Regarding rostering of staff in the ED, which ONE of the following statements is TRUE?
Answer: C In planning a shift-based roster, the following features have been found to have beneficial effects on health and work/life balance:
The adaptation of circadian rhythm to night shift takes around two weeks – a biological argument may be made for staff working permanent night shift (this may, however, create difficulties in obtaining balance in staff rosters, and involving night staff in communication and business management).
The Australian Medical Association has a voluntary code of practice relating to risk assessment of roster patterns in which backward rotation, speed of rotation and longer shift lengths are regarded as higher risk patterns.
Reference:
In considering work-related stress in emergency clinicians, which ONE of the following statements is TRUE?
Answer: C Stress is dependent on an individual’s perception of lack of control over a situation. A study of Australian emergency clinicians found that perception of control over hours worked and varied clinical activities was positively associated with work and life satisfaction but negatively associated with work stress and measures of well-being. Effective strategies are person- and context-specific, for example, being around family may be a positive or negative experience, depending on circumstances. Effective time management – such as organizing one’s tasks in a Do, Defer, Drop or Delegate system – may promote a sense of personal control and reduce stress. This can be positive in both personal and professional arenas.
Burnout is a form of low-grade stress that may be recognized by features including depersonalization, compassion fatigue, and negative perceptions of one’s own work and accomplishments. It has a very high incidence in medical staff in Australian EDs. Risk factors include:
Regarding complaint management in the ED, which ONE of the following statements is TRUE?
Answer: A: Complaints may be useful in highlighting areas of ED performance in which patient satisfaction has not been met. Rather than an indicator of poor treatment, it may simply be that there is a disparity between a patient’s expectations and their management process, which has not been adequately addressed or explained. A senior staff member addressing this in person at the time of the event is often able to resolve the issue without the complaint progressing further. Issues relating to responsibility of other departments should be redirected to the appropriate manager.
While many staff may be distressed when informed of a complaint, these consistently occur in relation to a few areas – most commonly, in communication with or attitude of staff, access to services, and inadequate/incorrect treatment. The majority of treatment complaints relate to issues that are simple to address by implementing CQI systems, such as missed fractures or inadequate analgesia.
Complaints should be adequately and carefully investigated, then responded to within a set time frame. Most complaints can be resolved by:
These steps will resolve most complaints to everyone’s satisfaction. Complaints can be a powerful tool to identify issues needing attention within the ED – such as interaction with inpatient specialties, delivery of services or access block – and drive necessary changes.
References:
Regarding clinical handover, which ONE of the following statements is TRUE?
Answer: C: Clinical handover is the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group. Poor communication between healthcare professionals has been found to be a key contributory factor in over 70% of sentinel events. In emergency medicine, its functions include:
Factors shown to improve the transfer of clinical information include:
Some authorities advocate bedside handover, involving the patient in processes. Advantages include improved patient satisfaction (as they are aware of changeovers and are seen by a senior doctor), pick-up of errors/misinformation, and earlier decision making. However, some functions of handover – discussion of errors, discipline and teaching – are less well performed at the bedside, and the process may act as a focus for some problematic or aggressive patients.
A 25-year-old man presents to the ED after being assaulted at home late on a Friday night. He has contusions to his scalp and face, Glasgow Coma Scale (GCS) 11/15, and is unable to provide any history. Two hours later, his brother and several friends arrive in the waiting room, demanding to see the patient. When the triage nurse explains that medical staff are all busy, they become verbally abusive, pacing up and down, while one starts smoking next to the desk.
Regarding aggression management in this situation, which ONE of the following statements is TRUE?
Answer: D: Violence is rarely entirely unpredictable. Paying attention to verbal and non-verbal behaviours will help staff anticipate potential problems, and modulate their own responses to affect the situation.
Several red flags for violent escalation are identifiable here: change in the group’s perception of staff role from helpful to being an obstacle, provocative and demanding behaviour, and physical restlessness. Further concerns might be behavioural, such as a shortened attention span, increased verbal aggression (taunting, sarcastic), and changes in speech – raised volume, higher pitch and more rapid intonation. They may also try to enlist the rest of the waiting room as an audience (‘Oh, we’re sorry you’re too busy’), which may cause further escalation as the aggressive individuals may feel a need to ‘win’ the confrontation, or lose face.
Attempting to communicate with a number of agitated people in a public place may provide a focus for aggressive action. Separating the concerned individual (the brother) from the audience and communicating with him in a quiet, controlled environment achieves a number of positive actions.
People who are aggressive may provoke automatically negative and forceful responses. However, a number of stresses may be acting on such an individual: unfamiliarity with the environment and with the behaviour expected; lack of information; and anxiety over his sibling’s condition (there is also the question of mechanism of injury yet to be established). Providing him with clear, current information may relieve these anxieties and reduce his aggression risk. This in turn can assist in defusing the hostility of his companions. Information must be calmly expressed in simple, clear terms, stated repeatedly to overcome his situational short attention span.
This conversation should take place in a private but not isolated area. Surrounding ED staff should be aware of the location of both staff and the relative. Security staff should be advised at an early stage of the potential hazard.
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