PHU Acute Admissions Policy

🎯 Purpose

This policy sets out the guiding principles for the safe, timely, and appropriate admission of acute patients to the correct clinical specialty team. It provides clarity on:

Responsibility for patient care at each stage of admission
Standards for response times and communication
Resolution of disputes between teams regarding patient ownership

This policy has been agreed by all Clinical Directors, Care Group Directors, Divisional Directors, the Medical Director, and the Chief Executive.

📋 Scope

This policy is for patients ≥16 years old. Adult services are responsible for patients ≥16 once admitted to the hospital unless they have a chronic condition and/or are well known to paediatric services and are in a transition phase. There may be exceptions to this rule which will need to be discussed on a case-by-case basis.

Please also see the Paediatric Admissions SOP – accessed on the intranet for further information.

🧭 Principles of Referral and Admission

All team members are expected to cooperate and collaborate to ensure safe and timely patient care
Disputes must be resolved at consultant level and must not delay patient admission
ACPs, Specialist Nurses and ENPs can refer directly to specialty teams without requiring a doctor review
Once a specialty accepts a patient, duty of care passes from ED to that specialty
If the accepting specialty subsequently believes another specialty is more appropriate, they are responsible for onward referral and transfer of care
ED will continue to provide support for patients physically in the resuscitation area only

🗨️ Bleep Etiquette & Communication

The baton bleep/phone is the primary route of contact with on-call specialty teams
If the bleep holder is unavailable (e.g. scrubbed), it must be handed to an agreed responsible team representative e.g. SHO, CNS, coordinator, ward manager, consultant on call
If handover is not possible, another available colleague must answer on their behalf
Those answering must actively gather information and relay it in real time, not simply take a message
This must occur consistently and in a planned manner

🕒 Timeframe Standards

Ambulance handover: within 15 minutes of arrival
Rapid Assessment and Treatment (RAT) and/or ED clinician review: within 60 minutes of arrival
Specialty review after referral: within 60 minutes

⚠️ Additional rules

If a specialty does not respond within 60 minutes, and an ED senior deems the patient stable, they may be transferred to the relevant ward within 60 minutes of referral
Any deviation from these timeframes due to clinical risk must be agreed between the admitting specialty consultant and the ED consultant
The ward nursing team must then escalate to the specialty for review
There are no exceptions to the requirement for consultant-to-consultant agreement when deviating from these standards

📌 Admission Pathways

Re-presenting patients (within 7 days):

Admitted under the original discharging team (if ward capacity allows)
Bypass ED to go directly to the relevant ward/SDEC, unless they require resuscitation-level care
If they must wait in ED, the discharging specialty must review them within 60 minutes

Expected and referred patients:

Go directly to the relevant specialty assessment area unless they require resuscitation level care
Be seen in ED by the relevant specialty team within 60 minutes if awaiting a bed
These patients are not routinely reviewed by ED unless they become clinically unstable
Inpatient teams must not direct patients to the Emergency Care Centre (ECC)

Specialties with patients in the ED:

Expected to assess and arrange ongoing treatment/management during time in ED whilst a bed is found
Exception: if a patient acutely deteriorates requiring immediate time-critical assessment/treatment, a senior Emergency Medicine clinician will commence initial management — but the admitting specialty should provide urgent assessment when requested

⚖️ Dispute Resolution

In ED, disputes are adjudicated by:

Emergency Physician in Charge (EPIC) (08:00–00:00) — 07525 288830
On-call Emergency Medicine Consultant (00:00–08:00) or delegated senior ED clinician

The EPIC's decision is final at the point of care to prevent delays.

Unresolved disputes should be escalated:

Clinical Director → Care Group Director → Divisional Director → Medical Director

Consultant-to-consultant discussion is the expected first step. Timely care and patient experience must always come first.

This policy is not exhaustive. Clinical judgement, timely senior decision making, effective communication and patient safety must always take priority.

This policy will be updated regularly, and the most recent version will be available on the intranet homepage under the 'important links' section.

Suggestions or comments: [email protected]

v5.9 · Revision date November 2026