The 30 minute rule

Within 30 minutes of assigning yourself to a patient, you are expected to have completed a focused history and examination, generated a reasonable differential diagnosis and formulated a plan of what to do next.  You should now discuss this plan with a senior ED doctor. Your plan at this time does not have to be the final definitive plan for the patient.  Patients are not to be discharged or referred to an inpatient team without senior input.

This rule not withstanding, junior doctors should immediately involve the senior ED doctor in cases where patients have:

HR <50 or >120/min                           SBP <90 or >200

RR <10 or >30                                     SaO2 <90% not improved with O2

Temp <35 or >39                                GCS <15

ECG abnormalities, especially evolving ones

Please inform the MOIC if you have a critically ill patient or deteriorating patient, or you are feeling out of your depth, or, need extra resources to help in your patient management. We are always happy to help and work with you to ensure you are learning and feeling supported throughout your shift.

If you are unsure of the next step in the patient care, please ask the MOIC rather than ploughing on with unnecessary investigations. You will learn more if you ask.

Please document your notes carefully and thoroughly. Don’t forget to note down each step of your management, i.e. write a progress note to update results and on-going management plan. Please note your final plan prior to discharge.

Please communicate with the referring doctor either by phone or letter. You can give the patient a copy of their discharge letter and they can deliver to the GP if they are due for follow up. When ordering investigations, you can ask for results to be copied to GPs and this really helps the GPs in the follow up.

The patient load will vary on level of the doctor and the acuity of the patients, however 1 patient an hour should be possible. Junior doctors are expected to see Cat 3, 4 and 5 patients. They may see Cat 2 patients under the direct supervision of a registrar or consultant. They will not be expected to take primary responsibility for Cat 1 patients, but will be assigned as part of the Cat 1 team on shifts.

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