1 MEDICAL OFFICER ORIENTATION MANUAL DEPARTMENT OF EMERGENCY MEDICINE BMDH Last updated: January 2020 2 TABLE OF CONTENTS 1. GENERAL DESCRIPTION AND PHILOSOPHY 2. GOALS & OBJECTIVES OF TERM 3. SENIOR STAFFING 4. BLACKTOWN EMERGENCY FLOOR AREA 5. SUPERVISION 6. ROSTER 7. SICK CALLS 8. SHIFTS 9. COMMUNICATION 10. ADMISSIONS 11. DISCHARGES 12. CASE PRESENTATION 13. HANDOVER 1 Handover Information 14. TRIAGE 15. BED AND AREA ALLOCATIONS 16. BAT CALLS TO RESUSCITATION AREA 17. ROLES AND SERVICES WITHIN THE DEPARTMENT 18. TEACHING AND EDUCATION RESOURCES 19. MEDICO-LEGAL ISSUES .1 Police Statements .2 Child Abuse .3 Needle Stick Injuries .4 Abnormal Radiology Results .5 Test Results .6 Media Inquiries .7 Police Requests .8 Blood Alcohol Sampling .9 Rectal and Vaginal Examinations in Females .10 Duty of Care .11 Work Cover .12 Re-Presentations of Patients 20. GENERAL HOUSEKEEPING 21. COMPLAINTS AND DISPUTES 22. DISASTERS 23. ANCILLIARY SERVICES .1 Pharmacy .2 Pathology .3 Radiology .4 Interpreter Service 24. FORMS AND DOCUMENTATION 25. MANAGEMENT POLICY AND PROCEDURE 26. CONCLUSIONS 3 APPENDIX 1 URGENT REVIEW CLINIC BUSINESS RULES APPENDIX 2 EARLY PREGNANCY ASSESSMENT CLINIC APPENDIX 3 AGED CARE SERVICES EMERGENCY TEAM APPENDIX 4 MEDICAL EMERGENCY TEAM (M.E.T) APPENDIX 5 CASE PRESENTATION TEMPLATE APPENDIX 6 ADVANCED MEDICAL PLANNING FORM APPENDIX 7 SAMPLE OF DAILY FLOOR ROSTER APPENDIX 8 SOCIAL WORK REFERRALS APPENDIX 9 TRANSITIONAL NURSE PRACTITIONER SCOPE OF PRACTICE APPENDIX 10 SENSIBLE ORDERING PATHOLOGY APPENDIX 11 EMERGENCY DEPARTMENT SENIOR ASSESSMENT AND STREAMING 4 1. GENERAL DESCRIPTION AND PHILOSOPHY The Emergency Department at BMDH offers emergency care for patients of all ages, 24 hours a day 7 days a week. The main purpose of the Department is the provision of initial assessment, stabilisation and acute management for patients presenting to the Department. Relevant subspecialty or the patient’s general practitioner carries out ongoing management. The Emergency Department has a major role as a liaison between Blacktown Hospital and the community. To many, it symbolises the whole hospital, as it may be their first or only view of the hospital. The department needs to be seen to be delivering a service to the community to help promote and maintain the hospital’s reputation. The service provided by the unit has to be of world standard. The Emergency Department is a level 5 department, (with the hospital being a Level 2 trauma unit) providing treatment for major and minor trauma and medical emergencies. It provides a service that ensures the timely, skilled and appropriate management of all patients. Approximately 60,000 patients attend the department each year (about 170 patients per day). The number of admissions to inpatient beds averages 30%. The Emergency Department also provides a focus for teaching and research. The unit is actively involved in many research projects. Being accredited for Emergency medicine training by the Australasian College for Emergency Medicine (ACEM) the unit provides structured teaching programmes in Fellowship, Diploma and Certificate training programme of the ACEM. An important role of the Emergency Department is its involvement in local and regional retrieval systems. Blacktown Campus sends half a disaster team (one doctor and two nurses) to the scene of a disaster as requested by the area response team. 2. GOALS AND OBJECTIVES DURING YOUR TERM To gain broad experience in the management of adult and paediatric emergencies. To develop and enhance your resuscitation and procedural skills. You are encouraged to keep your on log book (Electronic Log Book). To further the ability to work in a multidisciplinary team and enhance your leadership skills. To develop a high standard of documentation in clinical recording. To participate in continuing education within and exterior to the unit. To enhance communication skills with colleagues, patients and relatives. To develop skills in the efficient and appropriate use of investigations. 5 3. SENIOR STAFFING Director Emergency Medicine Blacktown and Mt Druitt Hospitals: A/Prof Reza Ali Deputy Director Emergency Medicine Blacktown and Mt Druitt Hospitals: Dr David Melvin Emergency Medicine Consultants: Dr Chamila De-Alwis Dr Harry Elizaga Dr Michael Hession Dr Karina Hochholzer (Co-DEMT BMDH) Dr Shaila Islam Dr Dushan Jayaweera Dr Daya Jeganathan Dr Ponnuthurai Jeyaruban (Co-DEMT MDH) Dr Gopi Mann Dr Richard McNulty Dr Satish Mitter (Network Co Director of Training) Dr Jannatun Nayim (Co-DEMT BDH) Dr Fernando Pisani Dr Greg Robinson Dr Liaquat Sheriff Dr Kenny Yee Dr Anj Amarasekera Dr Peter Preisz Dr Susie Stapledon Emergency Medicine VMOs : Dr Irshath Abdul Raheem Dr Richard Lennon Dr Vijay Manivel Dr John Shirley Dr Jana Usenko Dr Behzad Vasfi Dr Payam Yahyavi Dr Nina Dhaliwal Dr Rasel Ahmed Dr Ravindar Jassal Dr Waseem Hassan Executive Assistant: Ms. Joan Brown Nursing Unit Manager Blacktown ED: Ms. Camille Dooley Nursing Unit Manager Mount Druitt ED: Mr. David Glastonbury Clinical Nurse Consultant (BMDH) (Acting): Mr Aaron De Los Santos Clinical Nurse Educator (BDH): Miss Catherine Priestley Clinical Nurse Educator (BDH) (Acting): Jonathamiel Abarquez Clinical Nurse Educator (MDH): Mr. Jonathon Hamilton 6 4. BLACKTOWN EMERGENCY DEPARTMENT FLOOR AREA The department is divided into different areas based on the model of care provided. There is Resuscitation, Acute, Urgent care, Front of House (Early Senior Assessment/ Team C) area. Resus area: 4 beds Acute area: 24 monitored beds Urgent care area: 8 recliner chairs and 2 beds, Eye ENT room Front of house area: 5 consultation rooms Short stay unit: 14 beds 5. SUPERVISION All JMO’s (Interns, RMOs and SRMOs) are supervised by the ED Consultant /Registrar/CMO. All JMOs are expected to discuss ALL their cases with a senior medical officer in the Emergency Department as soon as possible, preferably even before starting to write their notes. It is our departmental policy that ALL patients seen by an Intern, RMO or SRMO will be seen briefly by the senior doctor (ED Consultant/ Registrar/ CMO) of the shift. This is to ensure clinical safety as well as allowing the department to achieve ETP (Emergency Treatment Performance set by Ministry) following on early senior decision- making with regards to patient management and disposition. JMO’s are not expected to make admission or discharge decisions without the direct supervision of a senior physician. The Consultant on the floor will be in charge of the shift and decide on patient management plans and deal with any administrative or policy issues that might arise during the shift. In the absence of the consultant, the CMO or Registrar will fulfil this role. When there is no ED Consultant on the floor, there is an ED Consultant rostered on call. Any complex issues that the CMO/Registrar have difficulty with, needs to be discussed with the on-call ED Consultant who is contactable via switchboard. If an emergency consultant is available, the ED staff handles management of all emergencies including cardiac arrests. At other times, call a code BLUE on 2222 for the hospital MET call team. The ED senior doctor will remain the team leader for all MET calls in ED. You are expected to assist with the resuscitation. You are expected to alert the ED senior doctor of any critically ill patient for immediate review in order to prevent further deterioration. You are expected to attend and notify ED seniors if a CERS call is activated in ED until team Doctors or ED seniors are available. The hospital’s surgical Team should be called to assist in the management of any multi- trauma cases. See the guidelines in Appendix 5. 7 6. ROSTER Blacktown and Mount-Druitt ED have their independent REG/CMO and JMO (Intern, RMO, SRMO) roster. The Executive Assistant of the Department is in charge of the Intern/ RMO/ SRMO roster. Dr David Melvin is in charge of the REG/CMO roster. The roster is arranged at least four weeks in advance. Thus any special requests must be made before this time. The Department has a rotating roster and it is expected that everyone would do their shares of day, evening and night shifts. Once the roster is finalised and published, Intern/RMO/SRMO/Reg/CMO must arrange their own swap/relief, if there is a specific shift they cannot work. The Intern/ RMO/SRMO/Reg/CMO concerned in the swap must complete a “Shift Change Form” and inform the Executive Assistant. The shift change must be authorised by A/Prof Ali or his delegate (Staff Specialist). All swaps must be within the same pay period. The change will also be noted on the master floor roster in the ED for pay purpose. The number of hours worked per fortnight depends on the number of staff available for the shifts. The number of hours may range from 80 to 90 hrs per fortnight. JMO/REG/CMO willing to work more shifts than usual should contact the Executive Assistant as early as possible for allocation to extra shifts. During your shift if you are leaving the ED floor to go to a different part of the hospital, please notify Staff Specialist or Registrar of your whereabouts, so that you may be contacted if required. You will be rostered to a team in ED. Team A and Team B consists mostly of 2 or 3 JMOs attached to an ED senior (ED SS or Reg/CMO).Team C consists of an ED senior (ED SS or Reg/CMO) with 1 JMO and 1 JMO in ESSU (short stay unit.). There is no Team C at night, hence the work load will be shared between teams A & B. You are expected to see patients BASED on team allocation and utilise any clinical space that might be available depending on how busy the unit is. 7. SICK CALLS If you are sick, you must notify the Director A/Prof Reza Ali on his mobile via the switchboard and in his absence the Deputy Director Dr David Melvin on his mobile via the switchboard.