Emergency Department signposting/ redirection guidance

Appendix F - Signposting/Redirection – Quick reference guide

Trigger - identified at Triage

• Patients attending with an illness or a health problem that would normally be seen and dealt with by a General Practitioner;
• Patients attending with a condition with which they have already attended their own General Practitioner, and
• Patients attending with a condition that has been present for more than 3 days.

Process

• The patient should be advised that their attendance is unlikely to be appropriate for the Emergency Department and that a senior member of the Emergency Department clinical staff will decide if they will be seen.
• While waiting they should be given a copy of the guidance which should give a positive message about the advantages of seeking care from alternative care providers and the need for Emergency Departments to concentrate on dealing with emergencies.

Clinical Decision

• The next step will involve an experienced member of nursing or medical staff. Local circumstances will dictate.
• The patient should be seen by the senior member of the Emergency Department team as early as convenient and advised to seek care from the identified alternative care provider (GP practice/ NHS 24 111/ self-care etc.) unless there is a clear and pressing need for immediate intervention. The following definition is suggested as a guideline in reaching this conclusion:
  • ‘the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part’
• If this is done by a senior member of nursing staff, there must be clear guideline for involving, and ready access to, a senior medical staff in cases of uncertainty or dispute.

Clinical Guidelines

• Each locality should develop a limited number of clinical guidelines to support a signposting/ redirection policy but these should not replace, undermine or be regarded as a substitute for the experience and judgement of the senior clinical decision maker.