GENERAL MEDICINE ADMISSIONS GUIDE

consultant PHYSICIAN IS FIRST ON-CALL

HOURS AVAILABLE FOR REFERRALS 0700-2330

 When phoning the physician to admit a patient, please follow the below formula for the cognitive ease of a shared mental model. The physicians have agreed to this format, however some physicians are more willing than others to take the time. Aim to be brief but thorough…

I.S.B.A.R D.I.R.E.C.T

I - Identify yourself, the patient, and the physician on-call

S - Situation, a brief summary “70 yo F with requiring admission for IV antibiotics…”

B - Background, PMHx, Meds, SHx

A - Assessment, a summary of examination findings and overall impression

R >>>> DIRECT

D - DESTINATION:

ICU/ACOU/Telemetry/COB/ward bed

I - INVESTIGATIONS

Discuss all abnormal investigations in ED including lactate. Clarify how and when these need to be rechecked. We can submit an eOrder for a later time or date for repeat bloods or imaging.

R - REVIEW OF PATIENT

In what time interval would the physician like inpatient review (next day, in 4 hours, on arrival to ward… etc)

E - END OF LIFE CONSIDERATIONS

Resuscitation planning, what are the patient’s wishes, what ceiling of care is appropriate, what interventions would likely be futile - completion of paperwork

C - COMMUNICATION REQUIRED

Consider handing over to medical SRMO after hours. Notify family/carer/trustee/other stakeholders

T - TREATMENT

ED treatment thus far, discuss ongoing inpatient treatment, antibiotic rationalisation etc

Patients usual medications that may or may not need modulation

Thromboprohylaxis (as per your already-completed risk assessment)

Diet (soft, thickened, diabetic etc)

The ED Doctor should document summary of above on back page of AEDOC (Obs chart) form as the agreed plan