Interview

1. Clinical Expertise

2. Problem-Solving

3. Decision Making

4. Teamwork

1. Clinical/Ethical Scenarios 

• Paracetamol Overdose (High Risk of Absconding)

• Elderly Patient with Neck of Femur Fracture (Wanting to Go Home)

2. Prioritization Scenarios

• Major Incident (e.g., Bus Accident)

• Overcrowded Emergency Department (Exit Block)

3. Communication Scenarios

• Patient Arrest After Recent Discharge (Handling Angry/Concerned Family)

• Missed Fracture in a Child (Handling a Complaint)

A. Ensure Department Safety

• Handover responsibilities: Assign your bleep to a colleague.

• Inform the Nurse in Charge (NIC): Let them know where you will be.

B. Gather Information

• Patient Records: Review current notes, including triage, previous medical history, lab workup, and imaging.

• Environment: Ensure the setting is quiet and private; request a nurse to act as a chaperone.

C. Engage with the Patient

• Introduce Yourself: Confirm the patient’s identity.

• Understand the Patient’s Concerns: Explore social, medical, and psychological aspects.

• Respect Privacy: If the patient is unwilling to discuss issues with someone present, offer to continue the conversation privately.

D. Address Clinical Concerns

• Capacity Assessment:

  • If the patient has capacity, respect their autonomy. Involve family/friends to provide support and facilitate decision-making.

  • If capacity is lacking (e.g., confusion, dementia, delirium), apply the Mental Capacity Act (MCA). Make decisions in the patient's best interest and involve Independent Mental Capacity Advocates (IMCA), if necessary.

E. Example Scenarios

• Elderly Patient with NOF (Neck of Femur Fracture)

  • Ensure the patient’s agitation isn’t due to underlying causes like pain, infection, or medication side effects.

  • Perform a comprehensive AE (Airway, Breathing, Circulation, Disability, Exposure) assessment, including reviewing recent imaging and labs (e.g., X-rays for head injuries or fractures).

  • Engage orthopedics early and explore options for fib blocks or other pain-relieving measures.

  • Consider social services involvement for home care, including arranging for the care of pets.

• Paracetamol Overdose

  • Secure the department to prevent absconding.

  • Conduct a capacity assessment to ensure the patient understands the consequences of their decision. If capacity is lacking, consider security measures and involvement of the mental health team.

  • Ensure critical monitoring, including blood work and treatment (N-acetylcysteine). Explore alternative treatments for needle-phobic patients (e.g., oral NAC).

  • Involve the family and a senior nurse to support and assess if psychiatric evaluation is necessary.

A. Space Management

• Clear the Department:

  • Move patients to wards, ITU, escalation areas, or short-stay units.

  • Discharge home or refer patients to other services (SDEC, outpatient clinics, or GP).

  • Reorganize areas for efficient patient flow (e.g., cohorting stable patients or using corridors as a last resort).

B. Staff Management

• Adequate Staffing:

  • Call in additional shifts, locums, or support staff from other departments.

  • Ensure staff are distributed according to skill mix (e.g., ANPs for minor injuries).

  • Support team morale by ensuring adequate breaks and supervision.

C. Equipment & Resources

• Contact Site Manager:

  • Request extra equipment or resources from other departments to meet the demands of a major incident or overcrowding.

D. Scenario-Specific Actions

• Major Incident (Bus Accident)

  • Activate the major incident protocol, including informing the switchboard, site manager, and consultant.

  • Evaluate the situation using METHANE (Major Incident, Exact Location, Type of Incident, Hazards, Access, Number of Casualties, Emergency Services).

  • Conduct reverse triage to prioritize life-threatening cases.

• Overcrowded Department

  • Escalate the situation to the silver team and inform your consultant.

  • Conduct a board round to identify patients who can be discharged or moved to other departments (CDU, minors, SDEC).

  • Open escalation areas (day surgery, endoscopy, recovery) to decongest the emergency department.

A. Initial Engagement

• Introduce Yourself:

  • Clearly state your name, role, and reason for the conversation.

  • Offer comfort (e.g., a seat, water) to the family.

B. Acknowledge Concerns

• Empathy and Understanding:

  • Acknowledge the family’s distress and validate their concerns (e.g., “I understand this is very difficult for you.”).

  • Avoid making assumptions or blaming the department until all facts are gathered.

C. Communication & Transparency

• Explain the Situation:

  • Use clear and simple language to explain what happened (e.g., “Your father suffered a cardiac arrest after being discharged”).

  • Be transparent about the investigative process (e.g., “We will perform a thorough review and keep you updated on the progress”).

D. Provide Reassurance and Next Steps

• Formal Complaints Process:

  • Offer details about the Patient Advice and Liaison Service (PALS) and assure the family that their concerns will be addressed through a formal investigation.

  • Discuss plans for future care or investigations, ensuring that the family is involved at every step.

E. Scenario-Specific Responses

• Patient Arrest Post-Discharge:

  • Offer reassurance that an incident report will be raised, and a departmental inquiry will follow.

  • Ensure that the family is aware that this will be discussed at departmental meetings to improve patient safety.

• Missed Supracondylar Fracture:

  • Acknowledge that errors can happen in complex cases.

  • Re-examine the X-ray with the family to explain the injury and the next steps.

  • Assure the family that the incident will be formally investigated and that they will be kept informed of the outcome.

• Stay Calm and Empathetic: In each station, demonstrate empathy, clinical acumen, and clear communication skills.

• Teamwork and Leadership: Highlight your ability to work with a multidisciplinary team in all scenarios.

• Preparation: Familiarize yourself with hospital protocols (e.g., mental health, major incidents, capacity assessments) and be ready to explain your decision-making process clearly.