446 Administrative and Legal Issues
Excellence in emergency department care
The aim is to provide excellence in emergency department (ED) care by cultivat-
ing the following desirable habits:
● Listen to the patient.
● Exclude the differential diagnoses (‘rule out’) and refine the possible diagnosis
(‘rule in’) when assessing any patient, starting with potentially the most
life-or limb-threatening conditions, and never trivializing.
● Seek advice and avoid getting out of depth by asking for help.
● Treat all patients with dignity and compassion.
● Make sure the patient and relatives know at all times what is happening and
why, and what any apparent waits are for.
● Maintain a collective sense of teamwork, by considering all ED colleagues
as equals whether medical, nursing, allied health, administrative or support
services.
● Consistently make exemplary ED medical records (see below).
● Communicate whenever possible with the general practitioner (GP) (see p. 447).
● Know how to break bad news with empathy (see p. 448).
● Adopt effective risk management techniques (see p. 449).Emergency department medical records
Record accurate and concise information for every patient examined in the
department. Details will obviously vary according to the nature and layout of
each department’s records. Computerization of the medical record mandates the
same high standards of recording.
1 Ensure all the boxes at the top of the page have been filled in (usually by the
reception staff ) to identify the patient fully.
2 Start by printing your own name and designation, and the date and time you
commenced seeing the patient.
3 Write legibly throughout. Other members of staff will be reading your notes,
which will be valueless if they are illegible.
4 Record all the positive clinical findings in the history and examination, and
relevant negative findings.
(i) Avoid the use of abbreviations, except for unambiguous,
approved examples, such as BP. Digits should be named not
numbered, and ‘left’ and ‘right’ should be written in full.
5 Make detailed notes in assault or motor vehicle crash attendances from the
patient’s recall of events, or from a witness. Document the exact size of
bruises or lacerations measured with a ruler.