The patient’s airways is blocked, time is running out. The only way to help them is an incision in the neck with the nearest sharp object. Has anyone got a ballpoint pen?
From Scrubs to M*A*S*H to Grey’s Anatomy, the tracheostomy is a favourite of TV dramas – but thankfully doctors in Westmead Hospital’s emergency department (ED) are always prepared for these rare but serious events.
The recent move into the new ED gave staff the opportunity to redesign the space, and one challenge in a large environment is finding what you need in a hurry.
Dr Kavita Varshney, Dr Margaret Murphy and a team of fellow emergency clinicians came up with the simple yet effective solution of colour-coded trolleys, meaning everything you need in an emergency is ready and easy to find at a glance – including for the famous tracheostomy.
We would probably have three surgical airways a year at the most. But even though it’s a very low frequency procedure, it’s a very high risk, high stakes procedure. It’s really urgent; you’ve only got a few minutes to make that decision, so you need that equipment when you need it. It needs to be ready, checked and good to go straight away,” Dr Murphy explained.
The different trolleys organise more frequently used items, including peach trolleys for airways, yellow for personal protective equipment (PPE), red for resuscitation and white for anaesthesia, asthma and dialysis needs.
The colour coding is consistent across the Central Acute Services Building, meaning junior doctors who rotate through different departments don’t need to learn new systems everywhere they go.
Emergency specialist Dr Kavita Varshney said one solution the team was particularly proud of was the trolley for labour emergencies.
“One of the realisations we had with the move to the new building is that we’re no longer close to the birthing suites or neonatal intensive care, so it’s not a simple case of running upstairs to get a piece of equipment in an emergency.
“We ran simulations with Obstetrics and Gynaecology and did proper workshopping of this to ensure we were prepared for any emergency,” Dr Varshney said.
Dr Murphy added: “It was a multidisciplinary approach. Being an emergency department, you have to interact with obstetrics, with anaesthetics, with orthopaedics; so we’ve worked with these different specialities and disciplines in the redesign.
“The neonatal intensive care and birthing unit teams have agreed to come and check the obstetric trolley, and while they’re here they’ll train our staff on what’s in it and what it’s needed for, to increase our knowledge of and expertise around those emergency procedures.”
The ED redesign team thanked Seven Hills-based supplier Astris for designing the trolleys and helping them create the most efficient partitioning system for each different type.
Read more about Westmead Health Precinct’s $1 billion redevelopment here.