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REMEDY : BNSSG referral pathways & Joint Formulary

Referrals (Paediatric) during COVID-19

Checked: 26-05-2020 by Rob.Adams Next Review: 14-07-2020

Overview

It is important that children continue to be referred for urgent problems during COVID-19.

Update **20.05.20** Paediatric services have been reopened on ERS for Routine referrals.

Emergency Department

Paediatric A and E continues to operate as normal and acutely unwell children should still attend if appropriate.

Please see the Guidance for Parents and Carers produced by NHSE which advises on when to present to ED, GP or call NHS111 if a child is unwell.

Out Patient Referrals

Paediatric out patient clinics will also continue in a limited way in order to reduce face to face contact and routine referrals will be suspended. Urgent and routine referrals are available via eRS. The Bristol Children's Hospital has also set up several routes to access advice if needed.

Please use Remedy or the Bristol Chidrens Hospital guidelines prior to making referrals.

Referrals to Paediatrics will only be accepted if the child is aged 15 years or under at time of referral.

Advice and Guidance

General Paediatric Advice and Guidance

Please see the Paediatric Advice and Guidance section for information about accessing general advice via secondary care (UHB or Weston) or the GPwSI service (Bristol and South Glos practices only).

Specialist Advice & Guidance

More specialist advice and guidance can be accessed via eRS for the following:

  • Paediatric Allergy Advice (click on link)
  • Paediatric Respiratory Advice (click on link)
  • Paediatric General Surgery & Urology Advice (see below)
  • Paediatric Orthopaedics Advice (see below)
  • Paediatric Plastic Surgery Advice (see below)
  • Paediatric Neurosurgery Advice (see below) - Paediatric Neurology advice needs to be requested through general paediatrics not paediatric neurosurgery
  • Paediatric Rheumatology Advice (see below)
  • Paediatric Dermatology Advice (see below)
  • Paediatric Infectious Diseases and Immunology Advice (see below)
  • Paediatric Ophthalmology advice
  • Paediatric Dentistry advice (requests should come via general dental practioner)

 

See full list of A and G services for adults and children:

UHBW COVID-19 Advice & Guidance

Respiratory

Please see the Respiratory Advice & Guidance page in the Paediatric Respiratory section

General Surgery and Urology

Emergency and Urgent Referrals should be sent in the usual way.Update: Now open for Routine referrals via eRS (20.05.20)

Advice and Guidance

For non urgent problems advice and guidance is available via e-RS that allows GPs across BNSSG to seek advice from the Children’s Hospital Paediatric Surgery and Urology Teams.

Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

Before using this service please consider the following options:

 Exclusions:

  • Advice will not be given about children aged 16 years or over.
  • Advice will not be given if a child is under the care of a paediatric surgeon in another hospital
  • Advice will not be given on management of wetting, UTI or constipation – GPs should go to the relevant Remedy pages for advice:

The following Remedy pages may also be useful:

Orthopaedics

Emergency and Urgent Referrals should be sent in the usual way. Now open for Routine referrals via eRS (20.05.20)

Advice and Guidance

For non- urgent problems advice and guidance is available via eRS for Paediatric Orthopaedics at UHB. Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

Before using this service please check the following guidelines on Remedy:

Orthopaedic problems of the lower limb

Back pain management in children

Congenital Hip Dysplasia (dislocation)

The department will aim to review and respond to requests online within 7 working days and this will be reviewed by the on-service consultant within the team. There are 9 consultants covering this service who will take it in turns to respond to requests.

The service will advise on Paediatric Orthopaedic conditions only.

Please note the following exclusions:

  • Please do not send queries relating to patients aged 16 years or over
  • Please not use for advice on scoliosis (Please call the Paediatric Spinal Nursing Team with any queries relating to orthopaedic issues of the spine Monday – Friday on Tel.0117 342 6846)

Plastics and congenital hand problems

Emergency and Urgent Referrals should be sent in the usual way. Now open for Routine referrals via eRS (20.05.20)

Advice and Guidance

For non-urgent problems advice and guidance is available via eRS for Paediatric Plastic Surgery. Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

Before using this service please check the List of BNSSG funding policies

The department will aim to review and respond to requests online within 7 working days and this will be reviewed by the clinical lead for the service every Thursday.

The service will advise on Paediatric Plastic Surgery conditions only (including queries relating to the hand).

Exclusions to this include;

  • Please do not send queries relating to burns
  • Please do not send queries relating to patients aged 16 years or over
  • Please do not send queries relating to orthopaedic conditions of the wrist or forearm

Neurosurgery

Please note that Paediatric Neurology advice needs to be requested through general paediatrics not paediatric neurosurgery

Emergency and 2WW Referrals

For children who are significantly acutely unwell with known neurosurgical conditions or new problems identified on brain or spinal imaging that require emergency neurosurgical input, the current referral pattern into the Children’s Emergency Department should continue.

For suspected brain tumours then please see the Paediatric 2WW page.

Urgent Referrals

When urgent advice is needed, but when a child is not acutely unwell, or at risk of neurological deterioration then enquiries can be made via the on call paediatric neurosurgery Registrar. UHB switchboard has this number. These referrals may be triaged into either an urgent telephone consultation or a face to face appointment when necessary.

Examples of suitable requests for urgent referral would include:

  • Infant with increasing head circumference, crossing centiles with full fontanelle but no neurological symptoms.
  • New significant neurological symptoms of acute onset that arise in a patient known to the neurosurgical service.

Routine referrals are now available via eRS (20.05.20)

Advice and Guidance

For children known to the neurosurgery service - When non-urgent advice is needed for known patients please contact the relevant neurosurgical secretary who will relay a message to either the child’s usual consultant or the on call consultant should the former not be available within a reasonable timeframe (1 week).

For children not previously known to the neurosurgery service - non-urgent requests for A and G can be processed via eRS.

Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

Examples of suitable requests for advice and guidance would include:

  • New minor neurological symptoms that are slowly progressive

Rheumatology

Urgent Referrals

For urgent referrals or advice please contact the paediatric rheumatology consultant on service directly via UHBW switchboard on 0117 923 0000. Please note eRS remains open for urgent referrals as well.

Advice and Guidance

An advice and guidance service has been set up via the electronic referral service (e-RS) that allows BNSSG GPs to seek advice from the tertiary Paediatric Rheumatology Team if there is concern about an underlying rheumatological condition during the Covid-19 pandemic.

Please ensure the letter contains enough information to be able to give a clear response. Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included. The requests will be viewed and responded to within 7 days by the nominated consultant.

Exclusions

For advice regarding patients already under our care please contact the Paediatric Rheumatology Nurses on PaedRheumaNurses@uhbw.nhs.uk or contact the paediatric rheumatology consultant on service directly via UHBW switchboard.

For secondary level new paediatric enquires please use the General Paediatric Advice and Guidance service.

Routine referrals Now available via eRS (20.05.20)

Dermatology

Emergency and 2WW Referrals

Emergency referrals will continue to be dealt with via the Children’s Emergency Department. Emergency “advice only” is available via the dermatology on call service as usual through the UHB switchboard (0117 923 0000) but this will be a skeleton service for emergency dermatology advice only.

Please see the Paediatric 2WW page for advice on referral of suspected cancer.

Urgent Referrals

Please note the service remains open to urgent referrals via e-RS although please consider using Advice and Guidance first. 

Advice and Guidance

The advice and guidance service (via e-RS) can be used for routine and urgent requests for advice during the COVID outbreak. If there is a need to see patients urgently face to face this will be used to identify those who need urgent referral via e-RS.

Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

There is an option to include photos and this is mandatory for lesions and rashes where the clinical question is about the diagnosis. If the diagnosis is already known and general management advice only is required (eg eczema) then photographs are optional but always desirable to guide the advice. If inadequate information is supplied the request will be returned to the GP.

The requests will be viewed most working days if possible. Advice will be submitted online with a reply provided within 7 working days for 80% of requests. There are only 2 part time paediatric dermatology consultants and this is likely to reduce to one during the pandemic period if one is also occupied on the medical wards as is likely.

The advice and guidance service is intended to cover all paediatric dermatology presentations that are significantly impacting on patients’ lives or are thought to have possible serious underlying associations that cannot be managed in primary care.

Benign Skin Lesions

Please note that referrals requesting removal of benign skin lesions will still need prior approval.

Routine referrals Now available via eRS (20.05.20)

Infectious diseases and immunology

Advice and Guidance

An advice and guidance service has been set up via the electronic referral service (e-RS) that allows BNSSG GPs to seek advice from the Paediatric infectious diseases and immunology service.

The service will advise on the recognition, diagnosis and management of:

  • Recurrent, severe or unusual infections in children
  • Suspected or confirmed primary and secondary immunodeficiency
  • Paediatric HIV
  • Contact screening and management of latent and active tuberculosis
  • Advice on the children receiving parenteral antibiotics at home as part of the OPAT service (paediatric outpatient parenteral antibiotic service)
  • Antimicrobial stewardship, including empiric antibiotic use
  • Immunization in children with suspected allergies, incomplete vaccination or un-immunised children
  • BCG vaccination
  • Advice about baseline immunological investigations and interpretation of the results if abnormal
  • Advice on coronavirus infection (Covid-19) for the children known to the PID service
  • Returning travelers with Fever

Exclusions:

  • Advice will not be given about children aged 16 years or over.
  • General advice will not be given for coronavirus (Covid-19) infection (it can be found:

https://www.gov.uk/government/organisations/public-health-england

Routine referrals - Now available via eRS (20.05.20)