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St James' ED General Management
1.4 Emergency Department Function
Patients ‘Streaming’ begins at the Reception desk. Ambulant patients can be directed from reception to the Minor Injury & Illness stream or come into the main ED. On arrival in the ED patients are seen by the nurse led Interventional Assessment team (IAT). 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 IAT the patients can follow several pathways:
- Relatively simple problems, unlikely to require any investigations will be placed in the ‘see and treat’ box for the IAT doctor to see.
- More complex cases will go into either blue or red 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.
- The IAT nurses will often send patients to x-ray according to a set protocol. 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
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 medical assessment unit for medical patients to do this but surgical patients are seen in the ED. 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 at LGI. 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