Page 29 - Registrar Orientation Manual 2016

 All GP referrals to General Medicine and Respiratory who are stable (triage 3-5) will be sent directly to the AMU from triage between the hours of 0800 and 2200.
 If the ED is very busy/overloaded specialty doctors may be asked by an ED nurse to help see patients who have self-presented to ED either instead of them being seen by an ED doctor, or when they have had only a “RAT” (rapid assessment & treatment), as long as the patient clearly has issues within your specialty scope of practice.
Inter-hospital transfers
 If you receive a call requesting an inter-hospital transfer, you must contact the bed manager before you accept the patient in accordance with the Inter-Hospital Transfer Guidelines.
 If the patient sounds particularly unwell or as if they may require HDU admission, you must review them in ED before admission to the ward – please phone the EPIC to inform them about the patient. Patients from inpatient wards of hospitals outside Waikato DHB (eg BoP, Lakes, Taranaki) are generally accepted as ward-to-ward transfers and do not come to ED unless they are acutely unwell. This is differentiated from patients who are referred acutely from other EDs who are expected to come to Waikato ED for further stabilsation if necessary.
Process for assessing and admitting patients
 When you are on call for acute admissions, as a patient referred to your service arrives in ED you will be notified by a nurse looking after the patient. They may call you or more likely just send a text message. If you are expecting patients to arrive in ED please keep an eye on the ED screen to see if they have arrived – the ambulance icon on the top menu bar of iPM.
 When you arrive in ED to see a patient if you have more than one patient to be seen you should see the patients in order of their time waiting and their triage score time waiting. Expected wait times for various triage scores are: 1 – the patient should be seen immediately, 2 – within 10 minutes, 3 – within 30mins, 4 within 1hr 5 require less urgent care. The ED team will help with initial assessment of triage 1 (in resus) and 2 patients, but your attendance is still required. Triage 3 and 4 patients should be seen in order of arrival in ED unless there are clear clinical exigencies that need to be attended to. This time priority also applies to patients referred to you by ED doctors. If you have any difficulty deciding who to see first, the EPIC, NIC or Flow Nurse will help you. It is often more appropriate to see a patient who has been in ED for a long time first as long as those with higher triage scores have been seen and stablised by ED doctors who have only been waiting a short time.
 The Minister of Health requires that 95% of patients presenting to the Emergency Department are seen, have an initial management plan initiated and are admitted to a ward or discharged within 6 hours of arrival in ED. Those patients presenting directly to ED are ideally to be seen and referred on by the ED staff within 3 hours, seen and sorted by the specialty they are referred to within the next 2hrs, to allow 1 hour to sort their disposition. This acute care timeline is not about rushing to do things at 5 hours and 55 minutes however.
 When you are ready to see a patient you must update the computer system to reflect this. In iPM, right click to bring up a menu, select “seen by” and select your name, so that we know the patient is no longer waiting for you. If your name is not on the system then immediately ask your service manager to arrange one for you. You must not do this unless you are about to see the patient.
 When you take the patient’s notes from their slot please select a coloured card from the back of the notes section that says “Notes with specialty doctor” and put it in the patient’s slot. Do not leave notes lying around the department as it causes notes to get mixed up and precludes other medical staff being able to use the notes to treat the patient.
 When you have assessed the patient, if you require them to have any more blood tests or receive any treatment e.g. antibiotics, analgesia, IV fluids etc. you need to let the nursing staff know as well as charting the treatment. There are individual white-boards in the cubicles now to write instructions if you cannot find the nurse. The nurses look after their patients in teams. If you look at the white board in the main adult area the name of the nurse allocated to each bed-space is listed and there is
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