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FACEM Written > Administration > Flashcards

Administration Flashcards

1
Q

ED Overcrowding Factors

A
  1. Increased Demands
    a. Demand in Surge i.e major event/pandemic
    b. Other hospitals on bypass
  2. Staffing
    a. Junior staff
    b. Lack of senior decision making staff
    c. Absolute staff deficiency - sick calls/rostering etc.
  3. Department
    a. ED treatment areas full of admitted patients
    b. Lack of other treatment spaces
    c. Delayed turn around of invetigations - pathology, radiology reporting
  4. Hospital Wide
    a. Hospital occupancy over census
    b. Delays to discharge of inpatients
    c. Poor discharge planning
  5. Allied health
    a. No primary care available - weekend or PH
    b. No allied health staff to help w/ D/C planning
    6.
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2
Q

ED overcrowding Mx

A
  1. Increasing demands
    a. Notify ED / Hospital executive to activate Internal Disaster Plan
    b. Notify ambulances to consider load-sharing
  2. Staff
    a. Call in on-call staff
  3. Department
    a.Clear ED treatment spaces by D/C, moving patients to wards or SSU
    b. Assign staff to review ramped patients and identify those who are deteriorating or need resus
    c. Early rounding to ensure senior decision making
  4. Hospital
    a. Move inpatients to d/c lounge
  5. Allied Health
    a. Increase allied health to help with D/C planning in ED
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3
Q

Adverse events / Near Misses

A

Immediate Priorities:
Patient - close monitoring
Staff - Support staff
Debrief - HOT and then distant time to review
Document / IMS

General
1. Ensure appropriate timing/environment
2. Review case/notes
3. Establish indication for course of managment chosen
4. Discuss correct course of Mx and options
5. Discuss other possible options
6. Review of guidelines / learning resources
7. Presentation at M+M

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4
Q

Impaired health practitioner

A

Areas of Concern
1. Health
2. Conduct
3. Performance

Mandatory Reporting
1. Practice whilst intoxicated
2. Sexual misconduct within work environment
3. Placing public at risk due to impairment
4. Placing public at risk by departing from porfessional standards

Grounds for notification
Action only taken if certain legal requirements met

  1. Provision of unsafe care - standard of professional conduct was too low
  2. Lack of reasonable knowledge, skill or judgement or exercise of enough care
  3. Not a suitable person to hold registration
  4. May be ill and pose a risk to the public
  5. Broken the National Law
  6. Breached condition on registration or obtained improperly
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5
Q

Competency vs Capacity

A

Competence = legal term = abilty to understand and apply knowledge to decision making process

Capacity = clinical term regarding person’s ability to make informed decision regarding certain treatment

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6
Q

Prinicples for Guideline Development

A
  1. Focus on outcomes
  2. Based on best avilable evidence
  3. MDT development
  4. Flexible and adaptable to local conditions
  5. Consider resources
  6. Developed for dissemination and implementation with target audience
  7. Implementation and impact of guideline should be evaluated
  8. Update regularly
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7
Q

Performance Mx

A
  1. Arrange meeting mutually convenient time /quiet space
  2. Describe area of underperformance
  3. Required outcomes and areas for improvment
  4. Strategies to improve performance
  5. Support leadership can provide
  6. Responsibilities of all parties involved
  7. Consequences if the performance objectives are not met
  8. Times for review
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8
Q

Breaking Bad News

A
  • Quiet space
  • Remove phones/minimise interruptions
  • Introduce self + SW
  • Ask who is present
  • Gain iunderstanding so far
  • Warning shot and break the bad news
  • Time / space for reactions
  • Tissues
  • Explain what happens next
  • Answer any questions
  • SW support
  • Food and drink
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9
Q

Coroner’s Referrals

A
  1. Violent or unnatural
  2. Sudden and cause uknown
  3. ID not known
  4. In custody
  5. During police operation
  6. Accident / injury related death
  7. Child w/ DCJ report in last 3 yrs
  8. Vulnerable pt - disability services / group home
  9. Anaesthesia < 24hrs
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10
Q

Court Appearances

A
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11
Q

Cultural competence

A

Cultural competency is a set of attitudes, skills and knowledge that allow an individual to interact effectively in cross-cultural situations

Incorporate into Practice
1. Rx the patient with their specific cultural context in mind
2. Ensure patient feels safe
3. Approaching those of other ethnicities with a mixture of empathy, respect, self-reflection and curiosity, ensuring that the patient does not feel judged based on their cultural background
4. Being aware of how our own culture impacts on our health practice
5. Knowledge of different ethnicities and their health statuses
6. Knowledge of different cultures and their beliefs and experiences around health
7. Continuing to improve your skills in these areas

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12
Q

Short Stay Unit

A

Advantages
1. Reduced LOS
a. More frequent pt review
b. simple admissions
c. concentration of services
2. Societal
a. avoids overnight D/C
3. Medical
a. Observation period
b. Further Ix
c. Consult with IP teams to organise FU on D/C
4. Operational
a. Spare temp capacity for main ED
4. Safety net
a. Prevents unsafe D/C when no team willing to admit

Disadvantages
1. May delay admission
2. Deferral of decision making
3. Failure to exclude serios diagnoses
a. abdominal emergencies
b. high risk tox patients
4. underestimation of pt requirements
5. Acces block if used for admitted patients

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13
Q

Critical Incident Management

A
  1. Ensure pt safety
  2. Ensure staff safe
  3. Mx complications
  4. Critical incident report
  5. Debrief - HOT and formal
  6. Educate
  7. Guidelines
  8. M+M
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14
Q

Developing Clinical Guidelines

A
  1. ID an area where performance needs improving
  2. Information gathering
    a. Benchmarks/standards
    b. Evidence
    c. Other hospitals
  3. Involve stakeholders
  4. Set objectives and timeframe
  5. Planning meetings
  6. Develop draft and circulate for comment + revise as needed
  7. Implement
  8. Post-implementation Evaluation
  9. Adjust
  10. Regular review
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15
Q

Informed Consent
Criteria

A
  1. Legally capable of giving consent (competent)
  2. Have Capacity
  3. Informed
  4. Specific to treatment proposed
  5. Voluntary
  6. Undertand risk/benefits and alternatives
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16
Q

Pts not legally able to give Consent

A
  1. Minors < 14 years
  2. Intellectual disability
  3. Mentally ill
  4. Intoxication
  5. Organic pathology leading to confusion/AMS
17
Q

SSU admission criteria

A

Inclusion
1. LOS < 24h
2. Stable
3. Concentrated allied health
4. Period of observation
5. A/w further investigations
6. Tox pt liaising with local tox service

Exclusion
1. LOS > 24hrs
2. Unstable - vitals outside flags
3. Violent / Delirious
4. No clear diagnosis
5. Complex care needs
6. Admitted IP team

18
Q

Complaints

A
  1. Acknowledge
  2. Gather information
  3. Respond
  4. Apologise
  5. Validate impact on pt
  6. Feedback to team involved
  7. Documentation
19
Q

Open disclosure

A
  1. Inform pt of adverse event
  2. Establish facts around event
  3. Reply promtly to letter of complaint
  4. Apologise
  5. Acknowledge impact on pt
  6. Provide info surrounding events
  7. Explain consequences of events
  8. Steps taken to minimse harm
  9. Advise Ix / reporting / education will occur
  10. Validate pt feelings
20
Q

M+M

A
21
Q

Violence in the ED

A
  1. ED Guideline on prevention, ID and Mx
  2. Staff training - carrying duress alarm, RF for aggression and violence, signs of escalation, ED communication, vioence prevention policy, use of sedation and restraints
  3. ED Design - Entrance to ED surveillance, WR prevent unauthorised access to ED, triafe area identified easily, seclusion room away from high traffic, appropriate lighting, noise
  4. Early ID - risk alrts, risk screening, deescalation techniques
  5. Mx - least restrictive, assessment rooms, restraints
  6. Post-incident Mx - debrief, IIMs, escalate to executive, EAP and medical certificate if needed
22
Q

Sedation and restraints in ED

A
23
Q

Medical Education

A
24
Q

Predictors of Violence

A
  1. Violence in previous 72 hours
  2. Male gender
  3. Substance abuse
  4. Psychosis
  5. Personality disorder
  6. Childhood abuse
25
Q

Domestic Violence

A
  1. Women 1.3 x more likely injured and 1.5 x more likely to be killed c.f men
  2. Increased risk at times of separation, pregnancy / newborn
  3. Hx of abusive/ violent behaviour
  4. Hx of EtOH abuse, drugs, MH low socioecomnomics and unemployment
  5. MH / Disability
  6. Children w/ family violence approx 50%
  7. LGBT
  8. Elderly - physica limitations, diminished capacity and legal oss of control
  9. Indigenous
26
Q

Business Plan Index

A
  1. Intro
  2. Executive Summary
  3. Projected outcomes
  4. Budget - revenue and expenditure
  5. Staffing Profile
  6. Avtivity
  7. Quality and KPIs
  8. Budget estimated
  9. Special issues i.e. projects, SSU expansion, HI research
27
Q

Business Plan Dvpt

A
  1. Establish team and lead planning process
  2. Planning team consider current environment
  3. Consult with staff and stakeholders
  4. Finalise prioroties from steps 2+3
  5. Draft the plan
  6. Ciculate draft plan and circulate to obtain feedback
    7.
28
Q

Policy / Guideline

A
29
Q

ATS Scale

A

1 - Resuscitation - immediate 100%
2 - Emergency 10mins 80%
3 - Urgent 30mins 75%
4 - Semi-urgent 60 mins 70%
5 - Non-urgent 120 mins 70%

Issue with triage
Inter-observer variability
Region and institutional variability - may be funded acoording to KPIs
Minimal information available at time of triage
Lack of privacy
Lack of time
Conflict betw/ pt and staff sense of urgency
Lack of evidence to support impact on pt outcomes

FACEM Written (34 decks)

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