Observation ward

The ED does not currently have a dedicated observation unit however there are still some patients who may need longer than 4 hours of observation under Emergency Medicine or are awaiting investigations/results. There are a limited number of beds available for ED patients on various wards in the hospital depending on the suspected diagnosis, e.g.:

• head injury - admit ward 18 (where the FY1 on ward can prescribe medicines and be first contact for nurses)
• back pain/?CES/Renal colic to the Day of Surgery Admission (DOSA) unit (Where a patient needs HEPMA prescribed and ED is the first contact).

If you are unsure please either discuss with a senior doctor, or refer to the separate Observation Ward and DOSA guideline documents available on the SJH ED intranet site.

Overnight, Mondays to Fridays, patients with simple general surgical presentations who present directly to ED can be admitted to the observation unit, if they are unlikely to deteriorate, for surgical review in the morning. This should be discussed with the senior doctor in the ED. If this is felt to be an acceptable plan the patient needs to be discussed with the surgical nurse practitioner on-call who will be part of the HAN team. Remember that the ED doctor working in the department or hospital at night doctor are the first ports of call for these patients at night with ED consultant cover at home. The aim must therefore be to admit patients in whom deterioration is unlikely. You should only very rarely need to treat an ED patient on the ward.