I have worked in hospitals all over the world and there is one constant, all of the departments within the hospital don’t like the Emergency Department (ED). There are many reasons for this but one might be that ED wants to get rid of the patients to reduce their workload and the wards don’t want the patients as it increases their workload. So how can we improve relations. I see the answer in reducing the workloads for both parties by improving communication and processes. An example of this might be a structured handover before the patient arrives on the ward so that the staff have time to prepare. Maybe a checklist could be completed before leaving the ED to ensure that the patient is correctly packaged and is safe to be managed outside of the ED. It might help in small ways to bring in new processes like this in isolation but wouldn’t it be better the review the transfer of patients within deportments as one process and improve many aspects at one go?
Inspired by Dr Brazil’s work at the Royal Brisbane and Womens Hospital on the transfer of patient to the Cardiac Catheterization laboratory I decided to create a scenario of the transfer of a patient from Queensland Ambulance Service (QAS) to ED then on to Intensive Care (ICU).
The Team that made it possible:
- Emergency Educator
- ICU Educator
- Medical/Surgical Educator
- Emergency Consultant
- Laerdal Rep
- SimMan 3G
For the simulation to work needed access to the staff and facilities of the Emergency Department and to the ICU. This was made possible with the excellent working realtionship that I have with their educators. In their respective areas they were able to supply all of the equipment and staff that were needed, and during the debrief they were instrumental in highlighting critical incidents from the scenario. Laerdal Medical kindly provided a SimMan 3G and the Laredal Rep Ronan kindly agreed to drive the manikin for me.
Patient journey Scenario:
Patient: Des McManus
Intensive Care Paramedic calls Emergency Department early warning phone -to advise transporting 24yr old male post Pulseless Electrical Activity (PEA) arrest now has Return of spontaneous circulation (ROSC). ECG shows Atrial Fibrilation (AF). Observations are stable although the patient is hypotensive. Estimated time of arrival 5 mins.
On arrival the 24 yr old male is being manually ventilated with second bag 1 ltr 0.9% Saline running. Patient has had I round of CPR followed by adrenaline 1mg.
- Assess patient
- Appropriate Treatment and intervention
- appropriate referals
- Package patient for safe transfer to intensive care
- Admit to ICU
Des is a 24 yr old male McDonald’s worker. His family say that he has been complaining of a sore throat headaches and fevers for a few days. He went to his GP who started him on oral antibiotics. Des was at work this morning when he collapsed. He is a non smoker but his father had a heart attack in his 50s.
Props and Gear:
- Emergency Resuscitation bay and equipment
- Intensive Care Bed and equipment
- EDIS/DEM Record
- QAS 12 lead ECG–AF
- DEM 12 lead ECG–AF
- Clothing for Des.
- Emergency Reus team
- ICU medical and nursing staff
- Communication stratergies
- Transfer protocols
- Allocation of roles
- Patient Assessment
- Clinical Skills
The Scenario was immersive was carried out by the clinicians involved as if it were a real person with excellent buy-in. The debrief lasted for nearly and hour and it became aparent that the team had thoroughly enjoyed the exercise. The debrief focused on the learning goals, particularly process issues for example who hands over the patient to whom and who is responsible for the patient in particluar areas. An unexpected benifit of the scenario was the team building that it produced. It was great to see the nurses and doctors from different speciality talking over the best way to transfer a patient and clearing up areas of confusion. We may discover that greatest benefit of these exercises is the improvemnt in relations between different departments that creates an environment for much greater improvements in patient care.