POW ED JMO Orientation

Prince of Wales Emergency Department is a busy, tertiary Emergency Department. We saw approximately 63,000 patients in 2019.  Our patient mix is of high acuity and complexity, with an admission rate of approximately 40%.

We see adults (from 16th birthday) from a highly varied local population from Waverley to Botany Bay, as well as those seeking or referred to us from around the state. We have some special roles: we are the ED serving the Correctional Complex at Long Bay, the ED for one of 2 spinal units in the state, and we are the receiving hospital for Lord Howe and Norfolk Islands. Our patent mix is also influenced by our proximity to beaches, the University of NSW, and the airport.

POWH is classified as a Local Hospital within the NSW Trauma Services Plan, and so our ED does not routinely receive major trauma, but we do receive moderate volumes of minor trauma and secondary referrals from throughout NSW for spinal/ neurosurgical care. We have a 24/7 Interventional Neuroradiology service. We also have large psychiatric, cardiology, renal (including transplant), haematology and cancer care services, all of which serve patients from a wide catchment.

Our function is to provide an acute medical service to the community. The ED is an important access-point to the hospital, and acts as a bridge between primary care, other community care and inpatient services. Our particular role is in stabilising and managing the sickest and least differentiated patients and guiding them safely to appropriate inpatient care.

Equally important is the role we play in treating acute illness and injury in those who do not currently need inpatient care, but for whom timely and effective treatment can prevent deterioration or disability, and allow return to work and safe return home.

Our catchment population, roughly the Randwick, Botany and Waverley Local Government areas, is over 200,000 people and growing, with widely varying socio-economic profiles. Over 20% of our patients are aged 75 or over, and this proportion is projected to grow significantly in coming years.

Roughly one in five of us will need to visit an ED in any 12-month period, so a well-functioning ED is important for all of us.

During the term, you will be providing medical services to patients attending the ED to the highest standard possible, in support of and under guidance and supervision of senior medical ED staff. The primary expectation we have of you is that you commit fully to an ethical and caring approach to all our patients.

It is the responsibility of consultant staff, and where delegated registrar and senior nursing staff, to ensure that JMOs have appropriate support and supervision both for training and for patient safety.

You will be working in a large multi-disciplinary team, including nursing, allied, clerical and ancillary staff, and your support and respect for the different members and roles within this team will be expected at all times.

You will be representing the ED to other groups, both within and outside the hospital, and will be expected to maintain the highest standards possible in doing so.

You will be expected to participate actively in training, both by attendance at the formal ED education program and by seeking training opportunities based on patients seen in the ED.

By the completion of this term the JMO may expect to acquire the following knowledge:

• How to assess, investigate and manage a broad range of undifferentiated emergency presentations, including but not limited to: chest pain; shortness of breath; altered level of consciousness; abdominal pain; trauma; headache, weakness, seizures; poisoning; fever
• Knowledge regarding the indications, performance and risks associated with various procedural skills necessary in the Emergency Department
• Knowledge regarding an holistic approach to patient care with emphasis not only on physical well-being but also mental and social well-being
• Knowledge regarding clinical research being carried out in the emergency department
• Knowledge regarding effective and efficient conduct of emergency care, including clinical responsibility, time management, communication and consultation with the emergency team, gathering and documentation of clinical information, investigation and referral practices, and overall risk management in the ED environment.

By the completion of this term the JMO may expect to gain competency in the following skills:

• Appropriate and sensible test investigation and interpretation of the results of those investigations in an emergency context
• Development of management & disposition plans
• Practical skills which may be obtained or observed include: iv cannulation; obtaining blood gases (venous unless by ED consultant approval); suturing; plaster splinting; lumbar puncture; insertion of intercostal tubes; pleural/ peritoneal aspiration; local anaesthesia; advanced life support
• ‘Presenting’ patients to senior colleagues in a coherent fashion
• How to recognise a ‘sick patient’
• How to approach a patient with abnormal vital signs
• How to monitor a patient appropriately
• How to know when to ask for help
• How to ‘multi-task’ under sometimes difficult conditions

Administratively the ED forms part of the Program for Emergency, Specialist and Continuing Medicine.

Acting Director: David Murphy

Staff Specialists (and other roles):                  

Therese Becker          (Toxicologist, Co-Director of Emergency Medicine Training)

Laura Brown               (PGY2)

Betty Chan                   (Toxicologist)                  

Angela Chiew              (Toxicologist)

Matt Davis                   (Quality/ incident review)

Michael Golding         (Medical Director, Emergency Care Institute NSW)         

Sarah Gollance           (PGY1)

Susan Hertzberg        (Incident review/ medicolegal)

Andrew Hugman        (Clinical Lead, My Health Record in Emergency     Departments)

Farzad Jazayeri          

Ezila Kapilan               (Complex Management Plans)

Daniel Khamoudes    (Simulation clinical co-lead)

Marian Lee                  (EDSSU clinical lead)

Claire Leonard            (PGY2, Mental health, Drug and Alcohol liaison)

Jeremy Lawrence       (Incident review)

Ellen Meyns                

John Mackenzie         (Medical Project Officer, Emergency Care Institute NSW)

Alvaro Manovel          (Ultrasound clinical supervision)

Sally McCarthy         (President-elect, International Federation for Emergency Medicine)

David Murphy            (Acting Director of EM, Director of JMO Training in ED)

Prianca Prabhakar     (Registrar rostering)

Zoe Rodgers                (Simulation clinical lead)

Irene Rotenko             (Ultrasound Special Skills Lead)

Kate Sellors                  (Co-Director of Emergency Medicine Training)

Joanna Short               (SRMO supervision, gynaecology liaison, medical student coordinator)

Bruce Way   (POWH Co-Director Prevocational Education and Training, Ultrasound Clinical Supervision)

Several sessional Visiting Medical Officers/ Locum Staff Specialists also complement our Specialist staff.

Nursing

Nurse Manager: Elizabeth Ryan
Acting Nurse Manager: Amy Fenton

Patricia Maurer      Clinical Nurse Unit Manager

Kathryn Power        Clinical Nurse Unit Manager

Carmel Hagness/ Deborah Tracy           Nurse Practitioners

Wayne Varndell/ Allison Jeffers Clinical Nurse Consultant/ ED

Eloise Berry, Kiri Hargreaves Nurse Educators

Ann Kelly, Dasha Riley: ASET team.

The ED has a very large and highly skilled team of nurses in a variety of roles, including nurse specialist and advanced practice roles.

On the floor, in addition to nurses assigned to each treatment area, you will come into contact with the following roles:

• Coordinator: responsible, in liaison with duty consultant, for immediate bed management and placement of new patients;
• Navigator: assists coordinator in placing admitted patients, needs to know about all new admissions or any requests to move patients.
• Triage nurse: will complete triage, place patients in an appropriate area and alert staff of any urgent or important issues.
• Waiting Room Liaison/ Clinical Initiatives Nurses: will monitor waiting patients, observe for any safety issues or deterioration, and undertake under protocol guidance procedures (e.g. x-ray, analgesia) that would be expected to improve or expedite care.
• Extended Practice Nursing (EPN): Several of our nursing staff have undergone extra training to pick up their own patients, and manage them under protocol guidance and senior medical supervision. Deborah Tracy and Carmel Hagness are our Nurse Practitioners and will see patients independently with support as needed from senior medical staff. They have a range of skills including wound closure and splinting, and will be happy to help you for specific procedures.

The ED is served by a physiotherapy team, led by Jimmy Roumanous, 7 days a week (Mon-Fri 0800 to 1630, Sat-Sun 1000 to 1800), based in Fast-track.

Physiotherapists will pick up patients independently within scope of practice, are available for advice or support for other patients (e.g plastering, musculoskeletal advice), and will seek medical support (or transfer of care) when required.

Senior Clerical/ Administrative Staff

Adrianne Love/ Judith Lissing     Medical Workforce Coordinators

Danielle Shephard              Clerical Manager

Anne MacLauchlan   Assistant to the Acting Director

Sally Jularic                           Clerical Supervisor

Chris Yap                               IT/ Data Manager

Grant Bernes                        Clinical Support Officer/ documentation support

Other important staff members include our Communications clerks, EMR staff, front desk Clerical Staff, Health and Security Assistant(s), ED porters, ED radiology porters, and Patient Services Assistants.

The ED is separated into 3 main functional work areas:

• Acute: with 3 resuscitation beds, 15 monitored acute beds and a large central bridge. This is the main area of the ED, where any patients who require monitoring and most ‘horizontal’ patients who require a bed for care will be assigned.

Adjacent to the bridge is the pathology dispatch bench where all specimen request forms are printed and blood and other specimens are bagged and sent to specimen reception via the vacuum chute. If the chute is not working a porter should be utilised to transfer specimens.

• Fast-track: comprising 7 cubicles with beds, eye, plaster and procedure rooms, and an open area with 9 recliner-chair treatment spaces, geared for ‘vertical’ patients who do not require a bed for ongoing care.
• Emergency Department Short Stay Unit (EDSSU): 15 beds for admissions up to 24 hours including monitored bed capacity.

Computers on wheels (COWs) and fixed PCs are available throughout the ED to allow efficient electronic documentation and access to information. All documentation is done electronically, and COWs can assist this very much. Please leave them on charge when not in use.

Other important areas include:

• Reception, with clerical area and triage. If you require information to be faxed from another doctor or hospital, please use the fax machine in the clerical office. The number is 9382-3966. An alternate fax at the main bridge is 93823911. You will need to check periodically for the fax’s arrival, or alternatively ask the clerical staff to keep an eye out for it.
• Ambulance Bay
• ED Offices and Conference Room
• ED tea room
• Storage areas

Lockers are available- please see Adrianne Love to arrange a key.

Patients may present ED via private transport, by ambulance, or occasionally from other services in the hospital. Referrals from admitting specialty services in hours should be via the Patient Flow Unit rather than to ED, unless it is anticipated that a patient may be unstable or need urgent ED care.

Inter-hospital transfers do not come to ED unless unforeseen deterioration occurs en-route or, in rare circumstances, when transfer for specific specialty care is urgent and an appropriate bed, though not yet available, is expected.

A patient arriving after-hours from another hospital may pass through the ED for stability assessment (and treatment if required), clerical registration and ward bed confirmation.

Our relationships with community general practice, aged care/ social support services and community specialist services are very important. The care of our patients should support their relationships with them, and particular attention should be given to communication with them by letter, phone calls, and by the instructions we give on discharge. Referral letters, ambulance sheets and pre-arrival notes should be read and interpreted carefully, and may be valuable sources of information.

Our relationships with inpatient services are also very important, with significant and complex mutual expectations. Our documentation and communication should be professional and clear, not only relating our patient assessments, but also to consultations and discussions with non-ED teams.

If any difficulty arises in liaison with non-ED teams, please discuss with an ED registrar or consultant as soon as possible. Some specific services, particularly spinal and renal (in particular relating to transplant or dialysis patients), would like to be contacted whenever a patient under their long-term care is seen for any reason. If in doubt consult senior staff.

POWH ED has some particular relationships, which can be of use to medical staff in the ED. Here is a non-exhaustive list:

• Toxicology: POWH provides a 24 hour regional referral service on 0423366022 led by Dr Betty Chan. Please contact the on-call toxicologist for any poisoning or overdose. Toxicology assessment forms are preformatted for your EMR notes to help structure the information required. Please discuss with senior ED staff before referral.
• Mental Health: a Mental Health CNC is on-site 7 days a week, at minimum 0800 to 2200 and, staffing permitting (generally Fri to Mon inclusive), overnight. A staff specialist- led team is available on weekday mornings. The Mental Health registrar is on page at other times.
• Aged Care: The ED has a well-developed ASET (Aged Care Services in Emergency) team, led by Ann Kelly and Dasha Riley, with nursing, social work and physiotherapy, and very good connections with both inpatient and outpatient services. This team is very important in assisting us with safe discharge, identifying and assisting patients who need increased care in the community, and assists in liaison both with the inpatient geriatric team and with residential aged care services.
• Pharmacy: led by Dana Strumpman and Patricia Conaghan provide a 6 day in-hours service to advise and review medication histories, prioritising complex patients, and to facilitate supplies.
• Social work: led by Annmarie Townsend, are available in hours for any patient, and after-hours for specified emergencies. Areas of expertise include finding accommodation (homeless or patient relatives if needed), helping arrange transport (including taxi transport is no safe alternative exists), attending families of critically ill or dying patients (see also bereavement packages on the bridge), for miscarriage (see below), and for advice in all instances of suspected child abuse or neglect, domestic violence or sexual assault. Information leaflets relating to bereavement and crisis supports can be found in the EDSSU shelves. Non-urgent out-of-hours referrals can be left in the social work book. Please note that our sexual assault service is at Royal Prince Alfred Hospital (95156111) for patients who request formal referral or forensic testing.
• Chaplaincy: a wide range of religious denominations can be and contacted at any time, particularly for end-of-life care.
• Dentist: an excellent on-call service is provided after-hours, and in hours the Dental Clinic can be contacted.
• Drug and Alcohol: led by Mary-Lou White can be contacted via the Sydney Hospital switchboard on x27111. Onsite consultation is usually available in hours Monday to Friday, and via Sydney Hospital after hours. Sydney has dedicated Drug and Alcohol beds, generally set aside for medically supervised alcohol detoxification, chiefly in those with a perceived increased risk or history of withdrawal seizures.
  Other services include the Gorman Unit (via St Vincent’s Hospital 83821111) for medically supervised detoxification and outpatient follow-up either at Langton Clinic in Surry Hills or at POWH Outpatients.
• PACS (Post-Acute Care Service)/ HITH (Hospital in the Home) is available (x22470 in hours, mobile overnight) for advice or referrals for IV antibiotics at home/ aged care facility, warfarinisation (for rare instances when this is still required), and some specific rehabilitation services.
• Royal Hospital for Women relies on our ED to provide acute care, including pregnancy-related issues up to 20 weeks gestation. Many patients in these circumstances are in significant distress, and we must avoid any gaps in care. After 20 weeks most presentations, especially if clearly pregnancy-related, will be referred directly to RHW labour ward after triage and brief medical assessment.
  The Gynaecology registrar is available for consultation 24 hours on page 44081. If delay is encountered please consult with senior ED staff +/- the RHW nurse manager on page 44020. A referral guideline is available on the ED SharePoint. Patients with presentations related to early-pregnancy can be followed- up in the Early Pregnancy Assessment Service.
  All patients being discharged with confirmed miscarriage, and any other pregnant patient about whom you are worried, should be offered a referral to POWH social work (either directly or via the Social Work book) to ensure adequate follow-up.
• Sydney Hospital: Medical Ward referrals are made to the physician of the day (x27111). Sydney Hospital is regarded for our purposes as an outlying ward of POWH, and is particularly suited for patients who are not severely ill but need inpatient care. Full allied health services are available at Sydney.
  Exclusion criteria include patient refusal (please ask before referring), patients requiring subspecialty or surgical care (other than Hand Surgery or ophthalmology), and patients with behavioural disturbance or active mental health risk (there is no psychiatry onsite and less capacity than at POWH to ‘special’ patients.) Please discuss with senior ED staff before referring.
• Corrections Health patients: we are the designated hospital for Long Bay Gaol, which in turn is the main prison in NSW for inmates in need of complex health-care.
  If admitted, Corrections patients will either go to a ward with guard escort (generally only applies to ICU or CCU) or to the Prison Annexe ward. Corrections patients are entitled to the same quality of health care as the rest of the community, but have particular needs and vulnerabilities in terms of privacy, autonomy and follow-up. Corrections Health is responsible for ongoing care at the Gaol and can be contacted to discuss further care.  
  Please discuss any difficulties with senior staff. Potential delay in return (for example if chest pain recurs) should be taken into account when planning discharge.
• Burns: the burns registrar at Concord Hospital should be contacted for burns requiring either transfer or specialty follow-up. Criteria for referral are available on-line. POWH plastic surgery does not generally provide a burns service, but can be contacted for advice. Some very minor burns may be accepted to the Review Clinic.
• Paediatrics: patients under 16 will be transferred to Sydney Children’s Hospital. Occasionally it will be appropriate to consider SCH for a child over 16 who has not yet transited to adult services. In the rare event of a severely unwell child presenting here first, we have limited equipment for vascular access and airways. In the rare event of a birth in or near the ED, we have a ‘birth pack’ to stabilise, warm and dry the baby before transfer to RHW.

Phone: 9382 2111

The medical Workforce Unit is able to assist you with any payroll/timesheet/ study leave queries; they are located on level 3 of the Prince of Wales Hospital High street building.

The campus parking is run by Metro parking and not by the hospital. Once you commence work at Prince of Wales you will need to visit the car park office on level B1 to put your name on the car park waiting list. The waiting list can be very long so in the meantime if you still wish to park in the Metro car park the cost for casual parking for a whole day is approx. $24. They also have a 5 day staff pass that can be used for out of hour shifts, the rules for the out of hours pass are as follows:

• You must enter the car park after 4pm and leave before 8am the next day, otherwise casual rates will apply.
• Weekends – any time
• The cost is $17.30 and can be used over a three-month period.
• The pass needs to be purchased within 24 hours of entering the main car park.

Another parking option is Early bird parking at Ezipark next to Randwick Ritz cinema on St Pauls street. This is a $6 all day flat rate, you must be in between 5.30am and 11am and out between 2pm and 7pm

Scrubs are not mandatory and discretionary funding is not currently allocated to the ED to provide them. They may be used in accordance with the SESLHDPR/281. The approved colour for Junior Medical Staff is green/ emerald.

https://www.seslhd.health.nsw.gov.au/Policies_Procedures_Guidelines/Clinical/Nursing_and_Midwifery/Documents/UniformsProvisionDressCodeandappearanceforClinicalandCorporate.pdf .

Resources for purchasing/ choosing scrubs include:

• https://www.infectious.com.au/
• http://www.healthshare.nsw.gov.au/__data/assets/pdf_file/0009/296244/Uniform-Catalogue.pdf

• Choosing a Scrub Style to Suit Your Body Shape ( 106.7 KB)

• Measurement Guide - Male Version 4 ( 1.1 MB)
• Measurement Guide - Female Version 3 ( 1.2 MB)