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…

Medical Registrar/SRMO on site after hours available on 72209

After Hours JMO available on 72207

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