Orange Health Service Emergency Department Registrar Orientation Page 1 of 32 Welcome Welcome to Orange! This orientation booklet intends to provide information that can be quite useful during your term as an ED registrar in this hospital. Orange Health Service opened in March 2011 and is part of the Western NSW Local Health District. It is a major rural referral health service and the regional trauma service for the central west. The Page 2 of 32 hospital provides a wide range of clinical services including emergency services, ICU, coronary care, general and specialist medical and surgical services. In addition, interventional cardiology, maternity, paediatric and neonatal services, aged care and rehabilitation, cancer services including radiotherapy, oral health, renal dialysis, psychiatric services and advanced imaging and interventional radiology are also provided. Apart from being the primary in-patient care facility for the nearly 40,000 people in Orange, it is a referral centre for a number of specialist services from adjacent towns in the central west region, including Bathurst, Canowindra, Condobolin, Cowra, Molong, Forbes, Parkes and for select services from Dubbo region. The OHS Emergency Eepartment places a strong emphasis on team work at all levels of staff and you are seen as a significant part of the team. With that in mind everyone in the department is there to help you and provide guidance to you in your daily work as well as your career. The emergency department consists of 19 beds comprising of: • 2 resuscitation/trauma bays • 12 monitored beds (including a monitored negative/positive pressure room) • 4 unmonitored beds • 1 secure assessment room • 2 fast track rooms • 5 consultation rooms (including ENT/Eye and plaster rooms) The Department provides care to over 27,000 patients per annum, 25% of which are Paediatric, with an overall admission rate of 31%. The department manages all the trauma patients for the region and deals with a wide variety of clinical presentations unique to rural medicine. Page 3 of 32 Page 4 of 32 Contacts Emergency Department phone number: 6369 3156 Emergency Department in-charge 6369 3862 Emergency Department fax number: 6360 2010 Director of Emergency Medicine – Greg Button: ext 3861 Acting Nursing Unit Manager – Meg O’Brien: ext 2202 Duty Emergency Officer / Admitting Officer phone: ext 3862 Clinical NUM: ext 3860 Trauma CNC – Vicki Conyers: ext 3904 Other Useful Numbers: Orange Base Hospital main switchboard: 6369 3000 / ext 9 Payroll Service Desk: 1800 428 283 Barb Pollinelli (JMO manager) 6369 3536 Medical Administration ext 3826 Westmead Hospital 9845 5555 Page 5 of 32 Staffing Emergency Physicians (FACEM / VMO / senior CMO) provide direct clinical cover during day and evening shifts, with on call cover being provided for most 24 hour periods by a senior emergency physician. In addition there are 4-5 junior staff / locum / CMO staffed between 8:00am to 23:00pm and 1 senior doctor / 1 junior doctor overnight. The on-call Emergency Physician overnight is rostered on the master roster in the doctor’s office. He/ she can be contacted by mobile phone on the number provided on the roster. Medical staff Emergency Director – Dr Greg Button (FACEM) DEMT - Dr Ruby Hsu (FACEM) Emergency Consultants Staff Specialists/VMO’s: - Dr Colin Dibble (FACEM) - Dr Nikki Grant (FACEM) - Dr Sally Clunas (FACEM) - Dr Fergal McCourt (FACEM) - Dr Brien Burns (FACEM) Emergency CMO: - Dr Louise Treloar - Dr Mike Sobotta (GP) - Dr Tove Riphagen (GP) Daily Schedule SHIFT ALLOCATIONS Day Shift: 08:00 – 18:00 (Bridging Shift: 10:00 - 20:00) Evening Shift: 13:00 – 23:00 Page 6 of 32 Night Shift: 22:00 – 08:00 (registrar) / 22:00 – 08:00 (JMO) ## Currently there is no specific rostered sick relief JMO on the roster. ED would call in the JMO rostered for ‘Overtime theatre cover as a backup if staffing level is low due to sick leave. WARD ROUNDS Ward rounds will be carried out on a daily schedule. · 0800 – morning ward round will be conducted with the senior ED physician and all medical staff. This allows appropriate handover of patients from the night to the day medical staff. · 1600 - afternoon ward round will be conducted with all medical staff and the NUM. · 2200 – evening ward round with senior night doctor and all medical staff. Allows appropriate handover of patients from the day to the night medical staff. Page 7 of 32 Pre-requisites for ED Registrars at Orange Health Service: An interesting case mix coupled with guidance from the friendly FACEMs provides ample learning opportunities for ED registrars rotating through Orange Health Service. It also provides a clinical challenge with a steep learning curve for entrants into Emergency Medicine training. Registrars are expected to have some pre-requisites which would enable them to function effectively. These include: 1. Knowledge and experience in Advanced Life Support (a brief review session on the topic will be done by the Intensivist as part of orientation package) 2. Theoretical and practical knowledge in Emergency Medicine at level of PGY3 or above 3. Clinical and people skills to deliver supervised and semi-independent medical care to patients 4. Ability to prioritize work 5. Leadership qualities to organize and supervise residents, interns and medical students in providing effective patient care 6. Ability to participate in team work and excel in communication – ability to liaise with ED consultants, other consultants, general practitioners and doctors in other hospitals to provide optimal patient care 7. Insight into environmental and individual limitations with keen ability to source resources to achieve optimal patient care 8. Enthusiasm to learn Emergency Medicine 9. Knowledge and readiness to teach medical students, interns and RMOs 10.Professional pleasant attitude and committed work ethics. Page 8 of 32 Role of ED Registrar · Responsible for initial assessment of patients presenting to ED · Establishing initial management plan and clear documentation of clinical notes on eMR/firstnet · Referral to the relevant admitting team and documentation of time of referral · Taking responsibility for the ongoing management of the patient whilst they are in the Emergency Department · Following up investigation results and ensure that admitted patient’s clinical condition and planning of further investigations or therapy (e.g. IV fluid, analgesia, DVT prophylaxis) are satisfactory when transferred to ward · Taking the team lead role (if necessary) or being a part of trauma and resuscitation teams · Taking an active role in managing critically ill patients in ED in close liaison with the intensive care team · Assisting ED consultant in managing the department and facilitating good team work · Taking the role of “ED senior-in-charge” in managing the department and taking referrals when there is no FACEM on duty · Maintaining and improving your knowledge and skills through attending and contributing to formal education and handover sessions · Actively participate in the teaching and supervision of JMOs and medical students Page 9 of 32 OHS Rapid Response Calls (Medical Emergency Team) The emergency department is not primarily involved in Rapid Response calls. If there are 2 medical emergencies at the same time, then the Emergency Department will be responsible for attending the 2nd medical emergency. The emergency department rapid response team should consist of a senior emergency doctor and nurse. They should take the resuscitation pack with them which consists of airway / breathing and circulation equipment and resuscitation drugs. To make a Rapid Response Call dial # 888 Trauma Calls Trauma calls will be initiated according to the established “Trauma Call Criteria” in ED, which can be ‘Adult Trauma Call’ or ‘Paediatric Trauma Call’. The aim of trauma calls is to provide critical care interventions to acutely injured patients caused by major trauma. This can only be achieved by all members working as a cohesive multidisciplinary ‘trauma team’. An ED senior will be the designated ‘team leader’ responsible for coordinating the patient’s care and monitoring progress. He/she should assign every individual team member to a different role with specific tasks. (Please refer to the chart of ‘trauma team members: roles & responsibility) ED registrars are encouraged to participate as the team leader when necessary or as a team member in managing major trauma patients. This will be beneficial for developing clinical/ resuscitative skills in any specific trauma team role and skills of team work. Page 10 of 32 Clinical Business Rules - Orange Base Hospital Admission Acceptance PROCEDURE FOR ADMISSION OF PATIENTS General – “one way referral”. After ED assessment, discussion with ED consultants and formulating a management plan for a patient who requires admission, the decision should be determined as to which specialty is the most appropriate for this patient to be admitted under. Once ED referral for admission is made to a specialist team, it will be the specialist team who decides one of these three paths: 1) admit; 2) discharge; 3) refer to a second specialist team if it is decided that the admission under the first specialist team is not appropriate. GWAHS Responsibility of the ED doctor who has made the referral to the admitting team: Jul 18, '13, 12:17 PM Added: Space • Document clearly the time and the member of the admitting team whom the patient was referred to. GWAHS Jul 18, '13, 12:19 PM Added Text • Outline clearly the ED management plan for the patient. Ensure the planned investigations have been in progress and ED-initiated treatment/therapy has been charted and carried out. Patient’s GWAHS Jul 18, '13, 12:20 PM appropriate regular medications should be documented/charted. Added Text GWAHS Jul 18, '13, 12:16 PM • Ensure the patient’s clinical condition continues to be satisfactory. Detect and manage any Added: Paragraph Break deterioration promptly while the patient is still in ED. • If there is undue delay in review for admission by the admitting team, a stable patient should be admitted to the ward directly after completing the ‘medical checklist for ward transfer’ (see appendix) and informing the admitting team.