Department Areas

As patients present to reception requesting to be seen, a nurse who also sits at reception will intervene to signpost the patient to a more appropriate alternative service e.g., to a Minor Injury Unit, pharmacy, dentist etc. A predefined list of patients/presentations have been agreed as suitable for signposting, thereby reducing ED attendances.

To ensure appropriate governance of this activity, this interaction is recorded on a separate IT system to the Trakcare one used for the Emergency Department.

When the rate of patient arrivals exceeds the capacity to see and assess patients immediately, a triage assessment is carried out to establish the urgency of each patient’s condition so they can be prioritised accordingly. In reality there is almost always a wait to be seen so Triage is now the norm for all patients arriving at ED.

This is done in the triage area by experienced nursing staff applying set criteria. There are two triage rooms positioned between the main waiting area and the ambulance corridor which leads to the rest of the Emergency Department and Acute Assessment Unit.

Standby patients who are very unwell are phoned ahead by paramedics and they go to resus directly without formal triage. They are met by the resus team for immediate assessment. Remaining patients will be triaged in the triage room whether brought in by ambulance or if they have self-presented. One of our triage nurses will take a succinct history and gather observations to decide on a triage category for each patient thereby establishing the priority with which they should be seen.

After the triage process is complete one of the Clinical Support Workers will perform an ECG and bloods to decide if there is any ECG finding which would require urgent review.

Those patients with chest pain will have been allocated a Triage 0 while awaiting ECG to decide if they require urgent review e.g., for STEMI, or less urgent review e.g., ongoing chest pain with normal ECG. The CSW will also perform blood tests for these patients and a sticker on the front of the notes and a laboratory test icon on Trakcare should alert you to the fact that these investigations have already been sent and the result needs to be checked. Benign sounding chest pains with normal ECGs are triaged to the ambulatory care area of the Acute Assessment (Zone 4) if capacity allows.

This triage plus service which front loads investigations allows quicker decision making as results are often available by the time of medical assessment.

A consultant allocated to Triage Plus supports this service and will often arrange imaging or other investigations early in the patient's journey to improve flow through the department. They will also sometimes review and discharge patients who might otherwise have unnecessary tests and delays to decision making by less experienced team members.

This is the main clinical assessment area in the department. It consists of 19 assessment cubicles including 4 monitored bays and one negative pressure room. This area has a triangular lay out with a large space in the middle where nursing and medical staff are based.

One of the senior nursing staff controls the flow of patients through the department from the main screen in this area. The consultant in charge works near them and will allocate staff and prioritise cards in the tray so they are seen accordingly. This consultant will discuss cases with you from the mandatory list of “Senior Sign Off” cases and will also help you decide on the best treatment for other cases. This consultant will allocate you to work in the correct area of the department, so please report to them at the start of your shift.

This area of the department sees slightly less acutely unwell patients, however the decision to place patients here is following a brief triage assessment. It is, therefore, wise to remain open to the possibility that the patient in Majors B may well be sicker than their location suggests.

Majors B has 10 assessment cubicles including two paediatric rooms, and an Eye/ENT room. There is a consultant allocated to work here 0900 to 1700 each day, and support is also available from the consultant in charge in Majors A.

Our resus area comprises 5 cubicles including a trauma bay, paediatric bay and 2 negative pressure rooms. Resus is the area used for the most acutely unwell patients and is where medical and nursing staff await patients that have been phoned in by paramedics for a “standby.” Please aim to have a ‘hands off handover’ with ambulance staff for all pre-alerted patients and record the information on the handover document. Patients can also be moved here from other areas of the department if their condition deteriorates or if they require a portable x-ray.

There is an ED Skills folder in Resus containing step-by-step picture guides for most ED practical skills including a run through of the various functions of the more important items of equipment. Every day the middle grade or consultant doctor allocated to Resus will complete a checklist of Resus equipment.

This area near cubicle 12 in Majors A allows you to move stable patients awaiting either the result of an investigation or a space becoming available on a ward, to sit out and vacate the cubicle that they would otherwise have waited in. They will have only minimal oversight from nurses here and so should be stable before moving here.

The ED has a dedicated 24-hour X-Ray/CT facility. Full X-Ray facilities are also available in Resus using a portable X-Ray machine. Requests are made using Trakcare. Images are viewed on “PACS North Glasgow.”
To request a CT please write a brief clinical history to explain the need for the requested exam. You should then phone the radiologist (20444 out of hours and 29713/4 in hours). Once they have vetted the scan, let the radiographer know in ED CT (21018) that the scan has been vetted so that they know to request the porter to bring the patient around.

For plain X-Ray, the request is also made on Trakcare. Please make a note of the cubicle where the patient is, as part of the request. The radiographer is not allowed to carry out exams that are not indicated and they are obliged to get a clinical history before X-Ray is performed. A brief clinical history on the request will save both of you time. Ambulatory patients can be walked to the ED X-Ray waiting room. Other patients will be transferred by porters at the request of the X-Ray department.

Take note of any “Red dots” placed on X-rays by the radiographer as they are experienced at reviewing X-Rays and a red dot shows they are concerned it is abnormal. Respect this concern and ask them or a senior if you can’t see the abnormality.

All X-Rays that you review should have a ‘sticky note’ placed on them with your brief opinion of your interpretation. This allows Radiology to assess whether a patient may need to be recalled as they report the film if you have missed something important. ED consultants review all radiology reports from the department and without sticky notes an already laborious task becomes even more time consuming.

There is an interesting X-Ray folder in Majors A to help facilitate teaching and our monthly departmental radiology meeting.

There is a co-located minor injuries department that is staffed by 2 ENPs and 1 CSW, which is open 8am-8pm daily. There is also normally a MSK Physio to support the department. Patients aged >=5 years that present to the Emergency Department with a minor injury within these hours will be directed to the Gatehouse

There is an adjacent Acute Assessment Unit for medical GP referrals (where you will find the ED Middle Grade office). The Acute Medical Unit (Receiving wards 50-53), Cardiology, CCU and Medical HDU are directly above the ED.