Monday, January 30
by Iain Beardsell on Mon 30 Jan 2012 10:09 PM GMT
So after sitting on the Solent website behind log ins and passwords we have now decided to publish the videos on the main SEMEP website for all to use. We've also added links to other materials in each section.
The aim is that doctors who are new to the ED can click on a section, watch a video, read the CEM curriculum, do some E learning and then complete a CBD/mini CEX. This is instead of the traditional didactic lecture format that we have always struggled to deliver during the first few weeks of the new block.
We really hope you find them useful. Do let us know - now that this work is out there we really what to take this on and develop the site more (including more blog posts!)
Friday, April 1
by Iain Beardsell on Fri 01 Apr 2011 12:38 PM BST
The last few weeks have been dominated by preparing my talk for the CEM CPD conference.
I used "prezi" an online presentation editor that is free to use (in an upgraded version if you are using it for education). It looks complicated, but after a bit of practice is no more tricky than powerpoint. Try it at http://prezi.com
It seemed to go down well - hopefully the video of the talk will be available either on the CEM website or via semep very soon, but for now here is the "prezi" version to give you an idea of what I was talking about. Just click on the arrows at the bottom to go through the presentation.
Monday, February 7
by Iain Beardsell on Mon 07 Feb 2011 12:49 PM GMT
Making referrals to in patient teams is one of the most challenging aspects of working in the Emergency Department. Every call you make generates work for your colleagues, who may already be dealing with multiple calls and patients and may be in theatre or the out patient clinic. Without proper preparation instead of being a simple one way delivery of information it can turn into an impromptu viva examination.
Referral - an example of what can go wrong
Here the SHO has made a few errors resulting in the specialist avoiding the referral and leaving the patient inappropriately in the ED.
1, Don't ask in patient specialities for "advice". Immediately they will think that by giving advice they can avoid the referral and thereby avoid seeing the patient.
2, Don't let yourself be interupted. If you have prepared a concise referral with only the pertinent details it should keep the attention and not take long.
3, Do not accept being fobbed off with advice to do further tests or keep the patient in the ED. The decision to admit is generally a clinical one and testing rarely makes a difference to whether the patient comes in or goes home.
Referral - how to make it easier
Before calling it is vital that you are clear on the purposes of your call - which will almost always be a referral for admission. Remember, if you need advice that is what your Consultant and Registrar colleagues in the ED are for. When starting out it is worth just running over the reason for your referral so you can anticipate any questions and hone down the content to just the things the person to whom you are referring needs to know. It is vital that for your own sanity and the patients well being the referral does not become a viva on your clinical knowledge, so prepare in advance.
The SBAR Way
At Southampton use the SBAR mneumonic to frame our referrals. This gives a format to these conversations and outlines the content of the referral
S- Situation - Identify yourself, your patient and why you are calling-
"Hi, This is Iain Beardsell one of the ED Doctors and I want to refer a 39 year called Jane Smith who I believe has appendicitis."
B - Background - Give some more details about the patient-
"She has had 24 hours of worsening right illiac fossa pain, with nausea, anorexia and three episodes of vomiting. She is previously fit and well and has no other relevant history."
A - Assessment - Outline your assessment-
"On examination she is tender in the right illiac fossa. Her urine dipstick is negative and her blood tests are awaited."
R - Recommendations - Say what you believe needs to happen next-
"I would be most grateful if you could review her and assess whether she needs further observation or a operation. I have requested a bed on the surgical ward."
Tips on referring
1, Never, ever lie or try to "sell" a patient. If you feel you have to do this ask yourself does the patient really need to be admitted or is there something else you could be doing in the ED? Also, word soon gets round if you are not telling the truth about patients and that important trust between you and the inpatient team is lost.An example of an SBAR Referral
2, Practice your referral in your head - Does it make sense? Is the reasoning clear? Are there any questions you might be asked that you cannot answer?
3, Introduce yourself with your name, not just your designation and try to refer to the inpatient specialist by their name. By personalising the process it is much harder for someone to be rude to you and dismiss your request.
4, You are referring the patient. Very, very rarely will you be "asking for advice". Your expected outcome is admission not further work up in the ED/CDU.
5, Try to get to know the inpatient teams (see 2 above) and show an interest in your patient's outcome. Try to call them later in the shift to find out how your patient did - not only does they help your learning, but shows the in patient specialist that you were interested in your patient having the best and most appropriate care, not just how you could shift them from the ED and forget about them
6, Remember that colleagues can be very busy. You may have just interupted their lunch - no wonder they can get grumpy. Try and be understanding whilst being assertive.
7, Finish your referral with your voice going down in pitch - suggesting the end of the conversation, rather than rising - suggesting you are asking a question and opening up an unwanted viva opportunity.
8, Show "Grace Under Pressure". Never, ever get into an argument about a patient - as soon as you raise your voice you have lost the moral high ground. If you are having real trouble inform the inpatient specialist (politely) that you are going to talk to your Consultant/Registrar to confirm the referral was appropriate and that you will call them back
Admittedly this illustration is a straightforward case, but using the same methodology for all your referrals should make this aspect of working in the ED easier.
Monday, January 17
by Iain Beardsell on Mon 17 Jan 2011 12:09 PM GMT
In this, our first podcast (click on the attachment link below) I discuss my top ten tips for how to both survice as an SHO in Emergency Medicine and get the most out of it your time in the ED.
My top ten tips are
1, Respect those around you and value their opinion
2, The History is everything
3, There are 4 key treatments we give in the ED - think whether every patient you see needs any of these and you will save lives and relieve pain
a, Oxygen4, Think "What difference have I made to this patient".
5, No patient (almost) wants to be in the ED.
6, Spend twice as long with patients you don't like or don't get on with.
7, Look the part.
8, Be on time.
9, Take your breaks - eat when you can and drink water when you can't.
10, Enjoy yourself.....
by Iain Beardsell on Mon 17 Jan 2011 11:58 AM GMT
This blog will aim to complement the content of our main website www.semep.co.uk and the video lectures that the team is currently producing.
The plan is to have comment, educational material and podcasts available via the blog and these will be added over the coming months.
This is a new venture for the SEMEP team so all comments and suggestions are very very welcome.