Emergency Abdominal Surgery

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.

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.

999 calls

All patients with acute abdominal pain will still be taken to the Horton General Hospital ED. Patients who 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 Co-ordinator 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.

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.

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.

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)