Dr Blake EddingtonEMET FACEM

Tweed/Byron Health Service Group

ED Presentations

Tweed 50,000

Murwillumbah 20,000

Mullumbimby 10,000

Byron Bay  10,000

Tweed/Byron Health Service Group

“Quality Care Out There.”

The location of the patientshould not impact their level of care.

Sweep the floor.

Tweed/Byron Health Service Group

Tweed/Byron Health Service Group

LUNCHTIME RESUS

In their Resus Room 2 per week

CHEAP‐ iSimulate and Low Fidelity Mannequin + local resus equipment

WHO? GP/CMO/Locum + nurses

WHAT CASES?

WHY? $500

Tweed Byron Health Service Group

Nursing staff are key especially in the rural setting

• Knowledge of equipment

• Location

• Guidelines

MULTIDISCIPLINARY APPROACH

Tweed Byron Health Service Group

THE SYSTEM

TEAMWORK

INDIVIDUAL

WHAT WE LOOKED FOR

Tweed Byron Health Service Group

WE WERE MAKING SIMPLE THINGS COMPLEX

EACH ED HAD DIFFERENT:

• Resus posters• Protocols displayed• Resus trolleys • Equipment• Drugs and IV Fluids• Call for Help

WHAT WE FOUND

Tweed Byron Health Service Group

CONCEPT 1 – COGNITIVE UNLOAD

THE INDECISION OF CHOICE

SOP’s

KISS 

Good COMMs

Tweed Byron Health Service Group

WHAT WE DID

SIMPLE, STANDARD GUIDELINES

8 RSI MEDS CONVERTED TO 2

REMOVE THE INDECISION OF CHOICE

Tweed Byron Health Service Group

WHAT WE DID

FAILED INTUBATION PROTOCOL

RSI CHECKLIST

Tweed Byron Health Service Group

WHAT WE DID

STANDARDISED RESUS ROOM WALL POSTERS

And NETS CALCULATOR

Tweed Byron Health Service Group

WHAT WE DID

STANDARDISED CALL FOR HELP

Tweed Byron Health Service Group

WHAT WE DID

STANDARDISED INSTRUCTION CARDS

+ OTHER ONE

Tweed Byron Health Service Group

WHAT WE DID

STANDARDISED KIT BOXES ‐ $7 BOX!

DIFFICULT AIRWAYS/SURGICAL AIRWAYS

SEPSIS BOX

STEMI BOX

CHEST TUBE BOX

Tweed Byron Health Service Group

CONCEPT 2 – PUT THE SYSTEM THROUGH IT’S PACES

• TELEMEDICINE‐MUTE BUTTON ON DEFAULT

• OUT OF DATE STOCK REMOVED ‐ CHEST DRAIN

• MIDAZ LOCKED INPHARMACY

• NEOPUFF SET FOR NEWBORNS AS IN A MATERNITY WARD

• SODIUM BICARBONATE

• INSUFFICIENT O2 OUTLETS FOR NASAL PRONGS

• FLAT BATTERIES IN LARYNGASCOPES

Tweed Byron Health Service Group

CONCEPT 3 – A PICTURE TELLS A 1,000 WORDS

TELEMEDICINE VIDEO CONFERENCING

IS  USED IN LUNCHTIME SIMULATIONS

SHARED RESPONSIBILITY

SUPPORT

SWEEPING THE FLOOR

Tweed Byron Health Service Group

CONCEPT 4 – STRESS INNOCULATION

NOISYVOCALALARMSFLESHMOUOLAGEUPSET RELATIVESVOMITING

Tweed Byron Health Service Group

CONCEPT 5 – EMBRACING ERRORS AS ASSETS

CREATING A CULTURE WHERE ERRORS AREEMBRACED AS AN OPPORTUNIY TO IMPROVE

DON’T SWEEP IT UNDER THE CARPET!