Plastics next-day referral process

As of May 2023, all potential plastics referrals (not including those directly referred to plastics from elsewhere) should be discussed with the EPIC (or registrar on nights) prior to referral. This includes referrals from triage or following ED review.

This aims to:

• Ensure all referrals need plastics input
• Check whether email referral would be suitable, reducing the need for out of hours junior Plastics review.
• Ensure all initial management/investigations required are completed prior to Plastics review.

Patients who do not require emergency admission or immediate specialist review but do require urgent plastics review/surgical management can be referred via email.

1. Complete the \aeplas proforma on trak and then paste into an email.
2. Email plastics.hands.trauma@nhslothian.scot.nhs.uk the proforma.
3. Put plastics order on TRAK prior to discharging the patient.
4. Give patient discharge leaflets and advise they will be contacted the following day by the plastics team.

Patients should have initial treatment performed by the ED staff prior to discharge eg: examination, wound washout, exploration, wound closure/suture, x-rays, antibiotics, tetanus, simple dressing. The following day these referrals will reviewed by the plastics team and they will contact the patient to make a treatment plan.

This process is in place Sunday to Thursday from 1600 until 0800. Overnight Friday/Saturday all patients should be referred to the on-call bleep via HAN but should only be reviewed by Plastics in the department if clinically indicated, i.e. there is doubt about treatment plan or the on call team may be able to manage the case there and then. Otherwise, a plan should be made on the phone.

Your first point of contact should be the senior ED Doctor on shift, if you are unsure following this or need further clinical advice then this can be discussed with the on-call plastics doctor. They may advise you to use the email system.

If you think your patient needs admitted overnight then refer via the plastics bleep as normal. Examples of patients who would need admitted would be, please note this list is not exhaustive and you should use your clinical judgement.

• Emergencies (severe infections incl. necrotising fasciitis, devascularised limbs/digits, major burns)
• Cases needing admission (infections needing IV antibiotics, bites animal/human, open fractures excluding distal phalanx – again for IV, burns meeting admission criteria)
• Patients who need admission for other reasons (frailty, comorbidities, extent of injuries..., unreliable patient, pain management)
• Pragmatic approach with patients presenting early morning (offer patient to call the bleep as might not be worth sending home to bring back shortly after).

Children should be referred via the bleep as usual as they will need follow up or admission to RHSC.

If we are overwhelmed with patients and there are patients in the queue who could be seen directly by the plastics doctor then they will still be available for this following discussion with Site/HAN.