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St James' ED General Management
1.2 General Managerial and Administrative Issues
General Issues related to shop floor duties –
- It is vitally important that you are PUNCTUAL for your duties. Arriving late for shifts in a busy A&E department such as ours will not be appreciated by your colleagues and rapidly noted by your seniors (buy a good alarm clock at the beginning of your post!).
- There is an 18 week rota which runs continuously other than at the very start and end of the 6 month period. It will occasionally be necessary to ask you to swap shifts in order to accommodate study leave or sickness absence. The secretaries or Consultants will inform you of changes.
- At the start of each shift check the work sheet on the white board in central area which allocates you to a work area such as red or blue team or assessment team. One doctor is designated to work in resus when needed.
- During your shift you are entitled to two 15-minute breaks for tea/coffee and a 30-minute break for a meal. Please co-ordinate with your colleagues to ensure all of you get your breaks in turn and the work on the shop floor does not suffer.
- You are expected to review x-rays and other investigations you have yourself ordered. If you have finished your shift, or are going for a long break, you MUST HANDOVER patients to one of your colleagues. Do not leave them with difficult problems that you yourself should have sorted and remember that it is rarely necessary to wait for the result of an investigation before forming a definitive plan for a patients care.
The 4 Hour Emergency Standard
You will be aware of the ‘4 hour target’. The aim is for all patients to have left the department within 4 hours of their arrival, whether they have been discharged or admitted. Although there are some down sides to this standard it is also worth noting that for the majority of patients in the department, and the staff too, it has greatly improved care in the Emergency department. None of us would wish to spend any more time than necessary in the ED and the 4-hour target allows us to focus the hospital on this idea. It is important to remember that this is not an A&E target, as we cannot achieve if the rest of the hospital is not ‘on board’.
To achieve this it is vital to try and make decisions regarding the patient’s care as soon as safely possible. To do this consultants and SpRs are always on hand and do two or three ‘board rounds’ a day to help with patient flow. Seek the advice of senior colleagues if you are having difficulties with this process. However always remember that patient safety and care will always come first. The consultants will always back a nurse or doctor who has led to a patient ‘breeching’ when there are good medical reasons for this. No patient should ever leave the ED without a doctor explicitly saying that they can, be that an admission or discharge.
For further advice see Appendix XX and XX which provide details of appropriate medical sub-specialties and guidance for other specialties
Rotas
A copy of the rota for 6 months of the post will be made available to you on the first day of commencement of your post. In addition a combined daily sheet is produced showing the duties of the Consultants, Staff Grades, SpRs, Clinical Assistants. Any casual changes in the shifts must be covered by your own arrangements with another SHO. These changes MUST BE notified to and approved by the Consultant in charge of the SHO rota or the Consultant on the shop floor at that time. Please make these changes clearly on the copy of the rota in the folder in the Secretaries Office.
Leave
Annual Leave – Each SHO is entitled to a total of 12.5 days annual leave in a 6-month period, plus a day in lieu of any bank holidays booked. Your 6-month rota incorporates the leave days and holidays are located in advance.
Sick Leave – It is vital if you are sick that you telephone the Department on Leeds 206 5790. Please speak to one of the Senior or Middle Grade Doctors, either the consultant (up till 9pm) or the Registrar team leader so that appropriate cover can be arranged for that period.
Study/Examination Leave – It is in your interest to notify us as soon as possible by filling in the appropriate forms about the dates so that we can plan a rota and facilitate you as best as we can. This is especially true if you are on nights during the period of leave.
Interviews – Please swap shifts at the earliest opportunity if you are working on the day of your interview. It is your duty to ensure that your slot is covered, so please make sure that your arrangements to swap are watertight. Discuss with the consultant responsible for rotas and/or Gill Wright.