Entrustable Professional Activities

LG7: Acute care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

  • assess seriously unwell or injured patients, and initiate management
  • recognise clinical deterioration with haematological emergencies, and respond by following the local process for escalation of care, including referral to other necessary services, such as intensive care
  • recognise and manage acutely unwell patients who require resuscitation
  • lead the resuscitation team initially, and involve other necessary services
  • liaise with relevant medical, surgical, intensive care, and laboratory teams
  • perform this activity primarily in inpatient settings

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 haematological conditions and deteriorating and critically unwell patients, and respond confidently to the following:
    • acute core conditions:
      • acute leukaemia, particularly acute promyelocytic leukaemia
      • acute thrombosis (such as life-threatening pulmonary embolus)
      • massive transfusion / critical bleeding
      • severe thrombocytopenia
      • sickle cell crisis
      • spinal cord compression
      • thrombotic thrombocytopenic purpura (TTP)
    • antiphospholipid syndrome (APLS), catastrophic
    • atypical haemolytic uremic syndrome (aHUS)
    • cytokine release syndrome (CRS) / immune effector cell-associated neurotoxicity syndrome (ICANS) after cellular and immune effector therapies
    • disseminated intravascular coagulation (DIC)
    • febrile neutropenia
    • herapin-induced thrombocytopenia (HIT) / other anti-PF4 immune diseases
    • leukostasis and hyperviscosity syndrome
    • malignant hypercalcaemia
    • severe tumour lysis syndrome
    • superior vena cava syndrome (SVC) and/or airways obstruction from massive mediastinal mass
    • vaso-occlusive crisis
  • perform advanced life support according to resuscitation council guidelines, to a high level of advanced resuscitation skills
  • demonstrate knowledge of potential risks and complications of resuscitation
  • effectively assess, diagnose, and manage acute undifferentiated clinical presentations
  • select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
  • systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
  • manage escalations or transitions of care in a proactive and timely manner
  • develop plans for multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
  • provide clear and effective discharge summaries with recommendations for ongoing care
  • optimise medical management before, during, and after operations

direction
Requires some supervision

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

The trainee may:

  • recognise seriously unwell patients with haematological diseases requiring immediate care
  • apply basic life support as indicated
  • recognise 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 healthcare team members during resuscitation
  • facilitate early communication with patients, families, and healthcare 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 situations to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
  • determine the level of health literacy of individual patients and 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, if possible, and what they perceive as the most desirable goals of care

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
  • evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
  • contribute to morbidity and mortality meeting discussions to identify system failures and contributing factors
  • identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
  • 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
  • raise appropriate issues for review at morbidity and mortality meetings
  • evaluate the quality and safety processes implemented within the workplace, and identify gaps in their structure

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 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 healthcare 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 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:

  • maintain up-to-date certification in Good Clinical Practice (GCP), and participate in locally available clinical trials as a sub-investigator
  • 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
  • refer to evidence-based clinical guidelines and protocols on acutely unwell patients
  • recognise the limitations of the evidence and the challenges of applying research in daily practice
  • use information from credible sources to aid in decision making

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, or belief systems
  • integrate culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori into patients’ management
  • consider cultural, ethical, and religious values and beliefs in 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 healthcare access

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:

  • develop management plans 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
  • consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
  • facilitate interactions within multidisciplinary teams that respect values, encourage involvement, and engage all participants in decision making
  • demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy
  • recognise and demonstrate the key elements of open disclosure, especially surrounding chemotherapy errors

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:

  • reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
  • 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
  • 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 journeys
  • 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 healthcare resources
  • collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems
  • identify equity determinants as they pertain to acute care, and devise strategies to address them

direction
Requires some supervision

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

The trainee may:

  • recognise 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