Review the 6 radiology related pathways from the Choosing Wisely campaign, which will be implemented soon.
Most of these are well known to ED clinicians and should already form the backbone of your clinical practice.
If you are unaware of these feel free to review them and discuss with a senior member of staff.
The PE flowchart is complex although can be distilled down – you should first start with a good grasp of the Well’s score and the PERC rule.
Acute Ankle trauma and the Ottawa Ankle RuleRANZCR-Clinical-Decision-Rules-pages-8-11
Suspected lower limb DVTRANZCR-Clinical-Decision-Rules-pages-12-13
Suspected Pulmonary EmbolismRANZCR-Clinical-Decision-Rules-pages-15-23
Acute low back painRANZCR-Clinical-Decision-Rules-pages-25-29
Cervical spine traumaRANZCR-Clinical-Decision-Rules-pages-30-39
There is a new sepsis pathway which will rollout 5th November at Western Health. The pathway contains two important and useful components:
- a bundle of actions to execute within the first 60 minutes of suspicion of sepsis
- empiric antibiotics, grouped by suspected source
There is an opt-out box to tick, should you, as the treating clinician, feel that sepsis is NOT likely – in ED these patients may include presentations such as likely viral illness, simple pharyngitis/tonsillitis or simple gastroenteritis.
There are new MANDATORY anaphylaxis notifications that have been issued by the Department of Health that are IN EFFECT as of 1st November 2018.
You can read the entire document below but the most important parts have been extracted below:
What to notify?
ALL cases of anaphylaxis that present to our emergency department – regardless of whether symptoms have improved or not, and regardless of whether the trigger is known or not.
Urticaria or angioedema, if occurring in isolation, do not need to be reported.
Cases of anaphylaxis that occur whilst in hospital, curiously, do not need to be reported.
How to notify?
Where the suspected cause is the consumption of a packaged food:
Notifications are required to be made:
immediately (within 24 hours of diagnosis),
by telephone (1300 651 160, which is staffed 24 hours a day, seven days a week),
• with the details listed in the ‘notification details’, below, to the departmental staff member.
If in doubt about whether the suspected cause was a packaged food, hospitals are advised to
use this notification route.
Where the suspected cause is anything other than packaged food
Notifications are required to be made:
• within five days of initial diagnosis of anaphylaxis,
• electronically via the online form through the department’s website at
and click on the link in the notification table for anaphylaxis,
• with the details listed in ‘notification details’, below.
Anaphylaxis notifications guidance Oct 18
This poster was created by Simon Green, a nurse practitioner, and modified for use at Western Health by Ian Law and Neil Long
REFERRAL TO HEADSPACE SUNSHINE:
(12-25yo, presenting with mild-moderate mental health difficulties)
Business Hours: Fax ED assessment/notes to headspace Access Team, followed up with phone call to confirm receipt of the assessment (if possible, patient can speak with Access Team to ‘fast-track’ intake process)
Afterhours presentations: fax assessment, leave a voicemail including patients name and send the UR number via email to Alex.Pleban@mh.org.au Sunshine Hospital Assertive Linkage Service (EMH) to follow up during business hours
FAX: 9312 1757
PHONE: 9927 6222
Note to patients/carers:
- Young people referred by ED are prioritised and typically contacted via phone within a few days for brief assessment and introduction
- A face to face meeting with an Access team clinician may also be booked if required to facilitate engagement/further assessment of suitability (typically within 1-2 weeks)
- A Mental health Care Plan from a GP is not required for referral and initial assessment with the Access team, but will be required thereafter to access ongoing therapy with an Allied Health Provider (e.g. 10 bulk billed sessions per calendar year)
- Wait times for Allied Health Providers can vary depending on demand, availability and client need (limited afterhours appointments are available Tuesday, Wednesday and Thursday evenings, Saturday mornings)
- Interim support via Groups and the Access Team can be provided where there is a need whilst waiting for their first appointment with one of our Allied Health Providers
Crisis support options
Kids Helpline 1800 650 890
Orygen Youth Health triage 1800 888 320
RCH triage 1800 445 511
- https://www.eheadspace.org.au or 1800 650 890 for online or over the phone counselling and support (non-crisis support)
- www.headspace.org.au for further psychoeducation material for clients and carers
Factors to consider when referring to headspace Sunshine:
– Young people aged 12 to 25yrs and presenting with mild-moderate difficulties can be referred
– There is no geographical catchment, however it is expected that potential clients are able to attend their preferred centre
– headspace Sunshine provides access to counselling, psychiatry, GP appointments, mental health nurse, vocational support and peer support as well as facilitating contact with various collocated providers (housing, AoD counselling and carer support)
– Requests for crisis support or management of severe/complex presentations should be directed to Orygen Youth Health Triage 1800 888 320, or RCH Triage 1800 445 511
Other questions queries to: