Happy International Emergency Medicine Day 2021
May 2021
I had a fantastic shift the other night. It (mostly) worked well. It reminded me about what I loved about Emergency Medicine when I started out and why I chose this specialty. I've been thinking on why it went so well.
I was rostered on with a great team. The skill mix was balanced. We had a couple of sick calls but we were able to find cover. We had enough medical and nursing senior decision makers that all ED models of care could function properly.
The hospital had beds available. We were able to see patients, complete their ED work up, refer for admission, then transfer to the ward. We had ED treatment spaces available to see new patients in beds, not in the waiting room.
The after-hours nurse manager was amazing. She visited ED at least every hour and kept the nurse navigator and I abreast of hospital bed availability. She helped us trouble-shoot a couple of staffing and patient flow hiccups and escalated a more serious issue to exec on-call.
The inpatient team registrars were super helpful. A special shout out to the surgical registrar who spent most of his shift in ED assessing patients (without imaging) and did some teaching on the run for the JMOs about interpretation of CT abdomen/pelvis.
A big thank you to the medical registrar and on-call physician. During a busy period, I overlooked an important clinical finding. I rang when I remembered and they followed up without criticism or judgment, and with a good outcome for the patient.
I don't like forgetting things at work, but in a busy clinical context, it sometimes happens. When it does, I am grateful to colleagues for helping me out in an empathetic, patient-centred and psychologically safe way. We're all on the same team. Civility saves lives.
Diagnostic tests were being performed and reported in a timely way, which helped ED clinicians make early treatment decisions. I had enough time and space to take time explaining diagnostic and management decisions, and to address patient and carer questions and concerns.
With beds available in ED, we were able to take paramedic handovers fairly quickly. Handover is of so much better quality when done (once) at the bedside with the treating nurse and doctor present. And the paramedics were back out on the road quickly too.
We had lots of kids present to ED. The paediatric pathway was working beautifully, with direct admission of stable patients for ward-based assessment and referral to the paediatric acute review clinic for those who needed next-day follow-up but not admission - a fantastic model.
Our excellent aged care outreach service worked its magic. We were notified about ambulance calls to RACFs via the dashboard and the team made calls, arranged in situ assessment, and made direct referrals to HITH - or arranged for patients who needed admission to come to ED.
The mental health team were fabulous. We worked in parallel, with good communication, to ensure that patients presenting with emotional distress received trauma-informed, compassionate and timely care plus necessary physical treatment too. No restrictive practice was required.
We had meal breaks, and toilet breaks, and we debriefed a challenging case in resus. We solved interesting problems. At the end of the shift we thanked each other and went home feeling like we were valued and had made a difference for our patients, our community and each other.
Things have been tough in ED recently. This shift stands out because I haven't experienced one like it in a while. It reminded me that what we do is important and that when systems work well, Emergency Medicine is possibly the most satisfying and rewarding job in the world.
On this #EmergencyMedicineDay I am proud to be a FACEM. I am proud to work alongside caring, intelligent and highly skilled health professionals providing acute care to our communities. I am proud to be training the EM workforce of the future.
Emergency Medicine is about all of us. Emergency departments are the safety net of the health system. They work best when all of us in health, across the entire system, work together to deliver integrated, effective and compassionate care.
On #EmergencyMedicineDay have a think about how you fit into this picture. How will you engage and collaborate to build a better health system? How will you make a difference?
Thank you and happy EM day 2021.
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