Patient–centred, high quality care must remain the focus at all times

Working up the patient

The usual step wise aproach of history, exam, investigations and plan does not apply! Multi-tasking is the key.

ED patient workup—all within 4 hours!

  • ABCs and resuscitation
  • Urgent symptom relief e.g. analgesia or splinting for pain, antiemetic for nausea
  • Commence treatment and investigations at the same time as performing a focussed history and exam
  • Involve ED senior within 30 minutes for all cases
  • Formulate a differential diagnosis or issues list
  • Get results of significant investigations, assess response to treatment
  • Complete detailed history and exam as indicated
  • Decide on a disposition for your patient: discharge or admit? transfer? HDU/ICU?
  • Learn to live with (some) uncertainty!
  • Referrals made and accepted
  • Patient ready for transfer, “between the flags” and all documentation completed
 ~ Assessment -> Management -> Disposition ~
 ~ Relies on excellent team work ~ 
 ~ Early senior input ~ 
 ~ Close attention to patient streaming and flow ~

Emergency JMO Term

  • If you’re not sure about something – ask!
    • ED seniors are happy to be approached at any time
    • We want to hear about your patients
    • Consult with your medical team leader within 30 minutes of starting to see each patient and keep us updated with their progress
  • Be on time for work
  • Identify yourself to your medical team leader on arrival
  • Develop your organisation & time management skills:
    • Plan to take your meal breaks
      • 30 minutes for day and evening shifts
    • Plan to be ready before handover times: 0800, 1700, 2300
    • Plan to get home on time
  • Learn how to take on multiple patients at once
    • Doctors need to see an average of 8 to 10 patients per day to ensure all patients get seen! Of course, this varies between Acute and Fast Track and from shift to shift.
  • Develop your communication skills
    • Learn how to “package” patients for referral – ISBAR is a helpful structure
    • Keep the ED team leader and the nurse-in-charge informed of your patient’s progress, and more importantly, keep the patient and his/her carer in the loop
    • Hone your doctor-nurse communication techniques
  • How to assess, investigate and manage a broad range of un-differentiated emergency presentations
  • Knowledge regarding the indications for, performance of and risks associated with various procedural skills performed in the Emergency Department
  • Knowledge regarding an holistic approach to patient care with emphasis not only on physical well-being but also mental and social well-being
  • How to work as part of a team
  • Appropriate referral patterns
  • Assessment and management of emergency conditions
  • Appropriate and sensible test investigation and interpretation of the results of those investigations
  • Development of management & disposition plans
  • A wide variety of practical skills
  • ‘Presenting patients’ to senior colleagues in a coherent fashion
  • How to recognise a ‘sick patient’
  • How to monitor a patient appropriately
  • How to know when to ask for help
  • How to approach a patient with abnormal vital signs
  • Chest pain
  • Fever
  • Shortness of breath
  • Altered level of consciousness
  • Abdominal pain
  • Trauma
  • Headache, weakness, seizures
  • Poisoning
  • Vaginal bleeding
  • Venepuncture
  • Intravenous cannulation
  • Arterial blood gases
  • Wound repair and Suturing
  • Plasters and splinting
  • Lumbar puncture
  • Pleural & peritoneal aspiration
  • Local anaesthesia and Nerve blocks
  • Advanced cardiac life support
  • Slit lamp examination

ED performance measures

Triage Category KPI target Time “To Be Seen”  
Category 1 100% Immediately
Category 2 80% 10 minutes
Category 3 75% 30 minutes
Category 4 70% 60 minutes  
Category 5 70% 2 hours  
81% of patients should be discharged, or admitted to a bed, within 4h of arrival in ED
80% within 30 minutes
JMOs should aim to see 8-10 patients per shift as a guide JMOS should aim to have all patients discharged or admitted to a bed within 4 hours of arrival in ED - when clinically safe to do so
  • 2 hours for ED assessment
    • 30-60 min for JMO to workup & discuss with ED Senior
    • 60 min turnaround time for bloods and imaging
  • 1 hour for referral or discharge
    • inpatient team to assess and/or accept the patient, or
    • ED senior accepts patient to Short Stay, or
    • Patient discharged home
  • 1 hour for transfer

Team Based Care

  •  Rapid assessment and turn around is supported by the team-based model of care. 
NEXT – team based care