MONASH CLAYTON ADULT EMERGENCY DEPARTMENT HMO ORIENTATION 


1. SOURCES OF INFORMATION: 

. Consultant in charge/Senior Registrar overnight (25134 or 85725134) 
. Switchboard (92) 
. Any Emergency Department Roster/Pay/Admin question: 


 Karen.Riccioni@monashhealth.org (95942875) 

 Clea.Schafer@monashhealth.org (95942707) 

. Orientation Handbook 


 
We acknowledge that Monash Health is a large organisation with a lot of moving parts and many 
idiosyncrasies regarding patient management (treating teams, campuses, policies and procedures 
etc.) and we do not expect the Residents to know all of this on day one but we do expect and 
welcome any and all questions they may have. 

2. VALUES 

Essentially the Monash Health ICARE values: (integrity, compassion, accountability, respect, 
excellence) considered in an Emergency Department specific context: 

. Integrity 
o Professionalism: maintain high standards and expect the same from others 
o Dress neatly or wear scrubs 
o Punctuality: 
. Arrive so as to be able to commence your shift on time 
. On arrival, find and introduce yourself to the SMS/SR in charge 
. Please call SMS/ SR if you are running late 85725134 


o Sick calls: Please call 85725134 an as soon as you know you will miss a shift 
o Communication. 
. ISBAR for Referrals and handovers 
. Communication Clerks 






 

o I hereby empower you to ask for clarification from ANYONE who attempts to 
handover a short stay patient to you with anything less than a crystal clear plan. 


. Compassion 
o Patient centred approach: remember that they are vulnerable and at a low point 
o Remember how privileged you are to be in a position to help 
o Advocate for your patients care 
o Maintain patients dignity and privacy (cover with blankets, close curtains during 
examination etc.) 
o Escalate to your consultant immediately if you have any concerns 




 

. Accountability 
o While you are not expected to be professors of emergency medicine, you are 
expected to be diligent and honest 
o Assessment: take a thorough history and do a thorough examination 





o Management plan: timely formulation and presentation of said plan to your 
consultant, with prompt implementation of the agreed plan within 30 mins 
o Documentation: thorough documentation of all aspects of patient care is absolutely 
integral to safe patient management. This includes not only your initial history and 
exam, but also subsequent discussions with your ED consultant and inpatient 
registrars (including names), working diagnosis, management plans (bed admission 
type and location), patient review (especially in short stay) and indeed any 
interaction that has a bearing on patient care 
o Investigations: Only order indicated, evidence based investigations (be they bedside, 
pathology or radiology). If unsure, ask your consultant. Document any abnormalities 
discovered on any investigations and the actions taken, including plans for follow up. 
This is particularly important for any patient who is discharged home 
o Discharge planning. Discuss the plan with the patient/carer, provide a written copy 
of GP discharge summary with detailed instructions on management plan and 
review instructions 




 

. Respect: 
o Yourself: Stay hydrated. Make sure you have a break every shift. 
Leave on time - we work hard to get you home on time. 
o Colleagues: ED and non ED, medical, nursing, allied health and support staff 
o Patients their families: Monash health encourages / expects the use of professional 
translators when required (contact switchboard to arrange) 




 

. Excellence: 
o High Risk Patients: potentially all patients but especially: 
. Elderly (over 65) with abdominal pain 
. Elderly (over 65) with blunt chest trauma 
. Patients who represent to ED within 48 hrs 






 

o Get into the habit of asking yourself what the worst case diagnosis might be, and if 
you don’t know what that might be, ask 




 

o Ask the ED consultant to review your patients with you if anything unclear/uncertain 




 

o Hand Hygiene: Latte training. 




 

o Cannulation: “Just say no to the Just-in-Case cannula” 




 

o Best Practice Resources 
. Therapeutic guidelines for antibiotic prescribing 
. Check medication doses on AMH or with ED pharmacist 
. Prompt for some specific conditions? 






 

 

 


3. PRACTICALITIES 

. How the ED works (model of care) 
o Triage -> paeds/adults -> fast track/acute/STAR -> admit/discharge/short stay 


 

. How the HMO shift works 
o Arrive on Time 
o TAP-ON to TOTO and log into EMR 
o Check allocations board to see where you are working 
o Introduce yourself to the consultant in charge of your stream 




 

. SSU HMO ROLE 
o Team structure: AM/PM/NIGHT 
o Handover times 0730, 1600, 2300 
o Handover location (SSU meeting room on level 5) 
o All patients in SSU are handed over to you 
o Subsequent patients sent to SSU are also handed over to you 
o You must see every patient handed over to you at least once 




Patient Review Order/SSU Ward Round Order 

1 

Unstable/Deteriorating Patients 

2 

Imminent discharges 

3 

ED SSU Patients (time order) 

4 

Admitted Patients (intern) 

5 

Huddle with SSU team (HMO/Intern/SMS or JR registrar) 



 

Patient Review Checklist 

1 

Check notes (Seen by inpatient team?) Management Plans Documented and Actioned? 

2 

See patient and Review Vital Signs 

3 

Medication Chart: Complete (regular medications, analgesia (regular+PRN), allergies) 

4 

Pathology and Radiology: requests and results (review and document actions as needed) 

5 

DOCUMENT COMPLETION + ESCALATE THE UNEXPECTED 



 

. STAR HMO ROLE 
o Default is to see the longest waiting, but check with consultant in charge 
o History/Exam/Consultant Discussion/Management/Disposition Plan within 30 mins 
o Close contact with consultant STAR nurse TL and NIC throughout shift 




 

. ACUTE HMO ROLE 
o Usually Consultant and Registrar but occasionally HMO 
o Opportunity to see sicker patients/to get into resus 
o Workload: consultant takes admitted handovers. 
o New patients will typically be critically unwell (resus) patients (+BAT calls), mental 
health patients (BAR) and infectious patients. 




 

. FAST TRACK HMO ROLE 
o Usually registrar or CMO or consultant, Rarely HMO 





4. IT ORIENTATION 

This could take a day in itself, and generally speaking it’s the individual HMO’s responsibility to 
familiarise themselves with the various programs, but point them towards the following: 

. EMR (Highlight Launchpoint check in, initial ED assessment and handover note) 
. Intranet and ED home page with links 
. SMR: including outpatient referrals 
. Pathology: 
. Carestream: 
. Health Track: 
. Pharmacy resources: AMH, therapeutic guidelines 
. Safescript: www.safescript.vic.gov.au 
. Paging (regular and smart-page) 
. Death certificates: Ensure you are registered with BDM Victoria: www.BDM.vic.gov.au 
. Webmail: check your work emails regularly 
. External Radiology: (Capital / Marina /MIA etc.) 


 

 

5. PHYSICAL ORIENTATION 

Walk them around the Department and show them where everything is 

. Front Door / Ambulance Door 
. Triage 
. A29 
. Family room 
. Resus 
. VBG/AQT machine 
. Sluice room 
. BAR, cubicle 6, mental health office 
. Main pod (allocated computers, NIC, ward clerks, Board with roles) 
. ED Drug Room 
. STAR cubicles (emergency buzzers and computers in all cubicles) 
. Acute cubicles 
. Radiology (Reception ; CT rooms 1 + 2 ; Radiology Reporting room ; Ultrasound) 
. Fast track (eye room and procedure rooms) 
. Paediatric ED 
. Short stay (level 5) 
. ED offices (+Karen/Clea) 
. Tea room (+Fridge for food and hollow blue couches for bags) 
. Toilets (+/- small lockers) 
. Consultant offices