Page 30 - Registrar Orientation Manual 2016

a photo of the nurse next to their name to help you identify them. If you cannot easily locate the primary nurse, please communicate with the NIC or the Flow Nurse.
 If you decide to admit a patient, as well as some documentation for the ward staff, you must fill in the green sheet with the patient’s notes detailing what team they are to be admitted under, their provisional diagnosis and a brief outline of the treatment they are to have. If you want to request a specific ward you may write that in the comments field or discuss it personally with the bed manager, but do not write it in the ward space on the green form as this is where the confirmed final ward disposition is written. This is important for the bed managers to allocate the patient a bed and the nursing staff to hand over the patient to the care of the ward staff. Again you mustn’t just leave this in the notes but hand it to the primary nurse, flow nurse or NIC so that they can expedite the disposition of the patient.
 If you decide to discharge a patient, please communicate this to the nursing staff - either the primary nurse, flow nurse or NIC. It is also mandatory for you to provide every discharged patient with a computer generated discharge letter and any necessary prescription to take with them.
 The comments field in iPM is used by ED staff to indicate plans (treatment and disposition) for patients. You may use this field to indicate your plans taking care not to wipe other important information regarding the patient when you edit the comment.
Responsibility for referrals of patients to a second specialty
GP-referred patients:
 If, after seeing a GP-referred patient, you believe the patient does not need to be admitted under your service (but still needs admission), it is your responsibility to refer the patient to the appropriate service. It is not an option to refer the patient to the care of the ED team (unless their condition is one that lies within the EM scope such as toxicology). The patient will remain the responsibility of the service to which the GP referred them until another service has agreed to take over care. Referrals to other specialities should be in accordance with the Specialty Referral Guidelines and the registrar of the appropriate service should agree to see the patient. Any disagreement should be escalated to the consultant level. Patients must not be left in the ED while registrars argue about the appropriate speciality.
ED-referred patients:
 ED will refer patients in accordance with the Specialty Referral Guidelines. A registrar cannot decline to see an appropriate referral. If you do not believe the referral should come to your service you must discuss with your consultant who should then discuss this with the EPIC. Any arguments should be escalated immediately to consultants and disagreements between consultants will need to be escalated to their CDs and if necessary their clinical leads. Patients must not be left in the ED while registrars argue about the appropriate speciality.
 If, having seen an ED-referred patient, you then believe the patient does not need to be admitted under your service, again it is your responsibility to refer the patient to the appropriate service rather than to refer the patient back to the care of the ED team. Such referrals should be in accordance with the Speciality Referral Guidelines. The registrar of the appropriate service should agree to see the patient. As noted above any disagreement about appropriateness of referrals should be discussed immediately at consultant level.
Asking the EPIC for help
 The EPIC runs ED and is available for clinical advice as well as discussion regarding any areas of dispute or uncertainty about responsibility for patients. If any areas of disagreement arise your consultants are welcome to contact the ED consultant to discuss what is best for our patients.
 If the patient requires a procedure that can be done in ED but requires the patient to be sedated, you should ask the EPIC to see if/when they can help you.
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