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LGI ED General Management
1.4 Emergency Department Function
Patients ‘Streaming’ begins at the Reception desk. Ambulant patients can be directed from reception to the ENP run SIEVE. This process sorts patients into those who may be suitable for ENP care in the Walk in Centre (Minor Injury & Illness stream) or for the main ED. On arrival in the ED patients are seen by the nurse led Interventional Assessment team (IAT) (or “Red team”). An initial clinical assessment is made following which the patient is directed into the appropriate team for definitive A&E care. The assessment includes the performance of relevant investigations (ECG, bloods, ABG etc) and a decision about the urgency with which the patient should be seen (triage).
From ‘red team’ the patients can follow several pathways:
- Relatively simple problems, unlikely to require any investigations will be placed in the red team ‘doctor to see’ category (also known as ‘see and treat’).
- More complex cases will go into either blue or green team, each of which consists of several nurses and a doctor. These patients are likely to require more in-depth assessment prior to referral or discharge. The A&E cards will be placed in the order in which they must be seen based on their triage category.
- Patients who clearly need admission under a particular speciality may be referred directly or after brief review by an A&E doctor. In some cases (for example ‘fractured neck of femur’) specific protocols are in place to facilitate rapid and appropriate care.
- A staff grade is employed by the surgeons to assess patients with surgical problems in the ED. During his hours of duty direct referrals can be made, otherwise the on call SHO is available
- The red team nurses will often send patients to x-ray according to a set protocol. Glass injuries and suspected skull fractures are also included. If you see a patient following a triage directed x-ray, you must still take a history and examine them.
- Patients may also be directed from assessment to the Returns Clinic (that day or later), the Trauma Clinic, and the Eye Clinic etc.
No patient should leave the ED for admission or discharge without a Doctor (or ENP in MIU) documenting this in the card
Patients with GP letters and the MSAA
Unfortunately the ED still receives many patients who have already been seen in Primary Care and have a GP letter. If a patient attends the ED with a GP letter requesting a team to see the patient and the patient is stable it is the responsibility of the specialty team to see the patient, preferably on their ward. There is a small ward area called the Mutli-Specialty Assessment Area (MSAA) at ward 38 for medical and surgical patients. Nursing staff have the ability to refer direct to the specialties but sometimes will require back up from medical staff. This process has been agreed by the Chief Executive and has his complete support; however we still find some resistance to its uptake from the specialties. If you are having difficulties with this process ask for help from a senior doctor or a floor manager. Please enforce this ruling as it is vital for our function.
Children
This trust defines a child as anyone who is less than 16 years old. From their 16th birthday they are considered suitable for adult wards, exceptions are 16 year olds or older children with chronic conditions who are well known to a Paediatrician. e.g. IDDM /CF
Paediatric surgical problems are admitted under Paediatric Surgeons. If there are any concerns regarding the circumstances in which they arose, children may be referred to the Paediatric Registrar or if the concerns are mild in nature they should be brought to the attention of the Health Visitor