Comprehensive approach

1. Validate the general inclusion and exclusion criteria

 General inclusion and exclusion critera for Access Clinic

The Clinical Access Service is an ambulatory service.  To ensure its proper operation, it is important to consult the information below. 

General inclusion criteriaGeneral exclusion criteria
  • 18 years of age and over.
  • Ambulatory clientele:
    • Ability to mobilize alone or with the help of one person.
    • Does not require hospitalization or observation time on a stretcher.
  • Stable clinical condition (and / or symptoms) of a sub-acute nature as per the conditions listed in the Access Clinic's preprinted individual orders registry.
  • Referral form completed and signed by the referring doctor or nurse practitioner.
  • Commitment of the referring physician (or nurse practitioner) to follow-up with the patient throughout the period of care (himself or a colleague he/she has identified). 
  • Known pregnancy (exception if inherent condition ex 1st trimester bleed).
  • Unstable medical condition.
  • Requiring urgent support (<24 hours).
  • Unstable mental health condition or cognitive impairment.
  • Requiring the help of 2 people or a medical ergo-lift to mobilize.
  • Absence of an identified physician or nurse practitioner to monitor and follow the patient’s care.
  • One or more exclusion criteria specific to the clinical condition listed in the Access Clinic's preprinted individual orders registry.

 

2. Validate the specific inclusion and exclusion criteria

All diagnostic tests, examinations and consultations with specialists stated in the algorithms will be managed by the Clinical Access Service team according to established clinical timelines. 

  • It is not necessary to send requests for these examinations with the referral request. 

 

Biliary colic

Consult the algorithm

Specific inclusion criterias: 

  • Present signs of biliary colic

Specific exclusion criterias:

  • Infection signs: Intense sweats, shivers, fever
  • Intense pain for more than 12 h, not alleviated by analgesics
  • Active and known liver disease
  • Severe hematologic disorder
  • Patient taking immunosupressants
  • Ascites

To be filled out / given to the patient

  • Please print, fill out and fax the referral form. 
  • The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Renal colic

Consult the algorithm

Specific inclusion criterias: 

  • Present signs of nephritic colic

Specific exclusion criterias:

  • Signs or urosepsis: shivers, fever, nausea, vomiting, tachycardia
  • Intense pain for <12 h, not alleviated by analgesics
  • Patient taking immunosuppressants
  • Kidney disease or single kidney

To be filled out / given to the patient

  • Please print, fill out and fax the referral form. 
  • The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

First trimester vaginal bleeding

Consult the algorithm

Specific inclusion criterias:

  • < 13 weeks pregnancy

Specific exclusion criterias:

  • >1 sanitary napkin/Hour
  • Hemodynamically unstable
  • Abdominal pain not relieved with PO analgesia
  • Fever > 38,5 °C oral

To be filled out / given to the patient

Please print, fill out and fax the referral form. 

The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Suspicion of diverticulitis

Consult the algorithm

Specific inclusion criterias:

  • Patient is experiencing NEW LLQ (left lower quadrant) pain >24h
  • The following symptoms are common: Nausea / vomiting, fever > 37.5°C , constipation or change in bowel habits

Specific exclusion criterias:

  • Signs of shock: hypotension, tachycardia, desaturation
  • Intense pain not relieved by PO analgesia
  • Signs of peritonitis: Abdominal rigidity, rebound tenderness upon abdominal palpation, absence of peristalsis

To be filled out / given to the patient

  • Please print, fill out and fax the referral form. 
  • The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Suspected artial fibrillation (AFIB) > 48 H

Consult the algorithm

Specific inclusion criterias: 

  • Presents signs and symptoms of AF (palpitations, tachycardia, fatigue, weakness, lightheadedness, mild dyspnea)

Specific exclusion criterias:

  • Signs of hypoperfusion
  • HR > 120 beats/min
  • AF < 48 h  
  • Syncope
  • Signs of ischemia: angina, ↑ chest pain 
  • Signs of severe heart failure: panting, palpitations, lipothymia
  • Patient with mechanical heart valve
  • Symptoms of TIA/stroke or previous event: partial paralysis, paralysis, numbness, aphasia, visual/cognitive impairment
  • Significant arrhythmia
    • Ventricular tachycardia
    • Ventricular fibrillation
    • Polymorphic ventricular tachycardia
    • Ventricular flutter
    • Idioventricular rhythm
    • Paroxysmal supra-ventricular tachycardia
    • AV block 2nd degree Mobitz 2 or 3rd degree
    • Wolf-Parkinson-White syndrome

To be filled out / given to the patient

  • Please print, fill out and fax the referral form. 
  • The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

Suspected deep vein thrombosis (DVT)

Consult the algorithm

Specific inclusion criterias: 

  • Referring MD/ NP must specify Wells Score for the patient on the referral sheet.

Specific exclusion criterias:

  • Febrile > 38,5 °C
  • Hemorrhage/peptic ulcer within the last 3 months
  • Kidney failure (eGFR <30)
  • Severe liver failure (AST > 37 IU/L, ALT >41 IU/L)
  • Patient anticoagulated
  • Active bleeding
  • Thrombocytopenia < 50 X 109/L
  • Signs of pulmonary emboli: Sudden chest pain (CP) or CP ↑ on deep breath, HR ≥100bpm, RR ≥22/min, O2 Sat<92% (unless chronic)
  • Recent CVA
  • Concomitant use of drugs that are strong CYP3A4 inhibitors and P-GP inhibitors (ex : antiepileptic, Amiodarone, Diltiazem, Omeprazole)

To be filled out / given to the patient

  • Please print, fill out and fax the referral form. 
  • The patient handout and the appointment trajectory should be printed and given to the patient.

Print the document

3. Fill out the referral request form and the prescription

Please print and fill out the referral request form if the user’s condition meets all the criteria. 

  • Pay particular attention to the clinical score, if necessary, to ensure that the Clinical Access Service team carries out an investigation that is appropriate and relevant.

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4. Submit the documents and get the results

Send the documents intended for the Clinical Access Service by fax to the number on the referral request form.

  • During the course of the next business day, a nurse from the Clinical Access Service should contact the user to start the care episode. 
  • The nurse will contact the referring physician if there are significant abnormalities unrelated to the clinical condition or discrepancies. 
  • You will also get updates on the progress of the patient’s care episode. 

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