Emergency Medical Assessment

The attached document has a list of the inclusion and exclusion criteria (as of 16th August 2024) for assessment in the Emergency Medical Assessment unit at SJH.

Patients who arrive in EMA after 7pm on weekdays are diverted to the ED. The EMA medical team monitor the ED Trak screen for referred patients and the ED NIC/EPIC will inform the EMA team of any patients waiting for assessment in the ED. It is the EMA team’s responsibility to request investigations and keep the ED NIC informed of all management plans. Patients requiring admission are transferred to MAU when a bed is available.

Patients who arrive in EMA after 5pm on Fridays are diverted to the ED. This is to facilitate prompt closure of the department at 9pm. All patients in EMA who require admission are transferred to MAU before closing.

The EMA team monitor the ED Trak screen for referred patients and the ED NIC/EPIC will inform the EMA team of any patients waiting for assessment in the ED. It is the EMA medical team’s responsibility to request investigations and keep the ED NIC informed of all management plans. Patients requiring admission are transferred to MAU when a bed is available.

To function as an assessment area, EMA requires sufficient assessment space. An assessment area with 2 trolleys is used for ambulant patients who can sit in the waiting room until investigations are completed. Two side room assessment spaces allow us to see patients with known or suspected infections. A 4-bedded room can be used to see patients who are too unwell or not sufficiently mobile to stay in the waiting room.

Decisions to admit patients are made by the medical team after an assessment and communicated to the Site Team during regular pauses. When there are beds available, all patients should be transferred to MAU. When inpatient beds are not available, EMA can accommodate a maximum of 4 bedded patients overnight.

Patients requiring admission from EMA for ongoing medical treatment, investigation and observation should be admitted to MAU. If a patient has stayed overnight in EMA and requires admission, direct admission to a downstream medical ward can be considered only if a patient has seen ben seen on a morning consultant ward round and is clinically stable. All such admissions must be discussed with the EMA consultant and a HEPMA completed prior to transfer and should occur before 3pm.

Moving patients from one assessment area to another should be avoided. Patients should not be moved from the ED to EMA outside of EMA operating hours. When there is significant pressure on space in the ED within EMA opening hours, decisions to move patients to EMA should be made in discussion with the ED/EMA NIC, ED EPIC and EMA Consultant. This does not apply to medically expected patients who arrive in the ED. These patients should be moved to EMA for assessment unless there is a clinical need for patients to remain in the ED (eg. needing telemetry or high NEWS).

Patients who arrive in EMA and are deemed unsuitable to stay for assessment (eg. due to high NEWS or emergency presentation, like DKA) should be discussed with the EPIC. Patients who need transfer to the ED may be suitable to remain under the EMA medical team's care. Others will need ED input. The EMA Consultant and EPIC should discuss the best pathway for individual patient management.