What goes on in the ED…

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Part of the mystique of the medical art is the use of language that is uninterpretable by the average lay person. Modern medical training includes huge efforts in communication in an attempt to break down this barrier, yet there remains a bewildering array of TLAs (three letter abbreviations!) and ridiculous words. For those coming to observe in ED here’s a translation guide, however this is just regarding the staff structure. Watch out for those pesky TLAs in handovers, notes and diagnoses… feel free to ask people to explain what they mean!

We have a huge team in Christchurch ED with over 600 staff employed. Every single member of the team plays an invaluable role – this is highlighted if anyone is off sick and not replaced, you really feel the difference each person makes! Broadly speaking we have the medical team, nursing team, clerical team, aides, radiographers, allied health team (physio, social work, occupational therapist, pharmacist) and mental health liaison team. Don’t be fooled into thinking it’s all about the nurses or doctors – we need everyone to keep the place running smoothly.

During the shift you will notice staff in ‘real clothes’ in the department – these are usually in-patient teams. When we refer a patient, the registrar from the team admitting the patient will come and assess them in ED. You may see the ICU team (black scrubs with red trim) or theatre staff (navy blue scrubs) if we have major trauma patients. You can see already how confusing it can be, hence the importance of clear introductions and wearing ID badges.

Medical staff:

The whole group is broadly broken into two:

RMOs = Resident Medical Officers = junior doctors, all licensed but working under supervision

SMOs = Senior Medical Officers = Fellows and Consultants ie those doing the supervising.

RMOS: royal blue scrubs

House surgeon = usually PGY1s (PostGraduate Year 1) doctors, fully supervised with all patients reviewed by a SMO.

SHO = Senior House Surgeon, usually PGY2 and 3

Registrar = PGY3+, expected to be more competent and independent but still supervised

Trainee = a registrar accepted onto a training program, eg ACEM for emergency medicine

Advanced trainee / senior registrar = doctor approaching the end of their training program, usually preparing for fellowship exams. Still under the overall supervision of the shift consultant.

SMOs: dark blue scrubs

Fellow = someone who has passed their fellowship exams and completed their specialty training but is not yet a consultant. No longer requires supervision. A recent addition to Christchurch ED, we now have 5 fellows, one on each shift.

Consultant = a Fellow employed as a consultant or medical specialist, is ultimately responsible for every medical decision that occurs on their shift. They will lead the medical handover and run the shift alongside the ACNM (see below).

In Christchurch ED we have a mix of training and non-training doctors. Doctors on most other training programs eg surgery, medicine, will still do a rotation in ED, and most junior doctors spend at least 2 years doing rotations prior to entering a training program. Each ED shift will have a team of 6 junior doctors: two SHOs, two junior registrars, two senior registrars. They are overseen by one Fellow and 3 Consultants spread around the department. At night there is a Fellow until 2am and a Consultant on call from home.

Nursing team: green scrubs

Triage nurse = at the triage desk in the waiting room

Sorting nurse = on the sorting board in resus or workup, allocating bed spaces and nurses, ensuring patient flow, being the point of communication between medical / nursing / clerical staff. The resus sorting nurse is also triaging all the ambulance patients.

Nurses are allocated to certain areas for their shift, either resus, monitored, workup, observation, ambulatory, FAST or triage. The FAST nurse is a recent addition to ensure patient safety, doing a Focused Assessment Supporting Triage, whereby after triage the patient gets assessed by another nurse with vital signs checked, a brief exam, bloods taken, Xrays ordered… so even if they’re in the waiting room and haven’t yet been seen by a doctor, their workup is underway.

ACNM = Associate Charge Nurse Manager, dark green scrubs.

  • They are in charge of that shift from the nursing side. Oversees everything, deals with any issues, tends to be the go-to person to sort all problems! They are a group of very experienced and senior nurses. They’ll lead nursing handover and run the shift, working closely with the consultant.

 

Other staff:

Clerical officers = blue shirts

  • One in each area of the department, registering patients, keeping bedscreens up to date, inputting referrals to inpatient teams, doing ACC paperwork, ensuring correct patient details for stickers and records, helping us keep track of patients and notes. Also 3-4 each shift at reception, booking patients in.

Hospital aides = light blue scrubs

  • keep department stocked up with all the equipment (a formidable task!), assist nurses with patient care eg cleaning, bedpans, log rolls.

Radiographers = patterned blue shirts, or grey scrub tops

  • attend all our traumas, for other patients either do portable XRs in the cubicle if patient really unwell, or take patients through to the ED Xray

Friends of ED (FEDs) = white polo shirts

  • these St John volunteers do a fantastic job of looking after patients with tea and coffee, finding kids toys, magazines, sitting with patients.. a huge asset.

 

Ways to get the most out of your shift in ED

  • listen out whenever the ‘bing bong’ goes off as this is your R40 radio. Unfortunately it no longer makes a bing bong noise but is still known as that! The team gather round for the call, take the details, work out what’s needed to prepare for the arrival. This is in the resus workstation.
  • Watch ambulance handovers and see it from both sides – how could communication be better? Did they work as a team or were people all doing their own thing?
  • Follow the patient journey – triage, FAST, workup, radiography, waiting, admission… great to get an idea of what happens to patients once they arrive. Generally a lot of waiting for the next part of the journey!
  • Get stuck in on any interesting patients – you’ll head “triage 2” called out lots in resus, which means a doctor needs to see that patient now (it’s within 10mins of arrival, which is usually used up by the time the patient is registered, found a bed, undressed and hooked up to monitors!) so these are generally the sicker patients.
  • Feel free to follow anything that looks interesting – you don’t have to stay shadowing the same person for the whole shift, as much of their time will be spent doing computer work – notes, handovers, imaging requests, bed requests, ACCs.
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