CALLS FROM RURAL SITES

If you are holding the 71262 Doctor in-charge phone you will field calls from Kurri Kurri (20km away) to Merriwa (170km away).

All peripheral sites have access to point of care pathology- VBG/ TROP/Biochem/INR. The table below provides a summary of what other services are available in these smaller places.

The health practitioners calling will vary in job title, skills and experience. CNC/RN managed sites will call overnight for simple advice or analgesia for each patient. GP led sites frequently call for patient transfer requests.

Management options for rural sites overnight:

Unstable- provide advice to stabilise, advise to contact retrieval service via JHH (number below) for transfer to appropriate site.

Unwell but stable accept transfer to TMH, assist site to establish initial treatment and urgency of ambulance transfer overnight Vs stable patient, patient transport in AM. If clear diagnosis, assessed by GP and not unstable attempt to have patient accepted by team to go to ward bed when available. E.g. not septic cholecystitis. If diagnosis unclear or need further investigations/ work up accept to TMH ED.

Stable patient with unclear diagnosis, in need of medical review, and no medical staff onsite - consider transfer to nearest GP run facility (Merriwa/ Denman may be advised to transfer to Muswellbrook for review) or accept for assessment at TMH ED.

Explore the possibility of admission at the current site if there is nothing additional that transfer to TMH will add to the patients care. e.g. Palliative care, pain management, N+V for symptomatic relief. Certain presentations will be suitable for discharge and review by the GP in the morning.

If the patient in question has an issue that cannot be managed at TMH they should not be accepted for review, rather directed to the appropriate site e.g. significant trauma, STEMI, UGIH —> JHH. The caveat to this is stroke patient’s who have been discussed with the Stroke Fellow at JHH who have requested CT imaging at TMH.

Below is the resources available at peripheral sites

Documentation for consults and expected patients

Ideally, for all calls from peripheral sites a clinical consult note on CAP is created in the patient’s notes.

>>>>To access this, click “add/edit document” then “Shared health summary”

Record the patient details, advice given, treatment and disposition advice, the staff member you spoke to, the time/duration of call; even if you do not accept care of the patient!

>>>> Ensure you click the (+) sign after adding in comments or your input will not be saved

This documentation is a legal requirement and will be referred to in the event of an adverse outcome. (Note you can have 2 CAP screens open at once to review patient results/ imaging on one and make the note in the other - open in a separate browser window - may not always work!)