FCEM Management Examination CONFIDENTIAL

November 2006 Day 2

SCORE SHEET
Name Number

Candidate

Issue / topic

Notes of candidate s ans!ers

"core

#rioritising papers and diary management $score 0 % &' 0%& Informing ("E or #o)ice about patient !it* nec+ in,ury $score 0 % &' 0%& Comp)aint from patient !it* t*reatened miscarriage $score 0 % &' 0%& Documentation of Ma,or Incident patients $score 0 % &' 0%& -etter from F)orence "troud. retired matron. about doctors c)ot*ing $score 0 % &' 0%& "taff /rade s re0uest to bring dog 1ess into ED overnig*t $score 0 % 2' 0%2

Name

Number

Candidate

-ong case scenario -ocum consu)tant and t*e c*est drain $score 0 % 22'

0%22 /enera) approac* and sty)e $score 0 % 3' 0%3 -atera) t*in+ing $score 0 % 3' 0%3

4vera)) score $examiner 2'

out of &0

4vera)) score $examiner 2'

out of &0

5greed score
out of &0

Name

"ignature

Examiner 2 Examiner 2

FCEM Management viva CONFIDENTIAL

6opic Diary and in%tray papers $score 0 % &'

November 2006

Day 2
RNI 5/10/2006

SUGGESTIONS re ANSWERS and SCORING

Needed to #5"" Consider de)egating !or+ if appropriate. eg "taff /rade or C)inica) Fe))o! cou)d do t*e 7evie! C)inic and as+ for *e)p if t*ey need it8 #rioritise items sensib)y. eg urgent / non%urgent and important / not important 6*is !as a serious accident. apparent)y on a bui)ding site. but very fe! detai)s are +no!n about t*e incident and !*ere it occurred8 6*e Estonian bui)ding !or+er is being treated for *is cervica) fracture but *e is un)i+e)y to +no! !*at s*ou)d be done about reporting t*e accident. nor *o! *e mig*t get compensation8 5s+ t*e neurosurgeons *o! t*e patient is and !*et*er t*ey *ave reported t*e incident $!*ic* is un)i+e)y'8 It seems sensib)e to discuss t*is incident by te)ep*one !it* t*e (ea)t* and "afety Executive !*o cou)d arrange to intervie! t*e patient !it* an Estonian interpreter8 6*e ("E cou)d t*en invo)ve t*e #o)ice if necessary8 6*is is a forma) comp)aint !*ic* must be passed on immediate)y to t*e Comp)aints Dept for ac+no!)edgement. !it* a fu)) rep)y from t*e C*ief Executive !it*in 2< !or+ing days8 7evie! and copy t*e ED notes8 Discuss t*e comp)aint !it* t*e doctor invo)ved8 6*is patient is understandab)y un*appy and angry. despite not )osing *er baby. and needs an appropriate apo)ogy8

Extra mar+s Notice )in+s bet!een different items8

Informing (ea)t* and "afety Executive or #o)ice about patient !it* nec+ in,ury8 $score 0 % &'

5 cervica) spine fracture is a 9ma,or in,ury: reportab)e to t*e (ea)t* and "afety Executive under 7IDD47 ;< $7eporting of In,uries. Diseases and Dangerous 4ccurrences 7egu)ations'8 6*e emp)oyer is responsib)e for reporting t*is incident but t*e circumstances as stated by t*e "p7 suggest t*at t*e emp)oyer is un)i+e)y to report it8 Confidentia)ity is un)i+e)y to be an issue in t*is case. but t*e patient !ou)d not *ave to te)) t*e ("E anyt*ing if *e did not !ant to8

Comp)aint from patient !it* t*reatened miscarriage8 $score 0 % &'

#re%numbered pac+s of

Discuss comp)aint !it* ED =usiness Manager $!*o is usua))y responsib)e for ED 7eception staff' and Matron $meeting at 22800'8 6*is case is re)evant for 7is+ Management meeting at 23800 and a)so "(4 teac*ing at 2&8308 6*e ED doctor !as too precise if *e said 9;0%;<> certain: pt *ad )ost or !as )osing *er baby. !*ic* s*e interpreted as 200>8 Feta) *eart monitor cou)d be usefu) in ED8 If u)trasound scan !as avai)ab)e at !ee+ends muc* !orry !ou)d *ave been avoided ? discuss !it* /ynaeco)ogy/7adio)ogy Depts8 6*e N(" Emergency #)anning

Documentation of Ma,or Incident patients8 $score 0 % &'

documentation are needed if many patients arrive toget*er. since it !ou)d ta+e too )ong to register t*em immediate)y on a computer system. but patients must be registered as soon as possib)e8 #atients Ma,or Incident numbers must be compatib)e !it* t*e ED computer system and a)so !it* t*e *ospita) patient record system and #at*o)ogy. =)ood =an+ and 7adio)ogy computers8 Ma,or incident p)ans must be updated and tested regu)ar)y? N(" Emergency #)anning /uidance specifies as a minimum re0uirement a )ive exercise every t*ree years and a tab)etop exercise every year8 6*is )etter needs a prompt response from t*e ED consu)tant and Matron. t*an+ing t*e retired matron for *er +ind observations about t*e c)inica) care and t*e attentive nurses. and stating t*at *er )etter !i)) be s*o!n to a)) t*e staff8 6*ey s*ou)d a)so t*an+ *er for *er observations on t*e doctors c)ot*ing and promise appropriate action8

guidance inc)udes advice on patient documentation8 Ma,or incident patients are )i+e)y to be distressed and may *ave been deafened by a bomb or may not spea+ Eng)is*. so getting important detai)s may be difficu)t and time%consuming8 Idea))y ma,or incident patients !ou)d be f)agged on t*e ED computer system so t*ey can be identified. trac+ed and ana)ysed in reports8 "ome patients may arrive before an incident is dec)ared and need Ma,ax f)ags adding )ater8 "ome patients not from t*e incident mig*t be f)agged incorrect)y as Ma,ax patients. so it must be possib)e to unf)ag patients8 If possib)e a fema)e consu)tant or "p7 s*ou)d advise t*e ,unior staff on t*e need for appropriate 9,oined up: c)ot*ing8 It !ou)d be best to *ave a)) c)inica) staff in proper uniforms or scrub suits !*ic* )oo+ professiona) and reduce t*e ris+ of contamination8 Funding t*ese for a)) staff may be difficu)t8 C*ec+ !it* E)der)y Medicine !*at *as *appened to F)orence "troud s e)der)y mot*er ? if s*e *as died t*e rep)y )etter s*ou)d offer commiserations8 If 1ane comes by car s*e cou)d per*aps par+ outside t*e ED and )eave 1ess in t*e car overnig*t. !it* occasiona) !a)+s around t*e car par+8 If t*e midd)e grade doctor on t*e ear)ier s*ift !or+ed )ater and t*e next day doctor started ear)ier. 1ane cou)d !or+ a s*orter s*ift and )eave 1ess at *ome overnig*t. but t*is !ou)d be a!+!ard to organise for tonig*t and !ou)d on)y be possib)e if t*e doctors get on !e)) and are prepared to *e)p eac* ot*er8

-etter from F)orence "troud. retired matron. about nursing care and doctors c)ot*ing8 $score 0 % &'

"taff /rade s re0uest to bring dog 1ess into ED overnig*t8 $score 0 % 2'

5 prompt response is needed since t*is doctor is due to !or+ tonig*t8 It !ou)d be easiest to say yes. as )ong as 1ess !ou)d not be seen by patients and no one !*o uses t*e office is a))ergic to dogs. but ot*er staff mig*t comp)ain. eg about infection ris+ $!*ic* is sma))'8 5))o!ing t*e doctor to bring *er dog into t*e ED !ou)d create a precedent !*ic* mig*t cause prob)ems in future if ot*er peop)e !anted to bring in anima)s. but in practice t*is is un)i+e)y8

"cenario -ocum consu)tant and t*e c*est drain8 $score 0 % 22'

6*is raises serious concerns about t*e )ocum consu)tant s ,udgement and competence8 If t*e facts are as stated a c*est drain !as not needed. and t*e )ung !as damaged by t*e trocar $!*ic* s*ou)d not *ave been used'8 7evie! and secure t*is patient s ED notes and ma+e good copies8 Discuss !it* IC@ consu)tant *o! t*e patient is no! and !*at *as been said to pt and re)atives8 7evie! c*est x%rays8 Find !*ic* "(4 and nurses !ere invo)ved and discuss !it* t*em to confirm !*at *appened8 5s+ midd)e grade doctors and senior nurses if t*ey *ave *ad any concerns about Dr A8 Discuss findings !it* consu)tant co))eague !*en *e/s*e arrives at 2<800 for t*e )ate s*ift8 5rrange to ta)+ to Dr A as soon as possib)e8 5t )east t!o ot*er consu)tants s*ou)d be present for any discussion !it* Dr A. and detai)ed notes must be ta+en8 Consider informing C)inica) Director and 6rust s Medica) Director and discuss !*et*er t*is incident s*ou)d be reported forma))y as a "erious @nto!ard Incident8 7is+ Management Dept s*ou)d be !arned of a potentia) c)aim for neg)igence8

Copy *ospita) notes $especia))y medica) and nursing notes after admission from ED. operation notes and observation c*arts'8 Copy t*e x%rays ta+en in ED and ma+e sure t*e origina) fi)ms are +ept secure)y8 C*ec+ t*e =ritis* 6*oracic "ociety guide)ines on t*e management of spontaneous pneumot*orax and t*e insertion of c*est drains. and print t*ese and 56-" c*est drain procedure before any discussion !it* Dr A8 Find out !*at siBe c*est drain !as used and +eep one or t!o of t*e same siBe $!it* trocars' for reference8 Carn t*e ED "(4 and nurses invo)ved t*at t*ey may need to !rite statements and t*ey s*ou)d not discuss t*e case in t*e ED. but reassure t*em t*at t*ey are not being criticised8 7evie! Dr A s CD and references8 7evie! Dr A s notes of some ot*er patients8 Consider te)ep*oning consu)tants at ot*er EDs !*ere Dr A *as !or+ed to as+ about any concerns8 Depending on a)) t*ese findings it may be necessary to suspend Dr A from *is )ocum post and inform t*e )ocum agency8 6*e Medica) Director and Director of #ersonne) cou)d decide to inform t*e Nationa) C)inica) 5ssessment "ervice. !*ic* can investigate concerns about a doctor s competence8 It !ou)d not be appropriate to discuss t*is case at today s C)inica) /overnance meeting but !*en it *as been reso)ved it cou)d usefu))y be discussed at a future meeting8