Oxford University Hospitals NHS Foundation Trust

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Emergency Abdominal Surgery

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Protocols for management of Emergency General Surgery patients in Banbury and at the Horton General Hospital

All patients requiring admission under the General Surgical Teams are now transferred to the Surgical Emergency Unit (SEU) at the John Radcliffe Hospital.

There is an on call resident General Surgical Core Trainee (CT) (SHO level) at the Horton General Hospital 24 hours a day to provide an opinion for ED and GPs, and to facilitate prompt transfer to Oxford for all patients requiring admission.

There are no emergency general surgical admissions to the Horton General Hospital.

GP referrals

GP requesting admission

All these referrals go directly to Oxford, and must be referred directly to the on call General Surgical CT on the SEU at the John Radcliffe Hospital in Oxford.

  • Tel: 0300 304 7777 bleep 4049

If the surgical teams at the Horton General Hospital receive any referrals from GPs for admission, they must all be directed to the on call General Surgical CT on the SEU at the John Radcliffe Hospital.

South Central Ambulance Service (SCAS) will transfer urgent GP referrals directly to the SEU at the John Radcliffe Hospital. Under exceptional circumstances the patient will be taken to the Horton General Hospital Emergency Department (ED) if there is concern about the patient's stability. Following appropriate resuscitation at the Horton ED, the patient will then be transferred to John Radcliffe Hospital, as below.

GP requesting an opinion, but not necessarily admission

Immediate opinion: GPs can refer such patients to the on call General Surgical CT at the Horton General Hospital (via Horton switchboard).

  • Tel: 0300 304 7777

If admission is required, the patient will then be transferred to Oxford following referral from the Horton CT to the Oxford SEU CT.

Patients not requiring immediate admission: details will follow.

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999 calls

All patients with acute abdominal pain will still be taken to the Horton General Hospital ED. Those that need to be admitted under the surgeons will then be transferred to John Radcliffe Hospital, as below.

Emergency Department referrals

Patient clearly needs admission

Patients who clearly need to be admitted will be referred by the ED staff directly to the on call General Surgical CT on the SEU at the John Radcliffe Hospital, following appropriate resuscitation and stabilisation - bleep 4049. If the bleep holder is not available, the ED staff will leave the details of the referral with the SEU coordinator and arrange transfer. All patients will be accepted by the SEU junior CT, and transfer will not be conditional upon the bed state. The Operations Managers will not need to be informed.

SCAS have agreed to transfer all patients with acute abdominal pain which might require urgent surgery as 'urgent patients', and when contacting SCAS, staff should state the patient is an 'acute abdomen' requiring urgent transfer.

Patients will not be admitted to a surgical bed in Banbury and will remain in ED or EAU until transfer. Patients will be transferred to the Surgical Emergency Unit at the John Radcliffe Hospital and not the Emergency Department.

Surgical opinion required, but not necessarily admission

Immediate opinion: ED should refer such patients to the on call Surgical junior CT at the Horton General Hospital. If admission is required, the patient will then be transferred to Oxford following referral from the Horton CT to the John Radcliffe SEU CT.

Patients not requiring immediate admission: details will follow.

If Ultrasound or CT scanning is required, and can be carried out without delay, this should be done at the Horton General Hospital, but should not delay transfer to the John Radcliffe Hospital. If the scan cannot be done promptly in the Horton, the patient should be transferred to the John Radcliffe Hospital.

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Urgent Surgical Clinic

An urgent General Surgical Clinic will be set up in February 2013. GPs and ED will be able to refer patients who do not need to be seen immediately into this clinic. The surgeon doing this clinic will also be available to review urgent referrals on the wards from other specialties.

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Abscesses

Some minor acute surgical problems such as abscesses may be treated by the General Surgical CT or ED staff under local anaesthetic in ED or main theatres as appropriate, with discharge home that day. If overnight stay is deemed possible, the patient should be transferred to the John Radcliffe Hospital.

In due course we will develop a day-case service for general anaesthetic drainage of abscesses.

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Inpatient referrals from other specialties (acute general medicine, trauma, gynaecology)

Referral will be made to the duty General Surgical CT at the Horton General Hospital who will then discuss with the on call senior surgical SpR at John Radcliffe Hospital if necessary.

If further surgical input is required, there are three options:

  1. Transfer to John Radcliffe Hospital.
  2. Review in the urgent surgical clinic (review on the ward).
  3. In extreme circumstances the Consultant second on call for the Trust at the John Radcliffe Hospital would attend the patient at the Horton General Hospital.

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Urology

All Urology patients requiring admission will need to be referred to the adult Urology service in Oxford, and admitted to the SEU at the John Radcliffe Hospital.

Referrals should be made to the duty Urology SpR via the John Radcliffe Hospital Switchboard. As with general surgery referrals, all appropriate referrals will be accepted by the Urology SpR, and transfer will not be conditional upon the bed state. The Operations Managers will not need to be informed.

Blocked catheters and acute retention will continue to be dealt with in the Horton General Hospital by the ED staff and on call Surgical CT.

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Paediatric Surgery

All children requiring surgical opinions or intervention will have to be referred to the paediatric surgical team at the John Radcliffe Hospital.

It may be appropriate to admit under the paediatricians at the Horton General Hospital if surgical pathology is not certain.

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Transfers by South Central Ambulance Service

These will be transferred according to clinical urgency (agreed with SCAS):

  • Time Critical Transfers - immediate, blue light
    Actively bleeding / profoundly septic etc. (small minority of patients)
  • Emergency Transfers - usually within one hour
    Acute abdominal pain / peritonitis / appendicitis / bowel obstruction etc. (majority of patients)

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