Much of the clinical resources on the net are NOT tailored for ED use and thus can be time consuming to find, read and decide on what will be relevant to your situation. In addition, they may not be relevant and comprehensible to Australian doctors who may be unfamiliar with international terminologies and practices.

I NEED something that I can direct junior staff to and know that they should be able to understand it, and apply it to their patient, THEN come back to me and discuss it BEFORE sending their patient home and without me having to spend 30min of time I don’t have to directly instruct them.

Emergency medicine is mainly about risk management of a large group of patients on your shift and the variable levels of expertise of both medical and nursing staff who will be assisting you.

Unlike many other areas of medicine we do not usually have the luxury of time to spend more than 10 minutes with a patient to elucidate the finer details or complex investigations and thought processes which may be needed to arrive at a more definitive diagnosis.

Thus instead of endless lists of differential diagnoses or legalistic prose combined with annoying advertisements of sponsors, we need support that helps us risk manage our patients in a timely manner and provide safe care that will enable them to survive or have minimal morbidity until definitive care can be attained.

For those who do not work in operationally challenged environments and who may not understand what many of us ED physicians are faced with, here is an example of what we are commonly confronted with.

Last night at 8pm on a typical relatively quiet Sunday evening in an ED, our adult ED medical team was a little down on our usual staffing which is less than is optimal for the patient demands, but that is another issue.

In addition to the 20 adult patients who had been seen and were under our direct care, there were 28 adult patients in the waiting room. I allocated our only adult team registrar to a fast track streaming role, while myself and an intern managed the acute patients in the department and all those in the waiting room not suitable for fast track care.

I was thus faced with a multitude of competing demands including:

• managing my patients (the majority on adult patients in the ED)
• risk managing those in the waiting room
• supervising the intern and advising the registrar
• checking almost every Xray performed by BOTH the adult and paed teams
• clinically reviewing paediatric patients about whom the paed team were concerned and advising on management plans
• liaison with nursing staff and in particular, nurse in charge regarding overall management of patients in the department as well as specific individual patient care and inpatient communications
• ensuring that advice given to junior staff by the inpatient unit registrars was appropriate and reasonable and above all, in the patients’ best interests
• a multitude of other responsibilities including being the prime person responsible for any patients requiring resuscitation

Now, it should be clear from this, that for the whole group of acute adult patients, their group risk management requirements means that I only have brief periods of mental and physical time available to address acute clinical concerns of individual patients and supervision of the intern.

THUS, I NEED tools to make my life efficient and able to cope with these challenges as best I can so that when I go home I can sleep in peace and will not be too disorientated when the ED phones me in the middle of the night when I am on call.

I NEED an intranet or Wiki I can trust that I can check myself, or at least know where I can rapidly get further information or direct junior staff to check up.

Unfortunately, most hospital policy and procedure guidelines on internal intranets do NOT fit the bill because they often have poor search systems, inadequate or non-existent linking to external sources, tend not to be focused on timely risk management, are in pdf format designed for print rather than rapid viewing on screen, are not transferable from one hospital to another as doctors move around, and perhaps worst of all have out of date practices as the time line for updating these tends to be of the order of 6-24 months.

Now, on reading this, some may feel that this is the last place anyone would want to work – on the contrary, I love coming to work and facing new challenges and intellectual exercises that keep me stimulated and makes the time go fast – as long as I have enough rest between this shifts that I can adequately manage my stress levels and not take the hostilities and frustrations of some of the patients personally.

I am indeed extremely fortunate that I work in an ED with great staff who are fun to work with, and at the same time know that we have made a difference to lives when they had no one else to turn to.

Make the most of resources to make your life more efficient and your ED more effective.

Incidentally, I have created a Wiki page of medicolegal resources here which you may find useful.