Description:

The Gynaecology Casualty (GC) is a specialised subdivision of emergency care located within the Emergency Unit at Groote Schuur Hospital. It is serviced by gynaecology registrars, interns and nursing personnel and supervised by Dr Khatija Kadwa and the gynaecology consultant on call. A dedicated gynaecology casualty offers in principle, a safe and private environment for patients to be attended to immediately by doctors with the relevant gynaecological expertise. This service alleviates the burden placed on the EU patient load by gynaecology patients and decreases patient waiting times.
 
Referral:

It is imperative that all cases are discussed telephonically prior to the referral with the gynaecology registrar on call. He/she will accept and prepare for the arrival of all emergencies and re-direct non-emergency referrals according to our triage guidelines.

Note: A recent audit of the gynaecology casualty demonstrated that the majority of referrals to the gynaecology casualty were from private practitioners and primary care centres. Patients were often not discussed with the registrar on call before referral and many referrals were not emergencies. In order to focus on emergencies and eliminate EU congestion we have introduced a triage system according to which non-emergency patients are re-directed to Gynae OPD, TOP services, Family Planning Clinics or appropriate level 1 services. This re-direction of patients can be avoided if referring clinicians/institutions refer non-emergency patients (see ‘green patients’ in triage guidelines) to the appropriate clinics and not GC.    

We look forward to working closely with all our referral centres. We are committed to two-way effective communication and feedback facilitating good relationships among all practitioners providing care to our patients.  

Contact details:

GSH switchboard (gynaecology registrar on call’s number) Gynaecology Casualty General Casualty Gynaecology OPD bookings Family Planning Clinic TOP Clinic (only by appointment, patients living in GSH drainage area and up to 20 weeks gestation) Colposcopy Clinic

021 404 6044 C24 021 404 4155 C15 021 404 5208        021 404 5566        021 404 5469        021 404 4527        021 404 4527        021 404 4489

GC Triage guidelines:

Gynaecology Triage
Red Patients – Resuscitate in the general casualty resuscitation room

•     Pregnant women haemodynamically unstable (including ectopic pregnancy)
•     Pregnant women with seizures
•     Women with septic shock due to uterine sepsis
•     Trauma Unit
•     Rape survivors, severely injured, unstable

Red/Orange Patients – Transfer directly to Gynaecology Casualty without observations

•     Rape survivors, physically stable
•     Pregnant women up to 20/52, haemodynamically stable
•     Women with complications post abortion/partum, haemodynamically stable
•     Women with newly diagnosed cervical cancer not yet under treatment (not known to already known to an oncology unit)

Orange Patients – Transfer to Gynae Casualty with observations and initial assessment by casualty officer

All women with

•     symptoms of gynae malignancy
•     suspected stage II or III PID
•     suspected ovarian torsion
•     severe anaemia (Hb <9g%) due to gynaecological causes
•     moderate/severe abdominal or pelvic pain

Non-emergency conditions (‘green patients’)are divided into urgent, semi urgent and non-urgent cases requiring medical care within 24-72 hours, one - three weeks or next available appointment at the appropriate site

Green Patients – Assess in triage and refer to Gynaecology OPD WITHIN 48-72HRS

All non-pregnant women with:

•     significant vaginal bleeding but stable
•     mild to moderate abdominal pain not requiring immediate treatment
•     pelvic-abdominal mass and mild-moderate symptoms

All women with:

•     postmenopausal bleeding
•     large and infected vulval warts: refer to Colposcopy Clinic

Assess in triage and refer to Gynaecology OPD WITHIN 1- 3 weeks

All women with:

–     moderate abnormal vaginal bleeding not requiring urgent management and not pregnant

–     pelvic abdominal mass not suspected to be malignant

–     chronic pelvic pain (> 6 months) not suggestive of serious illness

Next available appointment (non-urgent)

All women with

–     mild vulval warts: refer to Colposcopy Clinic

–     long standing gynaecological problems without significant physical compromise

Assess in triage and refer to Family Planning Clinic

All women with contraception-related problems

Assess in triage and refer to TOP Clinic

All women requesting TOP up to 20 weeks