BIRMINGHAM EYE EMERGENCY DEPARTMENT SERVICES
The answers on how to work out the common logistic issues in the eye casualty department
WHEN DOES A PATIENT QUALIFY TO BE TRANSFERRED FROM UCC TO ED FOR REVIEW?
Please observe the following rules before transferring a patient from UCC to ED section for review. This is to avoid adding more backlog to the patients in ED if the patients can be dealt with directly in UCC with advice from a senior ED doctor.
Discuss with the ED doctor to agree with the transfer.
Discuss with consultant in charge of ED session if unable to find ED doctor.
Arrange for any further investigations/treatment that may be required before transfer.
Most importantly, “do not pass the buck”. If you’re unsure, just ask.
Please refer to this guidance for more information.
HOW DO I MANAGE REFERRALS FROM LOCAL HOSPITAL?
Please ensure that these patients are seen by their local ophthalmology department during the daytime working hours if possible.
If for whatever reason they can't, please document the details of the patient in the reception or the handover file (for oncall doctors). Also ask the patient to bring some form of referral letter as well.
If you are not sure if the patient needs to be seen or how to be managed, please discuss with the consultant on ED shift or 4th oncall doctor.
HOW LONG IS EACH ED SHIFT FOR DOCTORS?
Each shift lasts for 3.5 hours. In the urgent care clinics, there will be a maximum of 10 patients booked for you to review. If you're working in the ED section, please be on time for your shift. Morning session starts from 9.00am-12.30pm and afternoon sessions from 1.30-5.00pm.
if you do come early before the 1.30pm start, you can end earlier than the intended end time of 5pm.
WHAT DO I DO IF I’M UNSURE ON WHAT TO DO WITH A PATIENT?
Consultant support is available at all times at office hours during each ED session. Call them if it is very urgent. If the patients needs a urgent follow up, email or call the respective subspecialty team if you are unable to get in touch with them. Please refer to subspecialty services section for the best person to contact.
HOW DO I ORGANISE THE ADMISSION OF A PATIENT TO THE WARD?
1. Inform the consultant in charge of the patient.
2. Inform the nurse in charge of the admission.
3. Complete the Drug chart on Unity (example).
4. Ensure patient has a review plan in place.
HOW DO I ARRANGE AN URGENT/SEMI-URGENT FOLLOW UP VISIT FOR A PATIENT?
Before arranging for a follow up, think of "how, when and where the patients will be best followed up?"
Patients can be followed up by 5 methods:
Refer to a subspecialty service for review in their clinic.
Primary Care Follow Up Clinic
Modality Clinics if need to be seen after a week. Click here for the criteria.
Back to their local hospital (see patient postcode) - ask reception to fax urgent letter to arrange appointment
Eye ED if need to be seen within 1-3 days (PLEASE ONLY USE THIS AS A LAST OPTION)
Please indicate on Medisoft and advised patient to go to the reception desk to make the relevant appointment as well as ticking on the sheet note for ED review / PCFU / Modality / subspecialist review.
HOW DO I HANDOVER A PATIENT WHEN MY SHIFT IS OVER?
Whenever your ED shift is over, it is good medical practice to handover cases that need to be seen. Remember this applies to all patients including the ones seen in UCC. There are 3 ways to do this:
There is a logbook to document any patients that need sorting out. This logbook is located in the cupboard next to the entrance of UCC (check with colleagues if you’re unsure where it is).
Contacting the on-call doctors directly.
Informing the nurse-in-charge of the ED session regarding these patients.
HOW DO I ARRANGE A PATIENT TO BE SEEN IN BMEC ED IF THEY ARE AN INPATIENT IN THE MAIN CITY WARD?
1) Discussed and agreed with a consultant for a management plan and if review is necessary in eye ED
2) Informed the nurse in charge of eye ED of the session when the patient is coming (best if the ward nurses where the patient comes from, to ring up eye ED for best time to come)
3) Informed the ward nurses that when the patients arrive, they are to come through the AMBULANCE entrance and NOT the main doors.
4) Check COVID19 status
Ideally, these patients are best seen in the ward and if necessary for a review, refer to the relevant subspecialty for review instead of ED. If they need diagnostic work, please inform the nurse in charge of eye ED when they are coming as well as informing the relevant technicians.
HOW DO I REFER A PATIENT TO ANOTHER SPECIALTY (NON OPHTHALMOLOGY RELATED)?
Call the respective specialty for advice
If the patient needs to be seen in the respective specialty, document in Medisoft - the place the patient needs to go to and the doctor that you have spoken.
If the patient needs imaging such as CT scan, either arranged it on behalf of the specialty or they can do it from their side. The patient will need to go the respective specialty after the scan.
*Copy and paste management plan from Medisoft onto the documentation section on Unity for the patient* Click here to see a demonstration of this.
Do NOT send patient to main city ED unless you have the agreement of the ED doctors.
WHAT DO I DO IF A PATIENT NEEDS URGENT RETINAL LASER - PRP OR INDIRECT?
1) Check if any colleagues are available to perform the laser especially if there is a laser clinic going on.
2) Anyone requiring top up laser or unsure with the laser treatment performed, please seek advice from a senior colleague if available or the vitreoretinal fellow (if retinal tear/detachment)
3) Perform the laser yourself if your ED session is not busy and after checking with the nurse-in-charge/consultant of the session is happy with it.
Laser keys are available at the lead triage nurse table next to reception. Please sign in and out the lens/keys used.
4) Please do your best to avoid bringing the patient back after 5pm except in exceptional circumstances.
HOW TO ENSURE THE GP/OPTICIAN IS AWARE OF THE PATIENT'S VISIT?
As we do not send out GP letters for patients seen in ED/UCC, it is important and requirement that all patients especially those that requires repeated eye drops, to have their GP letter printed out and a copy given to them. The other copy will have to be placed in a special box available (ask nursing staff) once you finished your shift to have them sent off to their GPs.
Every room in ED/UCC will have a working printer/paper ready to print. If for whatever reason, the printer is not working or you are in a room without one, you can always ask the patient to go to the reception to have a copy of the letter printed out for them.
If the letter is not printing due to lack of GP details, please refer to this document.
In the long-term, we are looking to improve this by getting Medisoft (hopefully once it's upgraded) to sent out this letters automatically to their GPs through email. Till then, would be ever so grateful if you would follow the action plan above.
WHAT ARE THE COLOURED BOTTLES FOR COMMONLY TAKEN BLOODS?
Haematology – FBC, ESR (lavender)
Biochemistry – CRP,LFT,UE,ACE, Immunoglobulins (ochre)
Immunology – ANA, ANCA, Rheumatoid Factor and Complement (ochre)
Serology – Syphilis (ochre)