Senior Decision Maker Responsibilities

Each dayshift will have a Consultant, Middle Grade and Junior allocated to Resus. Backshift has an allocated Middle Grade and Junior (with Consultant support based in Majors A).

There is a Resus Handover pause including all staff allocated there at 08:30 and 16:30 daily. This includes a team introduction, patient handover, equipment issues and educational opportunities.

Please ensure Resus checks are completed on a daily basis. Daily checks of the Difficult Airway and Trauma trolleys are vital and also improve familiarisation with equipment. There is a step-by-step guide for ventilator and anaesthetic equipment checks in the Daily Checks folder. A guide to the ventilator checks can also be found in the ED Sharepoint folder.

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 Oxylog 3000 ventilator. (See also: Skills and Drills)

Ensure you understand how to turn on a portable O2 cylinder. This can be more complicated than it sounds!

Please aim to have a ‘hands off handover’ with SAS staff for all pre-alerted patients. 

GRI Emergency Department

Consultant Contact Criteria

There is a consultant on duty within the emergency department from 8am to 12 midnight (and 24 hours/day mon-fri then tues-thurs alternate weeks) and available 24/7 365 days a year.  This document outlines absolute notification criteria.

The duty middle grade doctor or flow coordinator should not hesitate to contact the duty consultant about any problem about which there is the slightest doubt.  Although the decision to contact the consultant outwith these criteria is at the discretion of the middle grade, the ultimate clinical responsibility for patients rests with the duty consultant.

8am - 12am 

Resus consultant (8am-5pm) or Duty consultant (5pm-12am) to be informed about:

• all standbys
• patients requiring resuscitation
• significant trauma
• ITU referrals

Anytime

• Major incident

12am - 8am

• Trauma calls
  • At time of pre-alert
    • Any trauma call with EMRS Major Haemorrhage Protocol (MHP) activation
    • Any trauma with multiple victims
  • At time of patient arrival
    • If initial assessment concern from MG or MHP activation
• Critically unwell children
• Patient management problems
  • Appropriate transfer request to off-site specialty refused
  • Dispute regarding patient referral or disposal not resolved by senior MG on duty
  • Delay in transfer to theatre or definitive treatment, particularly if multi-specialty input
  • Request for EM middle grade transfer
• Any consultation from in-patient specialty (possible exclusion of ITU) involved in a patient's management in Resus
• NEWS >6 at 6hrs following senior MG review and consultant input deemed appropriate
• NEWS >6 on Ward 46 following senior MG review and consultant input deemed appropriate.

GRI ED Senior Sign Off Criteria

Certain conditions require discussion with a senior decision maker prior to discharge.  This is due to a high level of missed significant pathology in the groups.

Oxylog Device Check (pdf)

Resus room daily checks (SharePoint)

Medical patients in Resus that require medical HDU care should be reviewed ideally in Resus by the Med Reg prior to transfer to ensure that HDU is the most appropriate place of care.

Unfortunately transfer to HDU may not be imminently possible, and the patient may remain in the ED for several hours, and if very unwell may need regular medical input. Both Medicine and EM would expect that the gold standard is that responsibility for this remains with the Medical team once the patient is deemed appropriate for transfer. Since both the ED and Medical registrar roles are probably the most demanding at that grade within the hospital and both may be detained with other emergencies, whilst being required to provide further input, it is vital that there is clear handover between the specialities and shared responsibility established with clear communication.

Major Haemorrhage Protocol

Major Haemorrhage Task Allocation