Daily huddle happens at 8am, 5pm and 10pm please ensure you are there to present your patients
Senior Reviews (ensure the review is documented):
Child under 1yr
Atraumatic Chest Pain >30yrs
Abdo Pain >70yrs
Return under 72 hrs (with the same condition)
Nursing Roles (unique to ED)
Nurse in Charge: They keep our department flowing, and need to know what is happening to your patients. Keep them updated with plans and referrals Or they will pester you.
Triage Nurses: They make a triage assessments, set priority and stream the patients to the most appropriate area. (they have <5min/patient). The information they document is really important – read it! But remember its a quick initial assessment and wont be perfect.
Multitalented HCA’s: They perform many roles in ED, bloods, cannulas, dressings, PoP’s and much more
Locum Doctor IT access
Locum doctors assigned a unique log in – by Flexible Workforce when booked for a shift.
If the details are not communicated prior to starting the shift, this should be escalated to Flexible Workforce in hours, and the On Call IT team out of hours.
Log in details can expire if they are not used frequently, in these instances the IT department can reactivate them.
Locum logins should never be used due to issues with Information Governance.
All patients that require transfer to another hospital with NEWS >3 are reviewed by a senior doctor (middle grade/Consultant) and the safety for transfer documented on EPR
Referrals
Surgical and Orthopaedic – speak to SHO at HRI (regardless of site)
Urology speak to the on-call SPR via switchboard
Medical referrals – NIC refers to MAU sister unless needs review in resus or for side room (speak directly to med reg)
ENT –speak to SHO at CRH (regardless of site)
Gynae at CRH speak to SHO, at HRI 9-1630 speak to gynae reg, otherwise speak to CRH SHO, for EPAU ring Gynae assessment at CRH and they will give you an appointment
Obstetrics is solely at CRH there is no delivery suite at HRI, during the day a midwife may be able to attend ED from outpatients if a delivery is imminent.
Plastics and Max Fac requires a discussion with Bradford SHO on call
Direct clinic appointments can be booked for fracture clinic, upper and lower limb MSK clinic, ENT, ophthalmology, new onset Angina Clinic and Arrhythmia clinics.
Ophthalmology – eye clinic emergency line via switch in hours or SpR out of hours based at CRH
Our Local Mix is 10ml 2% lidocaine + 10ml 0.25% chirocaine(research from our anaesthetic colleagues has shown this gives best effect of patient experience)
Use Ultrasound guided + nerve block needle (code your ultrasound on the depart docs as gets the ED an extra £50)
Document procedure on Adhoc forms> ED procedures>Femoral Nerve block
Sedation
Document sedation & procedure on Adhoc forms> ED procedures>sedation and reduction
This ensures data recorded fits RCEM standards and is easy
Need minimum of 2 middle grades – (1 for sedation 1 for the procedure) present plus nurse to sedate
Ensure full AAGBI monitoring in place
Trauma Patients
We use a Scoop to transfer patients to CT
Secure the patient to the scoop using spider straps
If imaging a head of an over 65 with a fragility fracture e.g #NOF/Colles etc then you must also image the C-Spine.
Please ensure you have a working Neurosurgical login for HRI and CRH activated – you can have both on the same login and change your site via the online helpdesk available on leedsneurosurgery.com website
Please document the trauma team assessments using the trauma form within Adhoc forms Adhoc Forms>Trauma
Non-mobile Infants with injuries that have left a mark need discussing with Paeds Consultant in terms of NAI even though the history (Mode of Injury) sounds very genuine & accidental. Please document your conversation. – GUIDE
Every child in majors must have 2 sets of PAWS before discharge from ED (home or to ward)
HRI has no Paediatric doctors but the PNP will review children in ED
All under ones must be reviewed by a senior
Abdominal pain (except ? testicular torsion) should be referred to paeds for review prior to surgeons (PNP or paeds reg)
Mental Health
Ensure the physical safety of patients: consult toxbase for overdose management. Consider removing obvious ligatures (oxygen/suction tubing, monitor wires etc) from the room.
Ligature cutters available with the ED co-ordinator on each site. – GUIDE
ADULTS:
All adult patients who self-harm should have a ReACT suicide risk assessment done on EPR.
All adult patients should be referred to the Mental Health Liaison Team for psychosocial assessment prior to discharge, even if low risk on ReACT. There is a member of the team on site 24/7.
You must consider whether mental health patients have responsibility for the care of children. If their capacity to do this is impaired, you MUST consider safeguarding actions for that child/children. This is known as the hidden child.
CHILDREN:
The CAMHS assessment and management flowchart can be found on EMBeds Link
Consider safeguarding concerns for any child who presents with mental health problems. Be particularly vigilant for Child Sexual Exploitation (CSE) in young people who present with alcohol or substance misuse. Refer children who present with alcohol or substance misuse to either The BASE (Huddersfield) or BRANCHING Out (Halifax)- how to guide on EMBeds.
If a patient requires CAMHS assessment in the department (as per flowchart on EMBeds), CAMHS can be contacted via switchboard. They will require the information from the CAMHS assessment form. They are based off-site so may take some time to respond.
For children aged 16/17 who present out of hours (after 5pm and weekends), the first point of contact is the adult mental health liaison team.
Tests
Blood gases
All abnormal blood gases should be reviewed and signed by a doctor at the time of taking them
Radiology
CT requests between 17.00 -21.00 M-F are to the radiologist on-call and must be an SPR or Cons. 21.00 – 8.00 requests are to TMC via switchboard.
Overnight @ CRH only Adult CT Heads available – anything else must be transferred to HRI (ensure CT is arranged, blue light transfer and plan is documented and handed over to HRI team)
