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BMDH
Blacktown Hospital
Emergency Department
Medical Officer
Orientation Information
D: /Manuals/Medical Officer Orientation Information-Blacktown

Updated February 2015
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TABLE OF CONTENTS
TABLE OF CONTENTS
1. GENERAL DESCRIPTION AND PHILOSOPHY
2. GOALS & OBJECTIVES OF TERM
3. SENIOR STAFFING
4. BLACKTOWN EMERGENCY FLOOR AREA
5. SUPERVISION
6. ROSTER
7. SICK CALLS
8. SHIFTS
9. COMMUNICATION
1 Between you and the Department
2 Within the Department and the Hospital
3 Between you, your patient and their family
10. ADMISSIONS
1 Who to Call
11. DISCHARGES
1 Discharge Letters
12. CASE PRESENTATION FOR ADMISSIONS AND DISCHARGES
13. HANDOVER
1 Handover Information
14. TRIAGE
15. BED AND AREA ALLOCATIONS
16. BAT CALLS TO RESUSCITATION AREA
17. ROLES AND SERVICES WITHIN THE DEPARTMENT
1 Fast Track
2 TCA (Treatment Commence Area)
3 PIT Area
4 Clinical Initiative Nurse
5 Nurse Practitioner
6 Physiotherapist
7 Social Worker
8 Care Navigation
9 Post Acute Community Care Program (PACC)
10 Aged Care Services Emergency Team (ASET)
11 Urgent Review Clinic
12 Drug and Alcohol
18. TEACHING AND EDUCATION RESOURCES
.1 Registrar/CMO
.2 Prevocational Teaching (SRMO)
.3 JMO Teaching (RMO/Intern)
.4 Library
.5 On-Line
.6 Term Assessment
.7 Mentorship Program
.8 Responsibility of Mentors
.9 Research and Quality Assurance
.10 UWS Medical School Rotation and Teaching
19. MEDICO-LEGAL ISSUES
.1 Police Statements
.2 Child Abuse
.3 Needle Stick Injuries
.4 Abnormal Radiology Results
.5 Test Results
.6 Media Inquiries
.7 Police Requests
.8 Blood Alcohol Sampling
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.9 Rectal and Vaginal Examinations in Females

.10 Duty of Care
.11 Work Cover
.12 Re-Presentations of Patients
20. GENERAL HOUSEKEEPING
21. COMPLAINTS AND DISPUTES
22. DISASTERS
23. ANCILLIARY SERVICES
.1 Pharmacy
.2 Pathology
.3 Radiology
.4 Interpreter Service
24. FORMS AND DOCUMENTATION
25. MANAGEMENT POLICY AND PROCEDURE
26. CONCLUSIONS
APPENDIX 1
URGENT REVIEW CLINIC BUSINESS RULES
APPENDIX 2
EARLY PREGNANCY ASSESSMENT CLINIC
APPENDIX 3
AGED CARE SERVICES EMERGENCY TEAM
APPENDIX 4
MEDICAL EMERGENCY TEAM (M.E.T)
APPENDIX 5
CASE PRESENTATION TEMPLATE
APPENDIX 6
ADVANCED MEDICAL PLANNING FORM
APPENDIX 7
SAMPLE OF DAILY FLOOR ROSTER
APPENDIX 8
SOCIAL WORK REFERRALS
APPENDIX 9
TRANSITIONAL NURSE PRACTITIONER SCOPE OF PRACTICE
APPENDIX 10
SENSIBLE ORDERING PATHOLOGY
APPENDIX 11
EMERGENCY DEPARTMENT SENIOR ASSESSMENT AND STREAMING

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1. GENERAL DESCRIPTION AND PHILOSOPHY
The Emergency Department at Blacktown Hospital offers emergency care for patients of
all ages, 24 hours a day 7 days a week. The main purpose of the Department is the
provision of initial assessment and acute management for patients presenting to the
Department. Relevant subspecialty or the patient’s general practitioner carries out
chronic or ongoing management.
The Emergency Department has a major role as a liaison between Blacktown Hospital
and the community. To many, it symbolises the whole hospital, as it may be their first or
only view of the hospital. The Department needs to be seen to be delivering a service to
the community to help promote and maintain the hospital’s reputation.
The Department is a major area in the hospital that may witness patient frustration. It
may present a stressful, confusing, or apparently hostile environment to patients and
relatives and may therefore be a source of complaints and litigation. Staff members are
requested to recognise the need for privacy, have a supportive and understanding
attitude and to offer a word or explanation and counselling services, when appropriate.
The Emergency Department is a level 5 department, (with the hospital being a Level 2
trauma unit) providing treatment of major and minor trauma cases and medical
emergencies. It provides a service that ensures the timely, skilled and appropriate
management of all patients. Approximately 40,000 patients attend the department each
year (about 115 patients per day). The number of admissions to inpatient beds averages
25 - 30 per day.
In addition, the Emergency Department provides primary care to non-acute ambulatory

patients including treatment to minor wounds, abscesses, septic hands, eye injuries, ear,
nose and throat complaints, minor fractures etc. Follow-up care for these patients is
generally performed elsewhere.
The provision of services for the non-urgent patients should not interfere with the
provision of emergency services.
The Emergency Department also provides a focus for teaching and research into the
acute emergency care of patients and the health and well being of the community as a
whole. The teaching is primarily for Hospital staff but also provides a service to others in
the community.
An important role of the Emergency Department is its involvement in local and regional
retrieval systems. Blacktown Campus sends half a disaster team (one doctor and two
nurses) to the scene of a disaster as requested by the area response team.

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2. GOALS & OBJECTIVES OF TERM
 To gain broad experience in the management of adult and paediatric

emergencies
 To develop and enhance resuscitation and procedural skills.
 To further the ability to work in a multidisciplinary team
 To develop a high standard of documentation in clinical recording
 To participate in continuing education
 To enhance communication skills with colleagues, patients and relatives
 To develop skills in the efficient and appropriate use of investigations.

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3. SENIOR STAFFING
Director Emergency Medicine Blacktown and Mt Druitt Hospitals
A/Prof Reza Ali
Deputy Director Emergency Medicine Blacktown and Mt Druitt Hospitals
Dr David Melvin
Emergency Medicine Consultants
Dr Chamila De-Alwis
Dr Harry Elizaga
Dr Michael Hession
Dr Karina Hochholzer
Dr Shaila Islam
Dr Dushan Jayaweera
Dr Daya Jeganathan (DEMT and Head of BEST Network)
Dr Ponnuthurai Jeyaruban (DEMT Mt Druitt Hospital)
Dr Patricia Kijvanit
Dr Catherine Kizana
A/Prof James Kwan
Dr Gopi Mann
Dr Satish Mitter
Dr Richard McNulty
Dr Jannatun Nayim (DEMT Blacktown Hospital)
Dr Fernando Pisani
Dr Greg Robinson
Dr Liaquat Sheriff
Dr Kenny Yee
Emergency Medicine VMOs
Dr Richard Lennon
Dr John Shirley
Dr Vijay Manivel
Executive Assistant
Ms. Joan Brown
Nursing Unit Manager 3
Ms. Colleen Mullens
A/Clinical Nurse Educator
Mr Johnathon Hamilton

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Nurse Consultant
Ms Jo Scullion
A/Clinical Nurse Consultant
Ms Tracey Newton
Nurse Practitioner
Luke Strachan
4. BLACKTOWN EMERGENCY DEPARTMENT FLOOR AREA

The department is divided into different areas based on the model of cares provided.
There is Acute, Sub-Acute, Fast Track, PIT (Early Senior Assessment) and Treatment
Commence Area (TCA).
There are 2 resus beds and 16 acute beds (4 – 19) in the Acute Area. There are 4 beds
(21 – 24) in the sub-acute area. There are 6 recliner chairs in the fast track area and 7
recliners in the TCA. There are two consultation rooms plus an eye/suture room and
plaster room, which may be used whenever appropriate. There is also a Short Stay ward
in the department which comprises of 4 recliner chairs.
5. SUPERVISION
All JMO’s are supervised by the EDSS/Registrar/CMO/.They are expected to discuss
ALL their cases with a senior medical officer in the Emergency Department as soon
as possible, preferably even before starting to write their notes and definitely before all
the results are back. This allows the department to reach the NEAT criteria by allowing
early senior decision-making with regards to patient management and disposition
JMO’s are not expected to make admission or discharge decisions without the direct
supervision of a senior physician.
Registrars/CMOs are expected to update and discuss with the consultant on the floor
regarding the patients they are reviewing and directly managing and to escalate any
deteriorating patient as soon as possible. The Staff Specialist directly supervises
CMO/Registrars.
The Consultant on the floor will be in charge of the shift and decide on patient
management plans and deal with any administrative or policy issues that might arise
during the shift. In the absence of the consultant, the CMO or Registrar will fulfil this role.
When there is no ED Physician on the floor, there is a rostered on call ED Physician

(please refer to the daily floor roster sheet). Any complex issues that the CMO/Registrar
have difficulty with, needs to be discussed with the on-call ED Consultant.
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Consultant on-call roster is published weekly and is clearly marked on the daily floor
roster.
If an emergency physician is available, the ED handles its own cardiac arrest. At other
times, call the Cardiac arrest team on 111. The MET (Medical Emergency Team) can
also be called, on the same number, whenever further assistance is required in an
unstable patient. The MET consists of the ED Senior as team leader, a medical registrar,
an anaesthetic/ICU registrar, a resuscitation nurse and a wardsman. There is a nursing
team leader, an airway nurse and a circulation nurse allocated for resuscitation in the ED
for each shift.
The hospital’s Trauma Team should be called to assist in the management of any multi-
trauma cases. See the guidelines in Appendix 5.
6. ROSTER
Blacktown and Mount-Druitt ED have their independent REG/CMO and JMO roster.
The Executive Assistant of the Department is in charge of the JMO roster.
Dr David Melvin is in charge of the REG/CMO roster.
 The roster is arranged at least four weeks in advance. Thus any special
requests must be made before this time.
 The Department has a rotating roster and it is expected that everyone would
do their shares of day, evening and night shifts.
 Once the roster is finalised and published, JMO’s/REG/CMO must arrange

their own swap/relief, if there is a specific shift they cannot work. The
JMO/REG/CMO concerned in the swap must complete a “Shift Change Form”
and inform the Executive Assistant. The shift change must be authorised by
A/Prof Ali or his delegate when he is absent. All swaps must be within the
same pay period. The change will also be noted on the master floor roster in
the ED for pay purpose.
 The number of hours worked per fortnight depends on the number of staff
available for the shifts. The number of hours may range from 80 to 90 hrs per
fortnight.
 JMO/REG/CMO willing to work more shifts than usual should contact the
Executive Assistant as early as possible for allocation to extra shifts.
Meal breaks are paid for after hours, and there is no need to claim for these. If you work
an in-hours shift (Day Shift), and do not receive a meal break, you must write next to the
shift “NMB”. The ED Director or staff specialist must countersign this.
If you are leaving the ED floor to go to a different part of the hospital, please notify Staff
Specialist or Registrar of your whereabouts, so that you may be contacted if required.

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7. SICK CALLS
 If you are sick, you must notify the Director A/Prof Reza Ali on his mobile via
the switchboard and in his absence the Deputy Director Dr David Melvin on his
mobile via the switchboard.
 It is expected that the call is made early on (at least 6hrs prior to
commencement of shift) and not just prior to commencement of the shift. This
is particularly important for night shifts.
 The person rostered on as night sick relief will need to work the shift. It is
essential that you give as much warning as necessary so that relief staff can
be organised.
 Doctors taking sick leave two or more days consecutively will need a certificate
from their LMO as to the cause. This certificate is to be given to the Executive
Assistant.
8. SHIFTS
BLACKTOWN MT DRUITT
D/DB 0800 -1830 D/DM 0800 - 1830

MB 1200 – 2230 MM 1200 – 2230
E/EB 1400-2400 E/EM 1400 - 2400
N/NB 2230-0830 N/NB 2230 - 0830
On the REG/CMO and RMO/SRMO rosters there is an on-call night cover person clearly
designated. The night cover person will be asked to cover any unexpected night sick call
relevant to their roster.
9. COMMUNICATION
9.1 BETWEEN YOU AND THE DEPARTMENT
This will be via email. Please ensure that you have provided the ED Executive Assistant
your CURRENT contact phone number, provider number and email address on
commencing the term. Please notify her of any changes during the term.
All rosters and ED messages will be sent to you via email.

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9.2 WITHIN THE DEPARTMENT AND THE HOSPITAL
Available forms of communication include, telephone paging, electronic documentation,

and writing legibly in the notes. However, the best way to communicate with other ED
staff is by polite personal communication. Nursing staff need to be informed of
management plans or changes to these, as they are often the personnel required to carry
out these plans. There is also an overhead communication system in the ED department.
The overhead system is for professional use only. It is not for personal
communications/messages.
The paging system is used to contact the relevant in-patient Registrar/Resident. If the
paged person is not answering his page, it is probably because the page number is
wrong, he/she has gone home, has not picked it up from switch, has not turned it on, has
left it in theatre, or most likely he/she is in theatre, etc etc. The variability’s are enormous.
So in this circumstance,
a. Check that the paged number is correct.
b. Check with the Communication Clerk if they have any information. The theatre is
a good place to start looking. With O&G registrars it is always worthwhile
checking with the Delivery suite. A communication clerk is available during
06:30am and midnight to help with the paging.
9.2.1 To page someone via the telephone:

Enter *2 and wait for tone
Enter pager number then press *
3 beeps indicate message is sent
Hang up
9.2.2 To page someone via the intranet:

This link can be found by either:
Via the Emergency Department home page – type in pager number and
message - send
Can be added to Firstnet as a link
The phones in ED have “group pick-up” and “search” facility.
9.2.3 Group pick-up:

If one of the phones is ringing, you can pick-up this call by lifting the
receiver of another phone in the area and dialling “1”.
9.2.4 Search facility:

If one of the lines is engaged or unanswered for 5 rings, the call jumps to
one of the other lines in the area.
 All REFERRAL phone calls to the department by a LMO or VMO for admission
should be referred to the Staff Specialist or CMO/Registrar in ED.

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Any communication with other teams or senior doctor in ED should be

documented clearly in the patient’s notes, especially with regards to plans or
advice given “If it hasn’t been documented it didn’t happen”
9.3 BETWEEN YOU AND YOUR PATIENT AND THEIR FAMILY
 Introduce yourself politely to the patient, and listen to what they have to say.
 Keep the patient informed of your management plan and what to expect.
 If imaging or other tests are being organised inform them as to why they are
being done.
 Again be polite and courteous.
By following these simple steps the complaints and dissatisfaction rate will be hugely
reduced. Just think of yourself in the patient’s family’s situation and what you would have
expected!
10. ADMISSIONS
ED medical staff assess and where indicated admit patients presenting to the
department. Exceptions to this are:
 Team admissions during office hours

 When workload demands assistance from ward staff.
After performing an assessment, organizing immediate management and investigations

the ED JMO should discuss the case with the ED Staff Specialist/CMO/Registrar and
agree on a differential diagnosis and management plan. If the plan is for admission then
the JMO should contact the appropriate in patient team subspecialty registrar (please
refer to “who to call” section), who should then review the patient as soon as possible
following this notification. The time that the call was made should be documented in the
patient’s notes.
Registrars should be called as early as possible about a possible admission, to prevent

delays in management. Results of investigation are not always necessary before review
by the registrar.
Surgical patients: Admitted under the consultant of the day unless specified otherwise
by the Surg Registrar. (Except those who are private and make a special request)
Medical patients: If a patient is known to a consultant or his/her team from a previous

admission for a similar issue, they are then usually admitted under the previous
consultant. If the patient is not known to a consultant or his/her team for the specific
presenting issue, then they are to be admitted under the on-call Physician of the relevant
subspecialty.

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All renal, palliative care and haematology/oncology patients attending the ED must have
their usual consultant notified while they are in the ED, regardless of whether or not they
require admission.
O&G patients: Admitted under the consultant of the day unless specified otherwise by
the O&G Registrar. (Except those who are private and make a special request)
Psychiatry patients: Admitted under the consultant of the day. (Except those who are
private and make a special request)
Paediatric patients: Admitted under the consultant of the day. (Except those who are
Orthopaedic patients: Admitted under the consultant of the day. (Except those who are
Plastics patients: Need to be discussed with the plastics/hands surgeon on-call. These
patients are managed in Auburn Hospital or a private hospital.
Urology cases: Admitted under the consultant of the day unless an Urologist on the
hospital staff already knows the patient. (Except those who are private and make a
special request)
10.1 WHO TO CALL
After hours:
(Weekends/Public holidays and between 1700hrs to 0800 hrs week days)
 Surgical Registrar for all surgical patients requiring admission.

 O&G Registrar for all O&G patients requiring admission.
 Paediatric Registrar for all Paediatric patients requiring admission.
 Acute Mental Health Team on 0429 390 579 between 0830-2230 hrs after which
the on call Psychiatry Registrar for all psychiatry patients requiring assessment
and or admission.
 Medical Registrar / On call VMO of particular subspecialty for all Medical patients
requiring admission,
During Hours:
(Weekdays 0800 hrs to 1700hrs)
The relevant team registrar needs to be contacted.
 The pager numbers are available on the communication folder on the

Communication Clerks desk in the acute area of the department.
 The VMO’s can be contacted via the switchboard.
 All phone calls to the department by a LMO or VMO for admission should be
referred to the Staff Specialist or CMO/Registrar in ED.
Once admitted, the doctor doing the admission (this could be ED doctor or the in patient
team doctor) should write up the medication and fluid charts as required.

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At this stage the CNUM should be informed of the admission.
Patients should not be transferred to the ward at any time until the appropriate
registrar or VMO (night med reg after hours) has been notified.
11. DISCHARGE
After a THOROUGH ASSESSMENT and necessary investigation, if it is deemed that a
patient does not require admission and may be managed in the out patient environment,
then the patient may be discharged.
ALL PATIENTS BEING DISCHARGED MUST BE REVIEWED BY AN EMERGENCY

MEDICINE STAFF SPECIALIST / CMO / REGISTRAR.
JMOs are not allowed to discharge patients without speaking to a senior

physician.
An ED Registrar/CMO/Staff Specialist must review patients representing unexpectedly

for the same problem within 7 days, whose conditions are not improving or whose
diagnosis remains unclear. It could be worthwhile discussing these cases with the
relevant subspecialty prior to discharge.
Elderly patients (65yrs and above) are NOT to be discharged home between 2200 and
0800, unless the patient and their family, and the medical and nursing staff, are satisfied
that they can be well cared for in their home environment.
Please also refer to Appendix 4.
All patients being discharged home from the ED require a letter for their LMO to enable
effective follow-up.
This letter must NOT be cut and pasted from the patient’s medical or progress notes but
a brief summary of their ED presentation with relevant discharge instructions.
Please make sure all cannulas are removed before discharging patients.
11.1 DISCHARGE LETTERS
All patients being discharged from the department must have a discharge letter to take to
their LMO’s for review.
All letters are written on First Net.
 It is accessed by Navigating to the Documentation section of the patient chart on

First Net.
 Select ED Discharge Summary in Type Field
 Select and highlight Discharge Referral ED template from list on Catalogue tab
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 Click on OK
In Visit Information free text under summary of care:
The information given to the GP should include:
 Presenting complaint
 Assessment - History and relevant positive examination findings.
 Investigations of relevance done (print a copy of the results
separately to accompany the letter)
 Treatment
 Follow up needed – when and what (Blood results, MCS results,
CXR etc)
Please do not copy and paste the admission notes.
In the Health status tab:

In Diagnosis - Enter the diagnosis – Essential
In results review – include investigation results
In Discharge information – click relevant advice given to the patient. e.g. “to represent if
symptoms worsen”, “Head injury advice”, “Advice regarding driving and swimming in
patients with seizures” etc
Save or sign the discharge summary. – If you save it you can come back to make
changes – e.g.: a doctor who gets handed over a patient can make changes to a
discharge letter written by the first doctor.
Print a copy for the patient.
If you are writing a referral letter to a specialist, you must ensure that your Medical
Provider Number is included on the letter.
12. CASE PRESENTATION FOR ADMISSION OR DISCHARGE

As a JMO you will be presenting / discussing all your patients with the REG/CMO/Staff
Specialist.
As a Registrar/CMO you will be discussing your cases with the ED Staff Specialist and
the In Patient team consultants regarding an admission or discharge.
The following template is to be used whenever you are presenting a case.

All the ED Consultants have agreed on this template of presentation and would expect
the presenter to follow it.
The following is an extension of the ISBAR / ISOBAR handover format
(Refer to Appendix 7 for detailed explanation of template)
 Introduce yourself (when speaking to a VMO on the phone)

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 Opening summary of the case History of presenting illness
 Relevant past medical issues
 Medication list
 Important social/person history
 On examination
 Investigations results obtained thus far
 Previous relevant investigation results on record
 Issues on presentation
 Diagnosis and possible differential
 Management plan
13. HANDOVER
The Departmental Formal Hand Over round is conducted at the patients Bedside.
The timings for the hand over rounds are:
 Morning shift handover at 0800hrs.

 Evening shift handover at 1715hrs
 Night shift handover at 2330 hrs.
 The round will be announced on the department overhead paging system.

 The ED Consultant will conduct the round.
 In the absence of the Consultant, the CMO/Registrar will conduct the
round.
 It is expected that the rounds would have a teaching focus for the
participants.
 The JMO’s will be allocated work areas and patients during these rounds.
It is a multidisciplinary round and the staff expected to attend are:
 Nursing: CNUM, Bedside Nurse

 CNE/CNC when available
 Social worker when available
 Care Navigation consultant when available.
 Medical Students.
13.1 INFORMATION YOU NEED TO GIVE WHEN HANDING OVER A PATIENT

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 Name and age
 Presenting problem
 Working diagnosis and if admitted under which team
 Brief History
 Positive Examination findings
 Relevant Investigation findings
 Management PLAN
 What needs to be followed up, i.e. Bloods, X-ray, CT, Urine ECG etc. etc.
 If all necessary documentation have been completed.
If the patient is for discharge then it is the responsibility of the outgoing doctor to write the
discharge summary before leaving the department and handing over his/her patient.
The incoming JMO should make an attempt to introduce him/herself to the patient.
It is expected that the outgoing doctor will have finished all relevant paperwork including
progress notes, medication and fluid charts as well as “Safety to Transfer” forms.
Handing these items over means that the incoming doctor has to review the patient again
to ensure no information is missed, which is not acceptable and adds to the workload
unnecessarily.
14. TRIAGE
All patients presenting to the department undergo a registration process followed by
Triage.
A senior nurse trained in the process does the triage. It is based on the medical needs
and acuity of the patient. Our department has to follow the guidelines by the Department
of Health in achieving the triage targets. The guidelines of seeing patients are:
 Triage 1: Immediate
 Triage 2: Within 10 min
 Triage 5: Within 120min
15. BED AND AREA ALLOCATION

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All JMO’s are allocated to a specific team in the department on the floor roster. The ED
Consultant/CMO/Registrar of the particular shift can change this.
You will be responsible for all Cat 2 arriving to that specific area.
You will be expected to go and see the patient immediately, and organise immediate
management / investigation / assessment. E.g. Patient with chest pain > organise
immediate ECG/Analgesia and make sure your REG/CMO/Consultant has reviewed the
ECG with you. Once that is done and the patient is stable you can go back to the task
you were completing prior to the Cat 2 arriving.
(Please refer to the daily floor roster for your team allocation in the department during
your shift.)
As a REG/CMO you will be assigned to a specific team or Fast Track on the floor rosters.
This allocation is not rigid, and all doctors are expected to help their colleagues as the
workload requires.
16. BAT CALLS TO RESUSCITATION AREA

CDA has a direct phone link to the ED and will notify the department of imminent
emergencies (eg cardiac arrests or multi-trauma). Information from such calls must be
relayed immediately to the appropriate staff. (This phone is known as the “Bat Phone”)
17. ROLES AND SERVICES WITHIN THE DEPARTMENT

17.1 FAST TRACK
The principal objective of the fast track area is to see and promptly manage
simple ED presentations (Category 4 and 5). The area is medically staffed by a
REG/CMO or a competent SRMO as well as a Fast track nurse and usually does
not need to be picked up by JMOs.
Patients designated for the Fast Track area will have a green arrow next to their
names on “First Net patient list”
Please refer to the “FAST TRACK business rules” for a better understanding.
17.2 TCA (TREATMENT COMMENCE AREA)
This area is co-located with the Fast Track area. There are 6 recliners in TCA.
Once a patient has been seen by a senior ED physician (EDSS/REG/CMO), and
if space in the area is available, the patient can then be transferred to the TCA to
receive ongoing management which might include IV analgesia, fluids, antibiotics
etc. The TCA form must be completed prior to patient going into TCA with clear
hand over to the TCA nurse.

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Please refer to the TCA business rules attached as well as protocols re

management of patients on recliners.
17.3 PIT AREA
This is a designated space in the department where patients are seen by the “PIT
TEAM C” on arrival to the department. Usually after a short triage the patients will
be taken to the PIT area for immediate assessment by the PIT team. The PIT
team will include, senior doctor (EDSS/CMO/REG), RMO, Nurse. Once the
patient is seen in the PIT they can then be streamed into TCA/Acute/Fast Track
etc as required. Rooms 26/27 or any other designated area can be used for PIT
assessment by PIT team.
Please refer to the PIT business rules for better understanding.
The Safe-T notes are not to be taken as a proper history and the JMO needs
to take a full History and examine the patient fully prior to making a
disposition plan.
17.4 CLINICAL INITIATIVE NURSE (CIN)
C.I.N is a senior nursing staff member who has gone through specific learning
objectives and can manage simple defined problems. CIN are allowed to treat
patients under the supervision of the senior physician. Their role can include
suturing, back slabs, organise bloods and other investigations as necessary
under the direction of the senior physician.
JMO’s from time to time may be asked to assist in this process by the
REG/CMO/EDSS.
Please refer to the “CIN role” document.
17.5 NURSE PRACTITIONER
The Nurse Practitioner is a senior nursing staff member who has gone through
specific training to obtain the ability to assess, treat and diagnosis patients and
discharge them home. Supervision will be provided by the Fast Track doctor and
the Staff Specialist on duty.
Please refer to “Transitional Nurse Practitioner Scope of Practice” appendix 11
17.6 PHYSIOTHERAPIST
The department has a Physiotherapist based in the unit. The role of this position
is to manage acute musculoskeletal injuries in liaison with the orthopaedic team
as well as the ED CMO/REG/Staff Specialist.
The Physiotherapist is available for assessment and advises regarding mobility

issues in the elderly population and Acute on chronic back pain in the younger
age group.
Monday to Friday: 0800 hrs - 1830 hrs

(variable) 0830 hrs – 1900 hrs
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0930 hrs – 1800 hrs

0930 hrs – 2000 hrs
Saturday and Sunday: 0930 hrs – 1800 hrs

(variable) 0930 hrs – 2000 hrs
17.7 SOCIAL WORKER
The department has a part time social worker, being available from 0830hrs –
1700hrs on pager 7699
After hours the Hospital on call social worker can be contacted.
The different issues the social worker would be able to assist with are:
Accommodation, Centre Link payment, bereavement support for distressed
families in the department
Please see Appendix 9
17.8 CARE NAVIGATION
 This service is based in the Emergency Department.

 Its main focus is to identify patients with Chronic and Complex co morbidities
 Organise early referrals for management of those conditions
 Case management of complex care needs in the acute care base as well as
in the community.
 Out come is to avoid ED Presentation and reduce representations
Monday – Friday: 0800hrs – 1630 hrs

Pager # 7529
Extension 48012
17.9 POST ACUTE COMMUNITY CARE PROGRAM (PACC)
This program attempts to reduce the number of inpatient admissions, as well as

reducing length of stay for patients who do require admission to the hospital.
Common sub groups of patients managed under PACC are:
DVT, Cellulitis, Simple uncomplicated Pneumonia
Criteria for a patient to be included on the program are:
 Reside in the WSLHD

 Treated at one of the WSLHD public hospitals
 Have access to a GP
 It is safe for the patient to be treated at home, with attendance by a nurse
to a maximum of twice a day

20
 Patients MUST be accepted by an in-patient team for discharge under

PACC and the accepting team must be clearly identified in the patient’s
notes.
Service provided by the PACC program:
 Up to twice daily visits by a registered nurse in the home, for up to 14 days

 Most types of illness can be catered for, provided it is likely that the patient
will be recovered within 14 days
 Able to administer IV antibiotics up to twice per day, to patients with IV
cannula in situ. However, these patients should have reasonable veins, in the
event that the nurse requires resiting of the canula this could be done by the
CIN or JMO
 Contact:
Page 8664 or Ext 46336
Mon – Fri 0800 - 1630 hrs

Sat – Sun / Public Holidays 0800 – 1630 hrs
After Hours 7 days: 1630 -2130 hrs

Ext 55555
17.10 AGED CARE SERVICES EMERGENCY TEAM (ASET)
ASET CNCs assess patients 70 years and over presenting to ED.
 Aim
 Assess the functional level of the patient on presentation to the department

and recommend any referral or admission to prevent a further decline.
 Prevent representation by early identification of at risk elderly patients in ED.
 ASET aim to target patients with problems with any of the following: mobility
or falls, personal care, cognition or behavior, caring or accommodation
issues, and those living alone.
Exceptions: Patients from Nursing Homes or patients being admitted to Bungarribee

House or Acute Stroke Unit.
Hours of business: 0700 – 2000 hrs Mon - Fri

0730 – 1600 hrs Sat Sun
(Alternate weekends vacant at present)
Pager numbers: 7787

7709
7631
7789 or 7514 (weekends)
21
Referrals after hours: Firstnet by clicking on power orders and searching for ASET, then
logging the referral. Liaise with the nursing team leader about this for the first few
referrals you make.
All ASET appropriate patients discharged home will receive a phone assessment the
following day or as early as possible.
17.11 URGENT REVIEW CLINIC

 This is an out patient clinic where you can organize follow up of patients being
discharged from the Emergency Department.
 The follow up will occur within 7 days and can be accessed earlier if required.
 Ensure that this has been organized after discussion with the relevant
subspecialty team consultant/Reg.
 To organize follow-up appointments please speak to one of the Clerical staff

or the Communication Clerk in the acute area. The appointments are done
through iPIMS.
 Refer to Appendix 2 to view the Business rules of the clinic.
17.12 DRUG AND ALCOHOL
During hours the D&A CNC can be contacted for referrals.
0830 – 1700hrs Monday – Friday page 22857 or 22639 (Mobile 0434 327 540)
Voice mail messages can be left on the mobile number in order to follow up any
admitted patients.
There are no in patient beds for D&A services in BMDH. If you have a patient who
needs admission you can seek advice from the on call D&A Consultant (available
via switch). Such a patient can be transferred to Nepean Hospital for a D&A
admission.
18 TEACHING AND EDUCATIONAL RESOURCES
Blacktown and Mount Druitt Emergency Department is Accredited by the College for
Emergency Medicine for Advanced training in Emergency Medicine.
Your time here will be counted towards Emergency Medicine training.
 The following are the different teaching sessions.

 All the topics and dates are published well in advance.
 You are encouraged to read up on the topic in advance to get maximum
benefit from the sessions.
22
 Presenters go through a lot of work in preparing for the topics so attendance

and participation is vital. This will be reflected on your term assessment.
18.1 REGISTRAR/CMO
 Organised by the DEMT.

 Held every Thursday.
 0830-1230.
 Paid and protected teaching time. (The names of attendee’s will be passed
onto RSU for payment)
 Blacktown ED Tutorial room
18.2 PREVOCATIONAL TEACHING (SRMO)
 Organised by Dr. Patricia Kijvanit

 Held every Tuesday and Thursday
 1400hrs – 1500hrs.
 Blacktown ED Tutorial room
18.3 JMO TEACHING (RMO/Intern)
 Organised by Dr. Patricia Kijvanit

 Held every Tuesday and Thursday , combined with SRMO teaching
 1400 hrs – 1500 hrs
 ED Tutorial room
Interns and RMO’s are encouraged to attend when possible the General JRMO training
sessions, which are held every Wednesdays and Thursdays 1300 to 1400hr in the LG
Seminar Room in the Imaging Department.
18.4 LIBRARY
 There is a small library in the Registrar Room of the Department.

 All the college recommended books for Emergency Medicine training are
available in the Departmental library.
 The books are not to be removed from the Emergency Department.
 The key is available from the executive assistant.
The University library is a short walk from the Department.
There is an Eye Educational CD and Emergency Ultrasound DVD available for loan.
18.5 ON-LINE
On the intranet, The BMDH Emergency Department “Website”, provides a wide variety of
information, both clinical and administrative, this includes paediatric and drug protocol.
23
They are constantly being updated and revised. Suggestions for improvement should be
made to the Director of Emergency Medicine.
http://wslhdintranet.wsahs.nsw.gov.au/Emergency-Medicine/Emergency-Medicine-
BMDH/Emergency-Medicine-BMDH
Through the Clinical Information Access Project (CIAP) link you can also access Harrison
on-line, Medline, Cochrane, MIMS, Poisindex and Antibiotic Guidelines.
18.6 TERM ASSESSMENT
You are assessed at mid-term and end of term.

Feedback is received prior to the assessment from all Senior Medical and Nursing Staff.
College trainee’s assessment is done by the DEMT.
18.7 MENTORSHIP PROGRAM
 The department has an active mentorship program.

 All REG/CMO/JMO will be assigned a mentor.
 It is expected that you will meet your mentor formally at least three times
during the term.
 The aim of the program is to give you a direct avenue to discuss any work or
career related, personal or departmental issues with a Consultant in the
department.
 Your mentor will also receive regular feedbacks from other senior staff in the
department and will be passing that onto you in the meetings.
 Your Mentor will be responsible for completing your term assessment
paperwork.
18.8 RESPONSIBILITY OF MENTOR
 At least 3 contact meetings lasting 5min with the allocated resident during the
term.
 To gather information from Registrars, Nurse, and Senior Ancillary staff
regarding any “on the floor” concerns.
 All problem residents to be referred to the Director of the department early on
so that appropriate measures to rectify the problems can be introduced.
 To be available to advise and guide the resident through the term.
18.9 RESEARCH AND QUALITY ASSURANCE
 Medical staffs are actively encouraged to take part in the process.
 You will be required to carry out an audit project while in the department.
Please see audit allocations as per appendix and contact your mentor within
the first 2 weeks of your term.
 Monthly M&M committee meetings are chaired by Dr Chamila de Alwis and

education sessions on them will be carried out in the relevant teaching

24
sessions for the different groups. A summary of recommendations are

available on the intranet.
18.10 UWS MEDICAL STUDENT ROTATION and TEACHING
 Medical students from the University of Western Sydney are rotated through
the department as part of the critical care rotation.
 If you would like to be involved in formal teaching of the Medical students

please inform the Director of the department.
 University conjoint appointment is a possibility.
 During your work in the department a student might be assigned to you in

order to “shadow” you.
19. MEDICO-LEGAL ISSUES

All notes and documentation have to be done on First Net.
Medical notes must be legible and contain the following information:
 Time seen and date (at every new entry.)Time stamp your documentation i.e.
start writing as soon as you start seeing the patients and sign off once finished.
You can always add on other things as an addendum: later reviews, more
information etc. If you are unable to write for a long time, ensure that you write
that you are writing in retrospect and document the time you saw the patient
first, referred the patient etc. Ensure you document the name of the person you
made the referral to.
 Presenting symptom
 Physical examination
 Differential diagnosis
 Management plan
 Tests performed
 Senior medical officers, or allied health staff contacted
 Time of discharge
 Doctor’s signature
 Entries should be in a “problem based medical record” format (see website).
19.1 POLICE STATEMENTS
Police statements may be required from time to time. If you receive a request for one,
refer this in the first instance to the medical records department. You can only put in a
police statement what YOU did for the patient. It is in your interest to complete the
statement as soon as possible. The alternative may be a court subpoena.

25
For clarification please discuss the statement with the Director of the department.
19.2 CHILD ABUSE
The paediatric registrar usually handles Child abuse cases. However, sometimes the ED
RMO will be required to perform the assessment (at least the initial recognition of the
problem). Coagulation studies, X-rays (indexed with the patient’s name, date and a 10cm
reference marking) provide useful supportive documentation.
19.3 NEEDLE STICK INJURIES
Adequate precautions must be taken when there is a risk of contacting patient’s blood or
other body fluids. Gloves must be worn when taking blood or inserting IV cannulas.
Goggles should be worn as the situation indicates. The “Vaccutainer” system is
generally used for the safe sampling of blood. A protocol exists for the management of
needle stick injuries. All such injuries occurring in the hospital are managed through the
ED.
19.4 ABNORMAL RADIOLOGY
Abnormal Radiology results from the ED are generally checked, and followed up on by
the ED Staff Specialist on the day shift. See “Alert BT” folder, Picture Archiving System
(Digital Radiology System). Patients are not requested to return merely for the follow-up
of routine results.
19.5 TEST RESULTS
Test results are not given to patients over the telephone. They may however be given to
the patient’s LMO, after checking the number and calling them back.
Information should not be given to family or friends without first checking with the patient.
19.6 MEDIA INQUIRIES
Inquiries from the media are referred to the hospital’s executive director. After-hours
these should initially be referred to the executive on-call.
19.7 POLICE REQUESTS
Please co-operate with police requests, provided patient care is not compromised.
Telephone inquiries should first be handled by obtaining the officer’s name, station and
phone number. The number can then be independently checked, and the return call
made.
19.8 BLOOD ALCOHOL SAMPLING
Patients requiring a forensic blood alcohol sample to be collected include:

Any patient aged 15 years or above who presents to an emergency department for
treatment within 12 hours of a vehicular accident, occurring on a public road. The test is
26
required for any patient who was the driver of a vehicle (includes cars, cycles – motor or
pedal), was in control of an animal, eg a horse, or a pedestrian.
There are special kits for this purpose. The samples must be collected in accordance
with the enclosed instructions and the sample placed in the designated police container.
Consent is not required for the collection of this sample. It is a statutory requirement. If
a patient refuses to allow the sample to be collected then the local police station needs to
be contacted and this must be clearly noted in the patient’s record.
19.9 RECTAL AND VAGINAL EXAMINATIONS IN FEMALES
Rectal and/or vaginal examinations on any patient require a witness to be present.

Please ensure a chaperone / Nurse is present.
When in doubt, SPEAK TO YOUR REG / CMO / CONSULTANT.
19.10 DUTY OF CARE
Remember your duty of care. Patients who are not lucid, or who are potentially not lucid
(and children < 14 years), may be detained and treated, to protect them from
themselves.
Do not assume that confusion in the intoxicated head injured patient is purely due to
intoxication.
Beware of the “labelled” patient.
19.11 WORK COVER
A “Work Cover” certificate should be completed on the initial consultation for a patient
who has been injured either on the way to or from work, or while at work. The form is
given to the patient once a copy has been made for the patient’s notes. Additional
certificates for the same condition may be supplied, but require only the standard medical
certificate to be completed.
19.12 “RE-PRESENTATION” OF PATIENTS
Patients re-presenting to ED (from any Emergency Department) with in 1 week should be

reviewed by a senior doctor.
20. GENERAL HOUSEKEEPING
Sharps Ensure that all sharps are disposed of properly in the

YELLOW BINS
Blooded Instruments All blooded instruments are to be rinsed and placed in the
blue box under the sink in the pan room, for sterilisation.

27
Plaster All residual plaster should be placed in plastic bags in a

bucket. It is not to be emptied into the sink.
IV Trolleys No blood is to be left on IV trolleys.
Faulty Equipment Report any equipment that is faulty or broken to

Maintenance staff.
It is imperative that any equipment or surface used is cleaned after use.
Meal Breaks It is your responsibility to ensure you take your meal break
at a timely fashion. The break is generally for 30min. It is
encouraged that you have your meals in the tearoom of the
Department. If leaving the department to go to the kiosk to
buy something please ensure that the Consultant or
REG/CMO is aware of you leaving.
Lockers Limited numbers of Lockers are available. Please contact

Ms.Joan Brown (Executive Assistant) to organise one for
yourself. If none are available it is safe to keep your bags
under the desks in the acute area. If using this option
please do not leave any valuables in bags, it might get lost.
Toilets Designated Staff toilets are located next to the tutorial room
Dress Please ensure that your appearance is neat, clean and tidy
reflecting the demeanor of a physician.
All doctors should wear Green Scrubs. These can be

ordered through the Executive Assistant.
Your ID badge must be worn and be clearly visible at

all times.
Parking Please do not park outside the emergency department.

This is to be kept clear for ambulances and other
emergency vehicles. It is also reserved for emergency and
disabled patient parking.
There are designated staff parking areas and access to
these is via your ID badge.
21. COMPLAINTS AND DISPUTES

Disputes between staff over any work or personal issues should NOT BE conducted in
front of patients. If reasonable discussion does not resolve the problem, it should be
referred to the Staff Specialist of the shift or the Director at an appropriate time.

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22. DISASTERS
The “Disaster Manual” indicates what to do in the case of fire, armed hold-up, bomb
threat, external disaster, cardiac arrest, and evacuation. During your term at Blacktown
Hospital, it is quite possible that you may be involved in one of these (mock or
otherwise). Please read the manual, and become familiar with the equipment in the
disaster packs. (Ask to be shown through these).
The Manual can be accessed from the Executive Assistant of the department
23. ANCILLIARY SERVICES
23.1 PHARMACY
0830 to 1700, on site 5 days per week.
On call after hours.
Hospital Administration encourages patients to have their prescriptions filled externally.
23.2 PATHOLOGY
24 hours per day 7 days per week on site.
 ABG’s are done within the department. Medical staff to organise training
and access to this machine as soon as possible. There are staff in the
department who can organise this training
Please notify biochemistry prior to sampling for ABG’s after hours.
 Printed labels are used on all blood samples except the group and hold
sample.
 Please hand write your employee number and date on each printed label
prior to attaching onto tubes.
 Ensure you are aware of how to attach the label onto the tube. (Ask a staff
member)
 Label blood specimens at the bedside, immediately after obtaining the
sample.
Results should generally be accessed via FIRSTNET/Cerner Powerchart.
Specimens are sent via pneumatic tube in the ED. Please ask a staff member regarding
how to use the tube.
23.3 RADIOLOGY
If a radiology service is not available at Blacktown Hospital, Westmead Hospital is to be
contacted in the first instance. If the service is unavailable at Westmead Hospital, private

29
imaging centres or another public hospital may be contacted. (A list of private centres is
available in the ED).
In general, if a patient is discharged, further investigation should be organised by the

patient’s LMO.
Out of hours investigations are expensive, and must be for genuine emergencies
only.
The radiology department provides the following services:
a) Plain Radiographs
24 hour service, with patients requiring a nurse escort after hours.
b) Contrast Radiography
0800 to 1600 Monday to Friday, IV and oral contrast studies are available. You
need to ring radiographer to book patient.
c) Ultrasound
 0800 to 1600 on site Monday to Friday

 Studies provided include abdominal, pelvic, transvaginal, testicular, venous,
thyroid, foreign body location, and examination of limb fluid collections.
Examination of joints is not available.
 After hours ultrasound is available in the Emergency Department, for emergency
patients, during the following hours:
Saturday & Sunday: 1200 – 2000
Monday – Friday : 1700 - 2300
NOTE: Transthoracic Echocardiography available through Cardiology team only
Obstetric ward has a portable ultrasound, which at times is available,

including after hours.
d) CT Scanning
 Available 24/7
 After 1700hrs the CT scan films are sent to an off site service “Tele Rad” for a
formal report. The report should be available within 1 hr of the images been sent
to “Tele Rad”
 Once completed the formal results are faxed back to the ED.
 To avoid delays please ensure that the films have been sent online to “Tele Rad”
 If you are not sure what type of CT the patient needs speak to the on call
radiologist at Tele Rad for advice.
e) MRI
30
 0630 to 2400 on site Monday to Friday

 EDSS provider number can be used to access the service.
 Patients can have this investigation as an out patient as well in which case they
would need a formal request form with the EDSS provider number on the request.
23.4 INTERPRETER SERVICE
Health Care Interpreter Service (HCIS) should be called for all patients where it is
ascertained that the patient requires assistance in understanding English. They are
available 24 hrs a day, 7 days a week on 9840 3456. (This contact with the service
should be done as soon as this situation is recognised. It is inappropriate for the
notification to be delayed until the treating doctor sees the patient. While awaiting the
interpreter, other resources such as family and friends may be used. However,
regardless of this assistance, the information should be double checked with the patient
once the interpreter arrives.
NOTE: A phone interpreter service is also available when the timely physical presence of
an interpreter is not possible.
24. FORMS AND DOCUMENTATION

 All clinical documentation is to be done on First Net electronically.
 Formal orientation to Cerner and First Net will be provided prior to your
commencing the term.
 All relevant ordering of test and services are documented and done on Cerner.
 Medical staff are required to enter certain data into FIRSTNET. This includes
“Time and Date Seen”, “Diagnosis”, and “Departure Status”
 This should be done accurately. We are monitoring closely the waiting time.
 If the discharge summary is not completed correctly in Firstnet doctors will be

requested by HIRS to complete all paperwork before the end of term.
 The “ED PATIENT HANDOVER DOCUMENT” must be completed prior to patient

going to the ward. This form is completed by the JMO/REG/CMO organising the
admission and counter signed by the shift senior REG/CMO/EDSS
 For patients who have a ceiling on their management and are not for
Resuscitation, the “Advance Care Planning document” must be completed. Refer
to Appendix …. For the form.

31
 All addendum to a medical record are documented in the initial clinical notes of
the patient so that there is a definite chronological order to the patient’s
assessment and documentation.
25. MANAGEMENT POLICY AND PROCEDURES

 This is being constantly updated.
 All finalized policies and procedures are available on the INTRANET web page of
the Department.
http://swahsintranet.wsahs.nsw.gov.au/Emergency-Services-Blacktown-Mt-Druitt/default.aspx
 Please ensure that you are familiar with the current policies.
 Any changes to the existing documents will be notified to the Medical staff via
email.
26. OUTPATIENT REFERRALS TO SPECIALITY CLINICS
Please see intranet regarding the paperwork required and processes involved
27. CONCLUSIONS
This orientation handout attempts to cover some of the common issues relating to the
functioning of the Emergency Department. However, it cannot hope to cover all aspects
of ED practice.
If there are other important points for medical officers, which should be included in the
guide, please inform the Director of Emergency Medicine.
Protocols exist for guidance only. The rules they set down may be broken, provided the
person breaking them knows why they are doing so, and can justify such actions.

32
Appendix 1
Urgent Review Clinic – Business Rules

(Note, in previous drafts we used the name “Ambulatory Care Unit”, but URC has now
been adopted to avoid confusion with other Ambulatory Care Services)
Purpose of URC
The Urgent Review Clinic is intended to provide an alternative to inpatient care for
patients who have presented to Blacktown/Mt Druitt Hospitals with an acute management
issue. It provides timely access to care by a specialist team for urgent management.
URC care is for short‐ term management only and patients should be discharged or
transferred to appropriate long‐ term follow within 2 weeks of the initial visit to URC. In
the second phase of its operation URC will also provide a day procedure service.
Patient Selection
1. Patients recently discharged from Blacktown or Mt Druitt Hospitals (within 7 days)

who require clinical review for issues pertaining to their admission problems
2. Patients referred from the Emergency Department of Blacktown or Mt Druitt Hospitals

after an initial ED assessment, and after discussion with a relevant consultant
medical officer.
3. Patients referred from Aged Care Facilities or the PACC Team, if their care has been
discussed with and accepted by a Consultant Medical Officer.
Referral Process
1. Patients must be seen in the URC within 7 days of discharge from hospital or
presentation to ED.
2. Planning for URC review must be documented in the patient medical record and must
be agreed by the managing medical/surgical team (consultant or registrar). The
specific purpose of URC review should be documented.
3. Appointments will be made using the iPIMS system and the clinician responsible for
attending the appointment (e.g. Registrar) must be informed at the time the booking
is made.
Communication and Discharge

33
1. All episodes of care in URC must be recorded in the patient medical record. The
clinician attending the patient should also consider appropriate communication (letter,
electronic or telephone) with the patient’s General Practitioner.
2. Patients may be rebooked for attendance at URC, but plans should be made for
discharge within 2 weeks (to appropriate long‐ term follow‐ up in consultant rooms,
outpatient clinics or General Practice, as needed).
3. If a patient reviewed in URC is deemed to require admission a Request for Admission

form should be completed and the Patient Flow Office informed urgently. If possible a
ward bed will be allocated for direct admission. In an emergency situation the patient
will be transferred to the Emergency Department.

34
Appendix 2
Early Pregnancy Assessment Clinic for Blacktown Emergency Department

Patient presents with a problem related to her early pregnancy
Gestation < 18 weeks
Patient triaged as Category 1 or 2 Patient triaged as Category 3, 4 or 5
Patient placed in a bed in ED or Referred to C.I.N. Nurse

Resuscitation Room
High Risk Low Risk
PV Bleeding > normal period PV Bleeding <or=normal period

ED Assessment O & G Registrar
Abdominal Pain present No Abdominal pain present
contacted
Previously sterilised Not Previously Sterilised
Previous ectopic pregnancy No previous ectopic pregnancy
History of fallopian tube disease No known fallopian tube
Fertility treatment conception disease
Normal conception
Contact O & G Registrar Patient chooses referral to Patient chooses to
on pager 3911 and arrange direct EPAC-REAT nurse collects wait to be seen by
transfer for gynaecologist ward. blood for BHCG and Group emergency doctor.
and hold.
Updated 24/01/17 34
36
Appendix 3
AGED CARE SERVICES EMERGENCY TEAM
Hours of business: 0700 – 2000 Mon - Fri

0800 – 1630 Sat Sun
Pager numbers: 7787 / 7709 / 7631 / 7789 (weekends)
Referrals after hours can be left on phone 47602 with patient details.
All ASET patients discharged home will receive a phone assessment as early as possible
ASET staff: CNC, CNS, RN’s, Allied health, home physio service available
ASET conduct a full aged care assessment of patients over the age of 70 years that present to the
Emergency Department. This includes mobility, falls, functional, cognitive, nutritional, elimination,
environmental, social, medications, carer issues, skin integrity and others as applicable
Referrals can be made to internal departments as well as external service providers eg. Homecare,
Compacks, Meals on Wheels,
If a Care Navigation patient over the age of 70 requires an aged care assessment this occurs in
consultation between the two services
Patients are prioritised with those having potential for discharge being seen first. Residents from
Aged Care Facilities can be reviewed if required by the Emergency Department team. Mental
Health and Stroke patients are referred in the first instance to the respective staff but can be
reviewed upon request.
The aim of ASET according to the Department of Health, 2007, is to improve the clinical care and
management of older people who present to Emergency Departments using the principles of
dignity, respect, equity, participating in decision making, a multidisciplinary approach, all with an
aged-care focus
Aged Care Facilities have 3 levels of accommodation:

1. IDLU (Independent Living Unit): No nursing support or supervision. Clients must be independent
in all care needs. Do not discharge patients after 2200hrs.
2. Hostel or Low Level Care: Clients should be independent with mobility and personal care and are
assisted with cooking, cleaning etc. Minimal nursing support given during day, often no support after
hours. Do not discharge patients after 2200hrs, call staff before discharge.
3. Nursing Home or High Level Care: 24 hour nursing and supervision with all cares and mobility.
Patients may be discharged after 24 hours, call staff before discharge.
Updated 24/01/17 36
37
Appendix 4
Medical Emergency Team (M.E.T.)
For MET calls in the Emergency Department, the ED Registrar is the Team Leader.
Other members of the MET team are:
Mt Druitt Blacktown
Day Night Day Night
Team Leader ED Registrar ED Registrar ED Registrar ED Registrar
M.O.2 ICU +/- MR ICU +/- ICU +/-
Anaesth Reg Anaesth Reg Anaesth Reg
M.O.3 Card Reg Ward RMO Card Reg / MR +/- Ward
MR RMO
A.L.S. RN Coordinates Coordinates Coordinates Coordinates

Nursing Nursing Nursing Nursing
Ward RN 1 “Airway”
2 “Procedure”
3 “Scribe”
ADON Coordinates
floor
Wards Person  Runs

pathology
 Accesses
lift
Updated 24/01/17 37
38
MET’s are called (dial 111 and say “Code Blue”) for the following reasons –
1. Airway Threatened
2. Breathing Resp Arrests
RR < 5 or > 36
3. Circulation Arrests
PR < 40 or > 140
SBP < 90
4. Neuro Sudden fall in GCS > 2 points
Repeated or prolonged seizures
5. Other Any patient about whom there is serious worry.
The idea is clearly to encourage the early detection of deteriorating patients in a “no blame”
culture.
Updated 24/01/17 38
39
Appendix 5
CASE PRESENTATION TEMPLATE
TO BE FOLLOWED WHEN JMO’s PRESENT CASES TO REG/CMO/EDSS/VMO or the
REG/CMO PRESENTING TO EDSS/VMO
1. Introduce yourself:
 I am Dr……… an SRMO at Emergency
2. Opening Summery of the case :
 I need to discuss a 60 year old gentleman with possible community acquired pneumonia who
needs admission for IV fluid, Antibiotics and Oxygen.
3. History of Presenting Illness:
4. Relevant Past medical issues:
5. Medication List:
6. Important social / personal history:
7. On Examination:
 General Appearance > SOB at rest or Comfortable
 Observation > HR, B/P, RR, Sat on Room Air or O2,Temp
 Spirometry /PEFR
 Chest exam finding
 Other systemic examinations if Relevant, Abdomen/Cardiac/Neuro
8.Investigation results obtained thus far:

 CXR
 ABG
 FBC,UEC,LFT
9. Previous relevant Investigation Results on Record

 Last Sputum MCS
 Last CXR finding
10. Issues on Presentation

Hypoxia
Acute Renal Impairment
Sepsis (Hypotension, Tachycardia)
11. Diagnosis and Possible Differential
12. Management Plan

 IV Antibiotics
 Oxygen
 IV Fluid at 125ml/hr
 Ward Bed/HDU Bed
Updated 24/01/17 39
40
Appendix 6
ADVANCED MEDICAL PLANNING FORM
To be completed for any patient who is “Not for Resuscitation” or has a ceiling on treatment imposed
Updated 24/01/17 40
41
Updated 24/01/17 41
42
APPENDIX 7- SAMPLE OF DAILY FLOOR ROSTER –
Updated 24/01/17 42
43
BDH - ED MONDAY 14th December 2015
In Charge Day
0800 -
TEAM A - 47130 TEAM B - 47987 TEAM C - 47988
1830
Staff
Specialist
Registrar/
CMO
Fast Track Day
In Charge Evening
1400 -
2400
Staff
Specialist
Registrar/
CMO
Fast Track Evening
In Charge Night
2230 -
0830
Registrar/
CMO
Staff Specialist On Call
Registrar On Call Night
JMO on call night
Nurse Practitioner
Physiotherapist
Updated 24/01/17 43
44
APPENDIX 8
SOCIAL WORK REFERRALS
Referrals can be made to the Social Work Department on

Pager 7699
Monday – Friday: 8:00am – 4.30pm
Refer via E-consult to pager 7699. E-Consult request must contain the reason for referral, and a contact
page or number for the referrer.
The following issues need automatic referral to Social Work:

 Sudden Death
 Domestic Violence
 Child at Risk or suspected of being at risk of harm (You are still a mandatory reporter,) however social
workers can be involved in following up some cases)
 An unwell patient who will be cleared for D/C but has no where to go/ stay upon D/C.
 A patient who is a carer but has no- one to help care for their care recipient whilst they are in hospital.
The following may be referred to Social Work if the issues are causing distress or are
complicating discharge.
 MVA/Trauma where Patient/family/friends are unusually distressed

 MVA Trauma where other family members/ victims known to the patient have been injured or transferred
to other hospitals.
 Grief & Bereavement / Counseling
 Homelessness / Accommodation
Mental Health and Drug and Alcohol issues-refer to Mental Health and Drug and Alcohol teams.
If you have trouble contacting SW, you can contact another Social Worker via the Social Work Crisis
pager (7725). Please allow time for the ED Social Worker to reply to the page before paging a
different number.
Weekends: A Social Worker is available Saturdays and Sundays from 10am-4.30pm. Contact is
via Blacktown Hospital Switch
Updated 24/01/17 44
45
APPENDIX 9
NURSE PRACTITIONER
SCOPE OF PRACTICE:
All patients over 16 years of age presenting with the following conditions:
� Upper and lower limb musculoskeletal Injuries not meeting the trauma criteria / open and
closed fractures / underlying structure damage (open and closed) / sprains and strains
� Lacerations and wounds including retained foreign body not meeting the trauma criteria /
with no self-harm / may have underlying structure damage
� Cellulitis - not systemically unwell / not bilateral
� Bites and stings- not systemically unwell
� Deep Vein Thrombosis- patients who have a definable cause related to travel, recent
surgery, immobilisation etc…
� Mild to moderate Asthma
� Mild to moderate URT symptoms - not systemically unwell
� Mild to moderate LRT symptoms - not systemically unwell
� Vomiting in Early Pregnancy - not systemically unwell
� Acute nausea and vomiting - not systemically unwell / <50 years
� Acute diarrhea - not systemically unwell / <50 years
� Mild corneal abrasions and conjunctival or corneal foreign bodies
� Splash injuries to eye/s
� Conjunctivitis
� Mild head injury- no LOC / GCS 15 / <55 years / not intoxicated / no anticoagulant therapy
� Acute sore throat
� Acute earache
Updated 24/01/17 45
46
� Acute foreign body in external auditory canal
� Localised Soft Tissue Infections or Collections
� Urinary symptoms- not systemically unwell
� Symptoms suggestive of STI
Updated 24/01/17 46
47
Updated 24/01/17 47
48
APPENDIX 11
Emergency Department Senior Assessment and Streaming
The Emergency Department Front of House Model of Care EDSAS encompasses clinical
assessment, clinical streaming and initiation of clinical treatment.
Objectives of Streaming:
Right patient to the right area of the Department

1. Patients seen on arrival.
2. Senior clinician input on arrival.
3. Waiting time should be less than 10 minutes. (Time taken for triage//registration//paperwork
to be available)
4. Once seen and management plan commenced patient to be sent to different MOC in the
department
a. Acute area
b. Fast Track
c. Treatment Commenced Area
d. Emergency Department Short Stay Unit
The Front of House Staff includes:
Triage Nurse:
The Triage nurse is part of the Front of House Team. This role is a senior nursing position within
the department and any staff member allocated into this position must have completed and be
proficient in resuscitation nurse role, advanced life support (ALS), triage and undertaking of the
Clinical Initiative (CIN) role is desirable. This roles criterion includes:
1. Assessing of patients presenting and allocating patients appropriate Triage category
pertaining to their presenting problem
2. Triage as per the ATS Guidelines
3. Once patient flow through the department has improved ED will move to Quick triage system
to optimise this model.
Streaming Coordinator:
The role of the Nurse Streaming Coordinator (SC) is an integral part of the flow of the
EDSAS model of care and will work in unison with the CNUM for overall process and patient
flow governance. Specifically this will involve coordination of care through the front end
processes. The registered Nurse must have completed all ED pathways.
This roles criterion includes:
1. Tracking the progress of patients care
2. Initiation of actions to address delays in the flow of patients
3. Streaming patients to the correct patient care areas
Updated 24/01/17 48
49
4. Ensure no bottlenecks occur at Triage
5. Ensure streaming team maintain agreed timeframes
6. Support streaming team in times of high activity
7. Escalate changes in patients condition through regular rounds of streaming areas and
waiting room
8. Liaise with key ED roles: Triage Streaming medical officer ED CNUM
Rapid Emergency Assessment Team Nurse (REAT)
The REAT nurse is part of the Front of House Team. This role is a senior nursing position within
the department and any staff member allocated into this position must have completed and be
proficient in resuscitation nurse role, advanced life support (ALS), triage and undertaking of the
Clinical Initiative (CIN) role is desirable.
This roles criterion includes:
1. The REAT nurse will assess patients unable to be allocated an acute bed due to
overcapacity of department including patients who are on Ambulance stretchers. These
patients may present with Chest Pain, Sepsis, Acute Asthma, Trauma etc. Assessment
includes ECG, administration of medications/fluids, reassessment of vitals and trauma care.
2. Becoming the 2nd Triage Nurse during ambulance/walk-in presentation Surge times
3. Relieve Triage nurse, resuscitation nurse and Clinical Nursing Unit Manager (CNUM) if
required
4. Carry resuscitation nurse role if 2nd resuscitation patients presents
5. Can carry the Medical Emergency Team (MET) Page – ALS trained and certified
6. Oversees Mental Health patients including over census admissions awaiting MH beds,
patients awaiting reviews, “specials” allocated to MH patients and administration of
medications.
Clinical Initiative Nurse (CIN)

The CIN role is part of the Front of House Team. The primary purpose of the CIN role is to provide
nursing care to patients in ED waiting rooms. This role is a senior nursing position within the
department and any staff member allocated into this position must have completed and be
proficient in resuscitation nurse role, advanced life support (ALS), triage and CIN competencies.
The role priorities are:
1 Clinically reviewing patients to determine if they require care escalation
Updated 24/01/17 49
50
2 Communication with patients and carers regarding their waiting time and provision of
relevant education on their health issues
3 Reassessment of patients following triage with a view to initiate diagnostics or

treatment (with a set end point, which is defined by the CIN protocols)
4 Appropriate referral of patients to suitable services, which may be external to the ED

(e.g. MAU, EPAS)
PIT
PIT is where the clinical streaming of patients commences. No Category 1 patients will be
streamed through this model. Cannulation skills is not a requirement for the Enrolled Nurse
allocated to this role however the EN must be medication endorsed.
Objectives of the Team
1. Assessment of patients on arrival

2. Commence management plan
3. Continue to be the “primary provider” for the patient during their stay in ED
4. Follow up on any investigations sent.
5. Disposition plan
6. Minimal time wasting
7. Use of Emergency department Senior Assessment and Streaming (EDSAS) objectives
Expected Role of the JMO in PIT
1. Assessment of the patient.

2. Carry out any procedures that might be required including cannulation and to obtain blood
samples.
3. Order relevant investigations online including imaging tests.
4. Chart stat dose of medication (i.e. Antibiotics and Antiemetic’s)
5. Completing the PRN chart for analgesia if required so that this can be given in the
Treatment Commenced Area (TCA).
6. Completing necessary documentation.
7. To continue looking after the patient while the patient is in the TCA.
Expected Role of the Staff Specialist /SRMO in the Team
1. To asses patients in the pit area and provide guidance to the management plan of the
patient.
2. Supervision of the JMO in the PIT area.
Expected Role of the Nurse in PIT
1. To bring the next patient into the PIT from the waiting room or Triage room.
2. Carry out necessary tasks including obtaining a set of Observations
Updated 24/01/17 50
51
3. Necessary procedures as requested including ECG, Spirometry, Urine sample for Dipstick,
wound swabs, slings, bladder scan, Fluids, Antibiotics, Analgesia etc as charted by the
medical officer.
4. To take patient from the PIT area to the TCA following completion of the designated tasks.
5. Brief hand over to the Registered Nurse in TCA regarding management plan.
Treatment Commenced Area (TCA)
TCA comprises of 6 recliners and is where the ongoing clinical management of the patients
continues. Category 2 patients may be streamed through this clinical area post - acute review. The
Registered Nurse allocated to this area must have completed the Transition to Emergency Nursing
Practice and ED Resuscitation Training and have cannulation and venepuncture skills.
Expected Role of the ED REG/CMO in the Team
1. Ensure that the circulation of patients in the TCA is maintained and patients are being
admitted or discharged from the TCA.
2. Assist the JMO in documenting / charting / ordering.
Expected Role of the Registered Nurse in TCA
1. Continuation of above treatment and management plans

2. Liaise with the medical team (as designated on Firstnet) regarding the management plan of
each patient.
3. Co-ordinate with imaging regarding X-Ray, Ultrasound and CT’s pending.
4. Inform the medical team as soon as possible of the following
a. Investigation results are obtained,
b. In patient team have reviewed the patient and decided on a plan.
5. Prepare patients for theatre as required
6. Initiate referrals to appropriate services ie; Care Navigation, ASET, Occupational Therapy,
Physiotherapy, Social Work
7. Escalate the deteriorating patient to the CNUM.
8. Enlist the assistance from the Fast Track nurse in busy periods.
Fast Track (FT)
Fast Track area refers to both the model of care and designated assessment and treatment space
that will be utilized to manage a particular cohort of Emergency Department (ED) patients. Patients
streamed into this model of care will be managed in a separate, designated area by a dedicated
multidisciplinary team. This team will consist of medical, nursing and allied health staff capable of
independently managing and discharging the majority of patients. The area consists of 6 recliner
chairs. A fundamental goal of this model of care is to facilitate the safe and appropriate
assessment, management and discharge of all patients within this model within 4-hours of arrival.
In order to achieve this goal, it is imperative that only those patient that meet the inclusion
criteria and none of the exclusion criteria are streamed to the FTMOC.
Updated 24/01/17 51
52
The Fast Track Team Leader role is a senior nursing position within the department and any staff
member allocated into this position must have completed and be proficient in resuscitation nurse
role, advanced life support (ALS), triage and CIN competencies and or a Nurse Practitioner.
Emergency Short Stay Unit

This will be for patients who will require prolonged workup or extended observation in the
Emergency Department. These patients should be recognized early and admitted to short stay unit.
This will free up acute beds in the ED ensuring continuous flow and processing of patients leading
to improved KPI’s for off-stretcher times, doctor seen times and NEAT targets. The EDSSU area
comprises of 4 recliner chairs.
Updated 24/01/17 52

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D: /Manuals/Medical Officer Orientation Information-Blacktown

.9 Rectal and Vaginal Examinations in Females

D: /Manuals/Medical Officer Orientation Information-Blacktown

1. GENERAL DESCRIPTION AND PHILOSOPHY

In addition, the Emergency Department provides primary care to non-acute ambulatory

D: /Manuals/Medical Officer Orientation Information-Blacktown

2. GOALS & OBJECTIVES OF TERM

 To gain broad experience in the management of adult and paediatric

 To develop and enhance resuscitation and procedural skills.

 To further the ability to work in a multidisciplinary team

 To develop a high standard of documentation in clinical recording

 To participate in continuing education

 To enhance communication skills with colleagues, patients and relatives

 To develop skills in the efficient and appropriate use of investigations.

D: /Manuals/Medical Officer Orientation Information-Blacktown

Director Emergency Medicine Blacktown and Mt Druitt Hospitals

A/Prof Reza Ali

Deputy Director Emergency Medicine Blacktown and Mt Druitt Hospitals

Emergency Medicine Consultants

Emergency Medicine VMOs

Ms. Joan Brown

Nursing Unit Manager 3

Ms. Colleen Mullens

A/Clinical Nurse Educator

D: /Manuals/Medical Officer Orientation Information-Blacktown

A/Clinical Nurse Consultant

4. BLACKTOWN EMERGENCY DEPARTMENT FLOOR AREA

When there is no ED Physician on the floor, there is a rostered on call ED Physician

 Once the roster is finalised and published, JMO’s/REG/CMO must arrange

D: /Manuals/Medical Officer Orientation Information-Blacktown

D/DB 0800 -1830 D/DM 0800 - 1830

All rosters and ED messages will be sent to you via email.

D: /Manuals/Medical Officer Orientation Information-Blacktown

9.2 WITHIN THE DEPARTMENT AND THE HOSPITAL

Available forms of communication include, telephone paging, electronic documentation,

a. Check that the paged number is correct.

9.2.1 To page someone via the telephone:

9.2.2 To page someone via the intranet:

The phones in ED have “group pick-up” and “search” facility.

9.2.3 Group pick-up:

9.2.4 Search facility:

D: /Manuals/Medical Officer Orientation Information-Blacktown

Any communication with other teams or senior doctor in ED should be

9.3 BETWEEN YOU AND YOUR PATIENT AND THEIR FAMILY

 Team admissions during office hours

After performing an assessment, organizing immediate management and investigations

Registrars should be called as early as possible about a possible admission, to prevent

Medical patients: If a patient is known to a consultant or his/her team from a previous

D: /Manuals/Medical Officer Orientation Information-Blacktown

10.1 WHO TO CALL

 Surgical Registrar for all surgical patients requiring admission.

The relevant team registrar needs to be contacted.

 The pager numbers are available on the communication folder on the

D: /Manuals/Medical Officer Orientation Information-Blacktown

At this stage the CNUM should be informed of the admission.

ALL PATIENTS BEING DISCHARGED MUST BE REVIEWED BY AN EMERGENCY

JMOs are not allowed to discharge patients without speaking to a senior

An ED Registrar/CMO/Staff Specialist must review patients representing unexpectedly

Please also refer to Appendix 4.

11.1 DISCHARGE LETTERS

All letters are written on First Net.

 It is accessed by Navigating to the Documentation section of the patient chart on