Chapter 65 · Practical algorithms
Referral and transfer pathways and admission criteria
Purpose of referral and transfer pathways
Referral and transfer pathways determine where a patient can receive the required care safely and without unjustified delay. They account for illness severity, the healthcare organization's expertise and equipment, availability of round-the-clock services, transport time, and emergency medical service rules.
Indications for admission
- Hemodynamic instability.
- Sepsis/septic shock.
- Infected obstruction.
- Acute urinary retention when outpatient management is not possible.
- Clot retention.
- Acute renal failure (postrenal).
- Testicular torsion.
- Genitourinary trauma.
- Postoperative complications.
- Failure of outpatient analgesia.
Choosing the level and setting of care
- Stable patient: outpatient observation, elective admission, or treatment in a specialist inpatient unit according to clinical indications and the healthcare organization's capabilities.
- Unstable patient: immediate stabilization, involvement of an anesthesiologist/intensivist, and transfer to a unit able to provide the required monitoring and intervention.
- Urological emergency without round-the-clock resources: early consultation with the receiving organization, preparation of the patient, and transfer after the necessary initial stabilization.
- Polytrauma: transfer to a trauma center capable of multidisciplinary care.
- Child: referral to a pediatric hospital with appropriate surgical and urological expertise.
- Pregnant patient: joint management with the obstetric service and transfer to an organization with the necessary obstetric, anesthetic, and urological resources.
Actions before transfer
- provide the necessary initial stabilization and continuous monitoring appropriate to the patient's condition;
- contact the receiving organization, agree on acceptance and admission arrangements, and record the time, surname, and role of the specialist receiving the information;
- select a safe mode of transport in accordance with emergency medical service and air ambulance rules;
- ensure that all catheters and drains are functioning, secured, and labeled;
- provide copies of medical records, laboratory results, images and reports, treatment details, and the times of key actions;
- identify unresolved clinical questions, pending investigation results, and actions required on arrival.
Minimum patient handover information
| Category | Required information |
|---|---|
| Identification | Full name, date of birth, healthcare organization and unit, accompanying person. |
| Clinical status | Working diagnosis, severity, trends in vital signs, allergies, pregnancy, anticoagulants, and other significant factors. |
| Care provided | Investigations, procedures, drugs, and infusions with times; patient response; complications. |
| Devices | Catheter, stent, nephrostomy, drain: type, side, insertion date and time, patency, output volume, and care restrictions. |
| Outstanding issues | Pending cultures, tests, and reports; the person responsible for communicating results; the agreed next step. |
| Contacts | Contact details for the referring physician and unit, receiving team contact, and time of transfer agreement. |
Regulatory basis: KZ-01, KZ-02, KZ-03, KZ-04. Further details are provided in Appendices 1 and 3.