Administration Flashcards

Question

define ed overcrowding. Name two causes from Input Throughout Output

Answer 1

ED function is impeded because number of patients waiting to be seen or assessed exceeds physcial bed space or capacity of the department: **Input** - complex presentations, increse in elderly, high volume of low acuity, no access to primary care **Throughput** - nursing or medical staff shortage, access to results **Output **- access block, ward staff shortage

Answer 2

Patient - poor outcomes, increased morbidity and mortality, more error, DAMA, increased chance of readmission Staff - stress, violence, ignoring protocols

Answer 3

Input- choice of ED, GP OOH, extend GP hours Throughput - FT, nurse initiated treatment of protocols, RAT doctors, increase staff, increase beds Output - ED admit rights, ED patients prioritised by teams, active bed management, nationwide targets

Answer 4

* Introduce yourself * verbally de-escalate and go somewhere quiet * acknowledge and reassure * dont blame * help facilitate management

Answer 5

*Formally acknowledge the complaint/ incident in writing with an expected time * frame for how long the review process will take * Inform patient liaison/ complaints and the quality department * Review the medical notes/ documentation * Interview the staff involved and support them * Review the department’s results checking processes / any departmental * guidelines or policies relating to the presentation * -Formalise your findings and any recommendations in written format and write * any actions arising from this (eg review a change in policy etc) * Present your findings in department M&M * Provide education to department/ the staff involved (individual education or as a department, eg formal teaching sessions) * Feedback your findings to patient / patient’s family, with an apology, if appropriate

Answer 6

manage ED patients who would benefit from extended stay but likely home within 24 hours

Answer 7

* Patients who should be admitted to in-patient wards - complex medical or surgical problems * Multiple problems * Elderly patient * Paediatric patients * Patients without clear management plan / diagnosis * Patients with intensive nursing requirements * Risk to staff patients - psychotic, violent, forensic history

Answer 8

Primary - Aims to prevent disease before it occurs Secondary - reduce the impact of disease once it has occured

Answer 9

C – have you ever felt you should CUT down on your drinking? A – have people ANNOYED you by criticising your drinking? G – have you ever felt bad or GUILTY about your drinking? E – have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover

Answer 10

Physical * unexplained injuries * injuries of various ages * injuries on hidden body parts * bite marks * injuries not fitting story Behavioural * Repeat presentations * partner talks over * looks ashamed * anxious

Answer 11

health staff threatened perp has weapon serious injury immediate risk

Answer 12

DV Alcohol use outbreak surveillence eg measles elder or child abuse screening for smoking preventative meds eg hiv/morning after pill

Answer 13

Call 000 dont enter scene initiate methane get walking patients together

Answer 14

**Initial** * ensure patient safety * ensure department is safe * have private convo * take secure notes * hot debrief * aim to talk in more detail later **Stakeholders** * other students * patients involved * ED mentor * University management * ED director **Definitive** * acknowledge seriousness and ensure safety * inform the university * inform ED mentor/HOD * Gather information from others and approach person in question * management plan for registrar * bullying education for department

Answer 15

**Patient** * Unusual presentation **Staff** * Lack of knowledge * lack of supervision * lack of experience **Process** * Understaffed * busy shift * not following protocols

Answer 16

staff fatigue exhausted stock communication failures overloaded radiology/pathology tracking patients

Answer 17

expedite admissions move patients to short stay move or discharge low acuity patients inpatient team early

Answer 18

invite interest from stakeholders gather information from ACEM guidelines, hospital policy about said committee establish committee establish lines of communication establish roles establish frequency of meetings

Answer 19

* deaths withing 24 hours admission/48 hours discharge * represents within 24/48 hrs * unplanned ICU admssions * complaints from patients/Gps/speciality teams * missed radiology or pathology

Answer 20

Unreasonable behaviour that creates a risk to health and safety. Has to be repeated over time or occurs as a part of a pattern of behaviour.

Answer 21

* Notify ambulance services to consider load-sharing * Notify ED/hospital executive to activate hospital wide processes such as Code Yellow/ Disaster Plan * Assign staff to review ramped patients and ensure deterioriating/critically ill are identified * Clear ED treatment space by admitting suitable patients directly to ward, moving suitable patients to * Short Stay or alternate space ie waiting room for ambulant patients awaiting test * Ensure adequate staffing – call in on-call staff if staffing deficiency * Early rounding in ED to ensure early decision making

Answer 22

appropriate translator early use of liason officers frequently touch base with patients ensure medical and non medical needs are met discuss with family members closed loop comunication

Answer 23

* Ensure a cultural history is taken from all patients/families * Ensure availability of cultural/religious consultants * Professional interpreter services are available at all times for languages in the ED * Create strong links with healthcare providers of local minority populations * Consumer feedback mechanisms allow culturally diverse input * Cultural training workshops/education sessions

Answer 24

local guidelines guidelines frm other hospials clincal nationwide eg etg/NICE journals consultant opinions

Answer 25

* Timely reporting of radiology * Notifications of medical staff of abnormal radiology reports * Follow-up up of all pending results by GP after patient discharge * Follow-up process for radiology reports arriving after patient discharge * Copies of all radiology reports automatically forwarded to GP * Audit of results review processes to ensure they are functioning effectively

Answer 26

inform patient inform doctor hopsital guideline review eg MM

Answer 27

impact on life eg physical loss of confidentiality

Answer 28

* ED Overcrowding * Patient dissatisfaction & complaints * Increase in DNW patients * Violence and aggression against staff * Delays to critical treatments (eg time to antibiotics in sepsis) * Increase risk of adverse outcomes and higher mortality

Answer 29

Quality assurance - a system to establish quality of care and assessing how these are met Clinical indicators - measure of clinical outcomes that can point to problems and allow data to be compared Benchmarking - comparing performance wth others to allow improvement

Answer 30

Plan – review relevant literature and data with relevant stakeholders and formulate plan. Do – implement plan through staff engagement Study – evaluate plan after a pre-defined period of time Act – Adjust plan accordingly as per initial evaluation. And repeat

Answer 31

practicing under the influence sexual misconduct placing public at risk of harm becuase of impairment placing public a risk of harm because of a departure from professional standards

Answer 32

admitted patient who remains in the emergency department for > 8 hours because of a delay in accessing an inpatient bed overcrowding is where ED function is impaired due to number needing to be seen outweighs physical space. access block leads to overcrowding

Answer 33

unknown person violent or unnatural death eg homicide or snakebite death in care death in custody death during police operation suspicious death scene and personal item preservaion -

Answer 34

* Pronounce the death in the medical record * Complete cause of Death certificate * Consider whether a hospital autopsy is desirable * Notify the family of the death * Complete discharge summary * Notify the GP * Begin the death review process * Consider tissue donation

Answer 35

error is inevitable harm is not an inevitable consequence find out what is wrong not who the person who made the error is least likely to do it again communication is key

Answer 36

the study of how people interact with complex symptoms how those interactions lead to errors and mistakes

Answer 37

clear ED documentaion regarding decision medications charted patient understanding of plan basic investigations intiated plan for when to escalate care