Epworth’s emergency department treats more patients than any other private hospital emergency department in Victoria; over 26,000 patients annually.

We met up with Associate Professor Ron Sultana; Emergency Physician and Director of Epworth Richmond emergency department to find out a bit more about the inner workings of Victoria’s busiest private emergency department.

When should someone go to the emergency department as opposed to seeking other medical assistance?

RS: On some occasions you won’t have much choice in the matter I guess, if you’re sick enough and an ambulance is required the paramedics who are well trained these days can ascertain whether you need to go to hospital or not, so they will obviously transfer you to hospital if you are that unwell. Otherwise, when there’s some choice in the matter there is a rough rule of thumb, which is really if there is any sudden change in your health, so anything that isn’t really typical for you, for example; chest pain, abdominal pain, headaches, these are all common things we see in emergency every day.

There might be other issues like injuries such as; lacerations, wounds, fractures involving bones, dislocations, and significant pain arising from any injuries, which would mean you need to get that injury assessed.

There’s also situations where you might have fever that’s unexplained or situations where you’re unsure and can’t get into your general practitioner and the symptoms are escalating, a lot of people have illnesses that they are quite aware of what’s normal for them and when things start to worsen or the patients unsure of what is going on than sometimes it needs to be checked out in the emergency department as well.

What should people bring with them to the emergency department?

RS: If it’s handy, the most important thing for us is your medications or a list of your medications (current medications and any past medical history that’s relevant), anything beyond that can really be sorted out later. So don’t be distracted by getting things like clothing and toiletries and really just stick to the basics because that other stuff can be sorted out later, but we’d certainly love to know what medication you’d taken.

What’s the process once people arrive at the emergency department?

RS: Usually the first thing that happens is you are assessed by a trained nurse who is going to ask you a few questions about your illness such as; duration, what symptoms you’ve had and what has changed. All the nurses in Australia are trained according to the Australasian Triage Scale so in essence, according to what symptoms you have the nurses are well trained to decide whether this patient will need to be seen urgently or whether this patient can wait to be seen and that’s really the driving principle of emergency departments, that patients who have the most severe illnesses are seen first and those that have less severe symptoms or potential severity can wait.

What is the average wait time at Richmond?

RS: The average wait time to see a doctor at Epworth Richmond in the emergency department is on our website and gives us a snapshot of what the waiting time has been like in the previous hour and overall, on average, that time is about 25 to 30 minutes.

Any other factors that affect how long the wait time may be for an individual patient besides the Australasian Triage Scale?

RS: Yes, there could be a lot of things actually and sometimes it’s interesting for people to know how emergency departments work. These are departments that have a lot of people involved in providing care, so it’s not only the medical staff, it’s the nursing staff, the orderlies, clinical staff and then behind us there’s obviously the services that help us make diagnoses, for example; radiology and pathology. As you can imagine, it’s quite a complex system depending on the complexity of the patients such as, when they arrive, how many arrive in a particular time, how they arrive, and more.

What can patients eat or drink once they get to the emergency department?

RS: We generally advise patients not to eat or drink anything until the nurse or doctor says that they are allowed to and we say that because sometimes initially we aren’t sure what the medical problem is and in some situations it might be found that the patient will need surgery and the surgeon prefers the patient has fasted, in order for that procedure to be done safely. So, in the first instance we say don’t eat or drink anything until we find out what is going on and then we can make our decisions once we have all the information.

What does post treatment look like for patients who haven’t been admitted to hospital and are free to leave the emergency department?

RS: There’s a number of paths post-treatment can go down depending on what we’ve found or what we provisionally think is going on. If we are reasonably certain of the diagnosis or the treatment that has been rendered then it might in fact mean no follow up is required as we expect the illness or problem will resolve on its own. The next level up would be when we believe the condition would benefit from a follow up, so we provide the GP with a discharge letter and a note to the effect of the aspects of the illness we would like reviewed and see how the patient is trending. In terms of other opportunities for follow up, we may also believe a specialist consultation would be helpful.

If patients are admitted post-treatment, are they sent to different wards?

RS: When a patient needs admission that generally means that the emergency physician has ascertained that it’s an illness that requires patient management, assessment and treatment, whether that be surgery or even medication provided in a hospital environment in order to produce the best outcome. Where the patient ends up depends on their individual problem, so is it a heart issue - in which case they end up with a cardiologist or is it a surgical issue like appendicitis, which will end up under a general surgeon. Within the hospital there are different areas that cater best to those conditions with specifically trained nursing and medical staff.

Do we cater for international visitors?

RS: Yes, we do cater for international visitors, in fact being so close to the CBD and the airport, we do see a lot of international visitors. In essence, it would work much similar if you were overseas and had to access medical care in another country, so being a private emergency department there are out of pocket costs and the international visitors are made aware of that and then at some point of course they would access their insurance and that usually lags a bit behind but they can claim their costs against their insurance depending on the level of insurance they have taken aboard before travelling.

Are certain times busier in the emergency department?

RS: In terms of busiest months of the year, December is actually the busiest time of the year for us in terms of presentations, closely followed by August, in particular last year we had a really busy August because of the flu, but luckily this year it wasn’t quite as busy. On a weekday perspective, Monday is usually our busiest and in terms of time of day, between 11am and 10pm it’s actually fairly steady.

The Epworth Richmond emergency department is staffed by a team of experienced doctors and nurses 24 hours, seven days a week.

14 October 2019


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