Active substances: Ciprofloxacin
This does not refer to patients seen on the consult service or those with renal transplantation. If there is a concern as to which service the patient should be admitted, residents are instructed to contact the STAFF physicians immediately and allow them to make the decision.
Management of HD Patients Referred to Emergency Department ED with Dialysis related Issues This protocol was arrived at between the Depts of Nephrology and of Emergency Medicine to expedite the care of patients who suffer complications while undergoing hemodialysis HD and are deemed to be in need of assessment.
If such a patient is identified in a hemodialysis unit the following should occur: 1. In the absence of beds in the appropriate service the patient will then be transported to the ED to be admitted to the appropriate service and consulted on by the Renal Team as needed.
The name and MRN of the patient will be communicated to the ED physician or the nurse in charge in verbal or written form. Patients referred from the HD Unit are quite complex with respect to their pathology. When they are referred to the ED they often present complex and time consuming diagnostic and therapeutic dilemmas.
If the department is in a bed crisis, attempts will be made to admit the patient straight to the floor. If the patient has medical issues, as outlined in the previous table, they would be admitted to the appropriate service at TW and followed in consult by the TW Nephrology resident.
New Nephrology Patients Any patient "new" to Nephrology coming through Emergency should be stabilized and upon discharge, referred to a Nephrologist in their area.
Ontario Renal Reporting System guideline.
Specify and document any condition that would shorten life expectancy to less than 5 years. Notify Diane Watson, NP currently on leave 14-8238 of patients new to dialysis, likely needing long term dialysis, who require education, dialysis modality options, or an out pt HD spot.
While Diane on leave, contact Anna Gozdzik for educational needs; contact Hemodialysis Managers for outpatient dialysis spots.
Sinai; patients at the Western are followed by the Nephrology fellow covering the Western, with advice from Kidney Transplant as needed.
Kindly inform Nephrology on call as a courtesy, so that they are aware of who needs dialysis. The Nephrology housestaff will then call in the HD nurse to do the dialysis, but will NOT do a consult — this is for triage only.
Please be prepared to discuss the urgency for dialysis, as patients needing dialysis immediately prior to transplant surgery will have relative priority.
If necessary, the second on-call nurse can be called in to perform the dialysis.