Departmental things

• Daily huddle happens at 8am 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.

ED guides

• EMbeds.co.uk
• If you want to write one let us know

Deaths

• Deaths are reported to coroner 24 hours a day via CHFT email on specific form
• EMBeds Link

Cross-site transfers

• 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 (See ENT pathways for direct access pathways – without referral)
• Gynae at CRH speak to MG
  • 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-Fax 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

Conditions

Fractured NoF’s

• Femoral Nerve block is standard – GUIDE
• Use Ultrasound guided + nerve block needle
• 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 clinicians – (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
• Link to WYTN guides

Paediatrics

• 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 on-site paediatric support
• 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 08-17:00 mon-fri through local radiologist (name through CT), OOH is TMC via switchboard.