A BRIEF INTRODUCTION TO PATIENT CARE
AT HASBRO EMERGENCY DEPARTMENT
An outline for medical students and outside trainees
- Identify the attendings and/or ped. emergency fellow with whom you will work.
- Pick up a patient by putting your initials (plus BMS 3, if applicable) in the "MD"
column next to the patient with the lowest census number on the "Board" across from the
nursing station. Patients who are written in red ink or with the red word "P-2" on the
Board have been triaged as urgent, having a higher level of acuity. Early attending
supervision is needed for these patients if you want to see them.
- Patient's charts are found beside the door that the patient is in; the chart will have
useful information at the top including demographics, census #, two brief nurses' notes,
and vital signs.
- Introduce yourself to the patient and family. Take a concise history--start with open
ended questions, then focus to other pertinent information. Perform a physical exam; you
may want to listen to the child first before other more anxiety-provoking maneuvers. Take
your best shot at the ears but don't feel bad if cerumen is in the way or if you're not sure
about them. Let the family know that you need to discuss the patient with the attending.
- Find the attending. Always let them know when you're ready to present a patient, but
don't be surprised if he/she can't staff your patient right away. You can use that time to
chart the H&P, or read about your patient's condition. There are several good texts at the
back of the station.
- If labs or x-rays are necessary, most can be ordered by circling the appropriate orders
at the right hand side of the patient's chart, then handing the last (white) copy of the chart
to the unit secretary for processing. Tear above the "Patient Instruction" section off
the last page -- the patient will need the bottom section later. Always let the patient's
nurse know what you are planning to do. (you will find his/her initials next to yours on
the Board). They are capable of doing most ancillary procedures such as venipuncture, IV's,
and urinary catheterization, especially if you ask them nicely.
- Charting. E.D. records are part of the patient's medical record: chart carefully! Be
concise--about 4-5 lines for a history and 6-7 lines for physical exam should suffice. Always
leave two lines for the attending to complete the chart. Ask your attending about using the
new T-system for charting. Discharge instructions should be easily legible and in lay
terms.
- After any ordered studies are back, discuss progress with the attending. It often
helps if you take a minute to re-examine the patient--especially if an intervention has
been given in the E.D. (e.g. Tylenol). Once a plan is made, discharge and follow-up
instructions need to be written, prescriptions given, and the patient's guardian needs to
sign in the yellow box at the lower left hand corner. Give them the last-page copy of their
instructions, and tell them that this slip of paper gets them out of the parking lot free.
A FEW REMINDERS
-
BE SURE TO TIME STAMP YOUR PATIENT'S CHART THE MOMENT THEY ARE DISCHARGED FROM THE
DEPARTMENT! Time stampers are located in front of the unit secretary.
-
LOOK FOR REFERRALS. Referrals are called in advance to the department and can be found
immediately behind the department's chart. A chart with a small red flag at the upper
right-hand corner identifies the patient as a referred patient. They may have important
background information or specific requests from private MD's. ALL REFERRED PATIENTS'
PHYSICIANS NEED TO BE CONTACTED PRIOR TO DISCHARGE.
-
A SEPARATE X-RAY REQUISITION NEEDS TO BE FILLED OUT FOR ALL X-RAYS--AT CERTAIN TIMES THE FORM
NEEDS TO BE FAXED TO MAIN X-RAY; JUST ASK THE UNIT SECRETARY.
-
ADMITTING A PATIENT:
If a patient needs to be admitted, try to ensure that the following checklist gets carried out:
a. ___Notify the patient's primary doctor (often the MD to whom you will be admitting the patient)
b. ___Notify the patient's nurse, so that the admitting paperwork gets started.
c. ___Make sure the ED attending signs the chart and writes a note.
d. ___Give report to the pediatrics admitting resident (page her / him). You may defer this to the attending.
e. ___Inform the family of the decision to admit... sounds obvious but embarrassing to omit.
For more information see
14. Pediatric Emergencies
in the Pediatric Clerkship Curriculum
OR
Pediatric Emergencies
in the Clinical Problems Supplement
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