Handing over a patient
How to make a referral to an Inpatient Team
An SBAR approach is a good system to ensure you give all the details in a systemic way. Think about what the person you are speaking to will want to know, have the notes, drug chart and observation sheets available so that you can answer any appropriate questions
Introduction
‘Hi, it’s Nicholas from Children’s ED. I am phoning because I have a child who needs a paediatric review for possible admission’
Situation (core details)
‘The patient is Jack Smith, a 3 year old boy with a viral induced wheeze in bed 8, who I am referring for your opinion because he is still only stretching an hour after initial burst therapy and is now hypoxic requiring 2 L of O2 to keep his oxygen sats at 92%’
Background (admission and history)
‘He has had a runny nose for 2 days and increased work of breathing since this morning. Jack has had two previous presentations with the same problem, once requiring high flow oxygen. He has never needed ICU. He doesn’t really suffer with any interval symptoms and only seems to get wheezy with a viral illness. He is otherwise atopic with hay fever and eczema but has no other significant medical history. Mum is especially concerned as her sister died of asthma in childhood.’
Assessment
‘On arrival he had a widespread bilateral wheeze and a tight sounding chest. There were no focal signs on the chest. He responded to an initial burst with some improvement in air entry but we have been unable to stretch him beyond 45 minutes. He has had prednisolone 2mg/kg and currently has EMLA on in case he needs an IV line and therapy. His current HR is 156, Sats 92% on 2L NP, RR 46 with a CEWT score of 5. He has been afebrile throughout’
Recommendation
‘I think he has a viral induced reactive airways disorder with some response to salbutamol but think he may need escalation to IV therapy and an extended stay due to his slow salbutamol stretch.’
Practice creating SBAR’s for the following situations or about patients you have seen over the first week. You can create your own history, PMH, observations and examination to suit each situation
An SBAR approach is a good system to ensure you give all the details in a systemic way. Think about what the person you are speaking to will want to know, have the notes, drug chart and observation sheets available so that you can answer any appropriate questions
Introduction
- Explain your name, role and division
- Explain what you want from them (e.g. I’m ringing for your advice or I’m ringing because I have a patient who needs a paediatric review or I’m ringing as I have a patient who I think needs admission)
‘Hi, it’s Nicholas from Children’s ED. I am phoning because I have a child who needs a paediatric review for possible admission’
Situation (core details)
- Patient Details (Name, age)
- Patient Location
- Presenting Problem or Major Complaint (Reason for referral)
‘The patient is Jack Smith, a 3 year old boy with a viral induced wheeze in bed 8, who I am referring for your opinion because he is still only stretching an hour after initial burst therapy and is now hypoxic requiring 2 L of O2 to keep his oxygen sats at 92%’
Background (admission and history)
- Past medical history
- Previous admissions
- Any other relevant history and important negatives
‘He has had a runny nose for 2 days and increased work of breathing since this morning. Jack has had two previous presentations with the same problem, once requiring high flow oxygen. He has never needed ICU. He doesn’t really suffer with any interval symptoms and only seems to get wheezy with a viral illness. He is otherwise atopic with hay fever and eczema but has no other significant medical history. Mum is especially concerned as her sister died of asthma in childhood.’
Assessment
- Vital Signs
- Examination findings
- Investigations received/ pending
- Management so far
‘On arrival he had a widespread bilateral wheeze and a tight sounding chest. There were no focal signs on the chest. He responded to an initial burst with some improvement in air entry but we have been unable to stretch him beyond 45 minutes. He has had prednisolone 2mg/kg and currently has EMLA on in case he needs an IV line and therapy. His current HR is 156, Sats 92% on 2L NP, RR 46 with a CEWT score of 5. He has been afebrile throughout’
Recommendation
- Diagnosis/ Differentials
- Management Plan
‘I think he has a viral induced reactive airways disorder with some response to salbutamol but think he may need escalation to IV therapy and an extended stay due to his slow salbutamol stretch.’
Practice creating SBAR’s for the following situations or about patients you have seen over the first week. You can create your own history, PMH, observations and examination to suit each situation
- A 5 year old boy with a fever, likely UTI and previous diagnosis of ureteric reflux
- A 4 day old baby with Jaundice and 11% weight loss since birth
- A 2 year old girl with a complex febrile seizure
- A 7 year old boy with a fever and petechial rash
- A 3 month old girl with bronchiolitis and poor oral intake