SCGH ED Clinical Guidelines

Note – The guidelines on this page are a combination of relevant guidelines for the management of a range of Emergency Department presentations, and include:

1. SCGH ED Specific Guidelines
   • These are predominantly developed by SCGH ED staff in consultation with the relevant inpatient specialty teams for use within the emergency department
   • These documents are hosted directly on this website and are accessible for anyone, regardless of the point of internet access
2. SCGH / OPH Care Group (SCGOPHCG) – Hospital Guidelines
   • These usually require access from within the WA Health network
   • Here is the link to the SCGOPHCG Policies Hub – including a A-Z title search
3. Department of Health Western Australia (DOHWA) Guidelines
   • Available outside of the WA Health network
4. External Guidelines
   • Selected guideline links from resources not covered above (ie. other hospitals, NHMRC, NICE, Trip Database, etc…)
   • Usually available outside of the WA Health network

For guidelines not covered on this page. Here is a list of Non-SCGH Clinical Guidelines that provide some useful guidance in patient management for a range of presentations / conditions not included in this list below.

(**) password protected – ask one of the consultants / registrars

SCGH ED Guideline Table Search:

SCGH ED Guidelines listed by Specialty:

Administration / Legal

• Patient Confidentiality – 08/2018
• SCGH Specialty Admission Criteria
  • SCGH Respiratory Admission Guidance – 12/2020
• Expedited Transfer of Medical Assessment Unit Patients to Another Specialty
  • The purpose of this policy is to outline the procedure to expedite transfer of patients between the MAU and other specialties
• Helicopter Interhospital Transfer Protocol – 2/2023
• KEMH – SCGH Transfer for Imaging Pathway – 11/2023
• Perth Tertiary Hospital Metropolitan Catchment Areas
• WA Country Health Service (WACHS) Patient Flow Information
  • WACHS Tertiary Hospital Catchments
    • List of the receiving metropolitan tertiary hospitals as per referring regional areas / medical and surgical specialties
  • SCGH accepts transfer of the following patients:
    • Patients from the Midwest (includes Gascoyne, Murchison and Midwest Health Districts) and Costal Wheatbelt Regions (Wheatbelt regional map), except those requiring specialist services at another tertiary service (ie. trauma or burns), OR
    • Any patient known to a specialist team at SCGH, OR
    • Patients requiring an SCGH specialty service not available at another tertiary service (ie. NIISWA – afterhours, Neurosurgery – atraumatic), OR
    • Patients that cannot get a bed at their usual receiving tertiary hospital, if one is available at SCGH
• Forensic Blood Sampling – Legislation – update 3/2017
• APTC Clinicians Dashboard
  • Showing all pending APTC directed transfers from the WA regional areas
• St John’s Ambulance Live Dashboard
  • Displays real time information on the location, allocation, and status of every St John WA ambulance crew and patient across the State, as well as capacity and performance metrics

Allied Health & Support Services

• Care Coordination Team (CCT)
  • Roles / The Who / Contacts
• Language and Interpreter Services
• Alcohol and Drug Service (ADS)
  • Link includes the SCGH drug withdrawal management guidelines
  • Take Home Naloxone

Analgesia and Anaesthetics

• General Analgesia:
  • SCGH ED Prescribing Pathway for Discharge Analgesia – 09/2022
  • Hydromorphone – 04/2015
  • SCGH Acute Pain Service – Analgesia Prescribing Tips
  • Intranasal Fentanyl: Emergency Department
  • Community Program for Opioid Pharmacotherapy (CPOP) – Continuation in Hospital
• Regional Analgesia:
  • Bier’s block – 06/2019
    • Ring Removal Guidelines – 08/2023
  • Local anaesthetic infiltration – 05/2017
  • Femoral Nerve Block Procedure – 03/2019
• Procedural sedation documentation and checklist  – 08/2010
• Rib Fractures / Chest Wall Injury in the Elderly – 12/2023

Cardiology

• Chest pain pathway & Code STEMI Protocol – 03/2015 & 12/2022
• Atrial fibrillation with Tachycardia – 02/2016
• Defibrillation – 05/2009
• Electrical cardioversion – 05/2009
• Transthoracic cardiac pacing – 05/2009
• ECMO for OOHCA – 04/2022
  • ECMO / ECPR Resources

Cardiothoracics

• Policy for the insertion of a chest drain by trainees – 05/2015
  • Chest Drain Insertion Guideline – 05/2009
  • Blunt Dissection Chest Drain (28Fg) Insertion Pack
• Pneumothorax  – 04/2014
• Rib Fractures / Chest Wall Injury in the Elderly – 12/2023
• ECMO for OOHCA – 04/2022
  • ECMO / ECPR Resources
• Pulmonary embolism advanced care pathway – 03/2023
• SCGH Massive Transfusion Protocol

Critical Care

• Airway Management Resources – 02/2024
• Central line insertion – 05/2009
  • Central Venous Line (CVL) – SCGH Recommended Fixation Standard  – 11/2015
• Post resuscitation care – 01/2013
• ECMO for OOHCA – 04/2022
  • ECMO / ECPR Resources
• Pulmonary embolism advanced care pathway – 03/2023
• Hyponatraemia Management Guidelines – 04/2024
  • How to make 1.8% and 3% saline solutions from hypertonic saline 23.4%
• Tissue / organ donation – 07/2024
• Metaraminol Infusion
• SCGH Massive Transfusion Protocol
• Traumatic Cardiac Arrest Guideline (Royal Melbourne Hospital) – 5/2018

Dental

• Dental Trauma – 08/2023
  • Dental Injuries – Patient Information Handout – 01/2024
• Non-Traumatic Dental Emergencies – 08/2023

Dermatology

• Delusional Parasitosis
• Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis – FSH Guideline – 06/2023

Disaster

• SCGH ED Disaster Management Resources – where can I find them in the ED?

ED Ultrasound

• SCGH ED Clinician Performed Emergency Ultrasound Guidelines – 01/2008

Endocrine

• Adult Variable Rate Intravenous Insulin Guideline – 08/2023
• Adult Diabetic Ketoacidosis (DKA) Guideline – 08/2023
  • DKA Flow Pathway / Disposition Plan – 06/2020
  • SGLT2 Inhibitors (gliflozins) and Euglycaemic Ketoacidosis – 08/2023
• Adult Hyperosmolar Hyperglycaemic State (HHS) Guideline – 02/2021
• Foot and leg ulcers – 05/2015

ENT

• Epistaxis Management – 06/2020
• Vertigo Assessment Guideline – 11/2020

Environmental

• Diving emergencies – 09/2015
• Anaphylaxis Management Pathway – 05/2023
• Heat Health Advice – DOHWA

Gastroenterology and Hepatology

• Upper GI bleeding – 05/2022
• Decompensated Chronic Liver Disease Guideline – 02/2017
• PEG re-insertion – 01/2009
• Paracentesis in Chronic Liver Disease

General Medicine

• Hyponatraemia Management Guidelines – 04/2024
  • How to make 1.8% and 3% saline solutions from hypertonic saline 23.4%
• Suspected Cauda Equina Pathway – 07/2020
• Rib Fractures / Chest Wall Injury in the Elderly  – 12/2023
• Hospital in the Home (HITH) Service – 08/2024
• Eating Disorder Management – 09/2016
• Hyperkalaemia Management Guidelines

General Surgical

• Some surgical guidelines coming soon…?!

Geriatric Medicine

• Geriatrics Assessment Team (GAT) Referral Criteria – 02/2024
• Hospital in the Home (HITH) Service – 08/2024
• Older Adult Discharge Supports:
  • Community – 09/2022
  • Residential – 09/2022
• Rib Fractures / Chest Wall Injury in the Elderly  – 12/2023

Haematology / Haematology Oncology

• Deep Vein Thrombosis (DVT) – 08/2023
  • Home Anticoagulation Support Service (HASS)
• Central catheter related venous thrombosis – 04/2014
• Iron Deficiency Management Guideline for SCGH ED – 10/2023
  • Iron infusions for chronic anaemia  – 12/2020
• SCGOPHCG Transfusion Policy Manual
  • Transfusion Forms
• SCGH Massive Transfusion Protocol
• Transfusion reaction algorithm
• Jehovah’s witnesses and blood products ** – 11/2015
• SCGH Haematology Policy Manual
• Neutropenic Sepsis Guideline – 08/2021
• Management of Immune Related Adverse Events in patients treated with IMMUNE CHECKPOINT INHIBITOR THERAPY: American Society of Clinical Oncology (ASCO) Summary of Clinical Practice Guidelines

Immunology

• Anaphylaxis Management Pathway – 05/2023
• PEP (Post Exposure Prophylaxis) HIV: Starter Packs for Occupational and Non-Occupational exposure
• Where to report vaccine associated adverse events:
  • Western Australia Vaccine Safety Surveillance (WAVSS) System
• Management of Immune Related Adverse Events in patients treated with IMMUNE CHECKPOINT INHIBITOR THERAPY: American Society of Clinical Oncology (ASCO) Summary of Clinical Practice Guidelines

Infectious Disease

• COVID-19 Outpatient Treatment – 05/2024
  • “Old” COVID-19 Guidelines – last updated 03/2022
• SCGHED Sepsis Triage Screening Tool – 01/2018
• Febrile Returned Traveller – Ax & Mx Guidelines – 08/2023
  • Dengue Mx
  • Malaria Mx
  • Traveller’s Diarrhoea Mx
• Hospital in the Home (HITH) Service – 08/2024
• SCGH Adult Sepsis Pathway – 03/2023
• SCGH Infectious Disease Guidelines
  • SCGH Antimicrobial prescribing policy
• Infection Prevention and Control – Infectious Disease Summary Table Guideline
  • Type and Duration of Precautions for Specific Infectious Diseases
• SCGH Viral Haemorrhagic Fever Policy
• Neutropenic Sepsis Guideline
• Homelink – Outpatient IV Antibiotics
• PEP (Post Exposure Prophylaxis) HIV: Starter Packs for Occupational and Non-Occupational exposure  
• Blood Cultures – How and when to take (SCGOPHCG Guideline)
• Sexually Transmitted Disease (STIs) Management – 07/2016
• Rabies and Australian Bat Lyssavirus exposures:
  • How to access post-exposure prophylaxis (PEP): Information for HEALTHCARE PROVIDERS IN METROPOLITAN PERTH Flow Chart
  • Post-exposure prophylaxis (PEP): Information for CACHE STOCK HOLDERS Flow Chart
• Infectious and Related Disease Notification Form

Neurology

• Stroke Call Pathway  – 12/2021
  • SJA Bat Phone Stroke Call Information Sheet – copies of this are found next to Bat Phone, and should be filled out for every pre-hospital stroke call
  • Acute Large Vessel Occlusion (LVO) Stroke: Emergency Clot Removal Information Sheet – 5/2017
• Transient Ischaemic Attack – Neurology Rapid Access Clinic (NRAC) – 03/2024
• Spontaneous intracerebral haemorrhage – 11/2014
• Vertigo Assessment Guideline – 11/2020
• Lumbar puncture – 05/2009
• Seizure Management – 09/2009
  • FSH ED Seizure Guideline – 12/2014
• Acute Headache Investigation Pathway – 07/2023
• Tissue (Organ) donation – 09/2015

Neurosurgery

• Head injury – 05/2015
• Spinal cord injury assessment and documentation – 04/2015
• Suspected Cauda Equina Pathway – 07/2020
• Tissue (Organ) donation – 09/2015

Oncology

• Neutropenic Sepsis Guideline – Intranet link
• Management of Immune Related Adverse Events in patients treated with IMMUNE CHECKPOINT INHIBITOR THERAPY: American Society of Clinical Oncology (ASCO) Summary of Clinical Practice Guidelines

Ophthalmology

• Emergency Eye Assessment Sheet – 12/2016
• Acute Angle Closure Glaucoma Management – 01/2020

Orthopaedics

• Basic Fracture Management – Upper and Lower Limb Quick Reference – 04/2024
  • Upper Limb Fractures – All – Quick Reference Poster
    • Clavicle / Upper Arm / Forearm Fractures
    • Elbow Fractures
    • Wrist Fractures
    • Hand / Finger Fractures
  • Lower Limb – Foot / Ankle / Lower Leg / Knee Fractures Quick Reference
    • Base of 5th Metatarsal Fracture – Patient Information Handout – 01/2018
• Dislocation Management – 04/2024
• Femoral Nerve Block Procedure – 03/2019
• Arthrocentesis (joint aspiration)  – 05/2009
• Cervical spine injury investigation – 01/2015
• Spinal cord injury assessment and documentation – 04/2015
• Philadelphia collar application – 04/2015
• Bier’s block – 06/2019
  • Ring Removal Guidelines – 08/2023
• Orthopaedic Investigation Ordering Guideline – for hip# and orthogeriatric patients – 08/2019
• Femoral Fracture Traction Splint (CT-7) – Training Video – 05/2022
• Ring Removal Guidelines – 08/2023

Obstetrics & Gynaecology

• First Trimester Pregnancy Complications:
  • First Trimester Pain &/or Bleeding – SCGH ED – 10/2015
  • First trimester pregnancy complications – KEMH – 08/2023
    • includes: bleeding / hyperemesis / ectopic pregnancy / miscarriage …
  • Guideline for the Mx of Nausea & Vomiting in Pregnancy and Hyperemesis Gravidarum – Society of Obstetric Medicine of Australia and New Zealand – 2019
• Sexual assault – 07/2024
  • Drink Spiking Mx – 10/2022:
    • Drink Spiking Mx letter to all Emergency Departments in WA
      • ED Patients Presenting with Recreational Drug Intoxication Clinical Guideline (RPH Guideline)
    • Drink Spiking Flyer
• Obstetric patients at SCGH ED – 11/2015
• KEMH – SCGH Transfer for Imaging Pathway – 11/2023
• Radiology Procedure for Imaging Pregnant Patients – 01/2016
• Imaging in Pregnancy and Lactation:
  • Radiology Imaging Pregnant Patients Procedure and Risks – 11/2017
  • Diagnostic Imaging Pathways – Imaging During Pregnancy and Lactation – 06/2017

Paediatrics

• Perth Children’s Hospital (PCH) Guidelines & Calculators
• Children’s Antimicrobial Mx (ChAMP) Guidelines
• Kids Health WA Paediatric Calculators

Palliative Care

• SCGH Palliative Care Service webpage
  • Evidence Based Clinical Guidelines for adult patients in terminal phase – palliative care book
• Voluntary Assisted Dying – Information Management System
  • It is where practitioners can:
    • submit forms to the Voluntary Assisted Dying Board in Western Australia
    • register for the Department of Health participating practitioner eligibility verification process (including access to the mandatory approved training)

Pharmacy

• Antiemetic Guideline – 02/2024
• SCGH Medication Guidelines
• How to make 1.8% and 3% saline solutions from hypertonic saline 23.4%

Psychiatry & Behavioural

• Mental Health Patient Flow:
  • SCGH Mental Health Escalation Plan (Draft Document) – 12/2022
    • for escalation of mental health patients in SCG ED >24/24
  • SCGH ED Policy – Mental Health Crisis Transfers Policy (ie. via SJA / Police / RFDS / Private Hospital)
  • NMHS Patient Flow Process to access a Mental Health Bed – 03/2014
  • Mental Health Catchment Areas – 02/2016
• Eating Disorder Management – 09/2016
• Delusional Parasitosis
• Child & Adolescent Mental Health Service (CAMHS)
  • Child & Adolescent Mental Health Service (CAMHS) Emergency Telehealth Service – General Flyer
  • Child & Adolescent Mental Health Service (CAMHS) Emergency Telehealth Service – Health Professionals Flyer

Radiology

• Cervical spine injury investigation – 01/2015
• Pulmonary embolism initial diagnostic pathway – 05/2011
• KEMH – SCGH Transfer for Imaging Pathway – 11/2023
• Radiology Eorder Information – 09/2023
• Imaging in Pregnancy and Lactation:
  • Radiology Imaging Pregnant Patients Procedure and Risks – 11/2017
  • Diagnostic Imaging Pathways – Imaging During Pregnancy and Lactation – 06/2017
• X-Ray Risk Calculator  – as the name suggests
• Diagnostic Imaging Pathways
  • online suite of evidence-based and consensus-based imaging guidelines and an educational tool, developed in Western Australia with the aim of optimizing appropriate choices of diagnostic imaging (DI) in a wide variety of clinical scenarios
• IV Contrast Agents use in CT Imaging
  • Joint Advisory Statement between The Royal College of Radiologists & Royal College Emergency Medicine regarding Emergency Computed Tomography scans and the use of Intravenous Iodinated Contrast Agents
  • Iodinated Contrast Media Guideline – The Royal Australian and New Zealand College of Radiologists (RANZCR) – download and see “Recommendations” page 15

Renal

• CAPD peritonitis – 02/2014

Respiratory

• Policy for the insertion of a chest drain by trainees – 05/2015
  • Chest Drain Insertion Guideline – 05/2009
  • Blunt Dissection Chest Drain (28Fg) Insertion Pack
• Chronic Obstructive Pulmonary Disease (COPD) – 08/2015
• Pulmonary embolism initial diagnostic pathway – 09/2017
• Pulmonary embolism advanced care pathway – 03/2023
• Pneumothorax  – 04/2014
• SCGH Respiratory Admission Guidance – 04/2021

Rheumatology

• Giant Cell Arteritis – 09/2022

Toxicology and Toxinology

• Paracetamol poisoning  – 06/2019
• Lithium toxicity – 04/2016
• Snake bite envenomation – 09/2015
• Toxicology Handbook (4th Edition) – via SCGH Library
• Drug Withdrawal Management Guidelines – as per SCGH Drug & Alcohol Service intranet link
• Take Home Naloxone
• Drink Spiking Mx – 10/2022:
  • Drink Spiking Mx letter to all Emergency Departments in WA
    • ED Patients Presenting with Recreational Drug Intoxication Clinical Guideline (RPH Guideline)
  • Drink Spiking Flyer
• Nitrous Oxide (N2O) – Management of Recreational Use (RPH ED Guideline) – 01/2021

Trauma

• Resuscitation / Trauma Team Roles – 04/2015
• SCGH Trauma Call Criteria – 02/2021
• Cervical spine injury investigation – 01/2015
• Philadelphia collar application – 04/2015
• Head injury – 05/2015
• Femoral Nerve Block Guideline – 03/2019
• Burns Assessment & Management – 08/2021
• Ring Removal Guidelines – 08/2023
• Rib Fractures / Chest Wall Injury in the Elderly – 12/2023
• Basic Fracture Management – Upper and Lower Limb Quick Reference – 04/2024
  • Upper Limb Fractures – All – Quick Reference Poster
    • Clavicle / Upper Arm / Forearm Fractures
    • Elbow Fractures
    • Wrist Fractures
    • Hand / Finger Fractures
  • Lower Limb – Foot / Ankle / Lower Leg / Knee Fractures Quick Reference
    • Base of 5th Metatarsal Fracture – Patient Information Handout – 01/2018
• Dislocation Management – 04/2024
• Sexual assault – 07/2024
• Family & Domestic Violence – 07/2024
• SCGH Massive Transfusion Protocol
• Wound Closure Advice from Closing the Gap Website
• Traumatic Cardiac Arrest Guideline (Royal Melbourne Hospital) – 05/2018

Urology

• Urinary catheterisation – 05/2009

Vascular

• Deep Vein Thrombosis (DVT) – 08/2023
  • Home Anticoagulation Support Service (HASS)
• Central catheter related venous thrombosis – 04/2014
• Foot and leg ulcers – 05/2015
• Type B Aortic Syndrome Guideline – 01/2022
  • Type B dissection = distal to the subclavian artery, and is managed by Vascular Surgery
  • Type A dissection = proximal to the subclavian artery, and is managed by Cardiothoracic Surgery
• SCGH Massive Transfusion Protocol

SCGH ED Guideline Table Search