Administration

Question 1

Components of competence assessment

Answer 1

1. Comprehend - Must be able to comprehend information
2. Retain - retain information provided
3. Process - Consider or process to make a decision
4. Communicate - Clearly communicate choice, with reason

Ask patient if they understand and to paraphrase information back to you.
Indicating they understand condition, treatment options, risks, benefits, alternative and consequences

Question 2

Situations in which a person may lack competence or capacity

Answer 2

Heavily intoxicated
Unconscious
Acute mental illness
Intellectual impairment
Dementia
Brain damage
Child <14 years

Question 3

DNW patient factors

Answer 3

Young male
Paediatric patients
Indiginous
Lower acuity/lower triage category
Social/behavioural issues
Intoxicated

Question 4

Strategies to manage DNW

Answer 4

Systems
- Whole hospital approach to alleviate access block
- Waiting room design

Processes
- Waiting room/CIN nurse
- Models of care incl. rapid assessment team, Fast Track model
- Alternate referral services incl. co-located GP clinic

Individual
- Staffing skill mix and rostering

Question 5

QI cycle components

Answer 5

Plan
- Acknowledge issue
- Understand it
- Gather information
- Consult stakeholders
Do
- Formulate response
- Disseminate for comment
- Implement it
Check
- Monitor
- Audit
Act
- Revise, review, plan
- Repeat cycle

Question 6

Guideline/Protocol design process

Answer 6

1. Acknowledge and identify need
2. Gather information
   - Current evidence
   - Benchmarking
   - Involve stakeholders
   - Consult local clinical governance
3. Formulate a draft and circulate for comment
4. Implement pilot and gather feedback
5. Implement guideline with staff education
6. Audit and update (QI cycle)

Question 7

Mandatory reporting of colleague: notifiable conduct

Answer 7

1. Practicing whilst intoxicated
2. Sexual misconduct
3. Health impairment putting public at risk of harm
4. Significant departure from accepted professional standards putting public at risk of harm

Question 8

Essential features of an M&M meeting

Answer 8

1. Onsite, preferably within ED
2. Medical and non-medical staff invited
3. Appointed chair
4. Minute-taking
5. Regular meetings e.g. monthly
6. Mandatory with record of attendance
7. Confidential
8. Non-judgmental open forum of discussion

Question 9

Equipment purchase, drug protocol or business case…

Answer 9

1. Identify need
   - Why? Who for?
   - Benefit to patient, department
   - Meets service need
2. Gather information
   - Current literature
   - Availability
   - Benchmarking
   - Cost analysis; lifetime and consumables
   - Risk management (what could go wrong and how to minimise)
3. Consult stakeholders
4. Formulate a plan
   - Indications/contraindications
   - Inclusion/exclusion crieria
   - Credentialing (procedure)
   - Storage and maintenance (equipment)
   - Administration
   - Staffing and rostering
   - Education
5. Implement change/policy/guideline
6. Review/audit (QI cycle)

Question 10

Measures for improving KPIs (ED vs Hospital)

Answer 10

ED
System
- Staffing: skill mix and disciplines
- Rostering to cover period of high demand
Processes
- Early senior review
- Nurse-initiated pathology
- Effective communication systems incl. overhead, dedicated phones for admitting officer
Individual
- Education on KPIs, ED role, when to handover care

Hospital
Systems
- Use of ancillary department resources incl. timely radiology, labs, specialty review
- Timely movement to inpatient beds
- Bed numbers and utilisation of surge capacity
- Out of hospital Step Down Units
Processes
- Timely pharmacy and allied health review
- Discharge planning
Individual
- Education on seeing patients in ED as priority

Question 11

Access block solutions (ACEM policy)

Answer 11

1. Increasing the inpatient bed capacity in hospitals or freeing beds
   - Identifying avoidable admissions
   - Over-capacity protocols to move 1 patient to each inpatient ward, spreads load
   - Improve inpatient discharge processes incl. discharge lounges
   - Availability of supported accomodation for discharged patients unable to care for themselves
2. Diverting patients with acute medical or surgical conditions to acute care units separate from mainstream inpatient services
   - SSU
   - AMU
3. Initiatives to minimise delays in assessing and processing ED patients to be admitted
4. Imposition of time targets for patients’ transit through EDs