ࡱ> ^`]Y "bjbj h h xPkbkb   8j$1& G1I1I1I1I1I1I1$t3*6m1TTTm11(((TG1(TG1((,|w.`r<({-31101-6F<6$w.6w.L6(;,gm1m11TTTT6 B P: Rapid Assessment for Infectious Diseases (RAID) Referral Guidelines. [Aug 2016] RAID provides rapid access to investigations, diagnosis and treatment for children with confirmed or suspected infectious diseases (ID). Patients are under the care of a district hospital paediatric team. The patient will return to the care of the referring team or the ID team at Great Ormond Street Hospital (GOSH) may become the childs lead team with shared care provided with the local team. The service is not intended for those children with severe illness who require immediate admission to a GOSH in-patient bed or to an ICU bed. Description RAID consists of 2 cubicles which are open from 09:00 to 18:00 Monday to Friday. Last admission time on RAID is 14.00 (NO patient can be booked on Tuesday due to the ID ward rounds). Criteria for patients admitted to RAID. All children MUST be accompanied by a parent or carer. Inclusion: Any child who is currently under the care of a local Paediatric Team or General Practitioner and who has a confirmed or suspected infectious disease of recent onset (within approximately last 2 weeks). Any child with non-severe deterioration in, or sudden exacerbation of, a confirmed infectious disease. Children who have been recently discharged from their local hospital or have been seen locally in an assessment unit and are currently at home. The local team must have continuing involvement in the care of the patient in case re-admission is necessary. Children who have been referred for an outpatient opinion for whom the urgency of the problem is such that they cannot wait until the next available outpatient appointment. Children who have been recently discharged from the GOS ID team (to home or their local hospital) and need a quick follow-up review or discussion of recent investigations. Children who attend a GOSH ID clinic (ABC, INFECT, INF2, INF3, INF4, INFDEL, IDNK) and whose condition requires urgent re-assessment. This should only be considered if it is a problem that cannot be dealt with by the local paediatric team that shares the care of these patients. Children who require multidisciplinary review that includes ID and will remain under the ID Team. Children who are under the ID Team who need a review by other GOSH specialities. The ID Team will discuss the patient with that speciality directly prior to RAID admission. Tuberculosis * Children and attending family member with suspected TB can be admitted to the RAID cubicle under strict infection control guidelines. This means keeping the cubicle door shut during admission and wearing masks when indicated. Children with confirmed TB having received >2/52 of sensitive TB medication can be admitted to RAID. Child or attending family member with a suspected MDR or XDR TB cannot be admitted unless they have 3 negative sputums for TB culture Suggested investigations: bloods, X-Ray, Echo, ECG, MRI/CT, gastric washing, sputum, mantoux (administration and interpretation) Exclusion: Children who have PUO must be discussed with Consultants as only stable PUO can attend RAID Children who have had a history of apnoea requiring resuscitation within 48 hours of admission. Children who have currently or have had within 48 hours of admission, a history of upper airways obstruction requiring bag and mask or other similar assistance. Children requiring any continuous airways support (other than face mask oxygen) including CPAP. Children requiring > 1:1 nursing care Children who require insertion of any intravenous lines other than peripheral cannulation Children likely to require immediate inpatient admission at GOSH as a result of assessment. Self-referrals of a new patient by parents. Referrals not made through the ID Team. Patients without a referral letter Admission of children with non-ID underlying diagnoses who require isolation but no ID team review Referrals made over the weekend or fall on Bank Holidays. Patients from local hospital with transport/escort needs, which the local cannot provide. Excluded diseases: Diseases that carry a public health risk making the use of RAID inappropriate (eg: SARS, Smallpox, Anthrax, Avian Influenza) Excluded investigations and procedures: Liver biopsy, Rituximab, Induced sputum, insertion of any intravenous lines, any child requiring overnight admission. Referral Process  Step 1 GOSH ID SpR ext 6314 will be available to discuss and triage the referral further with the referring team if necessary. External referrer will fax the referral letters of patients for RAID to FAX 0207 8138552 or email  HYPERLINK "mailto:RAID.gos@nhs.net" RAID.gos@nhs.netGOSH admission code will then be generated. ID Clinicians Assistant on ext: 5085 or bleep: 0963 will collate and record referrals.  Step 2 The referring team will provide: A referral letter by fax or nhs.net email [with details of GP, patient dob, address and all contact numbers] Detailed results of all investigations so far carried out Copies or originals of all radiology images sent by electronic transfer in advance of the admission date if possible. If this is impossible, images should be sent with patient.  Step 3 If child is currently an in-patient at local hospital, the ID SpR/Fellow will contact the referring team to discuss the plan and arrange an admission time. Step 4 If the child is not an in-patient, the ID Clinicians Assistant on ext: 5085 or bleep: 0963 will contact the childs family to discuss a suitable admission date to RAID and send a letter out with admission details. Step 5 Patient details and admission plan will be entered into the RAID diary. Planned investigations, observations will be booked in advance where possible/necessary. Level of nursing involvement MUST be assessed. If specialized clean required, this will be booked in advance with Mitie.  Step 6 Discharge: The ID SpR/Fellow will record the childs admission into the medical records and provide a discharge summary within 24 hours of discharge to Referring Team, GP, parents. If summary not available at time of discharge then a verbal handover to Referring Paediatric Team will be done.  Transport and escort arrangements Patients who are currently in-patients at local hospital MUST have their transport and nurse escort arranged by the referring hospital. In-house users, please refer to GOSH transport policy. Nurse escorts must remain with the patient during the admission (except for meal breaks), and be available for the transfer back to the referring hospital. Nurse escorts can give patient oral medication as prescribed by the referring hospital.     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