Clinical Services

The Emergency Department at CUH provides a large number of services that complement the core work of the department namely Psychiatry, Social Work, Physiotherapy, Radiography and many more.

The Emergency Department will be heavily involved in the current reconfiguration process for emergency services in the Cork/Kerry area. The department has over the years been a leader in the advancement of Pre Hospital care and Telemedicine in the region.

 

 Minor Injuries

The Department runs a very busy Minor Injuries Treatment Area, with 2 dedicated treatment bays and additional accommodation available when the department becomes very busy.

Patients seen in this area are suffering from minor complaints or injuries. Following a medical examination they may be referred for x-rays, or have treatment initiated directly. On occasions they will have sutures inserted in wounds or dressings applied and follow up appointments in the emergency department review clinic may be arranged if indicated. Some patients with relatively minor problems such as a wrist fracture or a finger injury may sometimes require admission to hospital for treatment.

Advance Nurse Practitoner

The Emergency Department at Cork University Hospital (CUH) was the first health service in the Cork/Kerry region to introduce Advanced Nursing Practice in 2006.

Adult patients (over 16 years old) attending the department with minor injuries and illnesses may be seen by an Advanced Nurse Practitioner (ANP) and have their condition diagnosed and treated by them.

The ANP will be educated to master’s degree level (minimum) and have undertaken significant education, training and supervision in clinical examination, investigation and treatment of minor illnesses and injuries prior to receiving national accreditation to practice. The ANP service is subject to audit and evaluation and is committed to continual update and development in response to evolving evidence based care and service need.

Currently the ANP service is only available on week days but with plans to expand the service in response to service need it is hoped that these hours can be expanded.

A sample of the types of injuries and illness cared for by the ANP service includes:

  • Limb      injuries (including sprains, strains and fractures)
  • Wounds
  • Minor      burns
  • Local      infections
  • Minor      eye, ear, nose and throat problems
  • Minor      head injuries

The ANP service endeavours to provide all care by a single practitioner including assessment, examination, investigation, treatment, arrangement of follow-up and discharge. In certain circumstances it will be necessary for the ANP to refer patients to other specialties. The ANP will identify themselves to each patient when they meet in the department and will be wearing a turquoise coloured uniform with their job title printed on their tunic pocket.

The ANP also has a role in research, education and development of clinical practice.  

Major Injuries

The Majors or general area is for stable patients with major illnesses and injuries who still need to be confined to bed (note that a "bed" in the ED context is almost always a gurney or trolley rather than a full hospital bed). This area is often very busy, filled with many patients with a wide range of medical and surgical problems. Many will require further investigation and possible admission. Examples of problems seen in this area include chest pain, shortness of breath, headaches, abdominal pain and significant injuries. Patients are assessed by a team of doctors and may have a number of investigations performed including blood tests, x-rays and electrocardiographs. They may be referred to specialty teams for admission or may be discharged following treatment to their general practitioner.

Paediatrics

There is a dedicated Paediatric Treatment Area for the treatment of children (under 16 years) with its own waiting area which includes a small play area with TV and also a baby changing area if required. The Department has submitted a proposal for the creation of a new Consultant post with a special interest in Paediatric medicine. This will greatly enhance the work of this important service.

Resuscitation

 The resuscitation area is a key area of the Emergency department where patients with life threatening injuries and illnesses are assessed and stabilised. It contains 4 individual resuscitation bays, with 1 specially equipped for paediatric resuscitation. Each bay is fully equipped with state of the art resuscitation equipment including defibrillator, airway equipment, oxygen, intravenous lines and fluids and emergency drugs. Resuscitation areas also have ECG machines, and our X-Ray department is located adjacent to the Resuscitation Room to perform whatever x-rays are necessary. Other equipment may include non-invasive ventilation (NIV) and portable ultrasound devices. Resuscitation is carried out according to internationally recognised Advanced Cardiac and Advanced Trauma Life Support protocols.
 

Review Clinic

The ED Review Clinic is held each morning Monday to Friday between the hours of 8.30 am and 10.30 am approximately. An ED nurse and registrar run the clinics supported by a member of the administrative staff. This further enhances the quality of care provided to patients.

Criteria for referral to the ED Review Clinic

  • Problems      suitable for the ED Review Clinic include, infections, soft tissue      problems, or minor hand injuries, possible scaphoid injuries (previous      normal scaphoid x-ray) etc. 
  • The      common denominator is that further care is needed and is most      appropriately provided by ED staff. 
  • The clinic is not for second opinions      which should, whenever possible, be obtained at the first attendance.

Triage

All patients that present at the emergency department are first of all assessed by what is known as Triage (preliminary evaluation) which is undertaken by a very experienced Emergency Department nurse. Triage is a system of prioritising patients so those in most need are seen first. This system categorises patients into 5 different categories ranging from life threatening injuries and illnesses to problems of a primary care nature. The triage system that is in operation in the department is known as The Manchester Triage System.  You will be assigned a triage category based on your medical need and informed of that category. You will then be asked to return to the waiting room, until a treatment area is available. Some patients will undergo a secondary assessment by a nurse and may be asked to return to the waiting room until a treatment area is available. Patients who are triaged as category 1 or 2 will be transferred to a treatment area where they will be prioritised for treatment before they are transferred to another area of the ED or a different department in the hospital. 

On occasions when the department is overwhelmed , in an attempt to speed up patient flow “fast tracking” is undertaken for patients in the minor category. A senior doctor and nurse will undertake this for patients who do not require a trolley to be examined. This is reversing the order of seeing patients i.e. the minor injuries seen first.

Maritime Medical Support

The ED provides medical advice and support to vessels at sea.  ‘Medico Cork’ is the communications call sign for the National Maritime Telemedical Assistance Service provided by the ED at Cork University Hospital.  Essentially, the department in the case of medical emergencies at sea provides medical advice and assistance. 19 calls for medical advice were requested in 2008 using the Medico Cork service.

The Medico service was extended to islanders in 2008. In the event of an emergency on any island off the coast of Ireland the medico number can be accessed for medical advice via ambulance or the Coast Guard. There was one island related call in 2008.

Since May 2008 diving related incidents in Ireland are dealt with through Medico Cork, with re-compression taking place as required at the Naval base in Haulbowline, Ringaskiddy Co. Cork. There were 2 diving related calls in 2008.

Due to changes nationally in facilities for the management of patients that need decompression treatment in a Hyperbaric Chamber, the Emergency Department at CUH in conjunction with the Naval Base, Haulbowline and Ringaskiddy became the recognized national facility in 2008. As a result this has led to the  education of emergency medical and nursing staff in relation to Management of patients that need decompression treatment in the hyperbaric chamber.

More than 150 delegates gathered in Cork for an Irish Maritime Medicine Conference in the National Maritime College of Ireland (NMCI) in Ringaskiddy, Cork on 9th October 2008.

The conference, which was the first of its kind in Ireland, was organised by Medico Cork and the Irish Naval Service, with the assistance of the Irish Coast Guard.  There was a large attendance present to hear the latest advances in the field of maritime medicine with local and international guest speakers making presentations. The aim of the conference was to increase the awareness of the maritime environment and its hazards.

Commenting on the conference, Professor Stephen Cusack, Director of Emergency Medicine in Cork University Hospital said, “Cork is Ireland’s maritime capital having the national maritime college, the Irish Naval Service and Medico Cork based in this city. This conference will mark further development of this strong maritime tradition.”

2008’s radio medical advice meeting between UK and Cork was held in Cork, with a French representative also attending.

As part of the liaison between the ED and the Irish Naval Service, Naval Emergency Medical Technicians (NEMT) have clinical placements in the emergency department. These placements have proved very beneficial for all concerned.

2008 also saw the continuation of attendance of ship captains trainees from the National Maritime College of Ireland to the Emergency Department.

Clinical Decision

The Clinical Decision Unit (CDU) is a unit within the Emergency Department and is an integral part of the emergency department.  Its sole use is for ED patients who require a short period of observation or treatment typically for a maximum of 24 hours. 

It is a 12 trolley unit split into:

●  2 x 4 bay rooms en suite

●  2 x 1 bay rooms

●  1 x 2 bay observation rooms

●  1 x sitting room which can cater for 6 people

Trolleys are used in the unit due to the short period of time that it is envisaged the patients will remain with us.

Patients are admitted to the unit under the care of the five ED consultants - Professor Stephen Cusack, Dr Chris Luke, Dr Gerry McCarthy, Dr Íomhar O’Sullivan and Dr Gemma Kelleher.  Each morning and afternoon (at a minimum), a Consultant undertakes a review of all patients in the CDU in an effort to ensure efficient, timely management and discharge of patients. Since the opening of CDU in April 2005, nearly 11,000 patients have passed through the unit.

Type of conditions treated in the CDU are:

  • Deliberate      self harm/overdose
  • Mild      traumatic brain injury
  • “Rule      out” subarachnoid haemorrhage
  • Soft      tissue infection e.g. cellulitis
  • Allergic      reaction
  • Victims      of high energy trauma without clear diagnoses
  • “Rule      out” D.V.T.
  • Non      specific chest pain

Any condition, which can be treated by the Emergency Consultant and discharged between 24 to 48 hours.

The CDU log (a software programme) has been set up to record and track the patients admitted to the unit.  This allows us to audit information such as:

  • Daily      trolley occupancy rate
  • Mean      length of C.D.U. stay
  • Diagnosis      on admission and discharge
  • Deaths      in C.D.U.