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Ms Felicity Gemmell-Smith RN, EDO NEATS Prof John Fraser FRACGP, FAFPHM, SME NEATS

IMPROVING GP REGISTRAR ORIENTATION AND LEARNING IN EMERGENCY DEPARTMENTS IN THE NEW ENGLAND REGION. Ms Felicity Gemmell-Smith RN, EDO NEATS Prof John Fraser FRACGP, FAFPHM, SME NEATS Ms Marianne Gaul CNC Emergency/Critical Care Services.

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Ms Felicity Gemmell-Smith RN, EDO NEATS Prof John Fraser FRACGP, FAFPHM, SME NEATS

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  1. IMPROVING GP REGISTRAR ORIENTATION AND LEARNING IN EMERGENCY DEPARTMENTS IN THE NEW ENGLAND REGION Ms Felicity Gemmell-Smith RN, EDO NEATS Prof John Fraser FRACGP, FAFPHM, SME NEATS Ms Marianne Gaul CNC Emergency/Critical Care Services Hunter New England Area Health Service

  2. NEATS’ Mission Statement “to provide and promote excellence in GP education and training in the New England region of NSW” NEATS is accredited as a GP training provider until 2007 to the standards of the Royal Australian College of General Practitioners (RACGP) & Australian College of Rural & Remote Medicine (ACRRM) Hunter New England Area Health Service Hunter New England Area Health Service

  3. Background • Rural NSW is receiving metropolitan trained GP registrars • A lot of GP registrars have not worked in smaller sites • All NEATS GP Registrars are required to be on-call to their local Health Services and Surgery Hunter New England Area Health Service

  4. The Nature of the Problem • The 2004 Orientation workshop found misconceptions within the GP Registrar group regarding services and equipment available at local health facilities, eg road side phones • GP Registrars’ lack of previous experience in working on call in a rural setting • Ad hoc, random and non-standardised orientation processes • Risk of wide quality variances depending on personalities involved Hunter New England Area Health Service

  5. Objectives • Provide adequate accountable orientation to GP Registrars of their local Emergency Department prior to their first call out • Improve communication between GP Registrars and local nursing staff to encourage team based approach to patient management • Identify unmet learning needs of GP Registrars which were to be incorporated into formal Learning Plans Hunter New England Area Health Service

  6. Method • Collaborative project between Hunter New England Area Health Service, Rural Training Unit and GP Training Consortia (NEATS) including a steering committee of nurse and medical educators • Project pre-tested with registrars and nurse unit managers • Self directed tools developed for registrars to reflect on unmet learning needs, on their present level of competence in managing emergency presentations and using common skills • GP Registrars were requested to meet with local Emergency Department nursing staff prior to first on-call rostering Hunter New England Area Health Service

  7. The Checklist • List of standard equipment formulated by CNC Emergency/Critical Care Services and RTP for checking by registrar in conjunction with nursing staff • Registrar required to locate listed equipment, or note if not available. • Location of all listed items was to be recorded • Checklist to be signed by registrar and accompanying nurse, and copy to be faxed to Regional Training Provider within two weeks of commencement of term. Hunter New England Area Health Service

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  9. Evaluation of Project • Post orientation questionnaires developed and distributed to all participating Health Services and their Emergency Department Nurse Unit Managers • Separate questionnaires developed and distributed to participating GP Registrars • Verbal feedback sought from Health Service Managers • 9 out of 11 Registrars completed the checklist and evaluation questionnaire (82%) Hunter New England Area Health Service

  10. Results GP Registrars • 100% (9) found that this process helped familiarise them with the equipment levels available locally • 89% found that it • assisted them with determining local services available in an emergency situation • assisted them treating patients • fostered a teamwork approach with the local nursing staff • 100% stated that this checklist assisted them with being on call Hunter New England Area Health Service

  11. Results GP Registrars • 89% stated specific benefits arising from this process, such as being able to locate equipment when required • Only 1 registrar indicated that there were barriers to completing the checklist (lack of time) • 1 registrar felt it was too detailed • It was recommended that supervisors also complete this orientation exercise Hunter New England Area Health Service

  12. Results GP Registrars • Differences between metropolitan and regional facilities were identified and stated differences included equipment levels as well as the lack of readily available staff specialists and consultants Hunter New England Area Health Service

  13. Results Nursing Staff • 100% (4) of those who had completed the checklist with the registrar felt the process helped them • familiarise the registrar with the equipment levels and local services available in an emergency situation • explain any relevant emergency situation issues to the GP Registrar • foster a team work approach • to assist the GP Registrar with treating patients Hunter New England Area Health Service

  14. Results - Nursing Staff • 75% of nurses who completed the checklist with the registrars believed that it helped re -familiarise them with the equipment and services available locally • Benefits of completing the checklist included • meeting and developing rapport with the GP Registrar • refamiliarisation with equipment and procedures • consolidating unspecified work site considerations • None felt the checklist could be improved upon Hunter New England Area Health Service

  15. Results - Stakeholders • Several health facilities have indicated that they would like a similar process completed for Community Health Services and General Wards and have indicated willingness to allocate staff to assist with same. • Co-operation between nursing staff and GP Registrars appears to have been enhanced by this process • All health facility managers spoken with endorsed the process and several requested copies of the checklist to use in VMO orientation Hunter New England Area Health Service

  16. Discussion: The Future • This process will form part of NEATS’ ongoing orientation processes for GP Registrars • There is scope to expand this process to JMO and Allied Health personnel orientation procedures • Community Health profiling as suggested by HSMs will be integrated into the orientation process for Registrars • Copies of the checklists have gone to several facilities for use with hospital staff Hunter New England Area Health Service

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