Académique Documents
Professionnel Documents
Culture Documents
BMDH
Blacktown Hospital
Emergency Department
Medical Officer
Orientation Information
TABLE OF CONTENTS
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
1 Between you and the Department
2 Within the Department and the Hospital
3 Between you, your patient and their family
10. ADMISSIONS
1 Who to Call
11. DISCHARGES
1 Discharge Letters
12. CASE PRESENTATION FOR ADMISSIONS AND DISCHARGES
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
1 Fast Track
2 TCA (Treatment Commence Area)
3 PIT Area
4 Clinical Initiative Nurse
5 Nurse Practitioner
6 Physiotherapist
7 Social Worker
8 Care Navigation
9 Post Acute Community Care Program (PACC)
10 Aged Care Services Emergency Team (ASET)
11 Urgent Review Clinic
12 Drug and Alcohol
18. TEACHING AND EDUCATION RESOURCES
.1 Registrar/CMO
.2 Prevocational Teaching (SRMO)
.3 JMO Teaching (RMO/Intern)
.4 Library
.5 On-Line
.6 Term Assessment
.7 Mentorship Program
.8 Responsibility of Mentors
.9 Research and Quality Assurance
.10 UWS Medical School Rotation and Teaching
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
D: /Manuals/Medical Officer Orientation Information-Blacktown
Updated February 2015
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
The Emergency Department at Blacktown Hospital 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 and acute management for patients presenting to the
Department. Relevant subspecialty or the patient’s general practitioner carries out
chronic or 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 Department is a major area in the hospital that may witness patient frustration. It
may present a stressful, confusing, or apparently hostile environment to patients and
relatives and may therefore be a source of complaints and litigation. Staff members are
requested to recognise the need for privacy, have a supportive and understanding
attitude and to offer a word or explanation and counselling services, when appropriate.
The Emergency Department is a level 5 department, (with the hospital being a Level 2
trauma unit) providing treatment of major and minor trauma cases and medical
emergencies. It provides a service that ensures the timely, skilled and appropriate
management of all patients. Approximately 40,000 patients attend the department each
year (about 115 patients per day). The number of admissions to inpatient beds averages
25 - 30 per day.
The provision of services for the non-urgent patients should not interfere with the
provision of emergency services.
The Emergency Department also provides a focus for teaching and research into the
acute emergency care of patients and the health and well being of the community as a
whole. The teaching is primarily for Hospital staff but also provides a service to others in
the community.
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.
3. SENIOR STAFFING
Dr David Melvin
Dr Chamila De-Alwis
Dr Harry Elizaga
Dr Michael Hession
Dr Karina Hochholzer
Dr Shaila Islam
Dr Dushan Jayaweera
Dr Daya Jeganathan (DEMT and Head of BEST Network)
Dr Ponnuthurai Jeyaruban (DEMT Mt Druitt Hospital)
Dr Patricia Kijvanit
Dr Catherine Kizana
A/Prof James Kwan
Dr Gopi Mann
Dr Satish Mitter
Dr Richard McNulty
Dr Jannatun Nayim (DEMT Blacktown Hospital)
Dr Fernando Pisani
Dr Greg Robinson
Dr Liaquat Sheriff
Dr Kenny Yee
Dr Richard Lennon
Dr John Shirley
Dr Vijay Manivel
Executive Assistant
Mr Johnathon Hamilton
Nurse Consultant
Ms Jo Scullion
Ms Tracey Newton
Nurse Practitioner
Luke Strachan
5. SUPERVISION
All JMO’s are supervised by the EDSS/Registrar/CMO/.They 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 and definitely before all
the results are back. This allows the department to reach the NEAT criteria by allowing
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.
Registrars/CMOs are expected to update and discuss with the consultant on the floor
regarding the patients they are reviewing and directly managing and to escalate any
deteriorating patient as soon as possible. The Staff Specialist directly supervises
CMO/Registrars.
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.
Consultant on-call roster is published weekly and is clearly marked on the daily floor
roster.
If an emergency physician is available, the ED handles its own cardiac arrest. At other
times, call the Cardiac arrest team on 111. The MET (Medical Emergency Team) can
also be called, on the same number, whenever further assistance is required in an
unstable patient. The MET consists of the ED Senior as team leader, a medical registrar,
an anaesthetic/ICU registrar, a resuscitation nurse and a wardsman. There is a nursing
team leader, an airway nurse and a circulation nurse allocated for resuscitation in the ED
for each shift.
The hospital’s Trauma Team should be called to assist in the management of any multi-
trauma cases. See the guidelines in Appendix 5.
6. ROSTER
Blacktown and Mount-Druitt ED have their independent REG/CMO and JMO roster.
The Executive Assistant of the Department is in charge of the JMO 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.
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.
Meal breaks are paid for after hours, and there is no need to claim for these. If you work
an in-hours shift (Day Shift), and do not receive a meal break, you must write next to the
shift “NMB”. The ED Director or staff specialist must countersign this.
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.
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.
It is expected that the call is made early on (at least 6hrs prior to
commencement of shift) and not just prior to commencement of the shift. This
is particularly important for night shifts.
The person rostered on as night sick relief will need to work the shift. It is
essential that you give as much warning as necessary so that relief staff can
be organised.
Doctors taking sick leave two or more days consecutively will need a certificate
from their LMO as to the cause. This certificate is to be given to the Executive
Assistant.
8. SHIFTS
BLACKTOWN MT DRUITT
On the REG/CMO and RMO/SRMO rosters there is an on-call night cover person clearly
designated. The night cover person will be asked to cover any unexpected night sick call
relevant to their roster.
9. COMMUNICATION
9.1 BETWEEN YOU AND THE DEPARTMENT
This will be via email. Please ensure that you have provided the ED Executive Assistant
your CURRENT contact phone number, provider number and email address on
commencing the term. Please notify her of any changes during the term.
The paging system is used to contact the relevant in-patient Registrar/Resident. If the
paged person is not answering his page, it is probably because the page number is
wrong, he/she has gone home, has not picked it up from switch, has not turned it on, has
left it in theatre, or most likely he/she is in theatre, etc etc. The variability’s are enormous.
So in this circumstance,
b. Check with the Communication Clerk if they have any information. The theatre is
a good place to start looking. With O&G registrars it is always worthwhile
checking with the Delivery suite. A communication clerk is available during
06:30am and midnight to help with the paging.
All REFERRAL phone calls to the department by a LMO or VMO for admission
should be referred to the Staff Specialist or CMO/Registrar in ED.
Introduce yourself politely to the patient, and listen to what they have to say.
Keep the patient informed of your management plan and what to expect.
If imaging or other tests are being organised inform them as to why they are
being done.
Again be polite and courteous.
By following these simple steps the complaints and dissatisfaction rate will be hugely
reduced. Just think of yourself in the patient’s family’s situation and what you would have
expected!
10. ADMISSIONS
ED medical staff assess and where indicated admit patients presenting to the
department. Exceptions to this are:
Surgical patients: Admitted under the consultant of the day unless specified otherwise
by the Surg Registrar. (Except those who are private and make a special request)
All renal, palliative care and haematology/oncology patients attending the ED must have
their usual consultant notified while they are in the ED, regardless of whether or not they
require admission.
O&G patients: Admitted under the consultant of the day unless specified otherwise by
the O&G Registrar. (Except those who are private and make a special request)
Psychiatry patients: Admitted under the consultant of the day. (Except those who are
private and make a special request)
Paediatric patients: Admitted under the consultant of the day. (Except those who are
private and make a special request)
Orthopaedic patients: Admitted under the consultant of the day. (Except those who are
private and make a special request)
Plastics patients: Need to be discussed with the plastics/hands surgeon on-call. These
patients are managed in Auburn Hospital or a private hospital.
Urology cases: Admitted under the consultant of the day unless an Urologist on the
hospital staff already knows the patient. (Except those who are private and make a
special request)
After hours:
(Weekends/Public holidays and between 1700hrs to 0800 hrs week days)
During Hours:
(Weekdays 0800 hrs to 1700hrs)
Once admitted, the doctor doing the admission (this could be ED doctor or the in patient
team doctor) should write up the medication and fluid charts as required.
Patients should not be transferred to the ward at any time until the appropriate
registrar or VMO (night med reg after hours) has been notified.
11. DISCHARGE
After a THOROUGH ASSESSMENT and necessary investigation, if it is deemed that a
patient does not require admission and may be managed in the out patient environment,
then the patient may be discharged.
Elderly patients (65yrs and above) are NOT to be discharged home between 2200 and
0800, unless the patient and their family, and the medical and nursing staff, are satisfied
that they can be well cared for in their home environment.
All patients being discharged home from the ED require a letter for their LMO to enable
effective follow-up.
This letter must NOT be cut and pasted from the patient’s medical or progress notes but
a brief summary of their ED presentation with relevant discharge instructions.
Please make sure all cannulas are removed before discharging patients.
All patients being discharged from the department must have a discharge letter to take to
their LMO’s for review.
Click on OK
Presenting complaint
Assessment - History and relevant positive examination findings.
Investigations of relevance done (print a copy of the results
separately to accompany the letter)
Treatment
Follow up needed – when and what (Blood results, MCS results,
CXR etc)
In Discharge information – click relevant advice given to the patient. e.g. “to represent if
symptoms worsen”, “Head injury advice”, “Advice regarding driving and swimming in
patients with seizures” etc
Save or sign the discharge summary. – If you save it you can come back to make
changes – e.g.: a doctor who gets handed over a patient can make changes to a
discharge letter written by the first doctor.
If you are writing a referral letter to a specialist, you must ensure that your Medical
Provider Number is included on the letter.
As a Registrar/CMO you will be discussing your cases with the ED Staff Specialist and
the In Patient team consultants regarding an admission or discharge.
Medication list
On examination
Issues on presentation
Management plan
13. HANDOVER
The Departmental Formal Hand Over round is conducted at the patients Bedside.
Presenting problem
Brief History
Management PLAN
What needs to be followed up, i.e. Bloods, X-ray, CT, Urine ECG etc. etc.
If the patient is for discharge then it is the responsibility of the outgoing doctor to write the
discharge summary before leaving the department and handing over his/her patient.
The incoming JMO should make an attempt to introduce him/herself to the patient.
It is expected that the outgoing doctor will have finished all relevant paperwork including
progress notes, medication and fluid charts as well as “Safety to Transfer” forms.
Handing these items over means that the incoming doctor has to review the patient again
to ensure no information is missed, which is not acceptable and adds to the workload
unnecessarily.
14. TRIAGE
All patients presenting to the department undergo a registration process followed by
Triage.
A senior nurse trained in the process does the triage. It is based on the medical needs
and acuity of the patient. Our department has to follow the guidelines by the Department
of Health in achieving the triage targets. The guidelines of seeing patients are:
Triage 1: Immediate
Triage 2: Within 10 min
Triage 3: Within 30 min
Triage 4: Within 60 min
Triage 5: Within 120min
All JMO’s are allocated to a specific team in the department on the floor roster. The ED
Consultant/CMO/Registrar of the particular shift can change this.
You will be responsible for all Cat 2 arriving to that specific area.
You will be expected to go and see the patient immediately, and organise immediate
management / investigation / assessment. E.g. Patient with chest pain > organise
immediate ECG/Analgesia and make sure your REG/CMO/Consultant has reviewed the
ECG with you. Once that is done and the patient is stable you can go back to the task
you were completing prior to the Cat 2 arriving.
(Please refer to the daily floor roster for your team allocation in the department during
your shift.)
As a REG/CMO you will be assigned to a specific team or Fast Track on the floor rosters.
This allocation is not rigid, and all doctors are expected to help their colleagues as the
workload requires.
The principal objective of the fast track area is to see and promptly manage
simple ED presentations (Category 4 and 5). The area is medically staffed by a
REG/CMO or a competent SRMO as well as a Fast track nurse and usually does
not need to be picked up by JMOs.
Patients designated for the Fast Track area will have a green arrow next to their
names on “First Net patient list”
Please refer to the “FAST TRACK business rules” for a better understanding.
This area is co-located with the Fast Track area. There are 6 recliners in TCA.
Once a patient has been seen by a senior ED physician (EDSS/REG/CMO), and
if space in the area is available, the patient can then be transferred to the TCA to
receive ongoing management which might include IV analgesia, fluids, antibiotics
etc. The TCA form must be completed prior to patient going into TCA with clear
hand over to the TCA nurse.
This is a designated space in the department where patients are seen by the “PIT
TEAM C” on arrival to the department. Usually after a short triage the patients will
be taken to the PIT area for immediate assessment by the PIT team. The PIT
team will include, senior doctor (EDSS/CMO/REG), RMO, Nurse. Once the
patient is seen in the PIT they can then be streamed into TCA/Acute/Fast Track
etc as required. Rooms 26/27 or any other designated area can be used for PIT
assessment by PIT team.
The Safe-T notes are not to be taken as a proper history and the JMO needs
to take a full History and examine the patient fully prior to making a
disposition plan.
C.I.N is a senior nursing staff member who has gone through specific learning
objectives and can manage simple defined problems. CIN are allowed to treat
patients under the supervision of the senior physician. Their role can include
suturing, back slabs, organise bloods and other investigations as necessary
under the direction of the senior physician.
JMO’s from time to time may be asked to assist in this process by the
REG/CMO/EDSS.
Please refer to the “CIN role” document.
The Nurse Practitioner is a senior nursing staff member who has gone through
specific training to obtain the ability to assess, treat and diagnosis patients and
discharge them home. Supervision will be provided by the Fast Track doctor and
the Staff Specialist on duty.
Please refer to “Transitional Nurse Practitioner Scope of Practice” appendix 11
17.6 PHYSIOTHERAPIST
The department has a Physiotherapist based in the unit. The role of this position
is to manage acute musculoskeletal injuries in liaison with the orthopaedic team
as well as the ED CMO/REG/Staff Specialist.
The department has a part time social worker, being available from 0830hrs –
1700hrs on pager 7699
After hours the Hospital on call social worker can be contacted.
The different issues the social worker would be able to assist with are:
Accommodation, Centre Link payment, bereavement support for distressed
families in the department
Please see Appendix 9
Aim
ASET aim to target patients with problems with any of the following: mobility
or falls, personal care, cognition or behavior, caring or accommodation
issues, and those living alone.
Referrals after hours: Firstnet by clicking on power orders and searching for ASET, then
logging the referral. Liaise with the nursing team leader about this for the first few
referrals you make.
All ASET appropriate patients discharged home will receive a phone assessment the
following day or as early as possible.
The follow up will occur within 7 days and can be accessed earlier if required.
Ensure that this has been organized after discussion with the relevant
subspecialty team consultant/Reg.
0830 – 1700hrs Monday – Friday page 22857 or 22639 (Mobile 0434 327 540)
Voice mail messages can be left on the mobile number in order to follow up any
admitted patients.
There are no in patient beds for D&A services in BMDH. If you have a patient who
needs admission you can seek advice from the on call D&A Consultant (available
via switch). Such a patient can be transferred to Nepean Hospital for a D&A
admission.
Blacktown and Mount Druitt Emergency Department is Accredited by the College for
Emergency Medicine for Advanced training in Emergency Medicine.
18.1 REGISTRAR/CMO
Interns and RMO’s are encouraged to attend when possible the General JRMO training
sessions, which are held every Wednesdays and Thursdays 1300 to 1400hr in the LG
Seminar Room in the Imaging Department.
18.4 LIBRARY
There is an Eye Educational CD and Emergency Ultrasound DVD available for loan.
18.5 ON-LINE
On the intranet, The BMDH Emergency Department “Website”, provides a wide variety of
information, both clinical and administrative, this includes paediatric and drug protocol.
D: /Manuals/Medical Officer Orientation Information-Blacktown
Updated February 2015
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They are constantly being updated and revised. Suggestions for improvement should be
made to the Director of Emergency Medicine.
http://wslhdintranet.wsahs.nsw.gov.au/Emergency-Medicine/Emergency-Medicine-
BMDH/Emergency-Medicine-BMDH
Through the Clinical Information Access Project (CIAP) link you can also access Harrison
on-line, Medline, Cochrane, MIMS, Poisindex and Antibiotic Guidelines.
At least 3 contact meetings lasting 5min with the allocated resident during the
term.
To gather information from Registrars, Nurse, and Senior Ancillary staff
regarding any “on the floor” concerns.
All problem residents to be referred to the Director of the department early on
so that appropriate measures to rectify the problems can be introduced.
To be available to advise and guide the resident through the term.
You will be required to carry out an audit project while in the department.
Please see audit allocations as per appendix and contact your mentor within
the first 2 weeks of your term.
Medical students from the University of Western Sydney are rotated through
the department as part of the critical care rotation.
Time seen and date (at every new entry.)Time stamp your documentation i.e.
start writing as soon as you start seeing the patients and sign off once finished.
You can always add on other things as an addendum: later reviews, more
information etc. If you are unable to write for a long time, ensure that you write
that you are writing in retrospect and document the time you saw the patient
first, referred the patient etc. Ensure you document the name of the person you
made the referral to.
Presenting symptom
Physical examination
Differential diagnosis
Management plan
Tests performed
Senior medical officers, or allied health staff contacted
Time of discharge
Doctor’s signature
Entries should be in a “problem based medical record” format (see website).
Police statements may be required from time to time. If you receive a request for one,
refer this in the first instance to the medical records department. You can only put in a
police statement what YOU did for the patient. It is in your interest to complete the
statement as soon as possible. The alternative may be a court subpoena.
For clarification please discuss the statement with the Director of the department.
The paediatric registrar usually handles Child abuse cases. However, sometimes the ED
RMO will be required to perform the assessment (at least the initial recognition of the
problem). Coagulation studies, X-rays (indexed with the patient’s name, date and a 10cm
reference marking) provide useful supportive documentation.
Adequate precautions must be taken when there is a risk of contacting patient’s blood or
other body fluids. Gloves must be worn when taking blood or inserting IV cannulas.
Goggles should be worn as the situation indicates. The “Vaccutainer” system is
generally used for the safe sampling of blood. A protocol exists for the management of
needle stick injuries. All such injuries occurring in the hospital are managed through the
ED.
Abnormal Radiology results from the ED are generally checked, and followed up on by
the ED Staff Specialist on the day shift. See “Alert BT” folder, Picture Archiving System
(Digital Radiology System). Patients are not requested to return merely for the follow-up
of routine results.
Test results are not given to patients over the telephone. They may however be given to
the patient’s LMO, after checking the number and calling them back.
Information should not be given to family or friends without first checking with the patient.
Inquiries from the media are referred to the hospital’s executive director. After-hours
these should initially be referred to the executive on-call.
Please co-operate with police requests, provided patient care is not compromised.
Telephone inquiries should first be handled by obtaining the officer’s name, station and
phone number. The number can then be independently checked, and the return call
made.
required for any patient who was the driver of a vehicle (includes cars, cycles – motor or
pedal), was in control of an animal, eg a horse, or a pedestrian.
There are special kits for this purpose. The samples must be collected in accordance
with the enclosed instructions and the sample placed in the designated police container.
Consent is not required for the collection of this sample. It is a statutory requirement. If
a patient refuses to allow the sample to be collected then the local police station needs to
be contacted and this must be clearly noted in the patient’s record.
Remember your duty of care. Patients who are not lucid, or who are potentially not lucid
(and children < 14 years), may be detained and treated, to protect them from
themselves.
Do not assume that confusion in the intoxicated head injured patient is purely due to
intoxication.
Beware of the “labelled” patient.
A “Work Cover” certificate should be completed on the initial consultation for a patient
who has been injured either on the way to or from work, or while at work. The form is
given to the patient once a copy has been made for the patient’s notes. Additional
certificates for the same condition may be supplied, but require only the standard medical
certificate to be completed.
Blooded Instruments All blooded instruments are to be rinsed and placed in the
blue box under the sink in the pan room, for sterilisation.
Meal Breaks It is your responsibility to ensure you take your meal break
at a timely fashion. The break is generally for 30min. It is
encouraged that you have your meals in the tearoom of the
Department. If leaving the department to go to the kiosk to
buy something please ensure that the Consultant or
REG/CMO is aware of you leaving.
Toilets Designated Staff toilets are located next to the tutorial room
Dress Please ensure that your appearance is neat, clean and tidy
reflecting the demeanor of a physician.
22. DISASTERS
The “Disaster Manual” indicates what to do in the case of fire, armed hold-up, bomb
threat, external disaster, cardiac arrest, and evacuation. During your term at Blacktown
Hospital, it is quite possible that you may be involved in one of these (mock or
otherwise). Please read the manual, and become familiar with the equipment in the
disaster packs. (Ask to be shown through these).
The Manual can be accessed from the Executive Assistant of the department
23.1 PHARMACY
0830 to 1700, on site 5 days per week.
On call after hours.
23.2 PATHOLOGY
24 hours per day 7 days per week on site.
ABG’s are done within the department. Medical staff to organise training
and access to this machine as soon as possible. There are staff in the
department who can organise this training
Printed labels are used on all blood samples except the group and hold
sample.
Please hand write your employee number and date on each printed label
prior to attaching onto tubes.
Ensure you are aware of how to attach the label onto the tube. (Ask a staff
member)
Label blood specimens at the bedside, immediately after obtaining the
sample.
Specimens are sent via pneumatic tube in the ED. Please ask a staff member regarding
how to use the tube.
23.3 RADIOLOGY
If a radiology service is not available at Blacktown Hospital, Westmead Hospital is to be
contacted in the first instance. If the service is unavailable at Westmead Hospital, private
imaging centres or another public hospital may be contacted. (A list of private centres is
available in the ED).
Out of hours investigations are expensive, and must be for genuine emergencies
only.
a) Plain Radiographs
b) Contrast Radiography
0800 to 1600 Monday to Friday, IV and oral contrast studies are available. You
need to ring radiographer to book patient.
c) Ultrasound
d) CT Scanning
Available 24/7
After 1700hrs the CT scan films are sent to an off site service “Tele Rad” for a
formal report. The report should be available within 1 hr of the images been sent
to “Tele Rad”
Once completed the formal results are faxed back to the ED.
To avoid delays please ensure that the films have been sent online to “Tele Rad”
If you are not sure what type of CT the patient needs speak to the on call
radiologist at Tele Rad for advice.
e) MRI
D: /Manuals/Medical Officer Orientation Information-Blacktown
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Health Care Interpreter Service (HCIS) should be called for all patients where it is
ascertained that the patient requires assistance in understanding English. They are
available 24 hrs a day, 7 days a week on 9840 3456. (This contact with the service
should be done as soon as this situation is recognised. It is inappropriate for the
notification to be delayed until the treating doctor sees the patient. While awaiting the
interpreter, other resources such as family and friends may be used. However,
regardless of this assistance, the information should be double checked with the patient
once the interpreter arrives.
NOTE: A phone interpreter service is also available when the timely physical presence of
an interpreter is not possible.
Formal orientation to Cerner and First Net will be provided prior to your
commencing the term.
All relevant ordering of test and services are documented and done on Cerner.
Medical staff are required to enter certain data into FIRSTNET. This includes
“Time and Date Seen”, “Diagnosis”, and “Departure Status”
This should be done accurately. We are monitoring closely the waiting time.
For patients who have a ceiling on their management and are not for
Resuscitation, the “Advance Care Planning document” must be completed. Refer
to Appendix …. For the form.
All addendum to a medical record are documented in the initial clinical notes of
the patient so that there is a definite chronological order to the patient’s
assessment and documentation.
All finalized policies and procedures are available on the INTRANET web page of
the Department.
http://swahsintranet.wsahs.nsw.gov.au/Emergency-Services-Blacktown-Mt-Druitt/default.aspx
Please ensure that you are familiar with the current policies.
Any changes to the existing documents will be notified to the Medical staff via
email.
Please see intranet regarding the paperwork required and processes involved
27. CONCLUSIONS
This orientation handout attempts to cover some of the common issues relating to the
functioning of the Emergency Department. However, it cannot hope to cover all aspects
of ED practice.
If there are other important points for medical officers, which should be included in the
guide, please inform the Director of Emergency Medicine.
Protocols exist for guidance only. The rules they set down may be broken, provided the
person breaking them knows why they are doing so, and can justify such actions.
Appendix 1
Purpose of URC
The Urgent Review Clinic is intended to provide an alternative to inpatient care for
patients who have presented to Blacktown/Mt Druitt Hospitals with an acute management
issue. It provides timely access to care by a specialist team for urgent management.
URC care is for short‐ term management only and patients should be discharged or
transferred to appropriate long‐ term follow within 2 weeks of the initial visit to URC. In
the second phase of its operation URC will also provide a day procedure service.
Patient Selection
3. Patients referred from Aged Care Facilities or the PACC Team, if their care has been
discussed with and accepted by a Consultant Medical Officer.
Referral Process
1. Patients must be seen in the URC within 7 days of discharge from hospital or
presentation to ED.
2. Planning for URC review must be documented in the patient medical record and must
be agreed by the managing medical/surgical team (consultant or registrar). The
specific purpose of URC review should be documented.
3. Appointments will be made using the iPIMS system and the clinician responsible for
attending the appointment (e.g. Registrar) must be informed at the time the booking
is made.
1. All episodes of care in URC must be recorded in the patient medical record. The
clinician attending the patient should also consider appropriate communication (letter,
electronic or telephone) with the patient’s General Practitioner.
2. Patients may be rebooked for attendance at URC, but plans should be made for
discharge within 2 weeks (to appropriate long‐ term follow‐ up in consultant rooms,
outpatient clinics or General Practice, as needed).
Appendix 2
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Appendix 3
AGED CARE SERVICES EMERGENCY TEAM
Referrals after hours can be left on phone 47602 with patient details.
All ASET patients discharged home will receive a phone assessment as early as possible
ASET staff: CNC, CNS, RN’s, Allied health, home physio service available
ASET conduct a full aged care assessment of patients over the age of 70 years that present to the
Emergency Department. This includes mobility, falls, functional, cognitive, nutritional, elimination,
environmental, social, medications, carer issues, skin integrity and others as applicable
Referrals can be made to internal departments as well as external service providers eg. Homecare,
Compacks, Meals on Wheels,
If a Care Navigation patient over the age of 70 requires an aged care assessment this occurs in
consultation between the two services
Patients are prioritised with those having potential for discharge being seen first. Residents from
Aged Care Facilities can be reviewed if required by the Emergency Department team. Mental
Health and Stroke patients are referred in the first instance to the respective staff but can be
reviewed upon request.
The aim of ASET according to the Department of Health, 2007, is to improve the clinical care and
management of older people who present to Emergency Departments using the principles of
dignity, respect, equity, participating in decision making, a multidisciplinary approach, all with an
aged-care focus
2. Hostel or Low Level Care: Clients should be independent with mobility and personal care and are
assisted with cooking, cleaning etc. Minimal nursing support given during day, often no support after
hours. Do not discharge patients after 2200hrs, call staff before discharge.
3. Nursing Home or High Level Care: 24 hour nursing and supervision with all cares and mobility.
Patients may be discharged after 24 hours, call staff before discharge.
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Appendix 4
Medical Emergency Team (M.E.T.)
For MET calls in the Emergency Department, the ED Registrar is the Team Leader.
Mt Druitt Blacktown
Day Night Day Night
Team Leader ED Registrar ED Registrar ED Registrar ED Registrar
M.O.2 ICU +/- MR ICU +/- ICU +/-
Anaesth Reg Anaesth Reg Anaesth Reg
M.O.3 Card Reg Ward RMO Card Reg / MR +/- Ward
MR RMO
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MET’s are called (dial 111 and say “Code Blue”) for the following reasons –
1. Airway Threatened
2. Breathing Resp Arrests
RR < 5 or > 36
3. Circulation Arrests
PR < 40 or > 140
SBP < 90
4. Neuro Sudden fall in GCS > 2 points
Repeated or prolonged seizures
5. Other Any patient about whom there is serious worry.
The idea is clearly to encourage the early detection of deteriorating patients in a “no blame”
culture.
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Appendix 5
CASE PRESENTATION TEMPLATE
TO BE FOLLOWED WHEN JMO’s PRESENT CASES TO REG/CMO/EDSS/VMO or the
REG/CMO PRESENTING TO EDSS/VMO
1. Introduce yourself:
I am Dr……… an SRMO at Emergency
I need to discuss a 60 year old gentleman with possible community acquired pneumonia who
needs admission for IV fluid, Antibiotics and Oxygen.
5. Medication List:
7. On Examination:
General Appearance > SOB at rest or Comfortable
Observation > HR, B/P, RR, Sat on Room Air or O2,Temp
Spirometry /PEFR
Chest exam finding
Other systemic examinations if Relevant, Abdomen/Cardiac/Neuro
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Appendix 6
ADVANCED MEDICAL PLANNING FORM
To be completed for any patient who is “Not for Resuscitation” or has a ceiling on treatment imposed
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41
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42
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In Charge Day
0800 -
TEAM A - 47130 TEAM B - 47987 TEAM C - 47988
1830
Staff
Specialist
Registrar/
CMO
In Charge Evening
1400 -
TEAM A - 47130 TEAM B - 47987 TEAM C - 47988
2400
Staff
Specialist
Registrar/
CMO
In Charge Night
2230 -
TEAM A - 47130 TEAM B - 47987 TEAM C - 47988
0830
Registrar/
CMO
Nurse Practitioner
Physiotherapist
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APPENDIX 8
Refer via E-consult to pager 7699. E-Consult request must contain the reason for referral, and a contact
page or number for the referrer.
The following may be referred to Social Work if the issues are causing distress or are
complicating discharge.
Mental Health and Drug and Alcohol issues-refer to Mental Health and Drug and Alcohol teams.
If you have trouble contacting SW, you can contact another Social Worker via the Social Work Crisis
pager (7725). Please allow time for the ED Social Worker to reply to the page before paging a
different number.
Weekends: A Social Worker is available Saturdays and Sundays from 10am-4.30pm. Contact is
via Blacktown Hospital Switch
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APPENDIX 9
NURSE PRACTITIONER
SCOPE OF PRACTICE:
All patients over 16 years of age presenting with the following conditions:
� Upper and lower limb musculoskeletal Injuries not meeting the trauma criteria / open and
closed fractures / underlying structure damage (open and closed) / sprains and strains
� Lacerations and wounds including retained foreign body not meeting the trauma criteria /
with no self-harm / may have underlying structure damage
� Deep Vein Thrombosis- patients who have a definable cause related to travel, recent
surgery, immobilisation etc…
� Conjunctivitis
� Mild head injury- no LOC / GCS 15 / <55 years / not intoxicated / no anticoagulant therapy
� Acute earache
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APPENDIX 11
The Emergency Department Front of House Model of Care EDSAS encompasses clinical
assessment, clinical streaming and initiation of clinical treatment.
Objectives of Streaming:
Triage Nurse:
The Triage nurse is part of the Front of House Team. This role is a senior nursing position within
the department and any staff member allocated into this position must have completed and be
proficient in resuscitation nurse role, advanced life support (ALS), triage and undertaking of the
Clinical Initiative (CIN) role is desirable. This roles criterion includes:
1. Assessing of patients presenting and allocating patients appropriate Triage category
pertaining to their presenting problem
2. Triage as per the ATS Guidelines
3. Once patient flow through the department has improved ED will move to Quick triage system
to optimise this model.
Streaming Coordinator:
The role of the Nurse Streaming Coordinator (SC) is an integral part of the flow of the
EDSAS model of care and will work in unison with the CNUM for overall process and patient
flow governance. Specifically this will involve coordination of care through the front end
processes. The registered Nurse must have completed all ED pathways.
This roles criterion includes:
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7. Escalate changes in patients condition through regular rounds of streaming areas and
waiting room
The REAT nurse is part of the Front of House Team. This role is a senior nursing position within
the department and any staff member allocated into this position must have completed and be
proficient in resuscitation nurse role, advanced life support (ALS), triage and undertaking of the
Clinical Initiative (CIN) role is desirable.
This roles criterion includes:
1. The REAT nurse will assess patients unable to be allocated an acute bed due to
overcapacity of department including patients who are on Ambulance stretchers. These
patients may present with Chest Pain, Sepsis, Acute Asthma, Trauma etc. Assessment
includes ECG, administration of medications/fluids, reassessment of vitals and trauma care.
2. Becoming the 2nd Triage Nurse during ambulance/walk-in presentation Surge times
3. Relieve Triage nurse, resuscitation nurse and Clinical Nursing Unit Manager (CNUM) if
required
5. Can carry the Medical Emergency Team (MET) Page – ALS trained and certified
6. Oversees Mental Health patients including over census admissions awaiting MH beds,
patients awaiting reviews, “specials” allocated to MH patients and administration of
medications.
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2 Communication with patients and carers regarding their waiting time and provision of
relevant education on their health issues
PIT
PIT is where the clinical streaming of patients commences. No Category 1 patients will be
streamed through this model. Cannulation skills is not a requirement for the Enrolled Nurse
allocated to this role however the EN must be medication endorsed.
1. To asses patients in the pit area and provide guidance to the management plan of the
patient.
2. Supervision of the JMO in the PIT area.
1. To bring the next patient into the PIT from the waiting room or Triage room.
2. Carry out necessary tasks including obtaining a set of Observations
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3. Necessary procedures as requested including ECG, Spirometry, Urine sample for Dipstick,
wound swabs, slings, bladder scan, Fluids, Antibiotics, Analgesia etc as charted by the
medical officer.
4. To take patient from the PIT area to the TCA following completion of the designated tasks.
5. Brief hand over to the Registered Nurse in TCA regarding management plan.
TCA comprises of 6 recliners and is where the ongoing clinical management of the patients
continues. Category 2 patients may be streamed through this clinical area post - acute review. The
Registered Nurse allocated to this area must have completed the Transition to Emergency Nursing
Practice and ED Resuscitation Training and have cannulation and venepuncture skills.
1. Ensure that the circulation of patients in the TCA is maintained and patients are being
admitted or discharged from the TCA.
2. Assist the JMO in documenting / charting / ordering.
Fast Track area refers to both the model of care and designated assessment and treatment space
that will be utilized to manage a particular cohort of Emergency Department (ED) patients. Patients
streamed into this model of care will be managed in a separate, designated area by a dedicated
multidisciplinary team. This team will consist of medical, nursing and allied health staff capable of
independently managing and discharging the majority of patients. The area consists of 6 recliner
chairs. A fundamental goal of this model of care is to facilitate the safe and appropriate
assessment, management and discharge of all patients within this model within 4-hours of arrival.
In order to achieve this goal, it is imperative that only those patient that meet the inclusion
criteria and none of the exclusion criteria are streamed to the FTMOC.
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The Fast Track Team Leader role is a senior nursing position within the department and any staff
member allocated into this position must have completed and be proficient in resuscitation nurse
role, advanced life support (ALS), triage and CIN competencies and or a Nurse Practitioner.
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