Admission policy

summary

Prepared by Presented by
Dr Mohamed Aon Dr Tamer Al-Johary
Department
DVT
Medical No past surgical history or
trauma

Surgical Within 30 days of surgical

procedure or trauma
Orthopedic Within 30 days of orthopedic
procedure

Ob/gyn During pregnancy or 6-weeks

post delivery
Department
PE
Remain under Inpatients diagnosed during
admitting their admission
team
Same rules as Stable PE
DVT
Cardiology or Massive PE
Medical
(ICU/CCU)
 VTE
Management and follow-up of
the anti-coagulation is to be by
the Medical/Hematology team
in the respective ward.
Department Advanced Metastatic Cancers for palliative care
(including those refusing intervention)
Presentation due to direct complications of the
primary cancer

Surgical Cancers originating from the GI, biliary

systems and breast

Medical Cancers originating from hematological,

lymphatic, neurological, hepatic & thoracic
systems
Urology Cancer originating from the urological system

Ob/gyn Cancers originating from the female

reproductive system
Department Advanced Metastatic Cancers for palliative care
(including those refusing intervention)
Presentation due to indirect complications of the
primary cancer

Surgical patients presenting with GI obstruction and

obstructive jaundice

Medical patients presenting with Pneumonia,

seizures, non-obstructive UTI and pleural
effusion
Urology patients presenting with obstructive UTI

Orthopedic patients presenting with non-operable

fracture
Patients operated in the Kuwait cancer control
center (KCCC) and presenting to peripheral
hospitals with complications related to his/her
cancer, are to be referred to & admitted in the
KCCC accordingly.
Department Acute GI bleeding
Medical Upper GI bleeding
Surgical Lower GI bleeding
Surgical Upper or lower GI bleeding
within 30 days post foregut
surgery (e.g. sleeve,
esophagectomy etc.)
Department Thoracic Pathologies
Surgical Pneumothorax (traumatic or
spontaneous)
Medical Pleural effusions 2ry to
Consult surgeon/thoracic medical comorbidities
surgeon if needed (Cirrhosis, ESRD, parapneumonic
effusion, empyema, CHF, lymphoma etc.)

Surgical Pleural effusions Post

thoracic surgery
Department Skin/soft tissue Pathologies

Surgical infected diabetic

foot/bedsores that
requires surgical
debridement
Medical infected diabetic
foot/bedsore with
ongoing active unstable
medical condition(s)
Department Skin/soft tissue Pathologies

Medical Acute cellulitis with no

abscess

Surgical Acute cellulitis with

abscess (any size),
clinically or by ultrasound
Department Acute Pancreatitis
Surgical Acute severe (by score),
necrotizing and/or obstructive
(cholelithiasis)
Surgical Post biliary procedures

Medical Mild acute pancreatitis,

proven to be non-obstructive
in origin by imaging
Department UTI
UROLOGY If any of the following:
1. Male patients below age 45
year
2. Obstructive uropathy for
intervention
3. SPC associated or needed
4. Collection or emphysema
proven by imaging.

Medical None of the above

criteria
Department Bone/joint Pathologies

Orthopedic Septic arthritis

Orthopedic Osteomyelitis needing
intervention OR post-
orthopedic surgery or
prosthesis/plate insertion

Medical Osteomyelitis needing iv

antibiotics
Department Sepsis/Septic Shock
According to Sepsis/Septic Shock
underlying
cause of the
sepsis/septic
shock
Department Radiological Imaging
Radiology Some radiological procedures
necessary for the diagnosis of the
department above relevant pathologies will need
to be done in the ER setting prior to
consultation of the respective
specialties
US limb to rule out abscess to
admit Cellulitis under surgery
instead of medicine.
CT chest to rule out
emphysematous bullae instead of
pneumothorax.
Department Pregnancy related cases

Ob/Gyn Pregnant patients with medical

conditions exacerbated by the
pregnancy are to be admitted
and managed by the Ob/Gyn.
Consultation of the respective
medical specialties should be
issued if needed
Department Pregnancy related cases

Ob/Gyn • UTI, BA, DVT/PE (up to 6 weeks post-

delivery)
• GDM, PIH, Known case of Epilepsy, Renal
impairment
• Pneumonia (suspected TB or severe
pneumonia requiring ICU admission >> to
be admitted under the medical team with
an Obstetrics team following up the
pregnancy)
• Pregnant patients with mild to moderate
DKA are to be admitted by Ob/Gyn and co-
managed with the medical/diabetology
department
• MOH committee on hospital clinical services
and polices will monitor the above policy.
• Senior doctor of the related team can email
the above-mentioned committee, in case of
any incidence.
• The email address will be:
incident@moh.gov.kw
 PE with any of the following
Need CPR 1-Cardiac arrest
SBP < 90 or vasopressors required 2-Shock
to achieve SBP >90 despite
adequate filling status
+
End-organ hypoperfusion (altered
mental status; cold, clammy skin;
oliguria/anuria; increased serum
lactate)

SBP < 90 or SBP drop ≥ 40 lasting > 3-Persistent hypotension

15 min
+
Not caused by
new-onset arrhythmia,
hypovolemia, or sepsis
 ORAL IV* NON PURULENT
CELLULITIS
Amoxicillin Cefazolin Features of Erysipelas
Cephalexin Ceftriaxone (Streptococci)
Clindamycin Flucloxacillin
TMP-SX Clindamycin

Dicloxacillin Cefazolin Features of CELLULITIS

Flucloxacillin Flucloxacillin (Streptococci + MSSA)
Cefadroxil Oxacillin
Cephalexin Nafcillin
Clindamycin Clindamycin

TMP-SX Vancomycin Features of CELLULITIS

Amoxicillin and Doxycycline Daptomycin (Streptococci + MRSA**)
Clindamycin

* Need IV antibiotics: Systemic toxicity, Rapid progression, Not responding (48hrs) /not tolerating oral therapy

**MRSA risk factors:

• Prior MRSA infection/ colonization
• Risk factors for MRSA (Recent hospitalization or surgery, long-term care facility, HIV, HDX)
• Cellulitis overlying indwelling medical device eg prosthetic joint or vascular graft
• Lack of response to antibiotics not active against MRSA
 BISAP APACHE II
• Chronic diagnosis

• BUN >8.92 mmol/L •

•
Age
Temperature
• MAP
• Impaired mental status •
•
Pulse
RR
•
• SIRS (≥ 2)
GCS
• PaO2 or A-a gradient
• PH

• Age >60 years •

•
Na
K
• Creatinine

• Pleural effusion •
•
HCT
WBCs

≥ 3 high mortality > 8 high mortality

 Severe Moderate Mild

<7 7.24-7 >7.25 PH

<10 10-15 15-18 HCO3

>8 4-8 3-4 KETONES

>12 >12 >10 AG

Stupor/coma Drowsy Alert Conscious
level
THANK YOU