I.S.B.A.R D.I.R.E.C.T - FOR ADMISSIONS

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

S - Situation, a brief summary “70 yo F with requiring admission COPD exacerbation”

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 & Thromboprophylaxis

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

Patients usual medications that may or may not need modulation

THROMBOPROPHYLAXIS (as per your already-completed risk assessment)

Diet (soft, thickened, diabetic etc)

The ED Doctor must document summary of admission plan on back page of AEDOC (Obs chart) as the agreement between Med and ED.