Introductory information to all trainees starting at TSHED

The Sutherland Hospital Emergency Department (TSHED)

The Sutherland Hospital is located in the Sutherland Shire (‘the Shire’), approximately half an hour drive south of Sydney, in the suburb of Caringbah. The Sutherland Hospital was established in 1958 and is a major metropolitan hospital and teaching hospital. 

The Sutherland Hospital Emergency Department, TSHED, is an ACEM Accredited Training Centre for 18 months.

Mixed Adult-Paediatric Urban District ED

Annual presentations to ED: 65000

Percentage of paediatrics : 20%

Hours of Operation: 24 hours, 7 days a week

Training Outline

Term Supervisor and ITA

Co-DEMTs: Siobhann Ritson and William Siu

Will and Siobhann will be your first port of call for any training matters big or small. We will also be the head coordinators of Teaching Programme at TSHED.

We understand setting goals will lead to achievements. We plan to discuss with training goals for the term and enter them into your Learning and Development Plan within the first 2 weeks.

Mid term review will take place in weeks 5-6 to address any training matters and review progress of LDP.

Term ITA will take place in the final 2 weeks of the clinical term.

All FACEMs in the department are surveyed on a regular basis to provided feedback on trainee performance.

email:

siobhann.ritson@health.nsw.gov.au
william.siu@health.nsw.gov.au

Teaching

4 hours of protected teaching time is allocated into the weekly roster.

Wednesday: 1400-1800
ED Tutorial Room

Access to teaching via teleconferencing is available – Zoom

Trainees are encouraged to give a formal presentation or chair a teaching session at least once per term.

All attendance is recorded for ACEM requirements and remuneration purposes.

Summary of the TSHED Teaching Program:

• 3 hours of contemporary and core Emergency Medicine education – presented by facems, trainees and guest speakers
• 1 hour of examination preparation sessions: SAQ/OSCE/Primary Viva
• Monthly M&M
• Monthly Journal Club
• Weekly Simulation Training
• Paediatric Topics: 4 hours per month
• Scheduled combined meetings with Paediatrics and Critical Care
• Procedural skills workshops: Airway, Procedural Sedation, CVC
• Wellness Sessions

Team Based Care

There are 2 clinical teams working simultaneously at TSHED

• Acute
• Fast Track/Paediatrics

Clinical Shift hours:

Day Shift: 0800-1800
Evening Shift: 1400-2400
Night Shift: 2300-0900 (N1 - Senior Decision Maker)

D1-Day Acute
D2-Day FT/Paeds
E1-Evening Acute
E2-Evening FT/Paeds
N1-Night Senior Decision Maker/Acute
N2-Night FT/Paeds

Each shift will be led by a FACEM together with a Trainee, JMOs and Nurse Practitioners. Both supervision and autonomy is provided to trainees at TSHED to meet their clinical experience and stage of training.

Trainee Representatives

The Trainee Representatives for TSHED in 2021 are:

DJ Taitz

Claudia Mische

We understand and value the input of voice of the trainees in the operation of TSHED. The Trainee Representatives role include:

• Represent the Trainee Body in Departmental meetings and key decision processes
  • Monthly Departmental Meetings
  • Mortality and Morbidity Meetings
  • Relevant Sub-committee meetings
  • Mid Term Trainee/DEMT meeting
• Serve as the communication interface between Trainees and other stakeholders in the Department
  • FACEMs
  • Nursing
  • Allied Health
  • Other service providers at TSH
• Gather Trainee experiences and perspectives in the strategic planning of new major clinical services. eg. Stroke Thrombolysis, MRI Access, pandemic planning.

How to contact your Trainee Representatives:

DJ Taitz: dtaitz@gmail.com

Claudia Mische: claudia.mische@gmail.com

Whatsapp: A TSHED Trainee WhatsApp group is available for trainee access only. It serves a platform for trainee only discussions in real time. Access will be provided at the start of each term by the Trainee Representatives.

WBA

WBA Coordinator: Leanne Farrell

Leanne will allocate FACEMs for Trainees to arrange CBDs and Shift Reports.

DOPS and Mini-CEXs can be arranged ad hoc on the floor.

TSHED and its FACEMs believe that WBAs are a valuable training tool to provide Trainees with direct FACEM feedback into their performances both on the floor and in case discussion in the office.

A reminder that the minimum requirement is 1x WBA per month during each clinical term. Your training timeline will be reviewed at the beginning of each term to ensure you are on track to meet the WBA requirements at significant training milestones.

email:

leanne.farrell@health.nsw.gov.au

MASH: Mentoring at Sutherland Hospital

MASH Program Supervisor: Leanne Farrell

Wellness is a core value at TSHED. We understand that at times we may face unexpected challenges in life. When the going gets tough it often helps to share your feelings and seek the advice from someone who may have journeyed down a similar road.

At TSHED all trainees are paired with a FACEM mentor to provide support when you need it most.

It is an opt out program and participation is most encouraged.

Leadership and Management: A non-clinical perspective

Participation in Department Audits

TSHED strongly encourages trainees to be actively involved in the administrative and non-clinical matters of our department. This will provide experience and insight into the operational matters of any department and prepare trainees for future consultant portfolios.

All trainees are encouraged to participate in at least ONE department audit each clinical year.

This will contribute to the performance and assessment of the Leadership and Management domain as outlined in the Curriculum Framework in ITAs.

FACEMs have all been encouraged to invite trainees to participate in audits and provide the relevant training and supervision.

Active projects include (not an exhaustive list):

• Stroke Audit
• Triage KPIs
• Hand Hygiene
• Death Audit
• IIMS and complaints management
• Paediatrics ETP

Checking of Investigation Results

All clinical investigations ordered by Trainees are made through the FirstNet (electronic medical records) interface. This includes all biochemistry, haematology, microbiology and radiology.

To ensure a high standard of clinical care, training and feedback, trainees are required to check their clinical investigation results at the beginning of each Day and Evening shift. FACEMs will be available on the floor to consult and advise on missed results or incidental findings.

Day Shift: 0800
Evening Shift: 1400

Duration: 5-10 minutes at the beginning of each shift

Rostering

Roster Supervisor: Courtney Peros

Please liaise with Courtney for all roster matters including leave requests.

email:

courtney.peros@health.nsw.gov.au

Sick Leave

In the event of illness or other emergencies, please call the department 95407222/95407121 as soon as possible. We also request that you to speak to the consultant directly on the phone (usually at 8am) to review the roster and make the necessary arrangements for future shifts.

Please send Nicole Vass an email Nicole.vass@health.nsw.gov.au and advise her that sick leave has been taken.

When to call a FACEM on a night shift

During each and every night shift, a FACEM is rostered to be first on call for the department. The N1 Trainee/Senior Decision Maker and the NUM are encouraged to contact the on-call FACEM to seek support on all clinical and non-clinical matters during the night shit.

A Guideline for trainees to help decide on calling the on-call FACEM is available below:

FACEM On-call/Recall Guideline for Trainees

• Cardiac arrest/Death in ED
  • If unexpected or complicated (eg toxicological/environmental cause)
  • If patient clearly at end-of-life then ED Consultant on-duty can be notified the following morning
• Major Trauma
• Patient requiring intubation – if unexpected or complicated or anticipated to be difficult
• Category 1 Paediatric patient
• Paediatric intubation
• Patient requiring urgent complex/uncommon/unfamiliar procedure (eg pleural/ascitic tap, CVC) and team unable to facilitate overnight
• ED overcrowding impacting on patient safety – especially if two or more critically ill patients requiring active resuscitation and beyond the resources / skill mix of the department
• Medical staffing issue eg sickness or injury impacting on safe staffing levels or skill-mix eg down to 3 medical officers overnight or no Senior Decision Maker (Senior Registrar)
• External disaster e.g. expecting mass casualty / influx of patients
• Situations likely to generate media or ministerial interest
• Situations generating conflict with inpatient team and unable to progress patient management / disposition further
• Situation where a consultant from another specialty is required to physically attend the ED

Also consider calling for: 

• Clinical deterioration despite ED management and trainee needing advice / support
• Complication/deterioration as a result of ED procedure or management
• Senior nursing team concern
• Any other time help or advice is required – our job is to support you!