Pennine Acute Hospitals NHS Trust is one of the largest trusts in the country. It comprises of four clinical sites – Rochdale, Oldham, Fairfield and North Manchester.
Further information about the trust can be found on the website here, or intranet (if you are within the hospital)
Welcome to the Emergency department. We hope that you will enjoy your time here.
They see nearly more new patients a year than any other Trust, so you will see a wide range of conditions. It is essential that if you do not know what to do, ask or look it up; there are senior medical and nursing staff available 24hours a day.
It is advisable to do some reading prior to taking up your post here. A textbook such as 'Oxford Handbook of Emergency Medicine' or 'Lecture Notes in A&E Medicine’, is a good start.
Always be pleasant and caring to the patients and relatives – this is often what is remembered and not whether your diagnosis was correct. Do not leave patients in pain-offer analgesia early; it is what you would expect if you were a patient, and often enables you to do a more thorough clinical assessment. If you can leave this post without being complained about or visiting the coroners court, you can consider yourself a success!
Please ensure you are prompt and START your shift on time. There is nothing worse than having to wait for your relief to come at 08:00 when you have been working hard all night! You are to have a 30 minute food break in the middle of your shift, so please ensure you take it, even if it is busy. If it is busy, you need your break more, and tired doctors make bad decisions, are slow and are more likely to get ill. Check with the doctor in charge first. When it is not too busy, a 10 minute tea break may also be allowed, but once again, through the doctor in charge.
No food or drink are to be consumed in the clinic areas and chewing gum is not allowed. There is a health and safety risk to this, computers do not work well with Coke in the keyboard, and it just looks unprofessional to patients and their relatives who may have been waiting a while.
All walking patients book in at reception before nurse triage. Ambulance patients are initially assessed by a nurse at the ambulance bay doors after they ring the bell, and either directed to a cubicle or waiting room. If they are directed to a cubicle the ambulance crew or relative book the patient in. Patients are seen by the doctor in priority order. You MUST see patients in order of priority as given at triage. Do not ‘pick’ your patients, as seeing people out of order often leads to complaints. Also, the fact that you might be tempted to skip a patient, usually indicates that you do not feel comfortable with that particular condition and so need extra practice, or perhaps, the help of a senior. We do not approve of "Cherry Picking". If you are within the last 15 minutes of your shift, you may see a minor patient, rather than a major complex patient, BUT do this with the blessing of the Consultant in Charge.
Manchester Triage System
Red: will require immediate attention, and you should drop everything to see these patients.
Orange: need medical or nursing intervention within 10 minutes. This may mean that they are in severe pain and require analgesia. Cardiac chest pain is in this category and the ECG needs prompt assessment. Possible fractured neck of femur also gets into this category to allow swift assessment and processing ideally within 1 hour.
Yellow: are required to be seen within 60 minutes. They may be in moderate pain and need analgesia.
Green: can wait up to 120 minutes and many patients fall into this category, some of whom will have had a nurse requested X-ray.
Blue: conditions that are over a week old and have nothing acute, ie, no bleeding, no pain etc. The standard to see these is 240 minutes or 4 hours.
Remember all patients need to be seen, assessed and discharged within 4 hours now.
As soon as you pick up the card to see the patient, please write your name in the space provided on the chart and ensure you 'sign in' on the computer before going to see the patient. Do not put any patient in a cubicle without informing the Shift Coordinator. As soon as you have decided to refer (AS EARLY AS POSSIBLE) please tell the Shift Coordinator or tracker before clicking on the computer. The earlier you can refer the patient and tell the coordinator, the earlier a bed can start to be sought. If you are taking bloods/ECG etc and want to wait for results discuss it with senior about what you are waiting for and why FIRST, it may not be necessary.
If the patient needs treatment, such as IV antibiotics, ensure that you start it, as there may be a wait for the specialty doctor. If you need to cannulate, then do the necessary bloods that you or the specialty may need. If you do not need to take bloods to make a diagnosis, and do not need to cannulate then we do NOT do the bloods for the specialty (eg pre-op work-up in simple abscess, d-dimer in high risk DVT etc). We are under a much greater time pressure than the specialties and we are not their phlebotomists. Any problems with this (and there will be!) inform a consultant. You are responsible for all investigations and treatment you initiate, so if you don't agree (e.g. with a CXR being ordered) then don't order it (you're obliged by the GMC in this regard).
Try and not to forget patients awaiting blood or x-ray results. It is easy to do, but 4-hour breaches generate large amounts of paperwork and headaches.
Many of the patients you see may not be an emergency. Be polite, do a thorough assessment to ensure that something sinister is not being missed, and refer back to the GP. Many patients may need GP follow up for further non-urgent investigation. We can't always reach a diagnosis in ED. Inform the patient we will be sending a note to the GP. Often an explanation to the patient as to why you are doing this, and the reason they need the GP's involvement goes a long way to avoiding confrontation and complaints.
Recent Department of Health and consequently Pennine Acute NHS Trust guidelines state that you must be bare below the elbows. You may wear a plain wedding band only. Ideally you should wear the uniform provided with closed shoes (or Professional Crocs in dark blue or black). If you are not in uniform, then short, or rolled up sleeves, and no tie.
Finally, discuss with a senior freely, that's what they're there for. Don't take problems home, it is the patient that has the condition not you. Any problems, concerns, worries speak to the consultants, they are all approachable and are happy to try and help. We would like all our staff happy (and productive too!)
NO patient should be sent home from majors/resus without informing a registrar or above. This is not a reflection on your abilities, but the sickest of patients should not be managed without involvement of senior clinicians.