SCGHED Newsletter 110 - Charlie's ED

WA health uses patient addresses to establish which hospital they should get follow up with.
If a patient is not within catchment area the ereferral gets delayed and often rejected.
IT work is underway to try and fix this. WA health IT dept hopes to have this fixed before the heat death of the universe.
In the interim a post code catchment checker has been developed and will be bookmarked on scghed.com and all our departments browsers.
Medical notes will also be stamped as ‘out of catchment’ if this is identified by our clerks.
Intranet link = here
To be honest we’re rarely doing the patient a favour by doing ereferrals for them – I would suggest most patients should have the referral made by their GPs.
Plastics dressing clinic and Fracture clinic are probably the only 2 medical outpatients we should be using with any frequency

After about 10 minutes of good behaviour with COVID the mess has gradually returned to our flight deck.
Please note ALL food and drink is banned from the clinical areas of the department.
I’ve lost count of how many times I’ve found carving knives left within reach of our mental health patients.
Attached are 2 photos from this morning with mouldy coffee cups and leftover bottles.
From tomorrow I will put every item of food or drink I find on the flight deck in the bin – regardless of whether it’s a diamond encrusted water bottle or not.
Yes, this includes cupcakes. Sorry folks.

Please note Procedural sedations should be treated with respect.
We’re so good at them it’s easy to get blasé about them.
Documentation has been noted to be absent from the medical notes on several recent occasions.
Please try and develop good habits and document what you’ve done to minimise risk as registrars and consultants.
It’ll be harder to defend you a few days post procedure when the patient develops an aspiration pneumonia if you haven’t documented anything.

We’ve got some formal Psychologist led debrief sessions available over the next 6 weeks.
Individual and group sessions are available Tuesdays, Wednesdays, and Fridays.
With our ongoing Mental health access block and frequent code blacks for toxicology patients it’s easy to forget how abnormal and potentially damaging these incidents are.
Please contact Lydia Hele our Nurse manager if you want to take advantage of this.

Congrats to Steven Ching who was awarded our star of the month for August.
This is open to all staff so please consider dropping a nomination for September into the box at the shift coordinators desk on the flight deck.
Voting on all our annual awards will be opening soon so have a think about who you might like to nominate for the Dennis Woods award, Registrar, clerk, and nurse of the year…

Accidental Paracetamol OD

We missed an accidental supratherapeutic paracetamol case recently – patient presented with Abdo pain and vomiting after a febrile illness and never volunteered how much paracetamol they were taking.
Dental pain, headache, manflu and back pain seem to be associated with excess paracetamol intake.
Check out the attached paper from a former RPH Toxicologist.

We’d a complaint from a patient who couldn’t get their prescription because the Dr only gave them the top sheet from the script pad.
Please make sure you give the top 2 sheets and that only the bottom sheet is kept in the notes – see attached photo if you’re not sure what I’m talking about.
Remember – when you’re discharging someone on antibiotics for a UTI PLEASE mention it in clinical comments so that the consultant doing results checking in 3 days’ time can quickly see if they need to contact the patient once their urine culture comes back

There’s a little bit of confusion with all the changes in the geriatric space recently.
FRAC – A clinic primarily for patients who are safe to return home but need ongoing assessment and management of acute medical issues including: geriatric syndromes (e.g. falls, dementia), pain, heart failure, leg oedema, postural hypotension, or new medications that need monitoring for response and side effects. They aim to see patients within 10 days of discharge if possible.
GAT – A shopfloor Geriatrician available to review patients in ED with a view to direct transfer to Osborne Park Hospital for rehab, or for discharge to home or Nursing Home. GAT have had to recently reduce their hours to weekday morning only. Contact them on DECT phone 76915. GAT get most of their business from our morning Obs round.

We’ve a new process for any batphone calls or ECGs that are faxed / emailed.
This is only relevant when the patient doesn’t come to SCGH ED i.e. anytime when the Dr taking the call doesn’t give the sheet to the shift coordinator.
Please hand the yellow sheets and ECGs to our liaison clerks who will file them for future reference in case we have to justify any of our decisions.
We have previously had to testify at coroner’s court over phone advice we’d given