Obligations of the physician or specialized nurse practitioner
- Always be reachable (phone, pager) during the Clinical Access Service’s business hours (or designate colleague)
- Assess the user
- Comply with inclusion and exclusion criteria
- Fill out and send the referral for the Clinical Access Service by fax
- Fill out the recommended prescription (if required)
- Ensure follow-up once the care episode at the Clinical Access Service is completed
Algorithms
Biliary colic
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.
Renal colic
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.
Hematuria
Specific inclusion criterias:
- MD/NP sends report of urinalysis which confirms hematuria
Specific exclusion criterias:
- Signs or urosepsis: shivers, fever, nausea, vomiting, tachycardia
- Anuria (macroscopic obstructive hematuria)
- Intense pain for > 12h, not alleviated by PO analgesics
- Patient taking anticoagulants or immunosupressants
- 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.
Restrosternal chest pain
Specific inclusion criterias (min of 1 out of 3):
- Substernal chest discomfort of characteristic quality & duration
- Discomfort provoked by exertion or emotional stress
- Discomfort relieved by rest or nitroglycerin within minutes
Specific exclusion criterias:
- According to the Canadian Cardiovascular Society classification: Grade III or IV angina
- Chest discomfort within the last 12 hours
- Hemodynamically unstable
- Crescendo pattern
- Known aortic stenosis
Exclusion criterias for stress test:
- Pt on B-blocker, Cardizem or Verapamil
- Arthritis to knee, hip or back
- Lumbar stenosis
- Patient not able to walk independently
- LBBB
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.
Rectorrhagia
Specific inclusion criterias:
- Significant blood loss (toilet water completely red)
- Referring MD/NP must do a rectal exam and write findings on reference form
Specific exclusion criterias:
- Hemodynamic instability: tachycardia, hypotension
- Severe abdominal pain not relieved by PO analgesics
- Patient at risk of cardiac instability (ex: with implantable cardioverter-defibrillator, mechanical heart valve, CHA2DS2-VASc ≥ 3, LVEF ≤ 35%, etc.)
- Repeated vomiting
- Hematemesis
- Fever > 38.5 °C
- Melena, maroon stool
- ≥ 2 episodes of significant rectal bleeding in last 12 h
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.
First trimester vaginal bleeding
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.
Suspected transient ischemic attack (TIA) > 48 H
Specific inclusion criterias:
- Transient unilateral motor weakness
- Transient unilateral sensory deficit
- Transient speech difficulty, expressive or receptive
- Transient monocular vision loss
Specific exclusion criterias:
- Brief symptoms (<1 min)
- Extremity numbness accompanied by pain
- Isolated vertigo that is positional
- Stereotypical and frequently recurring symptoms over he past weeks
- Migraine with aura
- Progressive gait difficulty
- Generalized weakness
- Isolated memory/cognitive decline
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.
Suspicion of diverticulitis
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.
Suspected artial fibrillation (AFIB) > 48 H
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.
Suspected deep vein thrombosis (DVT)
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.
Clinical Access Service
A dedicated point of entry to gain access to investigation services and specialist consultations
Upon referral by a physician or a specialized nurse practitioner, the Lakeshore General Hospital (LGH) Clinical Access Service coordinates access to hospital resources for certain pre-defined sub-acute or semi-urgent clinical conditions. Through the use of algorithms, the Clinical Access Service provides service corridors to technical and diagnostic platforms and to specialists for ambulatory clients and, in some cases, allows for treatment initiation. The Clinical Access Service serves as an alternative, keeping users out of the Emergency or from being hospitalized.
The benefits of the clinical access service
Upon receipt of your completed request, a team of nurses will:
- Direct the user to the required services throughout the course of the investigation
- Manage the requests to be sent to the various diagnostic services or to specialists according to the agreed upon deadlines
- Inform you of any developments or abnormalities encountered
Documents needed to refer a user
The physician must consult and use standardized documents that apply to the user’s clinical condition. The documents were developed in collaboration with the specialists concerned.
Pre-printed individual prescriptions and pre-established investigation algorithms were created to enable the nursing team to confirm a user’s eligibility and, if necessary, to manage the investigation.
Comprehensive Approach
For more on the Clinical Access Service
To familiarize yourself with the Clinical Access Service’s algorithms or to stay up-to-date, consult the comprehensive approach.