POW Emergency Department Function

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.

Alternatively you can contact Adrianne Love in the emergency department.