• Medical Orientation

ECGs, Pathology, Radiology, Cardiology

ECGs

All ECGs must be signed by a senior doctor (consultant or registrar) as soon as they are completed. If you see an ECG that is not signed, please discuss it with and get it signed off with a senior.  This is a significant risk management and patient safety mechanism in our department.  Some registrars are junior and may not feel comfortable signing an ECG off (eg paediatrics, complex ECGs) in which case they will get a second opinion from someone more senior.

Radiology

The radiology department is located next to the emergency department on the ground floor. There is a full suite of services (except interventional).  All of the modalities including MRI, are generally more accessible than in metropolitan hospitals.

Requests

All CT/US/MRI imaging requests should be discussed with the ED consultant - unlike some hospitals, radiology in Bendigo is privately run and the gate keeper for appropiate test ordering is mostly the ED Consultant.

All Radiology requests are now done on EPR, please ensure that appropriate clinical Documentation is added to the request so that radiology can appropriately triage urgency of requests. Please also ensure that if any infectious risks that this is clearly documented so that Radiology can continue follow their approrpiate policies, it only delays imaging further if this is not completed

Viewing

All films are viewed electronically.  The program is Synapse.

There are logins and passwords for all other private radiology services in Bendigo, Echuca and the rest of the region.  These logins are in the flight deck and allow ED staff to view films over the internet for all our referral sources.

High Street Radiology and Bendigo Radiology (covers most of Loddon Mallee region) both use inteliviewer.  Echuca uses Goulbourn Valley imaging and sometimes the link has to be re-downloaded from their website.

For patients being sent on to tertiary hospitals, there are 2 options: sending the images via the medical imaging exchange system where the images are loaded directly onto the PACS system at the receiving hospital.  This requires you to sign a simple form - print and send to radiographers (or search "MIX form" on the intranet).   Option 2 is to burn a CD - this is still used for private hospital transfers to Melbourne - ask the radiographers.

Reporting

There is a radiologist in hours on site and will answer questions free of charge but speak to senior ED doctors first. Reports are generated rapidly in hours.  After hours radiologists  should be contacted by phone if a report is required or there is any doubt in interpretation of a CT.  It is better to group your phone calls to radiologists and ask if anyone else needs their input about a CT.  The in charge consultant should know who is getting CTs and who is not. Please speak to your in-charge doctor prior to calling radiology.

The reports from overnight imaging get checked in the next 1-3 days by ED consultants.  If you have any concerns about missing abnormalities overnight, discuss it with the day shift at handover.  You can also write a "note" on synapse (using the power jacket, notes function and write "normal" etc) to the radiologist - if they disagree with your interpretation they will contact the ED consultant the next morning.  We do not expect junior staff to be definitive on interpreting CTs - a radiologist or consultant should be involved before sending the patient away.

Ultrasound after hours + daily ED timeslots

There are almost no indications for a sonographer to be called in.  There are 2 spots reserved each morning  11:00 + 11:30 (4 on Monday) for urgent bookings where a patient can be sent home and come back for imaging (eg pelvic pain) as a continuation of the ED consultation.  These are not to be used for routine outpatient scans.  A request is completed on EPR and a patient sticker placed on the timeslot sheet on the radographer whiteboard in the main patient waiting area/ward in radiology.  Patients must have clear instructions (eg full bladder for 1st trimester scan or pelvic scan, fasting for biliary scan) and told to come at the alotted time directly to radiology (and to be on time).  All of these patients must be seen in ED after the scan for the results and to finish the ED consultation unless a clear plan is formed to be followed up in the Early Pregnancy Assessment Service (EPAS) clinic.

Pathology

Pathology runs an excellent 24 hour service. Pathology requests must be relevant to the patients immediate emergency care.

Requests

All requests are ordered on EPR, the form is then printed, pathology tubes labelled with patient Bradma's, date and signature, then sent pathology with printed pathology form.

Do not order tests that you, personally, will not review.  For example, any swabs, serology etc should not be requested.  There may be exceptions to this where specific clinical indications for a test with specific and explicit follow up is required.  However if this is not explicit, results only get sent to overburdened emergency consultants with very prolonged follow up times.  We do not perceive this as our role in the community as we have no ongoing care of patients.  Often patients cannot actually be contacted. Inpatient Unit requests for more detailed investigations should be ordered by that Unit when the patient is admitted, not by the Emergency Department medical staff.  If there is doubt or disagreement then discuss with the ED consultant. In general, FBC, U+E, LFTs, Lipase, Blood Gas (with lactate), troponin, CK, Paracetamol, Alcohol and Group + Hold can be ordered without restriction where indicated. Other tests should be carefully considered in the context of relevance and expense to the department and your own tax payers money.  For example the indiscriminate ordering of “Ca/Mg/PO4” is unacceptable - but may definitive in some patients - learn about rational investigation ordering while you are in ED.

Pneumatic Chute

Specimens are sent via the chute system next to the flight deck.  Put the specimen in a pathology bag, then in the RED canister.  Put the canister in the chute machine and the RED cannister will automatically be sent to pathology.

Specimens

Group and Hold specimens must be hand written, the patient positively identified, and then a witness to the collection must sign the request form in the space provided.

The likelihood of a specimen being haemolysed and unusable is related to the time taken for the sample to be drawn from the patient mostly and secondly the time taken to put into tubes. Do not take samples out of IV lines or downstream from IVs with fluid attached – this will make a very healthy patient anaemic and give them often a sodium approaching 150 (if normal saline is running).

Cardiology

All cardiology diagnostic test results can be looked up on the computer program Cardiobase.   The login and password is medward.  You can also use you personal login.  Cardiobase can be accessed from the medical portal on the intranet.