Admission & Discharge Criteria

Examples of admissions criteria provided by units. The documents have been provided in Word format where possible for ease of use and editing for your own purposes.

 

  • The Freeman's PACU is an adult service only.
  • All patients booked into PACU must be considered highly likely to be fit for ward discharge by 8am the following morning.
  • Invasive monitoring and basic inotrope / vasoactive infusions can be managed but will need to be weanable well before the 8am discharge requirement.
  • Significantly unstable patients or those requiring very frequent medical intervention should be referred on for a Critical Care bed not admitted to PACU if in doubt discuss with Critical Care or the on-call Anaesthetic Consultant.

 

Ward J27 is a short stay acute medical assessment ward based on Level 3 Chancellor Wing at SJUH. The old JAMAA area which was designed as a non-bedded area has been redeveloped in order to make it an inpatient area as part of Ward J27.  The project to re-develop and modernise J27 was funded using building and engineering capital and was completed in December 2017.

As part of the Emergency and Specialty Medicine CSU five year Clinical Business Strategy there was a desire to create  one bay of level 1b High Observation Beds (HOBS) for the most unwell patients in Acute Medicine that currently are scattered across the acute assessment wards in Chancellor wing and are increasingly awaiting step down from Critical Care. Cohorting the sickest patients in the CSU will improve patient care, safety, and flow through monitoring, rapid recognition and treatment. Having a dedicated area on the acute floor for these patients will allow:

  • Timely transfer from the resuscitation area in the Emergency Department (ED)
  • Early senior input from the medicine speciality team
  • Support the CSU to better meet the Emergency Care Standard
  • This will support right patient, right place, and right specialty

The HOBS area provides three high observation beds for the most acutely unwell adults who require higher level monitoring including fixed cardiac and arterial monitoring, more frequent clinical observations with a higher staff to patient ratio. The area will increase to six beds on the 28 May 2018 and will provide High flow O2 therapy. The aim of the medical HOBS area is to improve flow from the ED department supporting the ECS standard and department safety. It will improve timely step down from ICU/ HDU and also prevent admissions to critical care for “monitoring” who require more intense nursing but not a critical care bed.

If 1 patient stepped down from a HDU bed 1 day earlier into a HOBS bed the Trust would save £541 per patient or enable surgical procedures requiring ICU/HDU to operate and receive associated income and performance improvement.

 

  • Categorise the postoperative level of care (0, 1, 1.5, 2, 3) a patient is likely to need before admission for scheduled surgery.
  • Calculate the temporary increase in monthly mortality caused by surgery to determine the level of care after surgery using a calculator developed with national population survival data.
  • Predicted 30-day mortality of >1% is the basis for postoperative HDU care.