Escalation Plan for urgent transfer to john Hunter Hospital for patients with
Critical Cardiac problems in response to
RCA 555
Introduction
This escalation plan is for patients with critical cardiac conditions that require
urgent transfer to a higher-level facility (John Hunter Cardiology) for ongoing
management. This escalation plan is to be used in conjunction with existing and
planned pathways for the management of cardiac patients including:
 Hunter New England Chest Pain Pathways
 NSW Health Chest Pain Pathway (Currently under development)
 NSW Health Monitoring Policy for cardiac patients
This plan was developed and approved by the Cardiac Stream for Hunter New
England Health in conjunction with representatives from:
 The Emergency Stream
 The Critical Care Stream
 Rural Hospitals
 Patient Flow Unit
 Retrieval team
 John Hunter Bed Manager
 Director of Cardiology JHH
 Director of Electrophysiology Studies and Pacing JHH
 Clusters and cluster managers
This escalation plan does not replace existing referral pathways for patients with
cardiac conditions, within rural hospitals who would usually be transferred to their
nearest rural referral hospital in the first instance.
The medical/nursing clinician is to consider whether the patient can be
safely managed at a rural referral hospital before activation of this plan.
Escalation Plan
Scope
This escalation plan is for patients with cardiac conditions, who the admitting
medical/nursing clinician feels requires urgent transfer to John Hunter Hospital
Cardiology and the admitting cardiologist at John Hunter has refused transfer.
.
Definition
Patients with any cardiac condition defined as:
Unstable Acute Coronary Syndrome (failed thrombolytic, ongoing chest pain with
ECG changes)
Life threatening Arrhythmia (ventricular tachycardia, complete heart block)
Any critical cardiac condition which the facility feels, is beyond its capability to
immediately manage, and requests transfer to John Hunter Hospital Cardiology.
Process
The usual process for transfer to John Hunter Hospital is to be followed in the
first instance:
In hours (M-F 0700-2200hrs Sat +Sun 0800 – 1600hr)
Contact Patient Flow Unit to organize a conference call between the transferring
hospital Doctor and cardiologist on call at John Hunter Hospital for further
management or transfer.
Out of Hours
Contact switchboard at John Hunter Hospital to contact cardiologist on call to
discuss further management or transfer.
If request for further management or transfer refused in an appropriate time
frame then referring clinician to activate escalation plan of:
In hours
Contact Patient Flow Unit and request cardiology escalation plan.
Patient Flow Unit will contact Director of Cardiology at John Hunter Hospital to
arrange a conference call to discuss patient management or transfer (transfer
may be to the Mater or Belmont hospitals).
Out of Hours
Contact switchboard at John Hunter Hospital to contact Director of Cardiology to
discuss patient management or transfer.
If transfer agreed:
In hours
PFU to arrange transfer and liaise with John Hunter Bed Manager
Out of Hours
Director of Cardiology to contact out of hours bed manager to arrange bed
Out of hours bed manager to admit direct to ward if bed available or notify ED
specialist of transfer to ED if bed unavailable.
Director of Cardiology to identify admitting Cardiologist.
Escalation Plan for Cardiology Patients Requiring Urgent Transfer to John
Hunter Hospital
Criteria for Escalation Plan
The medical/nursing clinician is to consider whether the patient can be
safely managed at a rural referral hospital before activation of this plan.
Patient with Unstable Acute Coronary Syndrome (failed thrombolytic >90 minutes
and/or ongoing chest pain with ECG changes)
(See rescue Angioplasty Guidelines)
Life threatening Arrhythmia (ventricular tachycardia/complete heart block)
Any cardiac condition that the clinician (medical or Nursing) feels is
beyond its capability of the facility to manage and requests transfer
And
Cardiologist at John Hunter hospital refuses transfer
In Hours (8-10 Mon –Fri)
8-4 weekend Public holiday)
Out of Hours
Contact Patient Flow Unit
Referring clinician
To organize conference call
Contact Director of Cardiology
With Director of Cardiology
Via Switchboard at JHH
at John Hunter Hospital (JHH)
TEL:49213000
TEL:49855300
TEL:1800 892 700
Acceptance of Transfer
PFU to liaise with bed manager
Director of cardiology to
contact out of hours bed
manager to arrange bed
Out of hours Bed Manager to
contact ward if bed available or
ED specialist if bed needed in
ED
Director of Cardiology to identify who the admitting Cardiologist will be
Acknowledgements
Professor Peter Fletcher
Dr Malcolm Barlow
Dr Caroline Hullick
Dr Martin Rowley
Lindsey Savage
Leanne Egan
Ann
Jenny Carter
Sandra Cox
Rhonda Walker
Nick Ryan
Director of Cardiology, John Hunter Hospital
Director of Electrophysiology and Pacing, John
Hunter Hospital
Director of Emergency Department,
John Hunter Hospital
Hunter New England Health Retrieval Service
Cardiology Area Liaison Officer Southern
Clinical Nurse Consultant Emergency, John
Hunter Hospital
Emergency Department, Singleton Hospital
Patient Flow Unit, Hunter New England Health
Clinical Nurse Educator, Northern Area
Bed Manager, John Hunter Hospital
Director Emergency Department, Tamworth
Hospital