A day in the life of an ED clinician

For Townsville University Hospital emergency department staff specialist Dr Michael Durkin, no two days in his job are the same with the diversity, complexity, and pace of an emergency department (ED) something most people couldn’t fathom.

Dr Durkin said a typical day shift for him would start with a handover from the night-shift, out on their feet after working through those hours when most of us are asleep.

“The peak activity is usually the late shift and a lot of that will flow over onto the night shift who already have a backlog of patients from earlier in the evening as well as those patients who present throughout the night,” he said.

“You come in in the morning and your goal is to relieve the overnight team, take handover of patients, continue treatment plans and start to work up those patients who haven’t been seen yet.

“This is also when the sub-speciality teams are starting work and you have to find the right team for your patient whether it’s cardiology, paediatrics or orthopaedics.”

Dr Durkin said the worst morning shifts were those after a chaotic night.

“Those nights where there has been a string of resuscitations, I feel for the team and I feel for the patients who are in the waiting room and who may have been waiting for many hours,” he said.

“It can really start you off for the day; the night shift is exhausted, and it shows how a few very sick patients can dominate a whole shift.”

Dr Durkin said people often saw the emergency department through their own experiences.

“The reality is it’s a juggling act to provide treatment to the 200 to 300 people who come through the doors each day,” he said.

“In any day, we can see people for chest pain, hypoglycaemia (low blood sugar), elderly falls, amnesia, altered levels of consciousness, palpitations (fluttering heart), and headaches.

“We can also have multiple traumas arrive at once which can take up to eight people off the floor to care for patients in the resuscitation room.”

Dr Durkin said a day for an emergency department clinician involved not only providing care to patients who came through the front doors, but to patients who arrived by ambulance through the back entrance.

 “The community doesn’t see that side of things, so I think it’s good to shine a light on that,” he said.

“As the tertiary referral hospital for northern Australia we also take multiple referrals a day from hospitals as far as Mount Isa, Thursday Island, and Mackay.

“It’s also important to understand that while someone may not seem that unwell, if they have complex co-morbidities, they will need more investigation.

“There are a lot of competing priorities but it’s what we sign up for and the team relishes the fast-paced nature of emergency medicine.”

For emergency department patient flow nurse navigator Carla Murray understanding every patient in the ED, including those in the waiting room, was key to safe care.

“My role is to basically work in the background looking at bed availability and to alleviate some of the pressures that come with treating such a diverse patient group,” she said.

“The goal is always to get patients who need more specialist care onto the wards and those, who can be discharged safely, home.

“There is so much that goes on behind the scenes to ensure people are getting the treatment they need and that they are in the right place, be it at home or somewhere else in the hospital.”

Dr Durkin said getting patients to where they needed to be took a dedicated team.

“We have social workers, physiotherapists, pharmacists all with a role to play,” he said.

“Different healthcare providers have the ability to do different things and have the ability to help the ED absorb the high demand it experiences daily.”

Dr Durkin said teamwork was key for staff who worked shifts around the clock.

“We look after each other; I’ll start at 12.30pm, for example, and be on a non-clinical shift and take patient handover at 5.30pm,” he said.

“But in that time, I’ll make sure I relieve someone for a lunch break and help out if it’s busy on the floor even though I might have meetings or teaching or some other responsibilities,” he said.

“Even when we are on a non-clinical shift, we support each other.

“We’re all responsible for a cycle of quality improvement and care and at the end of the day we’re a team.”

Dr Durkin is also the co-lead for paediatrics in the emergency department where almost a quarter of all presentations are children aged under 16.

“With my co-lead, we spend a lot of our time doing what we can to improve the care of children whether it’s developing new guidelines, working on a redesign of certain processes, or reviewing interesting cases to see where we could have done better,” he said.

Dr Durkin said switching off after a day at work wasn’t always easy.

“Often, as the senior decision maker on a shift, I’ll make so many decisions in a day that I can’t tally them up,” he said.

“I’m physically and mentally exhausted but the reality is that for some patients, the decision to do an investigation or send someone home could very well be a matter of life and death.

“Some shifts I’ll make a decision and go home and ruminate on it for a few days and be eager to follow up the patient and see how they are.

“I think that’s pretty normal for emergency physicians.”

In addition to this emergency work at the hospital, Dr Durkin also has a couple of flying shifts a month with Retrieval Services Queensland as a credentialled emergency retrieval doctor.

“It’s a great balance of working in the emergency department and still being able to fly and keeping those skills up.”

Dr Durkin said retrieval work was a definite adrenaline rush.

“There was recent trip to a western town where we picked up a nineteen-year-old with a serious head injury from a motorbike accident,” he said.

“He was being managed by the local doctor but without specialist neurosurgery he would have died.

“I was also winched down to a container ship off Mackay a while ago to pick up a very unwell patient with a suspected perforated appendix.

“He needed to quickly get to hospital, and an aeromedical retrieval was the quickest and safest way.”

The ED has not been immune to the effects of COVID-19 with significant changes to day-to-day operations.

Ms Murray said the threat of the virus had forced the department to change every process to protect patients and staff.

“A person presenting with cold and ‘flu symptoms now equates to a whole other level of clinical care,” she said.

“We wear full PPE, a time-consuming but critical layer of protection for ourselves and the patients around us.

“Patients with symptoms are placed in isolation until they receive a negative COVID-19 test.

“After we have seen a potentially COVID-19 positive patient we cannot simply move onto the next patient; we have to remove all PPE first which takes about 10 minutes.

“There are definitely flow-on effects from this and how it impacts our patients but as emergency department clinicians we are there on the frontline to tackle anything that is thrown at us.

“At the end of the day, we are privileged to be able to be one of the first points of call for people when they are at their most vulnerable.”

The Townsville Bulletin is partnering with Townsville University Hospital to take you behind the scenes of one of Queensland’s busiest emergency departments. Meet the people who care for our community and share in their stories and challenges in looking after more than 90,000 people a year who come through their doors injured, sick, drug affected, scared, dying and all in need of help. Come behind the curtain for a unique perspective on emergency medical care in the 21st century.

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