Welcome to AROW

The Acute Rule Out Waiting area.

Why have I been sent to this other area?  

  • Referral to AROW ( the Acute-Rule-Out Waiting Area) allows stable patients to wait for their test results in a calmer, more comfortable environment. It also frees up space elsewhere to see other patients, so hopefully improving the experience for everyone.  

  • You will be waiting in this area for the results of your investigations. If nothing concerning is found, you r clinician will explain exactly what that means and you will be discharged. Patients usually remain in this area for a few hours (and cannot stay more than 12) .  

 

There is a range of conditions we might be trying to rule out. Skip to the section that applies to you:

Pulmonary embolism (PE)

What will happen now?  

  • If your clinician suspects that you may have a PE, they will have take n a blood test called a D-Dimer ( or in some cases, e.g. pregnancy arranged a different kind of test). This will detect any signs of abnormal clotting of the blood .  

  • In AROW you may eat and drink, and if you inform the nursing staff, you are free to leave briefly (for example if you need fresh air or a coffee).  

What happens if the result of this test is negative?  

  • If there is no evidence of abnormal clotting in your blood you will be discharged home, and no further investigation is needed. We recognize that you still may have symptoms but have proven that it is not dangerous for you.   

  • There are other causes of PE-like symptoms – with pain and breathlessness that can be just as severe – that include:   

    • Lung inflammation, often from a minor infection (Pleurisy) .   

    • Gastro- oesophageal reflux disease (GORD , Heartburn)  

    • Costochondritis - Inflammation in the joints in the ribcage .  

    • Strained chest muscles  

    • Anxiety – chest pain commonly occurs during periods of stress, as well as during anxiety or panic attacks .  

  • Treatment. The treatment will depend on the likely cause  and your doctor or nurse will be able to recommend the best treatment for your condition, for example regular simple pain killers.  

What happens if the test is positive?  

  • A positive test does NOT mean that you definitely have a PE. It means you MIGHT have a PE; several other conditions can cause the result to be slightly raised (such as minor infections). 
  • To confirm a clot, further tests will be needed. In the daytime these may be arranged while you are still in AROW.  Out of hours, or if services are very busy it may need to wait a day or two.   
  • This is perfectly safe as you will be started on the treatment for a PE while waiting for the further tests, and you will leave AROW with both the medication and an appointment for the follow up tests. 

What if it doesn’t get better?  

  • If you develop any new/concerning symptoms after being discharged from AROW, please seek urgent medical advice (via 111 or 999 depending on the severity).
  • If you find that your symptoms are persisting after you leave the hospital, and you have been ruled out from emergency abnormalities in AROW, you should contact your GP for further advice.
  • Please feel free to contact the AROW team with any feedback or recommendations to improve either this leaflet or the AROW. 

Cauda Equina Syndrome (CES)

What will happen now?  

  • If your clinician suspects that you may have CES, they will arrange an emergency MRI scan. This will detect any signs of a dangerous kind of ‘slipped disc’, pressing on specific essential nerves in your back. This is a rare problem. Most people who have an MRI will not have CES.  

  • In AROW you may eat and drink, and if you inform the nursing staff, you are free to leave briefly (for example if you need fresh air or a coffee).  

What happens if the result of this test is negative?  

  • If there is no evidence of those critical nerves being affected, you will be discharged home, and no further investigation is needed. We recognize that you still may have symptoms but have proven that it is not immediately dangerous.   

  • If other nerves are being compressed, but not the critical ones, the neurosurgical team may arrange to follow you up in clinic and arrange further treatment from there.  

  • There are other causes of CES -like symptoms – with pain and changes in sensation, power or bladder and bowel function that can feel just severe. All of those symptoms can be related to a slipped disc, other nerves being pinched (sciatica), or spasm and stiffness in the muscles and joints of the back. In the majority of cases these settle over 4-6 weeks .  

  • Treatment. The treatment will depend on the likely cause and y our doctor or nurse will be able to recommend the best treatment for your condition, for example physiotherapy, regular pain killers or referral into the Lumbar Spine Pathway for consideration of epidurals (anaesthetic injections) .  

What happens if the test is positive? (Remember, this is RARE).  

  • Any concerning MRI scan will be reviewed by the duty neurosurgical consultant. In the case of true CES, an emergency operation will be arranged to relieve the pressure on the nerves in your back. You will be admitted to a ward for this to take place (and may go back into the main department while this is being arranged).  

What if it my back pain doesn’t get better?  

  • If you develop any new/concerning symptoms after being discharged from AROW, please seek urgent medical advice (via 111 or 999 depending on the severity).
  • If you find that your symptoms are persisting after you leave the hospital, and you have been ruled out from emergency abnormalities in AROW, you should contact your GP for further advice.
  • Please feel free to contact the AROW team with any feedback or recommendations to improve either this leaflet or the AROW. 

Deep vein thrombosis (DVT)

What will happen now?  

  • If your clinician suspects that you may have a DVT , they will have taken a blood test called a D-Dimer (or in some cases, e.g. pregnancy arranged a different kind of test). This will detect any signs of abnormal clotting of the blood.  

  • In AROW you may eat and drink, and are free to leave briefly (e.g. if you need fresh air or a coffee). Please inform your nurse if you do.  

What happens if the result of this test is negative?  

  • If there is no evidence of abnormal clotting in your blood you will be discharged home, and no further investigation is needed. We recognize that you still may have symptoms but have proven that it is not dangerous for you.   

  • There are other causes of DVT -like symptoms – with pain and swelling that can be just as severe – that include:   

    • Cellulitis, which is a (usually minor) skin infection.   

  • Treatment. The treatment will depend on the likely cause and your doctor or nurse will recommend the best treatment, for example antibiotics, anti-inflammatories or regular simple pain killers.  

What happens if the test is positive?  

  • A positive test does NOT mean that you definitely have a DVT, it means you COULD have a DVT ; several other conditions can cause the result to be slightly raised (such as minor infections).   

  • To confirm a clot, further tests will be needed.  In the daytime these may be arranged while you are still in AROW.  Out of hours, or if services are very busy it may need to wait a day or two.    

  • This is perfectly safe, as you will be started on DVT treatment while waiting for the further tests, and you will leave AROW with both the medication and an appointment for the follow up tests.  

What if it doesn’t get better?  

  • If you develop any new/concerning symptoms after being discharged from AROW, please seek urgent medical advice (via 111 or 999 depending on the severity).  

  • If you find that your symptoms do not settle, you should contact your GP for further advice.  

Head injury or neurological deficit

What will happen now?

  • If your clinician feels you could have had a significant head injury or medical event affecting your brain, they will have arranged a scan (MRI or CT). Once it is reported by the specialist they will come and discuss the results with you.
  • In AROW you may eat and drink, and if you inform the nursing staff, you may briefly leave (for example if you need fresh air or a coffee).

What happens if the result of this scan does not show any significant injury or neurosurgical concerns?

  • If there is nothing concerning on your scan, you will be discharged home and no further investigation is needed. We recognize that you still may have symptoms, but we have proven that it is not dangerous for you.
  • Any treatment will depend on the likely cause and the result of your scan, and your doctor or nurse will be able to recommend the best treatment for your condition, for example regular simple pain relief or a specialist review. An advice sheet may be provided.

What happens if the scan shows significant injury or neurosurgical concerns ?

  • Depending on your scan results, you may be required to stay in hospital for further investigations or a period of observations. You may also be referred to other specialist teams such as neurosurgery, neurology, occupational therapy (OT), physiotherapy (PT)or our frailty team.
  • You may have changes on your scan, but if the clinician feels it is safe for you to go home, you may be followed up in the community by specialist services through an outpatient route, rehabilitation services such as OT/PT or your own general practitioner (GP)

What if my symptoms don’t get better?

  • If you develop any new/concerning symptoms after being discharged from AROW, please seek urgent medical advice (via 111 or 999 depending on the severity).
  • If you find that your symptoms are persisting after you leave the hospital, and you have been ruled out from emergency abnormalities in AROW, you should contact your GP for further advice.
  • Please feel free to contact the AROW team with any feedback or recommendations to improve either this leaflet or the AROW.

Was this page helpful?

Was this page helpful?
Rating

Please answer the question below, this helps us to reduce the number of spam emails that we receive so that we can spend more time responding to genuine enquiries and feedback. Thank you.

*
Recruitment - Page Footer Image