2.4. Interface with other units
- Pull patients out of ED.
- Review patients within 30 minutes of referral.
- Personally review delayed ED admissions.
- Consider sending ICU nurse down to ED to care for, or transfer patient awaiting ICU – this may be best if ED full but still delivering care for the patient (ie. half way through lines, CT etc etc). Talk to the ANUM.
- Avoid keeping patients in ED overnight while awaiting an ICU bed – usually best to transfer them out.
- Don’t make them do your SJOG work for you during the day (inserting lines etc).
2.4.2. General Surgery
- They manage drains and wounds.
- We manage their nutrition, but guided by them, but …..unless there is a reason to keep an elective surgical patient on a restricted diet, our evidence based approach is –
- Day 0 – fluids as tolerated
- Day 1+ - diet as tolerated.
- We manage everything else
- Don’t use laxatives without talking to surgeons (particularly stimulants post-anastomosis)
- Similar to General Surgery except can be a little more directed in their advice to us regarding areas such as nutrition (often more conservative then general surgeons), avoidance of vasopressors (after certain procedures viz ileal conduit formation) and epidurals (one urologist in particular).
- One future task is to address these issues with them.
- Beware more than 24 hours of antibiotic prophylaxis. If there is no reason (and there usually isn’t), then cease them. There is no need to consult with them. They know we are going to do it.
- The only unit with whom we “co-manage” patients with.