Ms Felicity Gemmell-Smith RN, EDO NEATS Prof John Fraser FRACGP, FAFPHM, SME NEATS

IMPROVING GP REGISTRAR IMPROVING GP REGISTRAR ORIENTATION AND LEARNING ORIENTATION AND LEARNING

IN IN EMERGENCY DEPARTMENTS EMERGENCY DEPARTMENTS

IN THE IN THE NEW ENGLAND REGIONNEW ENGLAND REGION

Ms Felicity Gemmell-Smith RN, EDO NEATSProf John Fraser FRACGP, FAFPHM, SME NEATS

Ms Marianne Gaul CNC Emergency/Critical Care Services

Hunter New England Area Health Service

NEATS’ Mission Statement



“to provide and promote excellence in GP education and training in the New England

region of NSW”

NEATS is accredited as a GP training provider until 2007 to the standards of the Royal

Australian College of General Practitioners (RACGP) & Australian College of Rural &

Remote Medicine (ACRRM)

Background

• Rural NSW is receiving metropolitan trained GP registrars

• A lot of GP registrars have not worked in smaller sites

• All NEATS GP Registrars are required to be on-call to their local Health Services and Surgery


The Nature of the Problem The 2004 Orientation workshop found

misconceptions within the GP Registrar group regarding services and equipment available at local health facilities, eg road side phones

GP Registrars’ lack of previous experience in working on call in a rural setting

Ad hoc, random and non-standardised orientation processes

Risk of wide quality variances depending on personalities involved


Objectives• Provide adequate accountable orientation to GP

Registrars of their local Emergency Department prior to their first call out

• Improve communication between GP Registrars and local nursing staff to encourage team based approach to patient management

• Identify unmet learning needs of GP Registrars which were to be incorporated into formal Learning Plans


Method• Collaborative project between Hunter New England Area

Health Service, Rural Training Unit and GP Training Consortia (NEATS) including a steering committee of nurse and medical educators

• Project pre-tested with registrars and nurse unit managers

• Self directed tools developed for registrars to reflect on unmet learning needs, on their present level of competence in managing emergency presentations and using common skills

• GP Registrars were requested to meet with local Emergency Department nursing staff prior to first on-call rostering


The Checklist List of standard equipment formulated by CNC

Emergency/Critical Care Services and RTP for checking by registrar in conjunction with nursing staff

Registrar required to locate listed equipment, or note if not available.

Location of all listed items was to be recorded Checklist to be signed by registrar and

accompanying nurse, and copy to be faxed to Regional Training Provider within two weeks of commencement of term.



Equipment Available? Location?

Yes No

After hours Drug Cupboard and FridgeAmbulance EquipmentAuroscopes

Bag Valve Mask DeviceBlood Alcohol Kits & DispenserBlood Warming DeviceBlood FridgeBlood Gas AnalyserBroselow (Paediatric) TapeBrown Paper Bags

Cardiac MonitorCatheters – SuprapubicCatheters – UrinaryCervical Collars (semi rigid)Chest Drain & Ambulatory Chest Drainage System

Evaluation of Project

• Post orientation questionnaires developed and distributed to all participating Health Services and their Emergency Department Nurse Unit Managers

• Separate questionnaires developed and distributed to participating GP Registrars

• Verbal feedback sought from Health Service Managers

• 9 out of 11 Registrars completed the checklist and evaluation questionnaire (82%)


Results GP Registrars 100% (9) found that this process helped

familiarise them with the equipment levels available locally

89% found that it assisted them with determining local services

available in an emergency situationassisted them treating patients fostered a teamwork approach with the local nursing

staff 100% stated that this checklist assisted them

with being on call


Results GP Registrars

• 89% stated specific benefits arising from this process, such as being able to locate equipment when required

• Only 1 registrar indicated that there were barriers to completing the checklist (lack of time)

• 1 registrar felt it was too detailed• It was recommended that supervisors also

complete this orientation exercise


Results GP Registrars

• Differences between metropolitan and regional facilities were identified and stated differences included equipment levels as well as the lack of readily available staff specialists and consultants


Results Nursing Staff

100% (4) of those who had completed the checklist with the registrar felt the process helped them• familiarise the registrar with the equipment levels and

local services available in an emergency situation• explain any relevant emergency situation issues to

the GP Registrar• foster a team work approach • to assist the GP Registrar with treating patients


Results - Nursing Staff 75% of nurses who completed the checklist with the

registrars believed that it helped re -familiarise them with the equipment and services available locally

Benefits of completing the checklist included meeting and developing rapport with the GP Registrarrefamiliarisation with equipment and proceduresconsolidating unspecified work site considerations

None felt the checklist could be improved upon


Results - Stakeholders• Several health facilities have indicated that they

would like a similar process completed for Community Health Services and General Wards and have indicated willingness to allocate staff to assist with same.

• Co-operation between nursing staff and GP Registrars appears to have been enhanced by this process

• All health facility managers spoken with endorsed the process and several requested copies of the checklist to use in VMO orientation


Discussion: The Future

• This process will form part of NEATS’ ongoing orientation processes for GP Registrars

• There is scope to expand this process to JMO and Allied Health personnel orientation procedures

• Community Health profiling as suggested by HSMs will be integrated into the orientation process for Registrars

• Copies of the checklists have gone to several facilities for use with hospital staff






Documents

Ms Felicity Gemmell-Smith RN, EDO NEATS Prof John Fraser FRACGP, FAFPHM, SME NEATS