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Ambulatory care is about providing same-day emergency care. Our Ambulatory Emergency Care Centre offers easy access to diagnostic tests and review by hospital consultants in one place. It is a way of providing safe care designed around the needs of patients. The service also aims to prevent unnecessary hospital admissions and provide a better experience for patients. 

The service is not pathway or condition-led to ensure all patients can be considered. All patients must be referred and clinically accepted by the ambulatory emergency care team. The centre is focused on providing the right care for our patients, in the right place.

Four main groups of patients are seen in the centre:

Patients with medical conditions needing emergency care who are referred by their GP

Patients redirected from our emergency department

Patients who have been in hospital in the acute medical wards stepped down to support early discharge

Patients discharged from acute medical wards with outpatient investigations requiring review and possible further intervention

This is a day-treatment service so patients may be required to come back the following day.

Location
Royal Stoke University Hospital 

Address
Ambulatory Emergency Care Centre
Trent Building
Royal Stoke University Hospital
Newcastle Road
Stoke-on-Trent
ST4 6QG

Telephone
01782 671700​

GP referrals
01782 671500​

Further contacts

Dr Zia Din, Clinical Lead for AEC
zia.din@uhns.nhs.uk

Mr Alan Bethell, Nursing Lead for AEC and Matron for Acute Medicine
alan.bethell@uhns.nhs.uk

Mrs Ruth Bradbury, Senior Sister for AEC
ruth.bradbury@uhns.nhs.uk

Opening hours
The centre is open Monday to Friday: 8am – 8pm
Referrals are accepted into the unit 8am-5pm​

Frequently Asked Questions

What is ambulatory emergency care?
Ambulatory emergency care is a patient-focused service where some conditions may be treated without the need for an overnight stay in hospital. Patients will receive the same medical treatment they would previously have received as an inpatient.

The aim of this service is to provide patients with the care required to treat their condition during scheduled ambulatory care opening hours.  They will be able to return home; if further treatment is required they will be asked to return to the unit to receive this.

What advantages does ambulatory emergency care offer?
The Ambulatory Care Unit provides a new way of ensuring that all our patients receive timely assessment. Despite not being admitted as an inpatient they will still have access to the same calibre of medical and nursing care that they would experience on one of our wards. If appropriate, they will be able return to their own home, even if further treatment is required on another day.

What can patients expect?
On arrival they will have an initial assessment within 15 minutes by a nurse or be reviewed by an acute care consultant. They may have a range of investigations and treatments arranged, the ultimate aim of which is to allow them to return home safely. We strive to deliver a compassionate, safe and reliable service. 

During their visit the team will ask patients to fill in a short questionnaire to tell us about their experience of this service. 

Will patients need to return to the hospital once they are sent home?
Patients may be asked to attend a clinic within the ambulatory emergency care centre or return to another hospital department for further investigations. An appointment for this will be given to them before they leave. If patients are unable to keep this appointment they should telephone us on 01782 671700 so that we can rearrange the appointment.

What should patients do if they feel unwell once they have returned home?​
Patients should call 01782 671700 if they are concerned in any way about their condition once they return home.

Our outstanding service
The Atrial Fibrillation Stroke Prevention Service works within the interface of primary and secondary care. The Clinical Nurse Specialist will assess patients with stroke risk for appropriate and effective anticoagulation management, sometimes these patients can be complex. This will give the patients diagnosed with AF an opportunity to discuss benefit versus risk of stroke prevention. In summary this service aims to deliver a high quality, person centred service that enables patients diagnosed with AF to receive specialist care whilst remaining under the care of their own GP. The service will focus on AF primary prevention and management with the primary purpose of reducing the number of avoidable AF related strokes.​

Why choose us?
As a service we are aware of the current capacity of GP Services and appreciate how busy you are. As a service we are also aware that the majority of AF patients are elderly and that Oral Anticoagulation can be complex and this is often a decision that cannot be made within a ten minute consultation. We are happy to review these patients within secondary care, discuss within a multidisciplinary team meeting and initiate effective management and anticoagulation ensuring that your patients are receiving optimum benefit in relation to stroke prevention.​

Referrals
Patients can be referred by Fax 08443342853 – There will soon be a referral form attached to the GP intranet that can be completed and faxed.

Alternatively for advice, support or to arrange educational events you can contact the CNS (Jodie Williams) on 01782679449​

Thank you for your support of bariatric care at UHNM. Below is some information you may find helpful.

Referral form

BOMSS-guidelines

Our service

Bariatric surgery at UHNM  - the North Midlands Institute of Metabolic and Bariatric surgery (NMIMBS) - has been operational for over 10 years and has gone from strength to strength.

We are proud to be one of the few high-volume centres in the country performing over 350 – 400 operations per year in the field of bariatric (weight loss) and metabolic surgery.

The population coverage is over 2.5 million, providing services to the regions of Staffordshire (Stoke, Stafford, Cannock), Cheshire ( East, West, Mid and south Cheshire) and Wolverhampton.

We have also been covering the regions of Merseyside (Liverpool) and Cumbria/Lancashire between 2017 and 2019 on a temporary contract.

We offer the following services:

Surgical services

The elective surgical services are offered at

• County Hospital, Stafford ( 3-4 days a week)
• Royal Stoke University Hospital (1 day a week for complex surgery/high risk patients)
  
  

A specialised team of over 15 bariatric anesthetists with a wide range of experience provide perioperative care to our patients.

The high dependency unit (HDU) and intensive care unit (ITU) at Stoke are used when needed on a selective basis.

Our surgeons perform primary and revisional bariatric surgery from within and outside the region. Each case is approached on a multidisciplinary basis and appropriate treatment/surgery offered only if felt necessary.

The main type of surgeries offered are as follows:

Laparoscopic Roux Y Gastric bypass (LRYGB)

Over 8/10 procedures we perfrom at UHNM are LRYGB procedures.

Laparoscopic Sleeve Gastrectomies

2/10 procedures are sleeve gastrectomies.

Laparoscopic One Anastomosis Gastric Bypass

This is not offered as a mainstream procedure but as an option if a standard RYGB cannot be performed due to technical challenges.

• Laparoscopic Band to Bypass

• Laparoscopic Sleeve to Bypass procedure

• Removal of Gastric Bands ( Insertion of gastric band not offerred)

• Infrequently performed/investigational procedures under consideration

• Gastric Balloon

• SADI-S

• Endoscopic bariatric surgery

Outpatient services

Outpatient clinics for new and follow-up patients are conducted in the following locations:

• Stoke on Trent ( Royal Stoke University Hospital)
• Stafford (County Hospital)
• Chester (Countess of Chester Hospitals)
• Wolverhampton (Royal Wolverhampton Hospitals)
• Liverpool (Aintree University Hospitals)

All patients are assessed by a multidisciplinary team on single or multiple visits. The team consists of surgeons, endocrinologists, specialist nurses, and a specialist bariatric dietetic team.

Further appointments with the anaesthetic team, psychologists, respiratory physicians, cardiologists, nephrologists are made on a basis of clinical need within the trust.

Emergency assessment and surgical services

The team at NMIMBS are one of the very few in the country offering a bariatric consultant-led emergency service 365 days a year. A bariatric consultant from the team is available for referrals from GPs and A&E departments from our drainage area. Patients who are discharged after bariatric surgery also have the option of visiting the surgical assessment unit without any referral from GPs/A&E portals for up to two weeks after any planned bariatric surgery.

Bariatric dietetic services

Our team of specialist bariatric dieticians are involved in preparing patients for surgery prior to the operation and continuing care to enable optimal outcomes until two years after surgery.

Bariatric specialist nursing team

Each patient will have a named specialist nurse who will be the point of contact for the patient and will oversee progress through the pathway.

Fluoroscopy guided band adjustments

Although we do not perform or offer gastric bands, our radiology team are experts in adjustment of bands (instilling/removing fluid) under X-ray guidance for patients who have had procedures done elsewhere.

Secretarial team

01782 – 679876 – Susan Dean

01782-675441 – Gabrielle Faulkner

Bariatric specialist nurses

Bridie Cornes – 01782 679896

Lynn Bedson-01782 671670

Ngozi Etumnu – 01782 -672977

Jan Turner – 01782 676331

Bariatric dietetic team

01782 -676050

Bariatric.dieticians@uhnm.nhs.uk

Contact the team
Oral Antibiotic Treatment Doses

The Trust has launched a new service for timely assessment of patients with suspected neuroinflammation/multiple sclerosis or those who are already diagnosed with MS but not under our regular care.

We aim to provide rapid diagnostic and treatment pathways with the objectives of shorter waiting times for diagnostic tests and avoiding unnecessary hospital attendances.

Contact

Neuroinflammation Clinic
Neurology Department
Royal Stoke University Hospital

Fax: 0844 272 9927
Phone: 01782 679465
email: Theresa.Denic@uhns.nhs.uk

In the interest of standardisation of care and in line with current NICE guidance we wish to inform you of a change to the referral process for our rapid access chest pain clinics at the County and Royal Stoke sites.  May we request that in future all referrals are made on the referral proforma​ which allows you to indicate the patient's choice of preferred clinic location?  Every attempt will be made to allocate clinic appointments according to this preference but we hope you will understand that there may be occasions when an appointment at your patient's preferred site may not be possible in the interests of preventing avoidable delay.

Kind regards
RACPC team

About RACPC

Referral profroma​​

The renal medicine department covers a population of approximately 1.2 million people, stretching from South Cheshire through to South Staffordshire. 

The inpatient ward is based at Royal Stoke University Hospital (Ward 124). 

We provide outpatient haemodialysis for patients at Royal Stoke University Hospital, Leighton Hospital (Satellite Unit run by Fresenius Health Care) and County Hospital (Satellite Unit run by UHNM). 

We have a large team of community nurses based in the kidney unit at RSUH. These teams provide ongoing care for patients receiving peritoneal dialysis, home haemodialysis, chronic kidney disease (including conservative care) and transplants. The department also provides urgent clinic assessments either for patients referred by GPs, or for our community patients who contact us who are unwell, on a daily basis. 

Patients can also be assessed as an emergency at the weekend. Our aim is to admit our inpatients directly to the renal ward.  Any GP who is concerned that a patient needs admitting under the renal team should contact us directly. We aim for GP calls to be taken directly by Consultants.  We can be contacted via 01782 679000, option 3.

All Consultants are happy to give advice and are happy to receive communication either via letter, phone or email from GP colleagues.

With regards to outpatients, we provide a number of general nephrology clinics based in RSUH, County and Leighton hospitals. We also provide specialty clinics including Hypertension, Diabetic Nephropathy, Vasculitis, Transplant, Haemodialysis, Peritoneal Dialysis and Low Clearance (preparation for dialysis). 

Patients being advised to book their appointment on Choose & Book should be aware that it is the same Consultant team who runs the service at County and Leighton hospitals as is based at Stoke. Whilst we aim to look after people close to home where possible, if a hospital admission is required it will be at the Royal Stoke University hospital.

The renal department has a number of strengths which are nationally or regionally recognised. We have an internationally recognised reputation for peritoneal dialysis research. Nationally we are one of the leaders in providing home dialysis, in particular supporting frail patients to have peritoneal dialysis in their own home. Regionally we are recognised for our care of transplant patients both in promoting and delivering pre-emptive transplant and in returning patients quickly post transplantation for local care.

We believe we are an approachable team and would also like to hear from GP colleagues either or about individual patients or ideas for how the service may develop for patient benefit. Please feel free to contact us.​

Tell us what you think

If you have used our services as a healthcare provider, please provide us with feedback:

https://www.surveymonkey.co.uk/r/STAC2017

The STAC team accepts referrals for a wide range of indications.  These include patients with atrial fibrillation, venous thromboembolism, a prosthetic heart valve and others. Patients requiring direct oral anticoagulants (DOAC and NOAC) can also be referred to STAC.

What you need to do

•Please send the referral form to us with completed clinical details:

Warfarin referral form​
​Dalteparin referral form

• Referrals will be reviewed to confirm appropriate indication and duration of anticoagulation
• The patient will be sent an appointment directly. Confirmation of the appointment will also be sent to the registered GP
• Urgent patients (based on clinical urgency) will be seen within seven working days
• Patients will be reviewed in the anticoagulation MDT if required
• For any queries or advice related to anticoagulation contact us
• For pregnant women and patients with active cancer please contact the maternity and oncology team directly. These patients are managed in primary care via shared care protocols

To refer a patient

•For Suspected DVT: call Ambulatory Emergency Centre: 01782 671500

Opening times and contacts

•For anticoagulation, complete a referral form and email or fax to STAC

To seek advice

•STAC nurse specialists:  01782 671633 or page: 07623604843                              (Mon-Fri, 8am-5pm)

Feedback and Complaints

Secure email : anticoagulation.uhns@nhs.net

Telephone : 01782 674252

Write to us:

Staffordshire Thrombosis and Anticoagulation Centre
1st Floor, West Building
Royal Stoke University Hospital
Newcastle Road
Stoke on Trent ST4 6QG​​

Please click here to open the new referral form for the County Hospital service

​HOT-TIA Referral System Instructions Manual​

Please fax urgent referrals to 01782 401075 or telephone the clinic on 03007900162 for advice. The team are happy to discuss cases.

 If you are concerned about a possible diagnosis of active TB patients will be seen within 1 week of referral. ​​

The opening times for the X-Ray Department at Cobridge Health Centre:

X-Ray Department

Cobridge Health Centre

Church Terrace

Cobridge

Stoke-on-Trent

ST6 2JW

Tel: (0300) 7900164

Opening Times: Monday – Friday, 8:30am – 12:00 o'clock, 1:30pm – 4:30pm​

My Planned Care gives patients advice and support while they wait for their appointment and to help prepare for a hospital consultation, treatment or surgery. This includes providing information about waiting times at UHNM and how long they might expect to wait for an appointment to come through. It also provides other supporting information and details about local services while you wait.

Please advise your patients to check this website https://www.myplannedcare.nhs.uk/before contacting us or you (GP) direct about when their appointment might be.

Haematology referrals for outpatient review

Haematology at UHNM is subdivided into;

• Malignant haematology; which is further subdivided into myeloma, lymphoma & myeloid (latter includes acute leukaemia, MDS & myeloproliferative neoplasms such as polycythaemia & essential thrombocythemia)
• Haemostasis & Thrombosis
• Red cell haematology e.g. sickle cell disease, thalassaemia
• General haematology including immunohematology e.g. ITP, haemolytic anaemia
• Joint Haematology-Obstetric clinic

Referring your patient to the appropriate C&B code from the outset helps us streamline clinics and best allocate resources.  The current referral options on C&B for haematology outpatient review include;

• 2 week wait – e.g. for suspected myeloma, lymphoma
• Haemostasis & Thrombosis - e.g. suspected bleeding disorder, complex anticoagulation queries
• Paraprotein clinic i.e. MGUS referrals
• IV iron clinic – see specific information below
• Clinical Haematology (all other referrals)

Alternatively consider sending an advice and guidance request; ensuring you include clear information and a specific question, so we can best support you and your patient in primary care.

IV iron referrals

IV iron is indicated where there is biochemical evidence of iron deficiency AND the patient is either intolerant or unresponsive to oral iron (OR as an alternative to blood transfusion). 

Primary care patients >18 years of age meeting these criteria can be referred for IV iron treatment via choose and book.  Please read further guidance on appropriate referral here. Patients not meeting these criteria should be referred to general haematology.

Note it remains the GP’s responsibility to undertake appropriate investigations to identify the cause of the iron deficiency, where the patient is anaemic as a result of iron deficiency.

IV iron at UHNM - Referral criteria for primary & secondary care 

Background information:

• UHNM haematology department currently provides a (limited at present due to staffing) service for GPs and secondary care physicians to access IV iron for patients that meet agreed referral criteria. 

• For primary care, referral is via the choose and book system (C&B) under ‘IV iron nurse led clinic’
• For secondary care, referral is via iPortal ‘haematology referral’
• For patients with anaemia of chronic kidney disease (A-CKD) with eGFR <30 refer direct to the renal anaemia service
• Following referral, a nurse led telephone clinic review to arrange IV iron will be scheduled by the administration team.  The waiting time for review will depend on clinical demand.

• It is the responsibility of the referring clinician to investigate the cause of the iron deficiency.  Please refer to
• NICE CKS ‘Anaemia – iron deficiency’
• NICE ‘Suspected cancer: Recognition and referral’ NG12. 
• Note 2021 national gastroenterology guidelines would not recommend investigation for isolated hypoferritinaemia (in the absence of anaemia)

• IV iron is routinely administered in our dedicated unit at County hospital. 
• Nurse-led follow up to assess efficacy/further treatment is arranged with discharge back to GP follow up/onward anaemia follow up depending on the cause of iron deficiency and IV iron requirements. 
• Regrettably the service is limited at present due to staffing but we envisage expansion (at both County and Stoke sites) so that local patients have rapid access to IV iron where clinically indicated to avoid unnecessary blood transfusion and hospital admission.
• If IV iron is required urgently then we will try to accommodate, however, referral to the ambulatory emergency care (AEC) may be required by the referring clinician in this situation.

Indication for IV iron:

• IV iron is indicated where there is biochemical evidence of iron deficiency AND the patient is either intolerant or unresponsive to oral iron (OR as an alternative to blood transfusion).  This includes

o   Iron deficiency anaemia (absolute iron deficiency)

o   Symptomatic non anaemic iron deficiency (NAID)

o   Functional iron deficiency (FID) where there is evidence of benefit of IV iron e.g. patients with CKD on erythropoiesis-stimulating agents (ESA), anaemic cancer patients on ESA, heart failure with reduced ejection fraction in the presence of iron deficiency

o   ‘Alternative to blood transfusion’ = Don’t transfuse red cells for iron deficiency anaemia without haemodynamic instability (RCPath choosing wisely 2016, NICE blood transfusion guidelines 2015 NG24)

• Always assess the cause of the anaemia/iron deficiency and the impact/severity of their symptoms 

Relevant definitions:

• Anaemia WHO definitions
• Men over 15 years Hb <130g/L
• Women (non-pregnant) over 15 years <120g/L
• Pregnant women <110g/L in T1, <105g/L T2/3, <100g/L postpartum
• Anaemia of chronic kidney disease (A-CKD) = Hb <110g/L, symptoms of anaemia, eGFR <30 (consider diagnosis if eGFR 30-60)
• Absolute iron deficiency (AID) = insufficient iron stores for erythropoiesis (see ‘Interpretation of laboratory results’)
• Functional iron deficiency (FID) = ‘inappropriate iron utilisation’ or ‘iron-restricted erythropoiesis’ (despite adequate iron stores).  Body has iron but is unable to use it effectively for erythropoies due to increased hepcidin levels.
• ‘Unresponsive to oral iron’ = Hb increase <20g/L after 4 weeks oral iron, taken appropriately.  (Or lack of normalisation of Hb where required increase is less).  Although note increase will depend on cause of iron deficiency/anaemia, starting Hb, baseline Hb, other factors.
• ‘Intolerant to oral iron’ = Intolerant (specify symptoms on referral) despite modification of dosing frequency, iron preparation, dose +/- addition of supportive medications (see oral iron below)
• Non anaemic iron deficiency (NAID) = No anaemia + ferritin <15ng/ml + moderate-severe symptoms of iron deficiency (specify on referral)

Oral iron

• Prescribe once daily high strength oral iron to be taken in the morning on an empty stomach
• If constipation, add laxatives
• If poor tolerance reduce frequency to alternate mornings, reduce dose, prescribe alternative preparation
• Assess response through Hb +/- reticulocytes from 10 days post commencement
• ‘when’ will depend on the clinical situation; including symptoms of anaemia, baseline Hb, cause of anaemia – often 3-4 weeks appropriate but may be 2-3 months
• MCH often corrects first, followed by MCV, then Hb.  You will not see the ferritin increase in the early stages.
• Increased reticulocytes indicate increased red cell production
• Continue oral iron for 3-6 months after FBC has normalised, to replenish iron stores
• On-going iron may be required where cause of iron deficiency persists e.g. heavy menstrual bleeding, however, monitor FBC and iron status (ferritin +/- TSATS) periodically to avoid iatrogenic iron overload

Interpretation of laboratory results:

• Ferritin is the gold standard to assess iron stores.  If ferritin is low, it confirms absolute iron deficiency.  If low, no other iron studies are required.  However, ferritin is an acute phase protein, so increases with concomitant inflammation/infection, as well as kidney disease, liver disease, malignancy
• Ferritin <15ng/ml = iron deficiency confirmed
• If anaemia (not congenital e.g. thalassaemia trait) & ferritin <30ng/ml = probable absolute iron deficiency
• If anaemia in the context of raised inflammatory markers or history of acute or chronic disease e.g. IBD & ferritin <100ng/ml = possible absolute iron deficiency (correlate with TSATS, historic results & clinical history)
• If anaemia in the context of raised inflammatory markers or history of acute or chronic disease & ferritin >100ng/ml = iron deficiency not excluded.  Note, however, these patients are ineligible for nurse-led IV iron service (excludes heart failure). Correlate with TSATS, historic results & clinical history and consider advice and guidance request to haematology/relevant secondary care clinician.  Anaemia of chronic inflammation (previously anaemia of chronic disease) is best managed by optimal treatment of underlying chronic diseases.  Consider other causes contributing to anaemia e.g. haematinic deficiency, myeloma, A-CKD
• Serum iron should be ignored
• Unreliable, highly variable, no correlation with iron stores (done so lab can calculated the TSATS).
• Transferrin is the liver-made protein that transports iron.
• Increases with iron deficiency but is reduced by inflammation etc (although less so than serum iron).
• Reduced in chronic liver disease.
• Similar measure to total iron binding capacity (TIBC) which is done by other laboratories.
• Transferrin saturation (TSATS) is the ratio of serum iron to transferrin expressed as a percentage.  It reflects the iron being transported around the body.
• Relies on transferrin and serum iron so variable and non-specific.
• Reduced in absolute and functional iron deficiency but also reduces with inflammation etc.  In good health normal >20%. (Consider iron overload if ferritin >50% males or >40% females).
• TSATS <16% can support the diagnosis of iron deficiency if initial tests are inconclusive.
• If anaemia, TSATS <16% with ferritin <100ng/ml = probable absolute iron deficiency
• If anaemia, TSATS <20% with ferritin <100ng/ml = possible absolute iron deficiency
• If A-CKD (anaemia <110gL) with eGFR <30 and TSATS <20% = refer to renal anaemia team (if ferritin <800)
• If heart failure with reduced ejection fraction even if Hb normal, TSATS < 20% and ferritin <300ng/ml (or ferritin <100ng/ml ) = iron deficiency
• If anaemia treated with erythropoietin and TSATS<20% = iron deficiency

Inclusion criteria for referral to UHNM Nurse-led IV iron service

1. Age 18 years or older 
2. Biochemical evidence of iron deficiency (for details see above):
1. Anaemia with ferritin <30ng/ml (where anaemia not attributable to congenital cause e.g. thalassaemia trait)
2. Anaemia with ferritin <100ng/ml and TSATS <16%
3. Heart failure with ferritin <100ng/ml (or <300ng/ml with TSATS <20%)
4. Non-anaemic with ferritin <15ng/ml and moderate-severe symptoms of iron deficiency (NAID/non-anaemic iron deficinecy)
5. Inherited haemoglobinopathy e.g. thalssaemia trait with worsening anaemia associated with ferritin <30ng/ml

AND

3. Undergone trial of oral iron & either:
1. Intolerant of oral iron (specify symptoms and mitigating measures) OR
2. Unresponsive to oral iron (including repeat FBC after minimum 4 weeks)
3. As an alternative to blood transfusion (likely alternative pathway more appropriate)
4. Recent blood test results available (including FBC <4 weeks of referral & relevant ferritin)
5. No known exclusion criteria e.g. 1^st trimester pregnancy, severe hepatic disease, iron overload, active infection
6. Confirmation that cause of iron deficiency will be investigated and managed (as clinically appropriate) by the referring clinician
7. Awareness that follow-up will most likely be handed back to primary care, with further IV iron referral required as necessary (information provided in clinical correspondence)

NB. If above inclusion criteria not met, patient ineligible for direct referral to nurse-led IV iron service.  Use alternate pathway e.g. advice and guidance request to haematology or relevant subspecialty.