TERTIARY CENTRES AND OUTPATIENT REFERRALS
In addition to a tertiary referral services in Newcastle at the JHH and Calvary Mater Hospitals, here you will find information about referrals to specialists in private practice in the Lower Hunter and Newcastle. There are also several instances where the service provider is based out of Sydney (tertiary burns, for one).
*denotes work in progress
outpatients
Lower Hunter Area
List compiled in 2019 by TMH ED Doctor
All of HNEH
LOGIN: hnehealth
PASSWORD: p1thw1ys
JHH switch 13000
calvary mater hospital
BURNS
NIGHTS IN CHARGE GUIDE
This guide will help you through trials and tribulations of a nocturnal existence at the mighty Maitland Hospital
Welcome to The Maitland Hospital (TMH) ED after hours guide.
The aim of this guide is to provide you with some tips and tricks to make things easier for your tired brain!
As well as looking after TMH ED you are also required to provide oversight to the other local rural emergency services. Overnight these rural sites are serviced by GP’s and NP’s of variable level of seniority and skill.
This guide covers care for your patients here in Maitland as well as information about the outlying sites to assist with your decision making. Some of the rural sites are GP led, others nurse led with no doctor cover. They may call for simple advice, medications, review of plans, acceptance of transfer or advice on alternative care/ assessment provision. Throughout the guide there some ideas on how you can provide best quality safe care to all patients and potentially avoid unnecessary transfers.
SETTING UP FOR SUCCESS
Familiarise yourself with the apps below before your shift starts.
ED WHITEBOARD:
Maitland Hospital Emergency Whiteboard. Useful for gaining (and ideally maintaining awareness) of the state of the department as a whole.
PATIENT FLOW WHITEBOARD:
Useful when wondering what is being transferred to department and what conversations have been ongoing
IPIMS
Patient Flow Management App - open via CITRIX application portal
Log in: TMHEMERG
password: Emergtmh1
HNE MEDICAL ON-CALL ROSTER INFORMATION*
Provides DECT and mobile phone info for on-call teams at JHH (avoids having to listen to JHH switch automated messages while on hold). This app is located in CITRIX application portal and is currently Live
PERIPHERAL SITES
TMH is a secondary referral site for several rural hospitals and 24hr services. Click the link below to learn more.
Documentation for consults and expected patients
Ideally, for all calls from peripheral sites a clinical consult note on CAP is created in the patient’s notes.
Record the patient details, advice given, treatment and disposition advice, the staff member you spoke to, the time/duration of call; even if you do not accept care of the patient!
This documentation is a legal requirement and will be referred to in the event of an adverse outcome. (Note you can have 2 CAP screens open at once to review patient results/ imaging on one and make the note in the other - open in a separate browser window)
peculiar equipment and where to find it: AND PUT IT BACK!!
Long IV Cannulas for US insertion - Two dedicated USS Trolleys in main department, silver, kept under bench of fishbowl on resus side
Medtronic and St Jude pacemaker check devices - Drawers next to SS computer in fishbowl
Nasoendoscopy- Storage room on west side of department (near ETZ)
Pan-otoscope- every bedside, eye shields only on some units
ENT head light- Drawers next to SS computer in fishbowl
Tonometer - ENT trolley (probes should also be on trolley, if not, FACEM office has spares)
Toolbox (of actual tools) - Staff specialist room in Activity Based work area on shelving
CLINICAL APPLICATIONS
When it comes to clinical applications in the HNE network, there are too many. And they are all useful and frustrating in unique ways.
citrix application portal
On the desktop of each ED computer you will find the following icon, this will open a folder with all the clinical applications you could possibly need as well as several hundred more.
Thankfully it is a reasonably simple process to right click the applications you use and add them to your Favourites.
All of the apps below are in the Citrix Web Interface folder.
IPMs Patient Management
Patient IPM “I-PIMS”
Generic Login: TMHEMERG Password: Emergtmh1
Link available in CITRIX folder
Via IPM patient’s are assigned beds, treating doctors, admitting teams, discharge or admission diagnoses. These processes are largely the domain of the Red Shirt nurse in charge. It is important for our junior doctors and trainees to be empowered to use the app for several reasons, outlined below.
This program creates a time log of triage to clinically review, and clinical review to disposition decision and referral. These data are used to audit KPIs and frequently find there is a long delay in ED from clinical review to referral to inpatient team. This is in-part a problem of delayed data entry at our end. This can be easily improved by more medical staff logging into iPMs and using it, rather than waiting for the Red Shirt to do it.
ED Whiteboard
Useful to refer back to to check on state of the department
Patient Flow Portal
Keep track of transfers
medchart
Your one stop shop for charting medications, and pulling out your hair. Useful for charting regular medications for patients who have had their medication list uploaded onto the app. Less useful for charting anything in a hurry.
If you don’t know, you’ll find out.
In a time critical situation it is reasonable to use a paper chart and later enter the medications and times into MedChart
CAP
CAP is the main Clinical App you will use. Show up to orientation and do the learning modules. This site is not the place to learn how to use CAP.
6 inhaler plans
12 inhaler plans
Hunter Clot Clinic Referrals
For patient’s with new PE/DVT, especially those with unprovoked VTE disease.
COBRRA Trial
Study Title: COmparison of Bleeding Risk between Rivaroxaban and Apixaban for the treatment of acute venous thromboembolism.
Patients excluded from trial should still be referred on the the Clot Clinic if they are being discharged home from ED with a new Acute Thrombus
DRUG AND ALCOHOL
Drug and/or alcohol dependence is a difficult thing to treat. Whether you’re a seasoned professional or a an intern on their first ED shift - drug and alcohol presentations can be very challenging.
During business hours there are D&A workers who are available to assess people who present with substance misuse/dependence and are seeking help with behaviour change. Staffing of this service is a bit haphazard at times. The mental health “Adult Pack” contains numbers for drug and alcohol services in the local area.
In Hours D+A nurse available on 0438221538
ALCOHOL WITHDRAWAL toolbox
For alcohol dependent patients admitted for withdrawal or any other reason:
Diazepam -
Be aware of high risk patients (e.g. previous delirium tremens or withdrawal seizures, frail/elderly pts)
NEED TO FRONT LOAD DIAZEPAM IF BEING ADMITTEED
10-20mg every 2 hours for 3 doses if mentation and respiratory status permits
THEN as per AWS
Alcohol level
LFTs, Coagulation profile, B12, folate and iron studies if for admission
Thiamine -
Wernicke’s encephalopathy 500mg IV and 300mg IV TDS
High risk patients 300mg IV or IM and 100mg IV TDS
All other patients 100mg IV or IM and 100mg TDS PO or IV
GENERAL MEDICINE ADMISSIONS GUIDE
consultant PHYSICIAN IS FIRST ON-CALL
HOURS AVAILABLE FOR REFERRALS 0700-2330
When phoning the physician to admit a patient, please follow the below formula for the cognitive ease of a shared mental model. The physicians have agreed to this format, however some physicians are more willing than others to take the time. Aim to be brief but thorough…
Medical Registrar/SRMO on site after hours available on 72209
After Hours JMO available on 72207
I.S.B.A.R D.I.R.E.C.T - For Admissions
I - Identify yourself, the patient, and the physician on-call
S - Situation, a brief summary “70 yo F with requiring admission for IV antibiotics…”
B - Background, PMHx, Meds, SHx
A - Assessment, a summary of examination findings and overall impression
R >>>> DIRECT
D - DESTINATION:
ICU/ACOU/Telemetry/COB/ward bed
I - INVESTIGATIONS
Discuss all abnormal investigations in ED including lactate. Clarify how and when these need to be rechecked. We can submit an eOrder for a later time or date for repeat bloods or imaging.
R - REVIEW OF PATIENT
In what time interval would the physician like inpatient review (next day, in 4 hours, on arrival to ward… etc)
E - END OF LIFE CONSIDERATIONS
Resuscitation planning, what are the patient’s wishes, what ceiling of care is appropriate, what interventions would likely be futile - completion of paperwork
C - COMMUNICATION REQUIRED
Consider handing over to medical SRMO after hours. Notify family/carer/trustee/other stakeholders
T - TREATMENT
ED treatment thus far, discuss ongoing inpatient treatment, antibiotic rationalisation etc
Patients usual medications that may or may not need modulation
Thromboprohylaxis (as per your already-completed risk assessment)
Diet (soft, thickened, diabetic etc)
The ED Doctor must document summary of admission plan on back page of AEDOC (Obs chart) as the agreement between Med and ED.TMH Inpatient Cardiology Service
24/7 service, On Site during business hours
SRMO/REG Dect -72238
RMO Dect - 72216
STEMI and complete heart block should still be discussed with JHH as first point of call.
Inpatient team available for admission and consultations for patients not requiring urgent angiographic/procedural interventions.
Referrals should be discussed with cardiologist on call
The cardiology team is not expected to review patients in ED, Admissions will be via direct admission and should be undertaken using the ISBAR DIRECT model.
GENERAL SURGERY
Hours on site ~ 0700-2200
REgistrar DECT 72227
Call switch or refer to on-call roster for mobile phone number after ~2200
Weekends: one registrar on call from Friday PM through Monday AM
Be considerate, but do call for emergencies overnight, otherwise referrals at 7am.
Specialist on call via mobile if registrar un-reachable after several tries
PAEDIATRIC SURGERY
general surgery for kids -
Depends on age/weight of patient and consultant surgeon and anaesthetist on-call on the day
DECT 72227 (as above)
Trauma -
Gen Surg at Maitland does not admit Paediatric Trauma
It is rare that Paediatric Trauma presents to TMH (apart from isolated limb injuries, managed by Ortho). The most common issue is with children with head injuries who require overnight observation based on PECARN. These patients need to be referred on to JHH
John Hunter Hospital Paediatric Surgeon on-call via JHH switch 13000
HOW TO MENTAL HEALTH
OBSTETRICS AND GYNAECOLOGY
HOURS ON SITE 24/7
DECT 72232
- overnight a single registrar is on-call for both ED, birthing suite and admitted patients
OG trainees, SRMOs or GP trainees - all generally very helpful. Overnight the registrar is often busy in birthing or in operating theatre, but will usually answer the phone regardless.
In a time critical emergency when the registrar is unavailable a consultant is second on-call (via mobile)
BLEEDING IN EARLY PREGNANCY
Management of bleeding in early pregnancy has been fine tuned in Maitland ED and multiple helpful resources are available.
These can be found on the wall on the west wall of the fishbowl in the main department. These include:
Clinical pathway for pregnant women <20/40 gestation presenting with bleeding and/or abdominal pain. A very useful form to risk stratify and manage patients with this presenting complaint.
Bleeding in pregnancy handout
RhD information leaflet
Miscarriage patient information fact sheet
EPAS patient information handout
EARLY PREGNANCY ASSESSMENT SERVICE
An outpatient clinic for problems in early pregnancy
Frequently, patients with bleeding in early pregnancy are suitable for discharge home and follow up with EPAS.
The process is simple and effective.
complete a discharge or referral letter. Refer to EPAS Referral Form below.
email it to 49223909@fax.hnehealth.nsw.gov.au (number saved on machine in photocopy room)
ORTHOPAEDICS
HOURS ON SITE ~0700-2200 (variable)
REgistrar Dect 72226
On-call via mobile (switch or hard copy on-call roster) 24/7 for life/limb threats.
For Fracture Clinic, after speaking to the orthopaedic registrar, click the button below, look for the “ED Internal Referrals” Icon and open it, then fill out the form and save with your network credentials. The referral should appear immediately in the list of referrals displayed after hitting “send request”
Frequently orthopaedic patients are instructed by the Ortho Reg to present for emergency day surgery via ED. These patients do not need to be seen by an ED Doctor unless they are unwell or are unexpected.
PALLIATIVE CARE
As well as community palliative care, there is an inpatient Palliative Care team. This is a consulting service, usually for General Medicine admissions but certainly available to all specialties.
We frequently deal with patient’s who present to ED in pain and distress. When this pain and distress is the result of end-stage terminal illness, or incurable cancer at any stage, or if an elderly patient has suffered a critical and irreversible insult to their health - you will almost always find that a call to the Palliative Care team is helpful.
You will find the number for Palliative Care physician Dr. Gareth Watts on the on-call medical staff rostering document.
There is an advanced Trainee available in hours via switch
CARE FOR THE DYING PATIENT IN ED
It is not uncommon for patients to present with their families at the end of life, even when it is an expected death. In addition, people can have rapid and critical declines en-route to or in the ED. Sometimes the most appropriate and kindest thing we can do is to offer comfort care.
No one wants to see their patient or loved one suffer in their final moments. The provision of effective palliative care for a dying patient can have a profoundly positive effect on a patient’s family, and on those caring for the patient. In contrast, denial or inaction can escalate suffering for the patient, their family members, nursing and medical staff.
Once the decision has been made to shift the focus from curative treatment to dignified and comfortable dying there are several documents needed to optimise this process in ED:
INITIATING LAST DAYS OF LIFE MANAGMENT PLAN
cOMFORT OBSERVATION AND SYMPTOM ASSESSMENT CHART
rESUSCITATION PLAN
sUBCUTANEOUS INFUSION FORM (IF APPROPRIATE
mEDCHART - PROTOCOL FOR PALLIATIVE CARE
For medical staff: Once the decision is made you will likely pick up a new patient and not return to review the dying patient or their family (except to confirm time of death). Therefore, if the RN caring for your patient has concerns about the patient’s pain, or agitation, or secretions, etc - take this concern seriously. If you don’t know how to manage the problem, talk to the FACEM or to the Palliative Care Physician on-call.
CALLS FROM RURAL SITES
If you are holding the 71262 Doctor in-charge phone you will field calls from Kurri Kurri (20km away) to Merriwa (170km away).
All peripheral sites have access to point of care pathology- VBG/ TROP/Biochem/INR. The table below provides a summary of what other services are available in these smaller places.
The health practitioners calling will vary in job title, skills and experience. CNC/RN managed sites will call overnight for simple advice or analgesia for each patient. GP led sites frequently call for patient transfer requests.
Management options for rural sites overnight:
Unstable- provide advice to stabilise, advise to contact retrieval service via JHH (number below) for transfer to appropriate site.
Unwell but stable accept transfer to TMH, assist site to establish initial treatment and urgency of ambulance transfer overnight Vs stable patient, patient transport in AM. If clear diagnosis, assessed by GP and not unstable attempt to have patient accepted by team to go to ward bed when available. E.g. not septic cholecystitis. If diagnosis unclear or need further investigations/ work up accept to TMH ED.
Stable patient with unclear diagnosis, in need of medical review, and no medical staff onsite - consider transfer to nearest GP run facility (Merriwa/ Denman may be advised to transfer to Muswellbrook for review) or accept for assessment at TMH ED.
Explore the possibility of admission at the current site if there is nothing additional that transfer to TMH will add to the patients care. e.g. Palliative care, pain management, N+V for symptomatic relief. Certain presentations will be suitable for discharge and review by the GP in the morning.
If the patient in question has an issue that cannot be managed at TMH they should not be accepted for review, rather directed to the appropriate site e.g. significant trauma, STEMI, UGIH —> JHH. The caveat to this is stroke patient’s who have been discussed with the Stroke Fellow at JHH who have requested CT imaging at TMH.
Below is the resources available at peripheral sites
Documentation for consults and expected patients
Ideally, for all calls from peripheral sites a clinical consult note on CAP is created in the patient’s notes.
>>>>To access this, click “add/edit document” then “Shared health summary”
Record the patient details, advice given, treatment and disposition advice, the staff member you spoke to, the time/duration of call; even if you do not accept care of the patient!
>>>> Ensure you click the (+) sign after adding in comments or your input will not be saved
This documentation is a legal requirement and will be referred to in the event of an adverse outcome. (Note you can have 2 CAP screens open at once to review patient results/ imaging on one and make the note in the other - open in a separate browser window - may not always work!)
HUNTER RETRIEVAL | 1800 463 777
NETS | 1300 362 500
TMH resus cameras
If retrieval are involved in the care of a patient in TMH ED they may request the cameras to be switched on.
This allows them to further guide you in the management of the patient. Familiarise yourself with how to turn on the Resus Camera when you are next on shift. Or right now.
When the red light switches on the cameras are on, you should see movement and lights come on the camera unit on the ceiling.
CARDIOLOGY JHH
STEMI or acute coronary occlusion (ACO)
ECG meeting STEMI criteria, or associated with concern for occluding MI - should be transmitted via Life Pak* to the Cardiology AT JHH for review. Primary PCI is is the goal. We have 60 mins to get the patient on the road to the JHH, any delay >60mins should prompt you to consider thrombolysis.
Cardiology advanced Trainee is contactable via 0428012776.
It is also possible to send images of previous and subsequent ECGs via SMS to this mobile number.
For STEMI, door to balloon time is ideally 90 minutes (out to 120 minutes), so our local agreement is thrombolysis at 60 minutes from arrival at ED, OR 60 minutes from when the STEMI starts if it starts while the patient is in ED.
If a delay has occurred or is anticipated, seek the advice of the cardio AT about thrombolysis
If the patient is not accepted by Cardiology AT and you are concerned contact the FACEM on call.
*Life Pak - ECG machine that automatically transmits ECG to JHH Cardiology AT at the time of recording
Acute stroke patients who meet criteria for consideration of advance imaging/ acute intervention should be discussed with the stoke team. There is a stroke cns at maitland hospital (di Woods) who will come and assist in acute stroke work up.
Available during Business hours 8am-4pm
dect 72614
24hrs a day
Stroke fellow phone 0429 184 610
or JHH switch on 13000 and ask for doctor on call for acute stroke
Especially relevant for patient’s with significant deficit, recent onset and previously functionally independent - potential for clot retrieval at JHH.
Imaging including CT, CT angio-arch-to-COW, and CT perfusion scan, can be arranged and performed onsite at Maitland.
Encourage GP’s and GP registrars who call from peripheral sites to speak to the Stroke Fellow
For patients to be admitted to TMH who may need extra cares, there is a CNS available on 72614
The below tool can be used to determine next step in investigation and management
TRAUMA
There is no trauma coverage at TMH.
Most seriously injured patient’s who are picked up by paramedics will bypass TMH completely. There are still “walk-ins” though, and then there are patients who have been under-triaged at the scene, often elderly patients with a benign sounding mechanism of injury.
However they arrive, if they are “trauma” they don’t have an inpatient team at TMH. Additionally there are no General Surgeons at TMH who are comfortable admitting trauma patients. The John Hunter Hospital is the local trauma centre.
In business hours and after hours, trauma patients should be assessed by a senior ED doctor. imaging and investigations should be arranged as required in stable patients.
For unstable patients the most senior team members on shift should be involved ASAP.
Patients who require admission should be discussed with the Trauma consultant on call at JHH who needs to accept the patient prior to transfer. The patient will go through JHH ED - please ensure their ED in-charge is aware of the patient transfer.
dial 13000 for JHH Switchboard
Sign up to feedly and have all your favorite blogs, podcasts and websites pushed to one location: one webpage, one app, one place to keep you up-to-date and relevant
TOP 10 EMCC podcasts:
Here's what we are listening to this month:
4. http://www.annemergmed.com/content/podcast
7. http://emergencymedicinecases.com/
Notable FAME (fee-paying accessible medical education)
http://www.emedhome.com/cme_emcast.cfm
TOP 10 EMCC blogs:
Here's what we are reading this month:
4. http://www.emlitofnote.com/
5. http://adelaideemergencyphysicians.com/
T
Team names and roles
s
Safety huddle allocations
i
P
P
i
N
G
Issues over the past 12 hours
Predicted issues over next 12 hours
PPE and safety
Individual wellbeing
Nominations of good things happening
Go through the TOOLBOX
Arranging Mental health outpatient follow up
1) Complete the MH Triage/ED Documentation form. These are your notes - you do not need to make duplicate notes.
2) Add any additional details in the section “action plan” or “additional notes” following relevant formulation of discharge plan
3) When referring to the community team/acute care team (ACT), email this form to hnelhd-act@health.nsw.gov.au
4) Make a brief note for the CAP discharge summary, include whether you have referred the patient to the acute care team or to the GP for GP mental health care plan.
5) If referring to the ACT mention in the CAP discharge that you have faxed your MH Triage/ED Documentation form to them
I.S.B.A.R D.I.R.E.C.T - FOR ADMISSIONS
I - Identify yourself, the patient, and the physician on-call
S - Situation, a brief summary “70 yo F with requiring admission COPD exacerbation”
B - Background, PMHx, Meds, SHx
A - Assessment, a summary of examination findings and overall impression
R >>>> DIRECT
D - DESTINATION:
ICU/ACOU/Telemetry/COB/ward bed
I - INVESTIGATIONS
Discuss all abnormal investigations in ED including lactate. Clarify how and when these need to be rechecked. We can submit an eOrder for a later time or date for repeat bloods or imaging.
R - REVIEW OF PATIENT
In what time interval would the physician like inpatient review (next day, in 4 hours, on arrival to ward… etc)?
E - END OF LIFE CONSIDERATIONS
Resuscitation planning, what are the patient’s wishes, what ceiling of care is appropriate, what interventions would likely be futile - completion of paperwork
C - COMMUNICATION REQUIRED
Consider handing over to medical SRMO after hours. Notify family/carer/trustee/other stakeholders
T - TREATMENT & Thromboprophylaxis
ED treatment thus far, discuss ongoing inpatient treatment, antibiotic rationalisation etc
Patients usual medications that may or may not need modulation
THROMBOPROPHYLAXIS (as per your already-completed risk assessment)
Diet (soft, thickened, diabetic etc)
The ED Doctor must document summary of admission plan on back page of AEDOC (Obs chart) as the agreement between Med and ED.Cardiology outpatient referral
For general cardiology, moderate risk chest pain, echocardiography and electrophysiology
Fax discharge summary with pertinent details to 4923 6425
State the name of the cardiologist you have spoken to about the case
EARLY PREGNANCY ASSESSMENT SERVICE
AN OUTPATIENT CLINIC FOR PROBLEMS IN EARLY PREGNANCY
Frequently, patients with bleeding in early pregnancy are suitable for discharge home and follow up with EPAS.
The process is simple and effective.
complete a discharge or referral letter. Please refer to EPAS Referral Form below.
email it to 49223909@fax.hnehealth.nsw.gov.au (number saved on machine in photocopy room)
NB: There is a clinical pathway for pregnant women <20/40 gestation presenting with bleeding and/or abdo pain on the wall in the fishbowl
CVA/TIA outpatient referral
For suspected stroke/TIA use “Emergency Department Stroke & TIA Clinical Pathway”
The referral for outpatient clinic for possible stroke/TIA is via the JHH Neuro clinic
Referral Fax 49213488
Flag on referral that patient is to return to The Maitland Hospital Clinic
Username: maitlandemergency
Password: MaitlandED1
Username: maitae
Password: Maitae51!
HOSPITAL IN THE HOME
When referring to HITH please ensure the GP is also involved in the patients care
Community Nursing
Outpatient Nursing service useful if patient unable to attend own GP surgery for nursing cares. Services include
Wound care
Dressing changes
Foot care
Education
To Refer, Complete “Hospital to Community Agency” referral form available at ASET desk in office area, or can be found in document/printing room in pink filing drawers (labelled)
Newcastle, port stephens, lake macquarie HITH
Rough area covered
Which patients can I refer?
Once Daily IV antibiotics
Anticoagulation/INR monitoring
Urinary retention (TOV)
Catheter Care and Education
Post-Op Drain and Wound Care
Allied health referrals-falls, mobility issues, home modifications, equipment, pressure cares
HITH Tea gardens/hawks nest
Rought area covered - Everything above the Karuah River Bridge - ask the patient
Note they have limited scope of practice- mostly general nursing/wound care, they do not do IV antibiotics and often will not do catheter care/Tov so please call prior to refferal for these - 65929536
Please complete both forms
ASET
Aged Care Services in Emergency Team
Team of Nursing and allied health staff trained to assess, advise and manage concerns about the elderly
EDAC nurse works 7 days a week can be contacted on 71278 or will be in the department (on floor or in office)
Out of hours - Place sticker in “ASET and MH referral” Folder which can be found in main department
Maitland Dental Clinic
There is a free dental clinic available to the public at TMH
Patients are only eligible if they are on a healthcare, pension or commonwealth Seniors card
Patients are able to self refer by calling 1300 651 625, Mon-Fri 830-1630
Patients will be seen on a triage basis
The clinic is located on the ground floor
The Clinic offers the following services
Emergency Care
Examinations
General treatment
Preventative treatment
Managed care and recalls
Referrals to specialist dentists.
Physiotherapy in the ED
Physiotherapists
Sophia Braithwaite & Sally Roper
Extension: 71287
The physiotherapy resource will be staffed by senior clinicians dedicated to TMH ED 7 days a week, 8:00am to 4:30pm.
The aim of this role is to provide a resource point for musculoskeletal and simple orthopaedic presentations, in addition to falls, mobility and aged care (ASET) presentations.
This position will be primarily located in fast track with an emphasis on providing primary contact physiotherapy care. Their role also services ED main room, paediatrics and ambulance bay.
What to expect from the service:
Comprehensive clinical assessment as the primary care provider
Can be referred to from an ED clinician to see a patient in a secondary capacity
To attend patient mobility and capacity assessments
Assist in the fixation of splints and limb immobilization
Provide patients an outpatient exercise and rehabilitation regime
Provide advice on return to work and return to sporting activities
Respiratory assessment and screening
Vestibular assessment
Spinal and Neurology management
OVERNIGHT/MORNING MEDICAL ADMISSIONS HANDOVER POLICY
from 11pm- 7am
at the time of admission decision, AND after consultation with ED in-charge Registrar:
Please use the hyperlink to outlook (found here). Don’t use the desktop
Create new email and attached the following address as the email recipient
9e468f24.o365groups.health.nsw.gov.au@au.teams.ms
ISBAR SUMMARY:
MRN/patient name
Write MRN and patient name here
Situation
a brief summary of the clinical case focused on the HPI and positive findings on examination
Background
any background relevant medical or social history
Assessment
a summary of the history/examination findings supporting the diagnoses and the medical decision making, inclusive of consideration why (or why not) certain high risk diagnoses have or have not been investigated.
Recommendation DIRECT
Diagnosis, investigations completed, review timeframe, end of life/Resus documentation, communication, thrombophalaxis
**All decisions to admit under medicine should be in line with the Local Procedure LHS-MAIT-70: Admission to Inpatient Units
ADMISSIONS SAFE TO GO TO THE WARD OVERNIGHT
Only patients with the following diagnostic criteria should be considered safe for admission to a ward level bed overnight.
1. Community Acquired Pneumonia
2. COPD
3. Atypical chest pain / stable NSTEMI
4. Congestive heart failure
5. CVA / Stroke / TIA
At 7am, the Day FACEM will review the Teams Channel with ED ‘in-charge’ and call the AMO to inform them of admissions, directing them to review the MS team channel for details.
This will not be a comprehensive handover conversation but rather an active handover and acceptance of admitted patient responsibility.
Where possible, the AMO can request to speak to ED JMO who has initially seen the patient should more information of the patient's overnight presentation be necessary
if AMO concerned or not accepting of a patient, they are to come to ED when they arrive at hospital to discuss the case further with the FACEM in-charge.
In line with NSW Health policy: PD2009_055 Emergency Department - Direct Admission to inpatient wards, the final decision to admit ultimately rest with the FACEM in-charge.
paeds stroke
PAEDS CRITICAL CARE AND RETRIEVAL
HUNTER RETRIEVAl 1800 463 777
NETS 1300 362 500
Hunter Retrieval Service (HRS) is the go-to service for paediatric and adult retrieval. A call to either service is perfectly fine.
NETS will likely take all the details and then patch-in the Hunter Retrieval PICU or NICU team.
JHH Virtual Kids
Who is eligible for the HNE Virtual Kids program? children aged 0-15yrs
Appropriate conditions
respiratory illness
vomiting and diarrhoea
fever
rash
reduced fluid intake
generally unwell
Children are eligible for HNE Virtual Kids if they meet the following criteria:
Parents/carers have provided consent
Parents/carers can be contacted by phone
Have a safe home environment
Are following the expected disease trajectory and are at risk of representation to the ED in the next 48 hours.
Have mild or moderate illness and do not currently require admission to hospital:
Oxygen saturations ≥ 92%
Mild to moderate work of breathing
Taking > 50% normal feeds
How to refer a child or young person to the HNE Virtual Kids program?
1. Check the patient meets the eligibility criteria above
2. Discuss referral with the family and gain consent
3. email HNELHD-JHCHPaedVirtualKids@health.nsw.gov.au
4. Provide service flyer
5. Safety net: Discuss RED FLAGS and when to return to hospital/call 000