Administration

Question 1

ED Overcrowding Factors

Answer 1

1. Increased Demands
   a. Demand in Surge i.e major event/pandemic
   b. Other hospitals on bypass
2. Staffing
   a. Junior staff
   b. Lack of senior decision making staff
   c. Absolute staff deficiency - sick calls/rostering etc.
3. Department
   a. ED treatment areas full of admitted patients
   b. Lack of other treatment spaces
   c. Delayed turn around of invetigations - pathology, radiology reporting
4. Hospital Wide
   a. Hospital occupancy over census
   b. Delays to discharge of inpatients
   c. Poor discharge planning
5. Allied health
   a. No primary care available - weekend or PH
   b. No allied health staff to help w/ D/C planning
   6.

Question 2

ED overcrowding Mx

Answer 2

1. Increasing demands
   a. Notify ED / Hospital executive to activate Internal Disaster Plan
   b. Notify ambulances to consider load-sharing
2. Staff
   a. Call in on-call staff
3. Department
   a.Clear ED treatment spaces by D/C, moving patients to wards or SSU
   b. Assign staff to review ramped patients and identify those who are deteriorating or need resus
   c. Early rounding to ensure senior decision making
4. Hospital
   a. Move inpatients to d/c lounge
5. Allied Health
   a. Increase allied health to help with D/C planning in ED

Question 3

Adverse events / Near Misses

Answer 3

Immediate Priorities:
Patient - close monitoring
Staff - Support staff
Debrief - HOT and then distant time to review
Document / IMS

General
1. Ensure appropriate timing/environment
2. Review case/notes
3. Establish indication for course of managment chosen
4. Discuss correct course of Mx and options
5. Discuss other possible options
6. Review of guidelines / learning resources
7. Presentation at M+M

Question 4

Impaired health practitioner

Answer 4

Areas of Concern
1. Health
2. Conduct
3. Performance

Mandatory Reporting
1. Practice whilst intoxicated
2. Sexual misconduct within work environment
3. Placing public at risk due to impairment
4. Placing public at risk by departing from porfessional standards

Grounds for notification
Action only taken if certain legal requirements met

1. Provision of unsafe care - standard of professional conduct was too low
2. Lack of reasonable knowledge, skill or judgement or exercise of enough care
3. Not a suitable person to hold registration
4. May be ill and pose a risk to the public
5. Broken the National Law
6. Breached condition on registration or obtained improperly

Question 5

Competency vs Capacity

Answer 5

Competence = legal term = abilty to understand and apply knowledge to decision making process

Capacity = clinical term regarding person’s ability to make informed decision regarding certain treatment

Question 6

Prinicples for Guideline Development

Answer 6

1. Focus on outcomes
2. Based on best avilable evidence
3. MDT development
4. Flexible and adaptable to local conditions
5. Consider resources
6. Developed for dissemination and implementation with target audience
7. Implementation and impact of guideline should be evaluated
8. Update regularly

Question 7

Performance Mx

Answer 7

1. Arrange meeting mutually convenient time /quiet space
2. Describe area of underperformance
3. Required outcomes and areas for improvment
4. Strategies to improve performance
5. Support leadership can provide
6. Responsibilities of all parties involved
7. Consequences if the performance objectives are not met
8. Times for review

Question 8

Breaking Bad News

Answer 8

• Quiet space
• Remove phones/minimise interruptions
• Introduce self + SW
• Ask who is present
• Gain iunderstanding so far
• Warning shot and break the bad news
• Time / space for reactions
• Tissues
• Explain what happens next
• Answer any questions
• SW support
• Food and drink

Question 9

Coroner’s Referrals

Answer 9

1. Violent or unnatural
2. Sudden and cause uknown
3. ID not known
4. In custody
5. During police operation
6. Accident / injury related death
7. Child w/ DCJ report in last 3 yrs
8. Vulnerable pt - disability services / group home
9. Anaesthesia < 24hrs

Question 10

Court Appearances

Question 11

Cultural competence

Answer 11

Cultural competency is a set of attitudes, skills and knowledge that allow an individual to interact effectively in cross-cultural situations

Incorporate into Practice
1. Rx the patient with their specific cultural context in mind
2. Ensure patient feels safe
3. Approaching those of other ethnicities with a mixture of empathy, respect, self-reflection and curiosity, ensuring that the patient does not feel judged based on their cultural background
4. Being aware of how our own culture impacts on our health practice
5. Knowledge of different ethnicities and their health statuses
6. Knowledge of different cultures and their beliefs and experiences around health
7. Continuing to improve your skills in these areas

Question 12

Short Stay Unit

Answer 12

Advantages
1. Reduced LOS
a. More frequent pt review
b. simple admissions
c. concentration of services
2. Societal
a. avoids overnight D/C
3. Medical
a. Observation period
b. Further Ix
c. Consult with IP teams to organise FU on D/C
4. Operational
a. Spare temp capacity for main ED
4. Safety net
a. Prevents unsafe D/C when no team willing to admit

Disadvantages
1. May delay admission
2. Deferral of decision making
3. Failure to exclude serios diagnoses
a. abdominal emergencies
b. high risk tox patients
4. underestimation of pt requirements
5. Acces block if used for admitted patients

Question 13

Critical Incident Management

Answer 13

1. Ensure pt safety
2. Ensure staff safe
3. Mx complications
4. Critical incident report
5. Debrief - HOT and formal
6. Educate
7. Guidelines
8. M+M

Question 14

Developing Clinical Guidelines

Answer 14

1. ID an area where performance needs improving
2. Information gathering
   a. Benchmarks/standards
   b. Evidence
   c. Other hospitals
3. Involve stakeholders
4. Set objectives and timeframe
5. Planning meetings
6. Develop draft and circulate for comment + revise as needed
7. Implement
8. Post-implementation Evaluation
9. Adjust
10. Regular review

Question 15

Informed Consent
Criteria

Answer 15

1. Legally capable of giving consent (competent)
2. Have Capacity
3. Informed
4. Specific to treatment proposed
5. Voluntary
6. Undertand risk/benefits and alternatives

Question 16

Pts not legally able to give Consent

Answer 16

1. Minors < 14 years
2. Intellectual disability
3. Mentally ill
4. Intoxication
5. Organic pathology leading to confusion/AMS

Question 17

SSU admission criteria

Answer 17

Inclusion
1. LOS < 24h
2. Stable
3. Concentrated allied health
4. Period of observation
5. A/w further investigations
6. Tox pt liaising with local tox service

Exclusion
1. LOS > 24hrs
2. Unstable - vitals outside flags
3. Violent / Delirious
4. No clear diagnosis
5. Complex care needs
6. Admitted IP team

Question 18

Complaints

Answer 18

1. Acknowledge
2. Gather information
3. Respond
4. Apologise
5. Validate impact on pt
6. Feedback to team involved
7. Documentation

Question 19

Open disclosure

Answer 19

1. Inform pt of adverse event
2. Establish facts around event
3. Reply promtly to letter of complaint
4. Apologise
5. Acknowledge impact on pt
6. Provide info surrounding events
7. Explain consequences of events
8. Steps taken to minimse harm
9. Advise Ix / reporting / education will occur
10. Validate pt feelings

Question 20

M+M

Question 21

Violence in the ED

Answer 21

1. ED Guideline on prevention, ID and Mx
2. Staff training - carrying duress alarm, RF for aggression and violence, signs of escalation, ED communication, vioence prevention policy, use of sedation and restraints
3. ED Design - Entrance to ED surveillance, WR prevent unauthorised access to ED, triafe area identified easily, seclusion room away from high traffic, appropriate lighting, noise
4. Early ID - risk alrts, risk screening, deescalation techniques
5. Mx - least restrictive, assessment rooms, restraints
6. Post-incident Mx - debrief, IIMs, escalate to executive, EAP and medical certificate if needed

Question 22

Sedation and restraints in ED

Question 23

Medical Education

Question 24

Predictors of Violence

Answer 24

1. Violence in previous 72 hours
2. Male gender
3. Substance abuse
4. Psychosis
5. Personality disorder
6. Childhood abuse

Question 25

Domestic Violence

Answer 25

1. Women 1.3 x more likely injured and 1.5 x more likely to be killed c.f men 2. Increased risk at times of separation, pregnancy / newborn 3. Hx of abusive/ violent behaviour 4. Hx of EtOH abuse, drugs, MH low socioecomnomics and unemployment 3. MH / Disability 4. Children w/ family violence approx 50% 5. LGBT 6. Elderly - physica limitations, diminished capacity and legal oss of control 7. Indigenous

Question 26

Business Plan Index

Answer 26

1. Intro 2. Executive Summary 3. Projected outcomes 4. Budget - revenue and expenditure 5. Staffing Profile 6. Avtivity 7. Quality and KPIs 8. Budget estimated 9. Special issues i.e. projects, SSU expansion, HI research

Question 27

Business Plan Dvpt

Answer 27

1. Establish team and lead planning process 2. Planning team consider current environment 3. Consult with staff and stakeholders 4. Finalise prioroties from steps 2+3 5. Draft the plan 6. Ciculate draft plan and circulate to obtain feedback 7.

Question 28

Policy / Guideline

Question 29

ATS Scale

Answer 29

1 - Resuscitation - immediate 100% 2 - Emergency 10mins 80% 3 - Urgent 30mins 75% 4 - Semi-urgent 60 mins 70% 5 - Non-urgent 120 mins 70% Issue with triage Inter-observer variability Region and institutional variability - may be funded acoording to KPIs Minimal information available at time of triage Lack of privacy Lack of time Conflict betw/ pt and staff sense of urgency Lack of evidence to support impact on pt outcomes