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MODULE 17 short answer questions.

saq 1.

You receive a complaint from the director of internal medicine that one of the ED registrars has been bullying admitting medical registrars, several of whom have become distressed. The ED director has asked you to handle the issue.
 
Question 1. (3 marks)
 
Outline three steps in the process that you will follow.
 
Must include:
  • Clarification of specific details from medicine
  • Interview doctor concerned and any other witnesses
  • Formulate a response to the director of medicine

Question 2. (4 marks)
 
Your investigation shows that the complaint is justified.
 
Give 4 actions you will now undertake.
 
Must include:
  • Informing the registrar that the behaviour cannot continue
  • Notifying department head/medical administration as required
  • Formulating a performance/management plan as required
  • Support junior doctor as required
 
Question 3. (8 marks)
 
The junior doctor breaks down and tells you that she has been very stressed by her work, and has been abusing opiate prescription medication to try to cope.
 
Outline four issues that you will now address.
 
Must include:
  • Mandatory reporting obligation: notification to AHPRA and senior medical management
  • Doctor in distress needs support: involvement of support people eg DEMTs
 
Plus any of:
  • Confidentiality: needs to be maintained
  • Medical welfare: referring junior to an appropriate service
  • Medicolegal: advise junior to speak to MDO
  • Departmental welfare: ensure rosters etc are covered while junior doctor is taken off duty.

saq 2.

Your director has delegated you to investigate a critical incident. A 19 year old man has returned with a non viable testicle after a missed torsion the day previously.
 
 
Question 1. (3 marks)

Outline your process for investigation which you will follow.
 
Must include:
  • Review of clinical notes and investigations conducted
  • Interview staff concerned, including treating doctor
  • Collate results and feed back to director
 
Question 2. (5 marks)
 
As a result of your investigation it is decided to conduct open disclosure with the patient and his family. List the important elements of open disclosure.
 
Must include:
  • Open and timely communication
  • Acknowledgement of the adverse event
  • Apology for the events
  • Support & meet ongoing expectations of patient
  • Forwards quality assurance/systems improvement
 
Question 3. (6 marks)
 
Outline 3 areas you might address to prevent a recurrence of this issue, and a suggested improvement for each.
 
Include:
 
  • Staff knowledge: education sessions about condition
  • Risk management: implement protocolized approach for this specific condition
  • Departmental factors: ensure supervision levels are adequate for junior doctors
 

saq 3.

Question 1. (10 marks)

Complete the following table for each ATS category.
ATS Category

1.

2.

3.

4.

5.
Timeframe to be seen

Immediate

10 minutes

30 minutes

60 minutes

120 minutes
Performance threshold indicator

100%

80%

75%

70%

70%
Question 2. (6 marks)

For each category below outline 2 methods which may be used to address access block.

1. PREHOSPITAL.
  • ambulance triage (eg trauma pts to trauma centers)
  • community treat/not transport protocols.

2. EMERGENCY DEPARTMENT.
  • early senior intervention
  • increase resourcing
  • use of community support to facilitate discharge, etc

3. INPATIENT UNITS.
  • streamline admission process
  • remove inter facility transfers from ED
  • protocolize common conditions
  • 2nd W/Rs during the day for discharges etc

(note there are large variety of answers to this question – feel free to discuss/share via the VSG)

saq 4.

Your registrar comes to you after a discussion with the surgical registrar. A child of non-english speaking background has appendicitis and is for theatre. The surgical registrar has left the department and asked your registrar to arrange consent for theatre.
 
Question 1. (3 marks)
 
Outline the three elements of informed consent.
 
Must include:
  • Patient has capacity/competence
  • Consent is free and voluntary
  • The consent covers the procedure to be performed
 
Question 2. (3 marks)
 
The child’s parents also do not speak fluent English. Outline your actions regarding consenting this child.
 
Must include:
  • Consent for a surgical procedure is a surgical issue
  • Therefore call the surgical registrar/consultant and inform them that they will need to arrange consent.
 
Question 3. (3 marks)
 
Give three important elements when assessing a patient's competence.

Must include:
  • Understands the information conveyed
  • Can apply it to their own situation
  • Clear consciousness/alert & oriented
 
Question 4. (4 marks)
 
List in order appropriate substitute decision makers/tools if a patient is unable to consent for themselves.
 
Must include:
  1. Advance health directive
  2. Enduring Power of Attorney (EPOA)
  3. Statutory health attorney (close friend/relative)
  4. Public guardian

SAQ 5.

Recently there have a number of incidents relating to central line insertion in your department.
 
Question 1. ( 10 marks)

Give three factors which may influence this, outline 2 examples of each and give a strategy that can be used to address the problem.
 
Must include:
 
System factors
  • Inadequate equipment (eg lack of ultrasound)
  • Inappropriate supervision of staff performing procedure
  • Review equipment and provide appropriate items
 
Individual factors
  • Individual techniques
  • Knowledge of procedure
  • Training/simulation to address knowledge deficits
 
Environmental factors
  • ED overcrowding/inadequate space to perform procedure
  • Timing of problem line insertions (overnight/handover etc)
  • Designate space and protocol for procedure
 
NOTE – pass criteria is appreciation that these problems are multifactorial, and an effort to address systems, people and environment or something analogous is undertaken.