Welcome to Emergency Medicine at the Leicester Royal Infirmary. We are an exciting and dynamic specialty, but it can also be daunting especially if you haven't worked in an Emergency Department before.
The induction programme is designed to give some useful advice to help you in your role within the Emergency Department team.
We hope that you enjoy completing this module as you prepare to start working in the LRI Emergency Department but this is also relevant to those starting in Emergency Medicine in general.
Some of our recent trainees have said...
Emergency Medicine in Leicester
This short video contains some familiar faces discussing some of the reasons why Emergency Medicine is a good career and how Leicester and the East Midlands are also a good choice.
The following web pages give some further advice on the benefits of working in Emergency Medicine and how the career is structured.
You should aim to complete the following before starting or within the first few weeks...
The Ten Commandments of Emergency Medicine
This slightly humorous blog entry makes ten rather important points for working in the ED. It is written by an American and based of journal article from 1991, however I find it hard to disagree with the points made and certainly by following them you will avoid some common pitfalls.
Preventing Nightmares: A Guide for Medical Students and Residents
One of the hardest parts of EM is the decisions and taking things home with you, there is a lot of truth in this blog and it describes situations eerily similar to ones I have had. It suggests a good way to approach your clinical work and some considerations to make. The ethos of recognising a mistake, learning from it and trying to move on is important. In EM there is always the next patient and the next problem, and hopefully you can take your mistakes and use them to help others.
This short article from the BMJ covers some important points about note keeping. Good notes in the ED are vital due to the the turnover of patients and that all admitted patients will be handed over to another team. Therefore the next person reading them needs to now what you were worried about/ planning. Not to mention that good note will keep the ED nurses on your side!
Risk Management in the ED
This video covers some of the strategies for management of risk. For optimal viewing watch in fullscreen.
If you want to know more about errors, human factors and the swiss cheese model you can read the following: http://patientsafetyed.duhs.duke.edu/module_e/module_overview.html
Every Minute of Every Day...
Ever wondered what is going on inside other people's heads? Do you think you would act differently if you did?
Watch this video that goes inside the minds of various people in a hospital (both patients and staff). It was produced in the UK by Heatherwood and Wexham Park Hospitals NHS FT.
Without labouring the point it is worth bearing this video in mind when on the shop floor, the Emergency Department can be a very emotionally charged environment and being able to show empathy will help diffuse most situations.
Compassion in Emergency Medicine
The video below has been produced by Dr Damian Roland and Dr Pro Mukherjee and it gives an insight into what compassion means in Emergency Medicine.
The Trust uses eUHL to book courses and to access the mandatory training.
It is available off site at: https://www.euhl.nhs.uk
You can keep track of you mandatory training (those in green are available as eLearning packages):
Moving and Handling
Equality and diversity
Health and safety
On top of the mandatory courses there are several other useful course available and it is worth having a look as many are free. Those worth considering include:
Acute Kidney Injury
Management of Hand injuries
Non-invasive ventilation for doctors
Simulation Faculty Training
Teaching Improvement Course (£150)
Critical Reading Course and Modules
This is not a mandatory task, however for those of you who want to know some good resources prior to or during your time in the ED the following may be useful. I have listed some books I have found useful for both my clinical work and my membership exams, however as you go through the teaching programs in the department the list of resources will expand to include podcasts and other media.
If anybody has any other book recommendations or is considering MCEM and would like further advice please post in the forum on the main page.
Recommended Reading List
The Oxford Handbook of Emergency Medicine: (ISBN: 0199589569)
The goto book for advice on the fly, it attempts to summarise one of the most diverse fields of medicine in one book, it will often contain enough detail to answer a question on ED management but may lack depth if you want deeper details.
Emergency Care of Minor Trauma in Children: (ISBN: 144412014X)
Not only is this written by one of the consultants in our department, it is a very useful guide to the assessment and management of minor injuries. It is obviously particularly relevant in paediatric ED, and contains top tips and warnings of things not to miss.
ABC of Eyes: (ISBN: 0727916599)
Opthalmology is not always taught well at medical school and your experience may be limited, however patients with eye problems will often present to the ED out of hours so knowing where to get some more information is vital.
ECG's For the Emergency Physician 1: (ISBN: 0727916548)
ECGs are a common enough investgation, but can be tricky to interperet in the busy ED with lots of external pressures and distractions. There is specific departmental teaching on ECG and a quiz to carry out before you can sign of ECGs in the department. For those who want a refresher this is a good place to start.
Accident and Emergency Radiology A Survival Guide: (ISBN: 0702026670)
By the end of your time in the ED you will have looked at a large number of radiographs, however as you start in the ED you may not feel comfortable interpreting certain types of imaging (particularly MSK films). Having a good book to refer to can be vital and this is the book I have used. The teaching program in the ED will also highlight some useful websites and other resources.
Many of our staff have consulted on a number of medical apps. Here is a current list of recommendations for new starters in Emergency Medicine:
The Paediatric Observation Priority Score (POPS) is a tool to aid decision making in urgent and emergency care. It combines objective, subjective and observational features to create a score 0-16 that can be ascribed to children and young people presenting to Emergency Departments, Urgent Care Centres and Primary Care Clinics (Family Doctor).
It is undergoing continuous validation (more information is available here) and we welcome feedback on its use, especially in environments outside the Emergency Department.
Single Best Answer MCQ
The following paper is made up of 100 questions. Each question is a short clinical scenario with a mixture of observations and investigation findings. There is then a lead in question followed by five options. Please select one single best option to answer the given question.
The answers are based on national guidelines, scoring systems and UHL/ED management guidelines. The questions are written to cover a range of presentations to the Emergency Department.
There are no trick questions and no negative marking, feedback will be given if you get a question wrong and will give advice on where to look for the correct answer.
Your score will be automatically generated and a report sent to your ED Clinical Supervisor. This will be discussed at your first appraisal meeting.
SBAR & Handover
Clinical handover occurs at multiple stages in a patients journey through UHL. It often occurs multiple times just within the Emergency Department (ED). Poor handover can lead to significant untoward incidents (SUIs), and even patient death.
We have adopted the SBAR tool to allow effective handover and we have a series of videos on our YouTube channel to get you started.
This is an external course from Canada developed to cover a systematic approach to interpreting the ECG and identifying common ECG abnormalities.
Whether you are starting to learn, need more practice or are just looking a resource for revision this is a good place to start.
There is also an excellent library of ECGs available from LITFL.
Emergency Medicine Research is a growing topic and within it a wide variety of research is performed covering a range of specialities which involves collaborative working within other areas.
Within ED at the LRI we have the Emergency Medicine Academic Group (EMAG) lead by Professor Tim Coats supported by a team of researchers (more information can be found on www.le.ac.uk/emag). All doctors within the department are encouraged to take part in research and support our current trials.
Research is also one of the areas identified by The College of Emergency Medicine; Common Competences for Emergency Medicine section CC20 (link found in additional resources) and by completing the tasks set out you will be at level 1 of the competencies heading towards the higher levels.
Once you have completed the tasks please complete the CV template, print off, sign and contact the research team via Emag.Office@uhl-tr.nhs.uk to arrange face to face trial training which takes approximately 30minutes. Once you have completed this you will be able to recruit to the HALT-IT and Crash 3 studies and will receive a certificate for each recruit for your portfolio.
An audit is a process that aims to improve the quality of patient care by examining current practice and modifying it where necessary. This is done by assessing how patients are managed in comparison to local or national standards.
A good audit will identify any problems in patient care and lead to effective changes that result in sustained quality improvement. You will be expected to participate in an audit during your time in the department.