Entrustable Professional Activities

LG6: Acute Care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

  • assess acutely unwell patients, and initiate management in the clinically appropriate care setting, such as community, sub-acute, or acute care settings
  • recognise clinical deterioration, and respond by following the local process for escalation of care in a patient-centred manner
  • recognise and manage acutely unwell patients who require decisions regarding goals of care with resultant acute resuscitation or palliation
  • communicate with ancillary services, such as intensive care or community-based teams

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
  • perform advanced life support, according to resuscitation council guidelines, to a high level of advanced resuscitation skills
  • demonstrate knowledge of potential outcomes, risks, and complications of resuscitation
  • effectively assess, diagnose, and manage acute undifferentiated clinical presentations, including oncological emergencies
  • identify unwell patients that can be safely managed outside of hospital, and initiate robust and safe management for said patients
  • select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues, avoiding wasteful and morbid investigations that will not improve patient care
  • optimise medical management before, during, and after operations
  • develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events, including consideration of prognosis and patient preferences
  • systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
  • manage escalations, de-escalations, and transitions of care in a proactive and timely manner
  • provide clear and effective discharge summaries with recommendations for ongoing care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise seriously unwell patients requiring immediate care
  • apply basic life support as indicated
  • identify general medical principles of caring for patients with undifferentiated and undiagnosed conditions
  • identify potential causes of current deterioration, and comply with escalation protocols
  • facilitate initial tests to assist in diagnosis, and develop management plans for immediate treatment
  • document information to outline the rationale for clinical decisions and action plans
  • assess perioperative and periprocedural patients

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • communicate clearly with other team members, and coordinate efforts of multidisciplinary team members
  • use closed-loop and clear communication with other health care team members during resuscitation
  • facilitate early communication with patients, their families, whānau, carers, and health care team members to allow shared decision making
  • negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
  • employ communication strategies appropriate for younger patients or those with cognitive difficulties
  • explain the situation to patients in an understandable, sensitive, and supportive manner, avoiding jargon and confirming patients’ comprehension
  • determine the level of health literacy of individual patients, and their level of understanding of agreed care decisions

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate communication skills to sufficiently support the function of multidisciplinary teams
  • determine patients’ understanding of their diseases and what they perceive as the most desirable goals of care if possible

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • maintain up-to-date certification in advanced life support
  • use clinical information technology systems for conducting prospective and retrospective clinical audits
  • analyse adverse incidents and sentinel events to identify system failures and contributing factors
  • evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
  • identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
  • document treatment given without consent in an emergency according to local guidelines
  • coordinate and encourage innovation, and objectively evaluate improvement initiatives for outcomes and sustainability

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • evaluate the quality of processes through well-designed audits
  • recognise the risks and benefits of operative interventions
  • evaluate the quality and safety processes implemented within the workplace, and identify gaps in their structure
  • raise appropriate issues for review at morbidity and mortality meetings

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate effective supervision skills and teaching methods that are adapted to the context of the training
  • encourage questioning among junior colleagues and students in response to unanswered clinical questions
  • seek guidance and feedback from health care teams to reflect on encounters and improve future patients’ care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • mentor and train others to enhance team effectiveness
  • provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
  • coordinate and supervise junior colleagues from the emergency department and the wards

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • select studies based on optimal trial design, freedom from bias, and precision of measurement
  • evaluate the value of treatments in terms of relative and absolute benefits, cost, potential patient harm, and feasibility
  • evaluate the applicability of the results of clinical studies to the circumstances of individual patients, especially those with multiple comorbidities
  • specify research evidence to the needs of individual patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate efficient searching of literature databases to retrieve evidence
  • use information from credible sources to aid in decision making
  • refer to evidence-based clinical guidelines and protocols for acutely unwell patients
  • demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • negotiate health care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, gender identity, sexual orientation, and belief systems
  • integrate culturally appropriate care of Māori and Aboriginal and Torres Strait Islander peoples into patients’ management
  • consider cultural, ethical, and religious values and beliefs in the assessment and management of acutely unwell patients and when leading multidisciplinary teams

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • practise cultural competency appropriate for the community serviced
  • proactively identify barriers to access to healthcare

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
  • develop management plans that are based on medical assessments of the clinical conditions and multidisciplinary assessments of functional capacity
  • advise patients of their rights to refuse medical therapy, including life-sustaining treatment
  • facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
  • demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • communicate medical management plans as part of multidisciplinary plans
  • establish, where possible, patients’ wishes and preferences about care
  • contribute to building a productive culture within teams

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise the need for escalation of care, and escalate to appropriate staff or services
  • integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and cause into clinical decision making
  • reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
  • use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • involve additional staff to assist in a timely fashion when required
  • recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
  • manage the transition of acute medical patients through their hospital journey
  • lead a team by providing engagement while maintaining a focus on outcomes

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • collaborate with and engage other team members, based on their roles and skills
  • ensure appropriate multidisciplinary assessment and management
  • encourage an environment of openness and respect to lead effective teams

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
  • prioritise patients' care based on need, and consider available health care resources
  • collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • identify the systems for the escalation of care for deteriorating patients
  • recognise the role of clinician leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes