Regarding the Australasian College for Emergency Medicine (ACEM) guidelines on emergency department (ED) layout design, which ONE of the following statements is INCORRECT?
Answer: C: ACEM provides recommendations on the minimum size and number of treatment areas in the configuration of an ED in Australia and New Zealand. These must be considered in relation to the projected activity, casemix and population served by an individual department.
Ambulatory and ambulance entrances should be separate, for reasons of security, control of patient flow and traffic safety. Paediatric areas require adequate space to accommodate not only the patient, but also adult carers, family and storage for toys, books and other distractants.
Reference:
Regarding the ACEM guidelines on equipping an ED, which ONE of the following statements is TRUE?
Answer: C: ACEM also provides recommendations for minimum equipment in each type of clinical area. A single central staff area enables better communication between, and coordination of, staff members. Isolation rooms require negative ventilation to minimise the risk of spread of infection.
Decontamination rooms should be accessible directly from outside the ED at the ambulance bay, with self-contained decontamination facilities rather than having hazardous patients in the waiting rooms with other patients. Consultation rooms should ideally be adapted to be multipurpose because specialisation of rooms imposes limits on patient flow. However, if a room is adapted for ophthalmology problems (with blacked-out or absent windows), equipment should include both a vision screen for testing vision, as well as a slit lamp for examining the different structures of the globe.
Regarding clinical practice guidelines, which ONE of the following statements is TRUE?
Answer: A: A clinical practice guideline is a systematically developed statement to support clinicians and patients when making decisions about appropriate healthcare in specific circumstances. It is the result of summarizing the current body of evidence on a particular issue, and translating it into a tool to improve the care of individual patients, or appropriate use of resources. Collating the evidence on a particular issue may be hampered by a lack of available literature on a topic. Available evidence should be graded on its quality, and all available evidence considered – not every topic has been researched via a randomized controlled trial. The ultimate quality of the produced guideline is dependent on the rigor of the development process, rather than the distinction of the authors.
A guideline should be considered in the specific setting and patient to which it is being applied, rather than as a blanket protocol of action. Much research may be carried out on otherwise healthy subjects with single conditions, or study populations very different from those attending our EDs. This must be taken into consideration when applying any guideline. New research and new medical practices constantly evolve. For this reason, it has been estimated that the effective half-life of a clinical guideline is around 6 years; the intention to review it by a certain date should be declared at publication.
Regarding ED information systems, which ONE of the following statements is NOT TRUE?
Answer: C: Primary uses of ED information systems are as tools to manage the ED by tracking the progress of patients, plus storage and retrieval of clinical data as required. They may also be used to provide data for wider purposes such as:
Manual (paper) systems have some advantages in terms of low cost, ease of use and reliability in the face of power supply issues. However, most Australasian EDs are so large that computerized systems offset these benefits, as well as displaying other advantages:
However, additional costs to consider include not only introduction but maintenance of both software and hardware, training of staff to maintain consistent practice, and ongoing development to ensure it supports expansion and changing practice within the department. Procedures to support data security, data integrity and back-up during power loss are required.
Regarding performance appraisals, which ONE of the following statements is TRUE?
Answer: D: Effective appraisal of staff is a powerful tool for developing behaviours and performance desirable to the ED activity. However, in order to do so, it is important to understand what incentives – financial, time-based, recognition – are important to the individual being appraised.
Logbooks are useful for recording caseload and the frequency of procedures; however, they indicate activity rather than provide any information on quality of care. Individuals involved in appraisals are prone to a number of potential errors, including personal tendencies to mark higher or lower than average, or submit similar appraisals regardless of performance. They may also be biased by:
For these reasons, appraisals are most effectively conducted involving multiple appraisers, drawing on multiple sources of information about performance.
Click to expand