/Nephrostogram Clerked, cannulated, drug chart, signed consent form, hospital gown, Recent clotting screen,
drug chart, LMP where applicable. Antibiotic cover 1hr before examination. If the patient has
Asthma, please arrange a 3 day course of steroids (day before, day of and day after
examination), this is for the administration of IV contrast during examination.
Renal cyst puncture
NBM 4hrs pre procedure, signed consent form, LMP where applicable, pre-med Diazepan
orally 10mg (contact Radiology nurse for queries)
Urethrogram
More commonly performed in males. Hospital gown.
Video Urodynamics
LMP where applicable, hospital gown.
Circulatory System
Arteriogram
Hospital gown, clerked, recent blood results, LMP where applicable
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Peripheral Arterial
Thrombolysis Intravenous
Digital Subtraction
Angiography. (IVDSA)
Venogram
CT:
NBM for 3 hrs prior to exam. Recent full blood count, prothrombin time, KCCT and fibrinogen
levels should be recorded the day prior to the procedure. The morning of the procedure blood
should be taken for cross matching. Signed consent form. Arrangements to be made for HDU
transfer post procedure. LMP where applicable.
Hospital gown, clerked, recent blood results, LMP where applicable.
* Please ensure all allergies are written clearly in the patients
notes.
The CT scanning department will telephone the ward with an appointment time and preparation instructions required
for each individual ward patient for their examination. Please refer to this, as it may have specific instructions for that
individual.
Diabetic patients on Metformin - During the scan IV contrast will sometimes be given. Diabetic patients on Metformin will be
instructed to stop taking the medication the day before, the day of and the day after the scan if given contrast.
CT Brain (+/- Contrast)
CT Neck
CT Thorax
All artifacts removed from that area – hairgrips/ jewellery etc. Hearing aids will be removed in
the Dept. Recent Creatinine and Urea levels and LMP (where appropriate) written in notes (required for contrast injection).
All artifacts removed from that area, jewellery etc. Recent Creatinine and Urea levels and
LMP (where appropriate) written in notes (- required for contrast injection). A working
cannula is required.
All artifacts removed from that area, jewellery etc . Recent Creatinine and Urea levels and
LMP (where appropriate) written in notes (- required for contrast injection). A working
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CT Abdomen/Pelvis
cannula is required.
All artifacts removed from that area, jewellery etc. Recent Creatinine and Urea levels and
LMP (where appropriate) written in notes (- required for contrast injection). A working
cannula is required
Gastrograffin preparation: Bottle B diluted in 1 litre of water. 2 hours before
the scan.
Bottle A diluted in ½ litre of water 1 hour before
the scan.
“Please drink gradually up until the appointment time. Do not drink all in one
go.”
CTPA (Computed Tomography
Pulmonary Angiogram)
CT Upper/Lower Limb
CT Biopsy
All artifacts removed from that area, jewellery etc. Recent Creatinine and Urea levels and
LMP (where appropriate) written in notes (- required for contrast injection). A pink or green
working cannula is required.
All artifacts removed from that area, jewellery etc. LMP (where appropriate) written in the
notes.
Blood clotting results, signed consent form, cannula in situ and clerked.
The weight limit for the CT scanner in 32 stone/203 Kg.
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MRI :
* Please ensure all allergies are written clearly in the patients notes.
The MRI scanning department will telephone the ward with an appointment time and preparation
instructions required for each individual ward patient for their examination. Please refer to this, as it
may have specific instructions for that individual.
Patient screening forms:
Before the exam the patient will be asked to fill out a screening form asking about anything that
might create a health risk or interfere with imaging. This needs to be done on the ward and read through with a Radiographer prior
to the scan. (A next of kin/Guardian/Doctor can fill this out on behalf of the patient, being aware that the responsibility for patient’s
eligibility to be scanned lies with whoever signs the screening form.)



The scanning time for MRI can vary from 20 minutes – 1 hour. The patient will be required to lie totally still for the scan.
Please make sure that the patient leaved all valuables on the ward before visiting the MRI department.
136Kg/21 Stone is the weight limit for this scanner.
MRI Request forms: MRI do not accept ‘Radiology request forms’ for MRI examination requests. Please make sure that the
Doctors’ fill out an MRI referral form (Please see over leaf), ensuring that the ‘Doctors Declaration’ section is filled in during a
consultation with the patient. It’s their responsibility as requests will not be accepted without the form being filled out completely.
The MRI scanner in Singleton is a 3T Scanner, which is stronger than the one at Morriston Hospital. Please do not assume that all
Cardiac stents are able to be scanned at Singleton. If the patient has a Cardiac stent in situ, the make and model number will be
required to see if the patient is suitable for scanning. Please state this clearly on the request form.
Pregnant patients:
MRI scans on pregnant patients are performed on a clinical need basis which needs to be discussed
between the referrer and Consultant Radiologist.
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Claustrophobia:
Some patients who undergo MRI examinations may feel confined, closed-in, or frightened. Oral sedation is
available for patients suffering from extreme claustrophobia who need to be scanned at Singleton. Patients requiring IV sedation
will need to be scanned at Morriston. If patients are properly prepared and know what to expect, it is almost always possible to
complete the examination.
Ultrasound :
* Please ensure all allergies are written clearly in the patients notes.
The US scanning department will telephone the ward with an appointment time and preparation
instructions required for each individual ward patient for their examination. Please refer to this, as it
may have specific instructions for that individual
Please note: Diabetic patients who are receiving abdominal ultrasound should not take their tablets or
insulin until after the examination, and should also receive morning appointments.
Upper Abdominal U/S
Lower Abdominal U/S
Pelvis U/S (inc. Kidneys)
U/S will contact the ward with any specific requirements for scan preparation.
NBM 6hrs before appointment.
U/S will contact the ward with any specific requirements for scan preparation.
NBM 6hrs before appointment, but drink 1 litre of fluid 1 hour before appointment. Do
not empty bladder after drinking.
Please drink 1 litre of fluid 1hr before appointment and do not empty bladder after
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US Biopsy
drinking.
Blood clotting results, signed consent form, cannula in situ and clerked.
There are no after effects so the patient may continue with their normal activities after the scan.
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