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Question 1

What is Capacity?

Answer 1

The mental or cognitive ability to understand the nature of ones acts

Question 2

What is Competence?

Answer 2

Having sufficient capacity, ability and authority to make a decision
A measure of the patients capacity to make medical decisions (ie consent for procedures) for themeselves

5 points (MURAW mnemonic)
- Maintain and communicate choice
- Understand the relevant info
- Retain the information
- Appreciate situation/consequences
- Weigh info in rational fashion

Question 3

Legally, how does age effect competence?

Answer 3

Over the age of 18 people are presumed to be competent until proven otherwise
Under 18 this is reversed and are presumed not to be competent until proven otherwise
Grey-zone between 14-18, competence of minors can be assumed under certain circumstances in these situations

Question 4

How can you quickly assess competence at the bedside?

Answer 4

BRAN mnemonic
What are the Benefits
What are the Risks
What are the Alternatives
What happens if I elect for No treatment

Question 5

What is the order of priority for significant medical decisions in patients with impaired capacity?

Answer 5

1- Formal Advanced Care Directive
2- Appointed Guardians
3- MPOA
If the above are not available then a statutory health attorney can be appointed in the following order
4- Continuing and close spouse
5- A person who is 18yrs or more and is a non-paid carer for the patient
6- A person who is 18yrs or more and is a close friend or relation to the patient (ie Adult child)
7- lastly if none of the above are found the office of the public advocate/guardian will take over

Question 6

What are the ideal exclusion criteria for an SSU?

Answer 6

Question 7

What are the ideal inclusion criteria for an SSU?>

Answer 7

• Clinically stable
• Low to moderate RF symptoms
• Expected to be discharged within 4 to 24 hours
• Have a clear documented management plan endorsed by a senior clinician

Question 8

What KPI’s should be used to determine the quality of an SSU?

Answer 8

• Patient satisfaction scores
• > 90% of patients moved to the SSU within 4hrs
• Unplanned represensations within 48hrs
• MET calls/deteriorations in SSU

Question 9

What are the physical design features of an ideal SSU?

Answer 9

• Requires 1 bed per 4000 ED presentations per year
• Minimum size of an SSU is 8 beds as per ACEM
• Thus 40,000 presentations per annum = 10 bed SSU

Question 10

How should a new ED guideline be developed?

Answer 10

Question 11

How many 02 outlets are recommended by ACEM in resuscitation bays?

Answer 11

3

Question 12

What are the components of an ED business plan?

Answer 12

• Addresses the 5 indicators of performance (revenue, expenditure, activity, quality and efficiency)
• Considers specific quality targets and indicators
• It is a management contract between the hospital Execs and ED
• Also address additional issues such as capital expenditure, information, communication and technology and special projects

Question 13

What are the highest priorities for patients according to satisfaction surveys?

Answer 13

• Shorter waiting times
• Symptom relief
• Correct diagnosis
• A caring and concerned attitude

Question 14

What are the most avoidable areas that contribute to complaints?

Answer 14

• Doctors not introducing themself
• Delays in care
• Missed diagnoses (ie fractures)
• Doctors not explaining the reasoning for treatments and investigations

Question 15

What is the definition of Quality assurance, Quality improvement and continuous quality improvment?

Answer 15

QA: The monitoring of the system for detecting emerging problems, taking steps to address them and ensuring stability over time

QI: A formal and systematic approach to the analysis and efforts the enhance performance

CQI: A management approach that focuses on the processes that review, critique and implement positive change to achieve quality improvement in a healthcare setting

Question 16

What is benchmarking?

Answer 16

Compares performance with others with the use of best practice as a marker for improvement

Question 17

How should a new policy be implemented?

Answer 17

• Approved by all relevant stakeholders
• Educate/inform/publicise
• Devise a specific date for the implementation
• Gather and review data regarding adherence
• Audit adverse outcomes related to the new policy

Question 18

What is Credentialing?

Answer 18

A formal process to recognize and verify an individuals qualifications to enable a view of their capacity to perform safely in relation to a field or task

Question 19

What are clinical indicators?

Answer 19

• Measures of clinical outcomes of care
• Population based screens that help point out potential problems, and allow comparative data to be collected nationally and benchmarking to occur

Question 20

What is the Deming Cycle AKA the PDSA cycle for Quality Improvement?

Answer 20

Plan, Do, Study, Act (PDSA)
- A fundamental tool for the approach to quality improvement projects

Plan - review data, benchmark and plan interventions
Do - Develop guidelines, implement resources and training
Study - Review results, seek feedback
Act - Implement and evaluate, audit outcomes

Question 21

What is the definition of Root Cause Analysis?

Answer 21

A methodology used to investigate an incident in order to assist with the identification of health system failures that may not be immediately apparent.
Answers 3 questions
- What happened
- Why did it happen
- How can it be prevented from occurring again?

Question 22

What are the features of an emergency department that make it a unique environment and present design challenges?

Answer 22

Question 23

Who are the ACEM ED design guidelines intended to inform?

Answer 23

• Clinicians
• Architects
• Designers
• Government
• Health planners

Question 24

What are common pitfalls encountered by user groups in the ED design process?

Answer 24

• A lack of review of other emergency department designs in Aus/overseas
• A lack of resources
• Not considering the need to adhere to legislation (ie disability support act)

Question 25

What rostering/fatigue management strategies can improve emergency department well being?

Answer 25

• ## Accommodating shifts changes and requests

Question 26

What infrastructure changes can be done to improve emrgency department worker well being?

Answer 26

Question 27

How is a Root Cause Analysis undertaken?

Answer 27

• Identify the incident and decide to investigate
• Select people for the investigation team
• Organise and gather data
• Determine the timleine of the incident
• Identify the problems
• Identify contributing factors
• Make recommendations and develop an action plan

Question 28

When meeting with a patient/family member regarding a complaint, how should this be prepared for?

Answer 28

• Gather all the relevant facts and information
• Appropriate environment (comfy, private room)
• agreed time
• Support workers (patient advocate, social worker etc) present
• Review relevant clinical polices, guidelines and procedures

Question 29

What 3 department issues have been shown to increase adverse events for patients?

Answer 29

• Access block
• overcrowding
• Inadequate handover

Question 30

What factors are associated with with patients “did not wait” in ED?

Answer 30

Question 31

What strategies can be implemented to decrease DNW and help those who do leave?

Answer 31

• Address and improve overcrowding/access block
• Early treatment/assessment ie RAT team