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1. Fellowship - Written SAQ > Administration > Flashcards

Administration Flashcards

1
Q

Name some goals of a frequent flyer management plan

A

not to miss serious illness
help patient in long term
improve patient care
minimise ED stay
reduce disruption to staff
improve engagement with community services

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2
Q

Who are the stakeholders in an ED mangement plan?

A

Patient
GP
ED medical staff
ED nursing staff
relevant specialty department
ED management team

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3
Q

What is the acronym for ascertaining whether someone has capacity?

A

Communicate - can patient choice and communicate a choice
Understand - does patient understand the risks and benefits
Reason -Can person make a rational decision
Value - is the choice consistent with the patients values
Emergency - is there impending risk to patient
Surrogate - are there surrogates or allies available

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4
Q

what is the generally accepted anount of DNW patient?

A

less than 5%

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5
Q

which two groups are over represented in DNW stats?

A

Children
MH patients

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6
Q

name 4 reasons and solutions for high DNW numbers

A

WR not suitable to wait - water/food/blankets/nurse
long wait to FT/paeds - FT/paeds stream
Inadequate stafing - hire more
Poor access due to bed block - hospital wide approach - early discharge/senior review

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6
Q

What are the ATS times and how quick should they be seen?

A

ATS 1 immediate 100% of patients
* ATS 2 10min 80% of patients
* ATS 3 30min 75% of patients
* ATS 4 60min 70% of patients
* ATS 5 120min 70% of patients

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7
Q

What is ETP?

A

Emergency treatment performance:
81% of patients should be seen and discharged with 4 hours. this can include discharge/admission/transfer and all patients are included

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8
Q

What is transfer of care? What is the targer?

A

time from abulance handover to WR or bed. Need 100% within 30 minutes
have to report if over one hour

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9
Q

List some general steps for developing a guideline

A

Identify the Need - Is it a priority? Review the status quo
* Complete a Project Initiation Proposal
* Establish a Steering Committee & Project Team
* Define the problem
* Review of evidence
* Understand the current state
* Draft the guideline
* Seek endorsement from appropriate stakeholders
* Develop Implementation Plan
* Implementation
* Ongoing monitoring
* Review and evaluatio

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10
Q

List diagnostic tools to identify how care is provided

A

Root Cause Analysis (RCA) reports
* Process mapping
* Patient journey mapping
* Patient/carer/staff interviews
* Staff/patient “tagalongs”
* Process observation
* Reviewing patient survey results
* Wait list analysis
* Variation analysis
* Data analysis – outcome indicators
* Adverse events – Incident & Injury Management System (IIMS)

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11
Q

At a major disaster list four areas that need to be set up to coordinate medical response

A

Command post
Casualty collection area
Patient treatment post
Ambulance loading point

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12
Q

Outline four main differences between disaster triage and ED triage

A

Disaster
1. Greatest good to greatest number
2. dynamic - repeat at multiple timeframes
3. done by disaster trained personnel of ambulance
4. sorted to immediate, delayed or unsalvageable

ED
1Individualised
2. Single point in time
3. performed by senior nurses
4. ATS basd on urgency

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13
Q

List the actions that been to be carried out before arrival of patients from disaster

A

Activate hospital disaster code/policy
decant existing patients eg home, ward
prepare designated areas for patients
allocation of roles per plan
recruit extra staff eg from home
notify key hospital areas eg radiology, pathology
prepare resources eg labels, equipment

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14
Q

What is the acronym for disaster handover?

A

METHANE
M - has a major incident been declared
E - Exact location
T - Type of incident
H - hazards present or suspected
A - Access - routes that are safe
N - Number type and severity of casualties
E - emergency services present and those needed

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15
Q

What is carried out in the hot, warm and cold zones of disaster management?

A

Hot - Actual disaster area for specialised and authorised crews only
Warm - Are immediatly outside hot zone, decontamination, triage, safe area for personnel
Cold - free of contamination, transport collection areas, assembly point for non injured/ambulatory

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16
Q

What are the advantages of sieve over sort triage

A

simple
quick
non specilaised personnel
no equipment needed

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17
Q

H

How is a ‘sort’ triage carried out

A

based on physical parameters
score assigned for each with a maximum of 12
assigned red orange or green based on score

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18
Q

What groups need to be liaised with during hospital emergency

A
  • Your Staff – nursing and medical
  • Medical Superintendent
  • Director of Nursing
  • ED Director / NUM
  • Retrieval Service alert
  • Supporting Base Hospital ED
  • Operating Theatres
  • Blood Bank/Pathology
  • Surgeon on call
  • Anaesthetist on call
  • ICU senior doctor/nurse
  • Hospital Bed Manager
  • Medical Staff Admin – JMO/ senior medical staff
  • Radiology Dept / Radiologist on call
  • Social Work
  • Police for crowd control
  • Senior Pathology doctor
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19
Q

What are the processes for stepping down a disaster?

A
  • clarify its its total or partial and if partial which parts to close
  • re-institute normal ED procedures
  • Diffuse - informal debrief with staff to anaylse response
  • Operational debrief - within a week seek further feedback to present to HoDs
  • Modify future plans based on feedback
  • councilling of staff affected by the event
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20
Q

What are the red, yellow and green traige categories

A
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21
Q

What are the components of a pre-brief in sim?

A
  1. inform its formative rather than summative and to identify overall areas for improvement
  2. orientation to the environement - mannequins etc
  3. expectations - not designed to trip up - to be based on their usual experience
  4. confidentiality - stays in sim
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22
Q

Outline components of sim de-brief

A
  1. Reactions - address feelings and emotions
  2. Identify components performed well and that were challenging
  3. Analysis - understanding of decisions made, address knowledge and communication
  4. Take home messages and summary
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23
Q

Identify some barriers to a succesful sim and how to mitigate these

A

reluctance of participation - encourage from consultants, set dates and goals
department too busy - organise in low fidelity times, agree on threshold for cancelling
disturbance of patients nearby - inform patients and relatives
Space in clinical area - have separate area
lack of equipment or funding - keep old stock and reuse thins

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24
Q

define ed overcrowding.
Name two causes from
Input
Throughout
Output

A

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

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25
Q

name some patient and staff effects of overcrowing

A

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

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26
Q

RE: overcrowding
Name two solutions for
Input
Throughput
Output

A

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

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27
Q

What are the steps of managing anger/complaints at triage

A
  • Introduce yourself
  • verbally de-escalate and go somewhere quiet
  • acknowledge and reassure
  • dont blame
  • help facilitate management
28
Q

What are the steps in dealing with formal complaints?

A
    • 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
29
Q

What are the main features of a new policy document?

A

Statement of intent – why/ what
- Purpose – for whom/ rationale
- Scope – who or what is affected
- Expected outcomes
- Related policies/ references
- Outline the expected procedure or recommendation – clearly list the steps
involved
- What documentation is expected for this procedure
- Any associated education/ training
- Who authorises/ approves this policy

30
Q

What is the role of a short stay unit?

A

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

31
Q

what are relavent exclusion criteria for short stay unit

A
  • 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
32
Q

Define primary and secondary prevention

A

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

33
Q

What is the CAGE criteria for asessing alcohol use?

A

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

34
Q

Name some physical and behavioural features of DV

A

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

35
Q

When should DV be reported to police against persons wishes?

A

health staff threatened
perp has weapon
serious injury
immediate risk

36
Q

List some public health interventions carried out in ED

A

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

37
Q

If you arrive at diaster scene what should you do?

A

Call 000
dont enter scene
initiate methane
get walking patients together

38
Q

What is the immediate response to someone claiming bullying to you during presenting a history?
Who are the stakeholders in this discussion?
What are further definitve actions

A

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

39
Q

Lift some reasons for a complaint

A

Patient
* Unusual presentation

Staff
* Lack of knowledge
* lack of supervision
* lack of eperience

Process
* Understaffed
* busy shift
* not following protocols

39
Q

what problems may you encounter when dealing with mass casualty event

A

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

40
Q

gg

What may you do to accomodate inbound patient in full department?

A

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

41
Q

what are the steps in establishing a committee

A

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

42
Q

how may you establish M+M data from an ED

A

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
audits of KPI times

43
Q

define bullying

A

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.

44
Q

list some causes for ambulance ramping

A

Demand ie Surge (ie major event)/ Pandemic
Lack of primary health care availability (ie public holidays/ long weekend)
Other health services on ‘bypass’ or redirect (due to internal disaster)
Lack of senior staff
Delayed decision-making
Delay to inpatient review
Absolute staff deficiency/sick leave/ rostering etc
Delayed turn around of investigations/reporting (pathology/ radiology)
Lack of alternate treatment spaces (ie SSW at capacity, lack of ambulatory care space)
ED treatment areas full of admitted patients
Hospital occupancy over census
Delays to discharge of inpatients
Poor discharge planning
Lack of alternate services ie Hospital In The Home, early outpatient clinic

45
Q

What steps can help fix ambulance ramping

A
  • 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
  • results/prescriptions
  • Ensure adequate staffing – call in on-call staff if staffing deficiency
  • Early rounding in ED to ensure early decision making
46
Q

What are the steps of the complaint process?

A

Investigation
* Look at documentation and consent
* chat to staff involved
* root cause analysis

Staff Councilling
* acknowledge feeling of guilt
* council RE errors
* ?identify defence organisation

Teaching and training
* Staff teaching
* consent teaching
* Simulation

Q+A
M+M
Protocol updates

Involve complaints department and inform patient

47
Q

How can you minimise cultural problems in consultations

A

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

48
Q

What are some department things you can do to ensure cultural competecy?

A

Ensure a cultural history is taken from all patients/families
 Policy development considers the diverse health beliefs of the population
 Develop prompts so that management plans account for cultural obligations
 Ensure availability of cultural/religious consultants
 Professional interpreter services are available at all times for languages in the ED
catchment
 Create strong links with healthcare providers of local minority populations
 Consumer feedback mechanisms allow culturally diverse input
 There is a system for non-judgmental reflection of cultural issues
 Cultural training workshops/education sessions
 Design of department with cultural sensitivity in mind
o Some examples: outdoor space, segregated gynae rooms, meeting space

49
Q

What are some exclusion criteria for SSU

A

Unstable haemodynamic status
Need for ongoing cardiac monitoring
GCS < 14
LOS likely to exceed 24 hours
Patients requiring intensive 1:1 nursing
Care better managed by inpatient unit (eg complex medical or surgical patients)
Patients without clear diagnosis or treatment plan
Patients posing risk to staff (eg psychotic, violent, forensic history)
Elderly patients who are unable to mobilise

50
Q

What sources can you use for clinical aspect of a guideline

A

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

50
Q

What are the components of an ED guideline

A

a. Title and Setting
b. Background
c. Aims
d. Inclusion criteria
e. Exclusion Criteria
f. Guideline – flow with supporting data/references
g. References
h. Date for audit/review
i. Sign off

51
Q

What are some strategies to limit missed radiology errors

A
  • 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
52
Q

What are initial steps in dealing with a missed investigation

A

inform patient
inform doctor
hopsital guideline review eg MM

53
Q

What are some medico legal implications of missed investigations?

A

open disclosure of seriousness of missed injury and impact on life
implications on other people and patient confidentiality

54
Q

what are some high risk DNW patients

A

children
intoxicated
MH
GP referrals

55
Q

W

what are some effects of long wait times

A
  • 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
56
Q

define the following:
Quality assurance
Clinical indicators
Benchmarking

A

Quality assurance - a system to establish qualit 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

57
Q

list some qualiy measures

A

wating times for ATS
DNW numbers
missed fracture numbers
miss pathology numbers
time to analgesia
patient feedback

58
Q

What are the 4 steps of the quality assurance cycle

A

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

59
Q

what things need mandatory reporting

A

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

60
Q

define access block
how is this different to overcrowding

A

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

61
Q

what are some effects of ED overcrowding

A

1 Increased adverse events
2. Increased violent behavior
3. Increased errors
4. Delayed time to critical care
5. Increased morbidity
6. Excess deaths

62
Q

What things need to be identified to coroner

State one important consideration that is required after notifiable death is reported to the
coroner or the police

A

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 -

63
Q

List five actions required by a medical officer in the event of a non-notifiable death in the
department

A
  • 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
64
Q

list the principles of harm minimisation

A

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

65
Q

what is the study of human factors

A

the study of how people interact with complex symptoms

how those interactions lead to errors and mistakes

66
Q

What are some criteria that could be implented to allow transfer to ward prior to being seen

A

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

1. Fellowship - Written SAQ (20 decks)

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