PHU Acute Admissions Policy

Abdominal pain of unknown cause (non-gynaecological)

Suspected lower abdominal pain of gynaecological cause (left or right iliac fossa)

Abscess – above clavicle, salivary or other origin

Abscess – above clavicle, dental origin

Abscess – limbs or spinal

Abscess – primary liver

Abscess – trunk, axilla, groin, boxers area

Acute ischaemic stroke

Stroke – haemorrhagic (not requiring transfer to UHS)

TIA (crescendo)

Chronic subdural haemorrhage (including delayed presentations with injury >2 weeks ago)

Head injury requiring admission overnight (per Wessex Neuro instructions)

Metastatic spinal cord compression (MSCC)

Acute kidney injury with oliguria/anuria ± metabolic acidosis/hyperkalaemia potentially requiring renal replacement therapy

Dialysis / renal transplant recipients / advanced CKD patients with medical issues not requiring acute intervention by another team

Renal colic (proven on imaging in past 14 days), representing in pain consistent with renal colic

Renal colic (suspected)

Haematuria (visible with clot retention or symptomatic anaemia)

Clot retention

Urinary retention

Obstructive uropathy

Pyelonephritis

Epididymo-orchitis requiring admission

Infected nephrostomy / nephrostomy complications

Nephrostomy tube issues (non-urgent)

Catheter-related problems (e.g. blocked, displaced catheter)

Cellulitis – perineum / scrotum

Chest pain – dynamic ECG changes or HSTnI ≥52 ng/L

STEMI (ST Elevation Myocardial Infarction)

Chest pain – non-dynamic ECG changes or normal ECG (HSTnI <52 ng/L)

Significant arrhythmias (VT, pauses, Mobitz II, complete heart block)

Heart failure

Ascending thoracic aneurysm (not requiring urgent intervention)

Aortic dissection – Type A (ascending aorta or arch up to left subclavian)

Aortic dissection – descending (Type B)

Post CABG complications (sternotomy wound, vein harvesting site)

Aortic aneurysm (symptomatic / leaking / rupturing) – abdominal or descending thoracic

Aortic aneurysm – asymptomatic / incidental (descending thoracic or abdominal)

Aortic aneurysm – asymptomatic / incidental (ascending aortic or aortic arch)

Acute limb ischaemia (acute onset <2 weeks)

Chronic limb ischaemia (rest pain >2 weeks, tissue loss, gangrene)

Leaking or ruptured AAA (for surgery)

Diabetic foot ulcer (severe) requiring admission

Vascular diagnosis (palliative) – new diagnosis on arrival

Vascular diagnosis (palliative) – diagnosis made as inpatient

Bleeding varicose veins or post-operative varicose vein complication/infection

Acute pancreatitis

Chronic pancreatitis

Chest wall injuries – displaced/multiple rib fractures or sternal fractures requiring admission

Rib fractures

Sternal fractures requiring admission

Traumatic haemothorax or pneumothorax (with or without rib fractures)

Traumatic haemopneumothorax

PR / lower GI bleeding (in absence of colitis)

Rectal bleeding (in absence of colitis)

Post endoscopy complications requiring admission

Cancer-related problem under the care of General Surgery

Upper GI bleed

Alcohol withdrawal requiring admission

Chest infection / pneumonia

Pulmonary embolism (proven or suspected) including post-operative VTE and <28/40 pregnant

Deep vein thrombosis requiring admission

VTE requiring admission

Sepsis of unknown origin

Pressure sore requiring admission

Isolated pubic rami fracture (uncomplicated, stable)

Oesophageal food bolus (symptoms below sternal notch)

Oncological diagnosis (new) made on admission

Dermatological diagnosis requiring admission (e.g. connective tissue disease, TENS)

Gout

Pseudogout

Rheumatological condition – flare or complication of known condition

Decompensated liver cirrhosis (variceal bleed, jaundice, ascites, encephalopathy)

Hepatic encephalopathy

Hepatology presentations (ascites, etc.)

Inflammatory bowel disease – acute support

Frail/elderly faller with fractures (except pubic rami fractures)

Fractures or musculoskeletal injuries (other), infected joints, haemarthroses – unable to go home or not for operative treatment

Fracture – neck of femur (proven)

Fracture – neck of femur (suspected, normal X-ray)

Fracture preventing patient from going home (stable comorbidities)

Fracture – pubic rami (uncomplicated, stable)

Fracture – facial

Haemarthrosis (traumatic and atraumatic)

Back pain, sciatica (unable to go home), possible cauda equina, spinal injuries, isolated discitis, spinal abscess

Cauda equina (suspected)

Spinal injury

Discitis (isolated)

Spinal abscess

Sciatica (unable to go home)

Musculoskeletal injury preventing patient from going home

Foreign body in the foot requiring admission

Hand injuries (including post-op plastics complications, wound problems)

Pretibial lacerations requiring admission

Plastic surgery post-operative complications (non-breast)

Breast surgery complications requiring admission

Burns requiring admission for pain / social reasons (no acute medical issue)

Burns meeting transfer criteria (Salisbury Burns Unit)

Flash burns to the face requiring observation for >4 hours (no immediate airway intervention needed)

Facial burns / flash burns requiring admission

Epistaxis requiring admission

Mastoiditis

Foreign body in oropharynx / ear / nose requiring admission

Oropharyngeal food bolus (symptoms in throat / above sternal notch)

Facial injuries requiring admission

Cellulitis / Erysipelas (uncomplicated) – above the clavicle

Cellulitis – trunk, above elbow and lower limb

Cellulitis – elbow to hand

Cellulitis related to complication of surgical procedure or cancer under surgical subspecialty care

Possible necrotising fasciitis – above the clavicle

Possible necrotising fasciitis – trunk, axilla, groin, boxers area

Possible necrotising fasciitis – scrotum / perineum

Possible necrotising fasciitis – limbs

Myeloma – acute decompensation or complication not directly attributable to concurrent medical illness

Leukaemia – acute decompensation or complication not directly attributable to concurrent medical illness

Lymphoma – acute decompensation or complication not directly attributable to concurrent medical illness

Thrombocytopaenia / pancytopaenia – acute decompensation or complication not directly attributable to concurrent medical illness

Sickle cell crisis

Cancer-related emergencies or complications related to non-surgical treatment

Potential post-chemotherapy neutropenic sepsis

Oncology-related complications (non-surgical)

Hyperemesis gravidarum

Pregnancy-related issues <20 weeks

Pregnancy-related issues ≥20 weeks

Significant medical illness in pregnancy ≥28/40 requiring admission

Pulmonary embolism (proven or suspected) ≥28/40 pregnant

Postnatal women (0–28 days post-partum) requiring admission

Paediatric mental health – acute presentation (up to 18th birthday)

Patients requiring palliative care input

Post-operative complications from a recent procedure (pain, infection, wound issue)

Patients with sequelae of cancer under current care of a surgical consultant at QAH

Orthopaedic post-operative complications (elective surgery within 2 weeks)

Patients requiring admission from outpatient clinic or imaging

Patients being repatriated from other hospitals or countries

Plastic surgery trauma / emergencies – out of hours (weekdays 17:30–08:00, weekends 17:30 Fri – 08:00 Mon)

Atrial Fibrillation

Cellulitis - Orbital

Cellulitis - Periorbital

EELRT Palliative Care

General post operative advice for a recent Urology issue

Pulmonary Embolism