Trainee Manual

2012

Princess Alexandra Hospital

Department of Emergency Medicine

Trainee Manual - 2012

INTRODUCTION TO PAH

The Princess Alexandra Hospital is one of three tertiary level facilities in Queensland, providing care in all major adult specialties, with the exception of obstetrics and gynaecology, and one of Australia’s leading teaching and research hospitals. The Hospital provides Acute Medical, Surgical, Mental Health, Rehabilitation, and Allied Health Services as well as state-wide services - Acquired Brain Injury Outreach Service, Queensland Amputee Limb Service, Spinal Outreach Team, and a Transitional Rehabilitation Program.

The Hospital is nationally recognised for its expertise in spinal injury management and is a major transplantation centre for livers, kidneys, bone cartilage, and corneas. The District houses the Queensland Liver Transplant Service, Queensland Eye Bank, the Queensland Bone Bank, and one of the major Queensland Health Pathology Services.

PAH is the major referral hospital for the Southern Area Health Service within QLD Health.

The Princess Alexandra Hospital Emergency Department (PAH ED) is a major referral department. It is responsible for the triage, assessment, immediate treatment, and disposition of acutely ill patients presenting to the hospital. The ED has approximately 55,000 attendances per year with an admission rate of 37%.

The Emergency Department has 3 main areas of focus: service delivery, education and research. Emergency trainees play an integral role in all these areas.

This manual aims to provide an overview of the department and how it functions along with an understanding of the training program for emergency medicine trainees.

Our mission is to partner trainees in attaining the aims of the PAH Emergency Medicine Training Program:

Our aim is to develop:

  • Trainees with the ability to be:
  • Higher order thinkers
  • Effective communicators
  • Trainees with the self-belief to be:
  • Independent
  • Decision makers
  • Resilient
  • Trainees with the capacity to:
  • Show empathy
  • Link actions to outcomes
  • Be discerning and ethical decision makers
  • Trainees with the courage and commitment to:
  • Aspire to excellence
  • Be tolerant and inclusive
  • Be patient advocates

The principles by which the entire PAH Emergency Department work by:

In order to allow patients presenting to the PAH Emergency Department (ED) to have their rights under the Queensland Health Patient Charter (2002) preserved, specifically their rights to be treated with respect and dignity and to be treated on the basis of their clinical condition, the following applies:

  • All PAH ED staff will continually work tooptimise the efficiency of our healthcare delivery, thus maximising the number of patients that we can provide quality care to.
  • The PAH ED recognises that within its health area the PAH is responsible for maintaining access to health services that cannot be accessed elsewhere.
  • Each patient has a right to be assessed and managed in an individual cubicle, affording them privacy during history, examination and management.
  • The clinical condition of a patient will dictate their right to an emergency bed and to the degree of observation and monitoring they require.

Contents of this manual:

Pages 4 – 8: PAH DEM – Staff, Security and Safety, Facilities, Patient Population

Pages 9 – 24: PAH Emergency Medicine Training Program

Pages 25 – 29: PAH Operations and Service Delivery

Pages 30 – 49: PAH Clinical Practice Manual

Pages 50 – 53: PAH Trainee Manifesto (includes trainee clinical expectations – the specifics)

PAH DEPARTMENT OF EMERGENCY MEDICINE

STAFF

Medical

Consultants:

There are 17.5 full-time equivalent Staff Specialist positions within the PAH ED. These positions are currently filled with a mixture of full-time and part-time staff.

The current personnel are:

  • Director: Dr Phil Kay
  • Co-Director: Dr James Collier
  • Deputy Director: Dr Andrew Staib
  • Director of Emergency Medicine Training: Dr James Collier / Dr Darren Powrie
  • Staff Specialists:
  • Dr Michael Sinnott
  • Dr Bevan Lowe
  • Dr Colin Page
  • Dr Marianne Cannon
  • Dr Ellen Burkett
  • Dr Andrew Parkin
  • Dr Sean Lawrence
  • Dr Roy Mulcahy
  • Dr Peter McSweeney
  • Dr Jonathon Isoardi
  • Dr Hector Fuentes
  • Dr Iain McNeill
  • Dr Tina Bazianas
  • Dr Jonathon Isoardi
  • Dr Glenn Ryan
  • Dr Kim Nicholls
  • Dr Katherine Isoardi
  • Dr Ogilvie Thom

Consultant Roles and Management Portfolios:

Michael Sinnott – Head of Research

Andrew Staib – Residents

Jonathon Isoardi – Department Education Supervisor

Marianne Cannon, Hector Fuentes – Medical Students

Sean Lawrence - Simulation

Glenn Ryan / Katherine Isoardi – Trauma

Katherine Isoardi – Clinical Guidelines and Procedures; USS

Ellen Burkett – Quality

Darren Powrie – Mental Health

Bevan Lowe, Hector Fuentes - Equipment

Colin Page – Toxicology, Drugs and Therapeutics, Rostering

Please see these consultants directly if you have any particular concern within these areas, otherwise contact either of the DEMTs or the ED Executive (Phil Kay, James Collier, Andrew Staib and Darren Clark (ADON)). The above describes some of the main management portfolios; a more extensive list covering all consultant responsibilities is displayed on the noticeboard and on

Consultant ACEM Roles:

Various consultants hold college appointments and as such may be a useful resource for trainees:

James Collier – Regional Censor, QLD; Board of Education; Chair of Accreditation; Court of Examiners; TRC – Senior Adjudicator

Sean Lawrence – Court of Examiners; FEC subcommittee – VAQ Committee; CPD – ACME Monitoring Subcommittee

Bevan Lowe – FEC subcommittee – VAQ

Hector Fuentes – PEC – Pathology Subcommittee

Ogilvie Thom – TRC – Adjudicator

Michael Sinnott – TRC - Adjudicator

Marianne Cannon – Public Health Committee

Andrew Staib – Standards Committee – ED Ultrasound

Registrars:

There are 17.5 full-time equivalent registrar positions in the ED. The PAH ED is accredited for 24 months of advanced emergency medicine training by the Australasian College for Emergency Medicine. The registrar positions are only filled by advanced trainees.

Each year a Registrar Liaison is appointed to chair monthly trainee meetings and liaise with the consultant group about trainee issues.

Training Senior House Officers:

There are 10 Training SHO positions available within the training program, generally for provisional trainees. They undertake a 12-month program involving - 9 months in ED and 3 months in ICU (8 trainees); or 6 months in ED and 6 months in the Acute Surgical Unit (2 trainees). At any point in time there are 7 Training SHOs working on the ED roster.

Resident Medical Staff:

There are 29 Resident Medical Officers assigned each term to the ED. This consists of 17 Junior House Officers / Senior House Officers and 12 Interns.

Nursing

Assistant Director of Nursing- Darren Clark

Nurse Manager – Jan Gehrke

There is also a small group of Clinical Nurse Consultants who supervise the ED floor from a nursing perspective.

Administration Staff

The ED Office Manager, Jillian Vernon and Administration Officers are the main points of contact for medical staff administrative issues.

Mr Pete Fugelli is the ED’s Database Manager and is responsible for organising your access and orientation to the Emergency Department Information System (EDIS).

Upon commencing at the hospital you should have been given passwords and orientation to PACS (radiology) and AUSLAB (pathology). If you have any problems please see Jillian Vernon, ED Office Manager.

Radiography Staff

The ED has dedicated plain x-ray facilities and radiography staff. Mr John Lucjan is the head radiographer within the ED. There is also a radiology registrar within ED Radiology 24/7 for CT, USS and plain film requests and reporting.

Wardpersons

The ED has dedicated wardpersons to assist in patient transport, patient lifting, and general cleaning.

Allied Health Staff

There are dedicated physiotherapists, occupational therapists and speech pathologists for the ED. Contact details and criteria for referral can be found in the PAH ED Clinical Practice Manual (CPM).

Community Health Nursing Coordinator

There is a Community Health Nursing Coordinator (CHIP nurse) based in the ED. There is also an ‘Aged Care Early Intervention and Management’ program coordinator. Contact details and criteria for referral can be found in the PAH ED CPM. They are also the initial point of contact for the ‘Hospital in the Home’ and ‘Hospital in the Nursing Home’ programs.

Social Work

A social worker is based in the ED; contact details and criteria for referral can be found in the PAH ED CPM.

Pastoral Care

There are a number of Pastoral Carers who provide support to patients and their families every evening shift.

EMERGENCY DEPARTMENT SECURITY AND SAFETY

The Emergency Department has secured entry and exit points. To access or leave the ED you are required to use your hospital ID badge on the infrared scanners to release the doors. These measures are to ensure safety of staff and patients from outside threats. They also ensure the safety of patients within the ED who shouldn’t leave for their own safety due to medical or mental illness.

Emergency Alarms:

These alarms are situated in all the cubicles and at the nurses’ station for your protection.

  • Emergency / Arrest - Blue
  • Security Alert - Red
  • Nurses - Handheld button
  • Wardpersons - Yellow

Fire exits/Alarms/Extinguishers:

Look around on your first shift for the fire exits and position of alarms and extinguishers. Follow the fire exit signs in the event of a fire or other emergency. The hospital provides fire safety lectures each year for all employees.

Hospital Identification Badges:

You are expected to wear your ID badge where it can be easily seen. The ID badges allow you access through the secured doors to and within the ED. They ensure you are recognised by security staff as a hospital employee, whilst patients and other staff can more readily identify you as well.

Safety/Security:

Please guard your valuables. Do not leave or store your bags in the medical write-up room. You will be given a key to the trainee office where valuables can be kept. Otherwise, there are lockers in each of the male and female toilets for storage of personal and valuable items. If you wish to make use of these, please see the ED Office Manager / ED Administration Officer.A $5 refundable deposit is required for a locker key.

EMERGENCY DEPARTMENT FACILITIES

Staff Tea Room:

The ED staff tea room has refrigeration, microwave, tea and coffee facilities. There is also a TV and general reading material. Pigeon holes for staff mail are located here. It is everyone’s responsibility to keep the tea room clean.

Toilet facilities:

Within the male and female toilets there are lockers that can be utilised for storage of personal and valuable items. Locker keys can be obtained from the ED Office Manager / ED Administration Officer (a $5 refundable deposit is required for a key).

There are also shower facilities within the toilets.

Trainee Office:

A dedicated office for trainees is located within the ED Administration area. Within this room are individual trays for trainee mail and correspondence; fridge for drinks, 2 computers (one of which has a large widescreen monitor that can be utilised for small group teaching within the room); resources for education (electronic and paper resources; a text book library, an EMRAP CD library, anatomy models, filing cabinet with other primary exam resources); and noticeboards for communication of education and training programs being run in the ED.

The room also serves as a ‘sanctuary’ from the floor to have meal or drink breaks and is lockable such that you may wish to keep personal items there.

Conference Room:

The ED shares a conference room with radiology. It contains all the necessary audiovisual equipment and is utilised for the weekly CME program and other larger clinical meetings.

EMERGENCY DEPARTMENT PATIENT POPULATION

PAH ED has a relatively high acuity workload with complex medical cases and multi-system trauma being a feature. An expansive knowledge and skill set is required with particular emphasis on acute resuscitative skills.

PAH ED sees approximately 55 000 presentations per year, with a 37% admission rate. A high proportion arrives by QAS (47%) which underlines the high acuity of the presentations the ED manages.

Being one of the 3 major trauma centres for QLD PAH ED attends to a high number of trauma cases.

The presence of a Professorial led Trauma Unit; interventional cardiologists and 3 catheter labs; a stroke unit that offers lysis to suitable patients; a respiratory HDU that allows for NIV in the ED through to the HDU; neurosurgical services; cardiothoracic services; cancer services; renal unit; transplant unit (renal and liver); spinal injuries services from acute surgical care to the rehabilitation unit; and the full spectrum of radiology services including interventional services, provides for a challenging but very interesting patient population that is managed through the ED.

Mental health patients (8% of PAH ED’s presentations) are catered for by a dedicated ED Mental Health Service which operates 24/7.

PAH ED has its own 8 bed Short Stay Ward for ED patients and access to Hospital in the Home and Nursing Home programs.

PAH EMERGENCY MEDICINE TRAINING PROGRAM

The PAH ED offers a high quality, comprehensive training program for emergency medicine trainees. It includes specific programs to suit the needs of trainees at all stages of their training.

An overview of the training requirements for fellowship with the college, and how these requirements can be met within the PAH ED training program, is as follows:

  • Basic Training – 2 years – usually but not necessarily, the intern and second postgraduate years.
  • Obviously this can be undertaken anywhere; if you are at PAH for the first 2 post graduate years, we would advise that in PGY 2 you seek to undertake some rotations from the following selection: anaesthetics, cardiology, ENT, orthopaedics, renal medicine, ophthalmology, plastic surgery.
  • Provisional Training – 12 months (minimum):
  • 6 months training in a single approved ED
  • 6 months other approved training (this may be ED or non-ED)
  • PAH ED, through the Training SHO positions, provides an ideal 12-month program for provisional training, ideally suited to PGY 3 or 4 trainees.
  • Completion of the Primary Exam (this may be completed at any time during basic or provisional training)
  • PAH ED provides a Primary Exam Preparation Program prior to each exam. It is expected that provisional trainees undertaking the Training SHO role will complete all their provisional training requirements, including the primary exam, within this year.
  • Extended training time requirements (if required) – whilst completing primary exam requirements beyond the initial 12 months of provisional training.
  • Depending on the needs and skill set of the trainee, additional provisional training time may be undertaken within a registrar position in PAH ED or more commonly it will be arranged to occur in one of the non-tertiary ED’s in SEQ.
  • Advanced Training – 48 months:
  • 30 months training in approved ED posts (minimum of 6mths in a tertiary and 6mth in a non-tertiary ED)
  • PAH ED is accredited for 24 months of advanced emergency medicine training (being a major referral ED this satisfies the ‘minimum 6 month tertiary ED’ requirement).
  • Non-tertiary ED time requirements (minimum 6 months) are generally provided by rotations to nearby Mater Adults, Logan, Redlands, Greenslopes, QEII or Ipswich ED (however PAH ED has links to all accredited EDs in QLD and a non-tertiary rotation can generally be arranged to wherever the trainee wishes). As PAH ED does not receive paediatric or obstetric presentations these rotations offer the opportunity to see these patient populations.
  • 18 months training in approved non-ED posts.
  • Non-ED rotations currently available to trainees at PAH include: PAH ICU (either at a junior or senior registrar level); PAH Psychiatry; PAH Internal Medicine; Anaesthetics (QEII)and Retrieval Medicine with Careflight Medical Services. Many other rotations are available via the DEMT on negotiation with the unit in question.
  • Minimum paediatric requirement – accredited via a logbook system or completion of 6 months in a JTC accredited paediatric ED.
  • Most trainees will satisfy the minimum paediatric requirement via a 6 month rotation from PAH ED to the Mater Children’s ED (accredited by JTC for 12 months training).
  • Otherwise Paediatric Logbook requirements can generally be completed during non-tertiary ED rotations.
  • Research requirement – to be eligible to sit the Fellowship Exam trainees must have completed their Trainee Research Project (TRP):
  • We strongly recommend that trainees within our program satisfy their research requirement by undertaking the necessary TRC approved university subjects.
  • The UQ - PAH ED Research Unit will help instigate, oversee and support trainees that wish to undertake a research project – preferably after they have completed their university subjects.
  • Fellowship Exam – may be undertaken after completing 36 months of advanced training and completion of the Trainee Research Project:
  • A highly regarded Fellowship Exam Preparation Program is run from PAH ED prior to each exam. This program is often accessed by trainees from all over SEQ.

PAH ED Trainees:

The PAH ED currently has positions for:

  • 17.5 FTE Registrars. The registrar positions within the ED are generally reserved for advanced training registrars.
  • 10.0 FTE Training SHOs. These positions are generally reserved for those commencing their training (i.e. provisional trainees).

Trainees are placed into Trainee Groups for the purposes of mentoring and allowing for small group teaching amongst similarly experienced trainees. The Trainee Group Structure template (including the coordinators and mentors) can be seen below.

Directors of Emergency Medicine Training:

James Collier and Darren Powrie are the Co-DEMTs. They are responsible for ensuring the provision of a training program commensurate with the accreditation status of the ED. The DEMT takes responsibility for all training issues within the ED and coordinates the delivery of trainee education programs and in-training assessment.

Jonathon Isoardi is the department’s ‘Education Supervisor’ and has oversight of all education programs running within the department, from medical students to consultant CME. In particular, he is heavily involved with delivery of education to the trainee group.