Emergency Medicine Network 5
Why Nepean Hospital?
Nepean Hospital is a 420 bed hospital situated in Penrith at the foot of the Blue Mountains. It is the tertiary referral unit for Katoomba and Lithgow Hospitals as well as for the Central West of the state. It is affiliated with the University of Sydney, forming the Nepean Clinical School 4 years ago and the Discipline of Emergency Medicine 2 years ago. The hospital has finished a major expansion with additional operating theatres, inpatient wards and ICU beds and a new and expanded psychiatric unit.
All of the major specialties are covered: ICU, neurosurgery, thoracic and vascular surgery, orthopaedics, plastic and faciomaxillary surgery as well as inpatient dialysis services. Complex imaging is available 24 hours per day, which includes interventional cardiology and radiology. We have an excellent high-risk pregnancy unit, neonatal intensive care unit and a well-staffed paediatric department. There is an after-hours referral arrangement with Westmead Hospital for ophthalmology and ENT services.
The hospital is classified as regional trauma unit by the Institute of Trauma. There is also a large and varied case-mix including a number of critically ill medical, surgical and paediatric patients, as well as a number of patients from a busy and high acuity oncology/haematology service. Many procedures are performed within the ED with a large amount of procedural sedation, including paediatric sedation.
About The Department
The Department of Emergency Medicine sees more than 65,000 patients per year, with a 40% admission rate and 20% paediatric load. It is accredited by The Australasian College for Emergency Medicine for 2 years of advanced training in Emergency Medicine.
The ED is divided into 4 clinical areas: the Resuscitation Rooms, the Acute Care Area, ‘WRAC’ and the Fast Track Area.
WRAC is a novel initiative whereby complex but ambulatory patients not requiring a bed for their clinical care can be worked up in an ambulatory setting. There are dedicated examination spaces and an internal waiting room to facilitate this. The Department is staffed by a number of Emergency Physicians guaranteeing coverage on the floor from 0800 to 2400 hours, seven days a week. There is senior CMO/registrar cover 24 hours per day.
We also have a 10 bed Emergency Medicine Short Stay (EMSS) unit serving the ED for admissions usually only requiring an overnight stay and is covered by the Emergency Physicians 7 days per week.
We have a number of nursing staff operating in clinical roles to assist medical staff. The clinical assistant’s role is to perform venipuncture, cannulation and other procedures, enabling the trainee to focus on their clinical case load. This role is covered up to 14 hours per day. The ED has a number of senior nurse practitioners who largely cover the fast track area which sees the less acute presentations to the ED, leaving the trainee in acute care covering the higher acuity patients.
There is also 24 hour coverage by the Psychiatric Emergency Care Centre doctors and nurse practitioners with a co-located psychiatric short stay unit.
The medical roster consists of consultants, advanced and provisional trainees, CMOs, SRMOs and JMOs. There are 3 tiers to the roster with the consultants having overall control of the ED. The CMOs, registrars and SRMOs form a second tier, overseeing the department and covering the resuscitation bays and some JMO supervision, with the JMOs on a separate roster covering the ED and EMSS Unit.
The roster for trainees is an 80 hours per fortnight rotating roster involving days, evenings, night and weekends. We roster 2-4 nights per month, depending on staffing and leave. Shift length is predominately 10 hours with roster usually consisting of a 4 x 10 hour week. Nepean is unique in that it incorporates non-clinical time into the clinical roster of trainees. This is rostered as part of the 80 hour fortnight, not as overtime in addition to 80 clinical hours. This non-clinical time is reserved for the Nepean Emergency Department training program. Trainees are rostered a non-clinical shift on the ‘Big Wednesday’ once a fortnight. Trainees get 4 weeks annual leave and 1 week study leave per year, as per the award. Study leave is actively encouraged, as this is an important part of training, especially for exam preparation. All leave requests are considered and leave for an exam is considered a priority.
Nepean ED schedules a teaching day that runs all day every second Wednesday. The day consists of lectures and workshops in the morning and fellowship exam focused training in the afternoon. Once a month we run the Trauma and Emergency Medicine M&M meetings in the morning, followed again by fellowship exam focused training in the afternoon. Twice per year we incorporate into the paediatric training day at Children’s Hospital Westmead and up to 4 times per year there is an Area teaching day held at Westmead Hospital.
Primary exam preparation involves both in house tutorials, practice exams and a Network trial exam every 6 months. Fellowship exam preparation incorporates the Sydney wide Fellowship exam. Fellowship candidates are encouraged to attend and are usually rostered non-clinical time on these days to facilitate this. Specific fellowship exam focused training, such as practice written exams, is also offered to local fellowship candidates. We also run formal tutorials every Wednesday afternoon for provisional and advanced trainees consisting of didactic presentations and workshops.
The ED has a dedicated ultrasound machine and formal credentialing of trainees for FAST ultrasonography is part of their training. We have an active simulation program with scenarios run every ‘big Wednesday’ afternoon as part of EM training. There are also 2 big simulation days run every 12 months. The trainee research project is largely satisfied by the university course option and support is given for this.
We are able to offer anaesthetics and ICU, as well as ward terms in paediatrics and medicine. Nepean has a medical education term and a medical (ED) administration term accredited by the college aimed at the senior trainee interested in teaching and education or in administration. They involve 20 hours per non-clinical and 20 hours per week on the floor, usually with no nights. Each 6 month term is accredited for 3 months ED and 3 months special skills.
Other terms can be organised on request and previous examples have included O&G, neonatology and psychiatry. Nepean actively encourages involvement in retrieval medicine for interested trainees and can incorporate this into terms and training for the trainee.
As part of the Network we rotate trainees out to Blacktown hospital to satisfy their district hospital ED requirements and a rotation to Westmead for more trauma experience will be available in the future.
Dr James Mallows firstname.lastname@example.org
02 4734 2763