Following is a guest blog by Peninsula Health grad nurse Mike Fox. Mike has a double degree from Monash University, Bachelor of Nursing/Bachelor of Emergency Health Paramedic. Mike has obtained a full-time role in Frankston Hospital’s Emergency Department following the completion of his grad year. Peninsula Health has expanded the Mornington Centre, and are taking applications for 60 new jobs in health care.

“I thought it’d be a good idea to give you an insider’s view of what a typical patient experience in the ED is like.

People attend Frankston Emergency Department for a number of reasons. They may ‘self-present’ (or be brought in by family) for general illness or injury. Patients can also be referred to emergency by their GP, and of course, many are brought in by Ambulance Victoria Paramedics. No matter who brings you to the ED, all patients undergo a process known as triage. Triage comes from a French term which (roughly) translates to ‘categorising by severity’, and was first used by Napoleon Bonoparte’s field ambulances to categorise alive, dead and dying soldiers on the battlefield. I’m happy to say that triage has come a long way since then! In Australia, there are five triage categories, ranging from Cat 1 (immediately life-threatening, such as a cardiac arrest) through to Cat 5 (non-urgent, such as filling a prescription).

The triage nurses determine a patient’s category by listening to their ‘presenting complaint’, assessing vital signs and taking a brief medical history. After being triaged, clerical staff confirm the patient’s details before the patient returns to the waiting room (unless they’re one of those Category 1’s I mentioned!). Patients in the waiting room are seen by the waiting room nurse, who regularly check vital signs, provides pain relief and anti-emetics for nausea, as well as performing basic procedures. Frankston ED is one of the only hospitals which have a waiting room nurse, and on the busy days it can be a hectic job!

Patients are next allocated a bed in the department, and where this is depends on a number of factors. Infectious (or immuno-compromised patients) are given a single room where possible, whilst children are placed in the dedicated paediatric beds, and patients with obvious fractures are placed in the procedure room area. This is where you will first meet the nurse who is caring for you, and their first task will be to ask you to change into a patient gown.

Many people underestimate the importance of this first step. Removing all clothes (expect underwear bottoms) and wearing a patient gown not only allows nursing and medical staff to assess and perform procedures, but in the event of a medical emergency, gowns are easily removable. Next up, the nurse will assess a patient’s vital signs or ‘obs’ (short for observations). These include pulse, blood pressure, oxygen saturation, respiratory rate and temperature. Other assessments, such as a blood sugar level, may be necessary. Patients will often remain ‘hooked up’ to this monitoring equipment, to allow a constant measurement of vital signs.

This initial encounter is also the time where a nurse may insert an intravenous cannula, which is a port through which blood can be taken and medications given. Small samples of blood may be sent to pathology for testing, so that when the doctor comes to see you, the results are available. Most patients will also receive a 12-lead ECG, which prints a picture of the electrical activity of your heart. For some patients, a continuous cardiac monitor may be applied in addition to taking a 12-lead ECG.

After these assessments, you’ll be met by one of the ED medical staff, who will listen to what issues have brought you into the ED, perform their medical assessment, take a detailed medical history and discuss with the nursing staff. From here, the doctor will often order further tests and medications.
The next few hours of a patient’s visit to Frankston ED may be spent undergoing tests such as X-ray, CT scans and ultrasounds. Some of these require preparation (such as having a full bladder for ultrasound), which means there is a necessary period of time between the test being ordered and being performed.  If the ED doctor believes you require an admission to hospital, a referral is made to one of the many medical teams onsite. These include surgeons, cardiologists, neurologists and other specialties. Allied health services such as physiotherapy, occupational therapy, social work and mental health are all available in the ED, and they may have input into patient care. During this time, family members are encouraged to attend (if the patient wishes) and be involved in the care planning process.

If a patient is to be admitted under one of the medical teams, they remain in the ED until a ward bed becomes available for them under that specialty. Whilst in the ED, admitted patients receive all the same care as they would on the ward, such as anti-biotics and other regular medications. For patients who are being discharged home, they may be moved to the Emergency Department Short Stay Unit for a few hours of observation and management. Patients will often be discharged with a prescription and a discharge letter for their regular GP.

The whole process does typically take several hours, although this does depend on the patient’s presenting problem. As a general rule, I tell most patients that their time in the ED will be at least around four hours, which, given the number of steps involved, is pretty good in my opinion. Many patients who start to feel better after arriving are keen to return home. The nursing and medical staff are also keen to return you to your home, but only where there is absolutely no doubt that you will return safely. That is our job after all!

A bit of a long post today sorry readers, but I hope you’ve learned a thing or two which will help you (or someone you love) understand all that is happening if you ever attend an Emergency Department. As for me, my ED days are almost up, but I will be coming back to you soon from one of the medical wards at Frankston Hospital.

Stay safe!
– Mike”