https://www.gosh.nhs.uk/wards-and-departments/departments/clinical-specialties/dubowitz-neuromuscular-centre-dnc-information-parents-and-visitors/refer-patient-neuromuscular-department/neuromuscular-admission-criteria/
Neuromuscular admission criteria
This is a list of patient diagnoses which are admitted to Great Ormond Street Hospital (GOSH) by our Neuromuscular team, the timeframe in which they should be treated and their estimated length of stay (LoS).
Health professionals are reminded that this information is for guidance only.
Emergency admissions
Children with the following diagnoses are considered an emergency and should be transferred to GOSH within hours from receipt of referral.
| Diagnosis | Estimated LoS |
|---|---|
| Myasthenia autoimmune - acute deterioration | PICU Ward |
| 'Weak' neonate - ventilated | 3-4 days in PICU |
Urgent admissions
Children with the following diagnoses should be transferred to GOSH within days from receipt of referral.
| Diagnosis | Estimated LoS |
|---|---|
| Myasthenia Gravis (congenital) | 3-4 days |
| 'Weak' neonate - not ventilated (not High Dependency) | RANU day case |
| 'Weak' neonate - not ventilated (not High Dependency) for biopsy | 2-3 days |
Elective admissions
Children with the following diagnoses should be referred to GOSH via the non-emergency pathway.
| Diagnosis | Estimated LoS |
|---|---|
| Diagnostic workup (no nursing input required) | Day case/Out Patient Department (OPD)/ Patient hotel |
| Diagnostic workup (inpatient/nursing input required eg ventilated, non-invasive ventilation, gastrostomy) including nerve and muscle biopsy, or with nursing needs and complex assessments with marked oromotor, swallowing dysfunction/feeding difficulties, requiring multiple teams' input | 2-3 days (Badger or Koala Wards) |
| Medication initiation | Day case - 3 days |
| Neuromuscular rehabilitation | OPD/patient hotel - 5 days |
| Plasma exchange | Day case |
| Surgery (other than biopsy, spinal surgery, limbs and joints, gastrostomy, fundoplication), thymectomy in myasthenia gravis | Case dependent |
| 'Uncertain' weakness (patient who requires assessment for strength/function correlation of dystonia) | 2-3 days |
| Weak patient (assessment) IVIG (intravenous immunoglobulin) initiation | 3-5 days |
Unlikely to admit
Routine neuromuscular diagnostic work-up in a stable child.
Reviewed by Adnan Mansur (Consultant), August 2011