Children’s Assessment & Treatment ( CAT ) Unit Escalation

Publication: 29/01/2014  --
Last review: 08/04/2019  
Next review: 08/04/2022  
Standard Operating Procedure
CURRENT 
ID: 3660 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

CAT Escalation Policy (CREAP)

CAT UNIT

CREAP Green (NORMAL) -  Core Triggers

 

1

Patients in CAT

< 15

2

Patients expected to CAT

< 5

3

PUMA Patients

0-1

4

Inpatient in Assessment

No patients

5

Triage waiting time

<15 mins

6

Minimum Staffing levels

  • 3 Qualified
  • 1 HCAs
  • 1 Ward Clerk
  • 2 SHOs
  • 2 Registrars
  • 1 Consultant (Winter - Cons from 9am-9pm

                      Summer - Cons from 2pm - 9pm
                      Both - 9pm - 9am cons on call)

7

Initial Medical/Surgical review

< 1 hour

8

Bed Availability

< 2 hours from bleeping IPFC

9

Transfer times (CAT - Wards)

< 2 hours from bed allocation

 

CREAP Green –  Actions

  • Captain (senior Doctor) and Nurse in Charge review CREAP throughout the day (07.15, 09.00, 12.00, 14.00, 16.00, 19.15, 22.00, 00.00, 03.00).  

 

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CAT UNIT

CREAP Amber (CONCERN) -  Core Triggers

1

Patients in CAT

15 - 25

2

Patients expected in CAT

5 - 10

3

PUMA Patients

0 - 1

4

Inpatients in Assessment

0 - 2

5

Triage Waiting Time

15 - 25 mins

6

Minimum Staffing Levels

  • 3 Qualified
  • 1 HCAs
  • 1 Ward Clerk
  • 2 SHOs
  • 2 Registrars
  • 1 Consultant  (Winter - Cons from 9am-9pm

                      Summer - Cons from 2pm - 9pm
                                   Both - 9pm - 9am cons on call)

 Nurse is in PUMA, triage time > 15 mins, Safeguarding case requiring Child Protection Medical by SPR or any variation from minimum staffing levels.

7

Initial Medical/Surgical  Review

1 - 2 hours

8

Bed Availability

2 -3 Hours from bleeping IPFC

9

Transfer times (CAT - Wards)

2 - 3 hours from bed allocation

 

CREAP Amber –  Actions

  • Captain and Nurse in Charge review CREAP throughout the day (07.15, 09.00, 12.00, 14.00, 16.00, 19.15, 22.00, 00.00, 03.00).
  • Nurse in Charge to escalate to IPFC and Ward Manager.
  • Nurse in Charge to look at allocation of staffing (between CAT and L09).
  • Captain to look at extra medical staff/call consultant (out of hours seek help from Specialty team).
  • Ward Clerks and Health Care Assistants to inform patients and families of extended waiting time.

 

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CAT Unit

CREAP Red (MODERATE PRESSURE) -  Core Triggers

1

Patients in CAT

25 - 35 

2

Patients expected in CAT

10 - 15

3

PUMA Patients

1 - 2

4

Inpatients in Assessment

2 - 4

5

Triage waiting time

25 - 30 mins

6

Minimum Staffing levels

  • 3 Qualified
  • 1 HCAs
  • 1 Ward Clerk
  • 2 SHOs
  • 2 Registrars
  • 1 Consultant  (Winter - Cons from 9am-9pm

                      Summer - Cons from 2pm - 9pm
                      Both - 9pm - 9am cons on call)

 Nurse is in PUMA, triage time > 30 mins, Safeguarding case requiring Child Protection Medical by SPR or any variation from minimum staffing levels.

7

Initial Medical/Surgical Review Time

2-3 hours

8

Bed availability

3-4 hours from bleeping IPFC

9

Transfer Times (CAT - Wards)

2 - 3 hours from bed allocation

 

CREAP Red –  Actions

  • Captain and Nurse in Charge review CREAP throughout the day (07.15, 09.00, 12.00, 14.00, 16.00, 19.15, 22.00, 00.00, 03.00).
  • Nurse in Charge to escalate to IPFC and Ward Manager and Matron.
  • IPFC to update at DOP.
  • Nurse in Charge to look at allocation of staffing (CAT and L09).
  • IPFC to look at moving staff from another area/IPFC to come and support CAT unit if possible.
  • Captain to escalate to Consultant and look at getting extra Medical staff (out of hours seek help from Specialty team).
  • Consultant & Nurse in Charge to review patients for discharge/admission in CAT.
  • Ward Team (SPR/Consultant) to review patients on the wards for home - to enable patient movement.
  • Nurse in charge/triage nurse to send patients (that are stable) waiting for inpatient beds directly to wards to relieve pressure on CAT unit/consider using PANDA
  • Nurse in Charge and Consultant/ Captain to discuss with ED regarding Red CREAP status.
  • Nurse in Charge to refer surgical patients to medics to assess patient and escalates to Surgical SPR when initial surgical review is delayed.
  • Consultant to take all referrals and to inform GPs when they are referring that wait time is prolonged.
  • Ward Clerks and HCAs to inform patients and families of extended waiting time.
  • Review situation in 2 hours.

 

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CAT UNIT

CREAP Black (SEVERE PRESSURE)  -  Core Triggers

1

Patients in CAT

35+

2

Patients Expected in CAT

15+

3

PUMA Patient

2+

4

Inpatients in Assessment

4 - 6+

5

Triage waiting time

30+ mins

6

Minimum Staffing Levels

  • 3 Qualified
  • 1 HCAs
  • 1 Ward Clerk
  • 2 SHOs
  • 2 Registrars
  • 1 Consultant  (Winter - Cons from 9am-9pm

                      Summer - Cons from 2pm - 9pm
                      Both - 9pm - 9am cons on call)

2 Nurses in PUMA, triage time > 30 mins, Safeguarding case requiring Child Protection Medical by SPR or any variation from minimum staffing levels.

7

Initial Medical/Surgical Review Time

3+ hours

8

Bed availability

4+ hours from bleeping IPFC

9

Transfer Times (CAT - Wards)

4+ hours from bed allocation

 

CREAP Black - Actions

  • Captain and Nurse in Charge review CREAP throughout the day (07.15, 09.00, 12.00, 14.00, 16.00, 19.15, 22.00, 00.00, 03.00). 
  • Nurse in Charge to escalate to IPFC and Ward Manager and Matron (Clinical Site Manager out of hours).
  • Matron to inform Head of Nursing.
  • IPFC to update DOP.
  • Nurse in Charge to look at allocation of staffing (CAT and L09).
  • IPFC to look at moving staff from another area/IPFC come and support CAT unit.
  • IPFC and matrons to consider opening surge beds to move patients out of CAT.
  • Captain to escalate to Consultant and look at getting extra Medical staff - (out of hours seek help from Specialty team).
  • Consultant and nurse in charge to review patients for discharge/admission in CAT.
  • Ward Team (SPR/Consultant) to review patients on the wards for home - to enable patient movement.
  • Nurse in Charge/Nurse in triage to send patients waiting for inpatients beds directly to ward to relieve pressure on CAT/consider using PANDA unit.
  • Nurse in Charge to refer surgical patients to medics to assess patient and escalate to Surgical Consultant and Surgical Matron when initial surgical review is delayed.
  • Nurse in Charge and Consultant/ Captain to discuss with ED regarding Red CREAP status.
  • Consultant to take all referrals.
  • Consultant to contact GP services to re-direct patients.
  • Ward Clerks and HCAs to inform patients and families of extended waiting time.
  • Review situation in 2 hours.

Provenance

Record: 3660
Objective:

To assist in the smooth patient flow through the CAT unit

Aims
To standardise and optimise the management of children who attend the CAT unit.

Clinical condition:
Target patient group: Children
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Not supplied

Document history

LHP version 1.0

Related information

Not supplied

Equity and Diversity

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