The EDs

We deliver our service across 3 Departments in NHS Lothian to approximately 200,000 patients a year. We believe in clinical excellence, provided within a strong multidisciplinary team ethos and with patient care at its centre.

Royal Infirmary of Edinburgh

The RIE ED is the biggest adult ED in Scotland, and thrives on seeing a high acuity of patients and delivering true emergency critical care at the front door. In 2012, we cared for 113,000 patient attendances, and have a majors:minors ratio of approximately 1:1. Despite this, we have a well-maintained admission rate of just around 30%, helped by increased Emergency Physician presence, real-time decision support, and continual innovation to treat patients closer to home or in ambulatory settings.

The RIE ED manages approximately 700 trauma cases annually, making it the busiest trauma receiving hospital in Scotland. Major trauma (ISS>15) accounts for around 120 of these cases. There is a helipad on site and increasing numbers of patients attend by air ambulance. It also acts as the base for our EM flying squad “Medic One”, which attends patients in pre-hospital situations of any aetiology approximately 100 times a year, including victims of trauma, and we have excellent links and working relationships with the Scottish Ambulance Service. Emergency Physicians ‘team lead’ all trauma resuscitation cases with excellent support from radiologists, surgeons, anaesthetists and intensivists. With the exception of plastics, burns and maxillo-facial surgery all specialties will be on site from 2017.
The Royal Infirmary of Edinburgh has been chosen as one of Scotland’s four major trauma centres and the major trauma workload will increase by more than thirty percent. This is an exciting time for trauma in Edinburgh and we believe our department offers the opportunity to improve the practical, clinical and non technical skills required to manage these challenging patients.
We also routinely perform all our own procedural sedations (approx 7-800/yr), Rapid Sequence Inductions (approx 350/yr with anaesthetic support), Bier’s Block anaesthetics and manipulations, and the team have developed a robust quality assurance infrastructure and culture of positive change and behaviours.
We also benefit from a fully developed 24hr Emergency Nurse Practitioner service, as well as 7 day Occupational Therapy assessment with support from the the Elderly Care Assessment Team, Physiotherapy practitioners, Clinical Decision-Making ED Nurses, Cardiology and Respiratory Clinical Nurse Specialists, and enhanced role Radiographers.
The unit has a fabulous team ethos – all junior doctors work in a team for their whole attachment, with registrars supervising and mentoring more junior doctors in training, for all their shifts. There is a clear consultant supervisor structure, and consultants are present on the shop floor from 0745hrs to 2300hrs, 7 days a week. The Emergency Medicine team was a finalist in the BMJ Healthcare Improvement Awards ED team of the year 2012.

St John’s Hospital

St John's Hospital opened in 1989 in Livingston, a new town 20 miles west of Edinburgh. The hospital provides for most common adult and paediatric specialties as well as mental health, but not acute general surgical or trauma/orthopaedic admissions which are centralised in Edinburgh. SJH also has the supra-regional plastic surgery and burns unit, oral and maxillofacial as well as ENT surgery.

The Emergency Department underwent a £2.75m rebuild and expansion that also created the 14 - bedded ED Observation Ward, officially opened by Scotland's First Minister in 1994. The department comprises interior-designed modern adult and paediatric clinical facilities, staff offices, teaching and rest areas. We are a medium-sized ED treating around 50,000 patients per year of whom 1:4 are children. Around 60% patients present with injury, 17% with medical illness and 8% with surgical problems; 2000 patients per year require immediate treatment and resuscitation and 1:5 patients is admitted.
SJH offers a friendly and efficient working environment. Within the ED and ED Observation Ward there is a very strong ethos of multidisciplinary teamwork and respect for everyone's contribution; there is a drive to provide excellent care for each individual patient. Although we are often very busy there is the opportunity to tailor care for a particular patient, often much harder to accomplish in larger more frenetic EDs and hospitals. The local population is demonstrably grateful for the ED service provided for them locally which makes working at SJH ED very satisfying.
Clinical staffing includes 24 hour ENP and 12 hour orthopaedic technician services. From March 2014 there will be 10 EM consultants based at SJH, who all have the opportunity to work elsewhere in Lothian either at RIE or RHSC EDs or in toxicology, adult or paediatric ICM. There is a full complement of junior staff (FY2, GP ST2s, clinical development fellows) plus specialty doctor sessions and sometimes specialty training registrars in EM based at SJH. The consultant rota is annualised as recommended by the College of EM (CEM) which ensures fairness as well as the flexibility to fit work around life to some extent. There is consultant cover in the ED from 9am to 11pm daily.
Teaching and training in the SJH ED includes programmes for undergraduate nursing and medical students (Edinburgh and international) as well as an hour a week for the trainee medical staff and one on management topics for EM registrars. There is a lively weekly ED radiology meeting for all clinical staff and students to attend. In addition trainees attend the monthly regional core EM training afternoon or weekly EM ST4+ training afternoon as appropriate. The Vice Chairman of the Scottish Board of CEM and the Training Programme Director of the SE Scotland specialty training committee for EM are based at SJH, another consultant is also working towards an MSc in medical education. Other special interests include paediatric EM, toxicology, medical informatics, clinical guidelines, minor injuries and two consultants are examiners for CEM fellowship.

Royal Hospital for Sick Children

The Royal Hospital for Sick Children or the ‘Sick Kids’ as it is fondly known currently lies in the centre of Edinburgh in the beautiful setting on the Meadows. In 2017 it is set to move to Little France where it will lie adjacent to The Royal Infirmary of Edinburgh. This move will see the Sick Kids increase its’ field of work by seeing children and adolescents up to the age of 16 years (previously 13 years).

The Sick Kids Emergency Department see 42,000 attendances per year and thrives on a mixture of high acuity medical and surgical presentations and trauma. We also receive children from Medic 1 pre-hospital flying squad and the Paediatric Retrieval Service. We have a team of 10 Consultants who provide supervision of shop-floor activity and also contribute to the Emergency Departments at SJH and RIE with some combining their role in Paediatric Medicine. In addition to this team of supportive consultants we also have experienced Nurses, Emergency Nurse Practitioners, Orthopaedic Technicians and Physician's Assistants. This mix provides a highly specialised team who strive to make the experience of Paediatric Emergency Medicine a valuable learning journey in a fun and enjoyable environment.
The Emergency Department at the Sick Kids offers a vast array of teaching and training opportunities. We incorporate a very active clinic in our daily activity which sees a range of pathology and allows the chance to witness the progression in management of these children. There is a weekly structured teaching programme covering all the basics of Paediatric Emergency Medicine and, due to the degree of Consultant presence, opportunities for real time training on the shop-floor are plentiful.
We are committed to maintaining current high standards in Paediatric care and developing strategies to ensure the specialty delivers on all levels. It is an exciting and rewarding time to be a part of this team.