WORKING IN ED
Hopefully, you now have a bit of an overview of the ED in Leicester! On this page, we will highlight some of the day to day useful bits for you to know about working in the ED. Again, we hope to have covered most things, but if after reading through this page, and particularly if after your face to face induction, you still have questions, then please do let us know - feel free to ask somebody or contact us using this form.
You should already have received your ED rota, and as you will see, there are a variety of different shift times. If you have not worked in ED before, these may look quite different to the types of shift that you have worked previously, and we know that these can take some getting used to!
The shift times do vary depending on your grade, so to avoid any confusion, we have outlined these below:
FY1 - 08:00-17:00 and 13:30-23:30 (no nights).
FY2/SHO - 08:00-17:00, 13:30-23:30, 17:00-02:00, 22:30-08:30, 08:00-20:30 (weekends only) and 20:00-08:30 (weekends only)
CT3/SDM/HST - 08:00-18:00, 13:30-23:30, 22:30-09:00.
Occasionally, somebody may also work a ‘modified’ late shift, working between 12:00-22:00 if, for example, they have teaching the next day, in order to ensure a sufficient rest period.
Handover takes place in the Seminar Room (in the ED Undercroft) at the start of the shift. We will show you exactly where this is at your face to face induction.
At handover, the doctor in charge (known as the EPIC) will check to make sure that everybody has arrived, and will then allocate everybody to an area within the department (i.e. Red Majors, Blue Majors etc).
During Handover, there is also time for any relevant updates/important information to be shared. This is usually done in the form of ‘Team Reads’ which are located in the red folder that lives in the Seminar room.
Although we call this ‘Handover’, we do not actually carry out any handover of patients at this point. This is usually done by those leading the areas when everybody has gone upstairs to the shop floor.
Please do try to arrive on time for handover, but if you are running late (don’t worry, it happens!), let the EPIC know (07977 957230 during the day, 07855 173627 at night)
The length of your break will depend on the shift that you are working:
If you are on an 08:00-17:00 or a 17:00-02:00 shift, then you will get 30 minutes break.
For 08:00-18:00, 12:00-22:00, 13:30-23:20, 22:30-08:30/9:00 shifts, you will get 60 minutes.
On the longer weekend shifts (08:00-20:30 and 20:00-08:30), you will get 90 minutes (this is usually split into two 45 minute breaks).
The doctor responsible for running the area that you are working in will usually allocate breaks (or at least ask you to do this amongst yourselves), to make sure that not everybody goes off at the same time!
Please try and stick to the time that you have been given. If you are feeling really bogged down, or have a particularly complex patient and you think that you might struggle to go on your break on time, please let the area lead know as they will likely be able to help. We really don’t want people working for 7 hours of a 9 hour shift before they have a break, as you will be tired and hungry!
The main canteen (LEat Street) is located on level 0 of the Balmoral Building. Here, you will find a variety of hot and cold food and drink options and a seating area (with some picnic tables outside). This can get busy and crowded, especially at lunchtime. The canteen does now serve hot food 24-hours a day, but please do bear in mind that the options are more limited overnight.
There is also a WHSmith shop in the Balmoral Building (near to GPAU and Injuries). Here, you can buy sandwiches, snacks and cold drinks.
Finally at the LRI, there is a WRVS cafe, which sells hot/cold drinks, sandwiches, paninis and cakes etc.
Outside of the hospital, and if you have time, there is a Tesco Express about 10 minutes walk away (on Welford Place). There is also a Jennos Coffee Shop next door to the Leicester Tigers store on Welford Road (just over the road from the hospital).
If you have bought your own food and drink (and if you are looking for somewhere to eat food that you have purchased), there is a staffroom in the undercroft. Here, there are a number fridges and microwaves as well as tea/coffee making facilities and a cold drinks vending machine. The CT3/HST/SDM doctors also have access to an office which is located on level 0 of the Balmoral Building (close to the canteen). As well as providing an area to work (with several computers), there is a fridge, microwave and tea/coffee making facilities.
The Doctors Mess at the LRI is located in the Windsor Building (swipe access for members only).
You should be smart and presentable at all times and ensure that you follow the relevant infection control policies (bare below the elbow, long hair tied back etc).
Whilst working on the shop floor, all ED clinicians wear scrubs. These will be provided, and will be given to you when you come for your face to face induction.
If you would prefer to purchase your own scrubs, this is not a problem, but please do be aware that some colours are associated with certain members of the team (e.g. ACPs and ENPs wear maroon, senior doctors wear navy), so we would advise that you clarify this before buying any.
You will also be provided with a lanyard. Please do wear the one given to you as firstly, it will have the proper ‘breakaway’ safety mechanism and secondly, the lanyards are colour coded, with each colour representing a different grade. This allows for quick identification of individuals/seniority when needed. Click here to see what each colour represents.
The logistics of how you see patients will vary slightly depending on which area you are working in, and you will become more familiar with this as time goes on. If, when you first start, you are unsure about something (e.g. which patient to see next, which room to see a patient in), please do ask!
Before you start, please make sure that you have watched the “How to Use Nervecentre” video (link here) for an overview as to how tpo. We have also very recently become a ‘Paperlite’ department, meaning that the majority of patient documentation, along with prescribing (e-Meds), ordering of investigations etc, is done through Nervecentre. There is a Learning Hub for Paperlite here, and you should also have an e-Meds module as part of your mandatory training on HELM.
Once you have finished seeing a patient, please make sure that you discuss the case with the person who is running the area (usually a registrar or a consultant) so that you can begin to formulate a diagnosis and come up with a plan.
If a patient is requiring admission to hospital, please follow the referral guidance here . For those being discharged, it is important that a summary of the patient’s attendance to ED, along with any relevant follow up, changes to medication etc is relayed to the GP in the discharge letter. It may also be appropriate to give a patient a ‘Patient Information Leaflet’ (PIL) when sending them home.
After senior review, it may be that some patients would be better suited to being reviewed in an area outside of ED, for example Eye Casualty or GPAU. Patients may also be ‘streamed' to these areas directly from the front door. A summary of these areas and the type of patient that may be suitable to go there, can be found here.
There may also be some patients who are suitable to go to the Emergency Decisions Unit (EDU) or the Children’s Short Stay Unit (CSSU) on a ‘pathway’ that must be signed by doctor in charge. Go to ‘Working in EDU’ for more information on EDU.
Regardless of whether they are being admitted, re-directed to a different area or discharged, please try to ensure that patients (and if relevant, family, carers etc) are kept updated, as well as the nursing team involved in looking after the patient.
Working in ED, it is likely that many of the patients that you see will require imaging of some kind. This could be anything from an x-ray for a suspected fracture, a CT for possible intracranial bleed to an MRI in order to rule out cauda equina syndrome.
When requesting imaging, please ensure that you are doing so judiciously and that you are using the most appropriate modality to answer your clinical question, with as minimal risk as possible to the patient. It is good practice to carry out a urinary pregnancy test on all women of child bearing age prior to exposing them to any ionising radiation, because if they are pregnant, there is an increased risk to the developing foetus.
Ideally, imaging requests should be written in an SBAR style format, allowing the radiologist to get a summary of the case and to establish what clinical question the imaging will answer. An outline of this can be seen here, and a clinical example is shown here.
If you have any questions, e.g. you are unsure as to which imaging modality would be most appropriate, or if you have a query regarding something in the report, you can contact the radiologist on x16969.
You will also notice that increasingly, we are carrying out Point of Care Ultrasound (POCUS) in the ED and we have several ultrasound machines in the department. If you use one of these machines, please ensure that you look after it! When you have finished using a machine, please ensure that it is cleaned, returned to the correct location and plugged in to charge. We do hold regular shop floor ultrasound teaching sessions, and these can be booked via the EM3 website.
There are a number of presentations and situations in the Emergency Department that can catch even the most experienced clinician out! We have compiled a list of some of these below. Remember to get senior advice if you are unsure or worried about something.
Visual acuity should be checked in all patients presenting with an eye problem.
All women of child bearing age are pregnant until proven otherwise (via a urinary pregnancy test)
Abdominal pain in patients aged over 60 has as serious cause (e..g AAA, ischaemic bowel, intra-abdominal sepsis, malignant) until proven otherwise
Patients with leg pain need their pulses checking
In patients with wrist pain, and a history of trauma - think scaphoid!
Never assume that a presentation is “just” down to alcohol. Intoxicated patients may well have serious underlying pathology (e.g. significant head trauma, hypoglycaemia)
In older patients presenting with an injury, remember to think about ‘Silver Trauma’
Foreign bodies and penetrating injuries should never be underestimated.
Always check the testicles in boys and young men who present with abdominal pain - they may have a testicular torsion.
Check for any red flags in back pain and do a full neurological examination (+PR exam).
In patients with cardiac sounding chest pain, check serial ECGs
In paediatric patients, all patients aged under 1 should be discussed with an ST4+. All patients who are under 3 months should be physically reviewed by an ST4+.
Lockers - These are available in the changing rooms downstairs in the undercroft. Lockers will be allocated when you come for your departmental induction. If you are a CT3/HST/SDM, there is also a limited number of lockers in the registrar’s office.
Tannoy System - There are several tannoys located throughout the department, allowing for quick communication between staff. When you are working in the department, please do respond (this doesn’t necessarily have to be instantaneous!) if somebody calls you over this system as in a big, busy department, it can sometimes be difficult to find individual staff members.
Switchboard - Working in ED, you have use of a ‘priority line’ for switchboard. The number to dial for this is x17711