link to page 1 link to page 2 link to page 2 link to page 2 link to page 3 link to page 3 link to page 3 link to page 3 link to page 3 link to page 4 link to page 4 link to page 4 link to page 4 link to page 5 link to page 5 link to page 6 link to page 7 link to page 7 link to page 7 link to page 7 link to page 7
If printed, this document is only valid for the day of printing.
Radiology Fast-Track Chest X-Ray – AED/APU
Document Type
Guideline
Function
Clinical Practice, Patient Care
Directorate(s)
Adult Health Medical Services
Department(s) affected
Adult Emergency Department (AED) and Admission and
Planning Unit (APU)
Applicable for which patients, clients Adult AED/APU patients that meet the inclusion criteria
or residents?
Applicable for which staff members? All AED/APU clinicians
Key words (not part of title)
Cardiac monitoring, transport, transfer, transit
Author - role only
Nurse Consultant - Adult Emergency Department &
Admission and Planning Unit
Owner (see
ownership structure)
Service Clinical Director - AED
Edited by
Clinical Policy Advisor
Date first published
Yet to be determined
Date this version published
13 February 2018 - updated
Review frequency
3 yearly
Unique Identifier
PP2005/RBP/036
Contents
1.
Purpose of guideline
2.
Definitions
3.
Inclusion criteria
4.
Exclusion criteria
5.
Initiating fast-track process
6.
Ordering the CXR
7.
L2 MRT responsibilities
8.
Collection of patient
9.
Radiology orderly role
10.
Transfer of patient
11.
During investigation
12.
Post CXR investigation
13.
Return of patient to designated area
14.
Education/training
15. Flowchart
: Fast-track process
16.
Supporting evidence
17.
Legislation
18.
Associated Auckland DHB documents
19.
Disclaimer
20.
Corrections and amendments
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 1 of 7
link to page 1
If printed, this document is only valid for the day of printing.
1. Purpose of guideline
The purpose of this guideline is to facilitate the safe and effective transit of a stable patient
undergoing cardiac monitoring who requires a chest x-ray from the Adult Emergency
Department/Admission and Planning Unit (AED/APU) within Auckland District Health Board
(Auckland DHB).
2. Definitions
The following terms are used within this guideline:
ACA
Acute Care Area (APU)
AED
Adult Emergency Department
APU
Admission and Planning Unit
CXR
Chest x-ray
EWS
Early Warning Score: A tool used to score a patient’s vital signs from normal to
abnormal on a scale of 0-10
HDU
High Dependency Unit located in APU
Level 2
The areas of AED/APU/Radiology on level 2 of Auckland District Health Board
MRT
Medical Radiology Technicians
Fast-Track
The practice of AED/APU staff members ordering a CXR and transferring a stable
cardiac monitored patient who meets the Fast-Track criteria. This patient will be
able to be transferred directly to radiology, have a CXR and returned directly
back to AED or APU with the L2 radiology orderly service without a transit nurse
in a timely manner with no disruption. This term does not relate to clinical
urgency
Transit Nurse A registered nurse who escorts a patient requiring nursing care during the
transfer from one clinical area to another clinical area
GCS
Glasgow Coma Scale
ROERS
Radiology order entry and results sign off
3. Inclusion criteria
The patient is booked only for a general CXR
The patient has no current or on-going chest pain
The patient is comfortable
The patient is haemodynamically stable - has an EWS score of ≤ 2
The patient requires no more than 3L of Oxygen via nasal prongs
GCS = 15
The patient is able to sit/stand with minimal assistance
The patient is not vomiting
IV infusion is safe to stop for duration of fast-track process
The patient does not meet any of the exclusion criteria
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 2 of 7
link to page 1
If printed, this document is only valid for the day of printing.
4. Exclusion criteria
A transit nurse is required if the patient does not meet the inclusion criteria above
or if the
patient:
o Is confused
o Requires a patient attender (watch)
o Requires a security watch
o Presents intoxicated and/or with an overdose
o Has self-harmed
5. Initiating fast-track process
The AED doctor or AED/APU nurse caring for the monitored patient designates the cardiac
monitored patient is stable and meets the fast-track inclusion and exclusion criteria.
6. Ordering the CXR
To order the fast-track process, complete the request via ROERS:
o Fast-track should be written in the additional information box on the ROERS electronic
request
o Update the whiteboard x-ray column with x-ray ordered
o Fast-track should then be typed in to the comments section on the whiteboard (for fast-
track CXR) to keep all staff members informed
Or via radiology form:
o Use the paper radiology form if there is a computer outage
o Fast-track should be written on the request form if ROERS is not working electronically
Note: This informs L2 radiology that a patient meets the fast-track criteria and is ready for
transfer.
7. L2 MRT responsibilities
L2 MRT responsibilities to prepare for fast-track:
o Phone the AED Monitoring Co-ordinator’s Cellphone or ACA staffbase to confirm that the
patient is suitable for fast-track
o Ensure room is available and vacant for patient to be transferred directly in for CXR
o Liaise with the L2 radiology orderly to collect the patient
8. Collection of patient
On collection of the cardiac monitored patient from AED or APU, the monitoring or HDU staff
nurse should:
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 3 of 7
link to page 1
If printed, this document is only valid for the day of printing.
o Ensure the patient still meets the inclusion criteria
o Ensure the patient is wearing a correct name band
o Ensure the patient is dressed in a hospital gown with no bra/jewellery/metal items
o Ensure the cardiac leads are straightened to one side under the gown, through sleeve/key-
hole of gown and not tangled
o Clamp or luer off IV fluids
o Check the transport oxygen is at correct flow
o Updates the comments section on the Whiteboard eg "@ x-ray"
9. Radiology orderly role
Checks with the staff nurse that the patient still meets the fast track criteria
Checks the wristband to verify correct patient
Remove the monitor from docking station
If the patient is on oxygen, connect it to a portable oxygen cylinder and ensures the staff nurse
checks the flow meter
10. Transfer of patient
The radiology orderly transfers the monitored patient directly in to the x-ray room for immediate
CXR by the L2 MRTs.
Note: The radiology orderly should wait for the CXR to be completed i.e. does not start another
job.
11. During investigation
If there are any concerns or need for assistance with the patient during the x-ray procedure, the L2
MRTs should:
o Ring the patient’s nurse at AED or APU
o Ring the clinical charge nurse of AED or APU
o Stop the x-ray and return the patient to designated area
o Follow normal emergency guidelines
o Activate the emergency bells
Note: If L2 MRT activates the emergency bells, the L2 AED team should respond rapidly.
12. Post CXR investigation
The patient should be returned directly back from CXR by the orderly to their designated area by
the L2 radiology orderly as soon as the investigation is completed.
Note: Any patient on the fast-track process should not be left in any waiting area/corridor.
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 4 of 7
link to page 1
If printed, this document is only valid for the day of printing.
13. Return of patient to designated area
The orderly is responsible for:
o Informing the patient’s nurse that the patient has been returned to their bed space
o Re-docking the monitor
o Reconnecting the oxygen to wall oxygen
The nurse is responsible for re-assessing the patient on arrival to ensure:
o The patient is comfortable
o The patient has no chest pain
o The cardiac leads, BP cuff and spO2 monitor are functioning
o The patient’s vital signs are cardiovascularly stable - EWS ≤ 2
o The oxygen (if prescribed) is connected at the correct flow to the wall
o The call-bell is within reach of the patient
14. Education/training
It is the responsibility of each service involved with the fast-track to ensure that the educational
and training requirements for their staff members are met. The AED/APU educators can also assist
with training on request by the service.
o AED/APU staff members
o MRT
o Orderly service (24-hour service)
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 5 of 7
link to page 1
If printed, this document is only valid for the day of printing.
15. Fast-track process
Does the
cardiac monitored patient
Fol ow normal process for
meet the fast-track criteria for
NO
escorted transfer
an unescorted transfer to
Radiology?
YES
Log request for fast-track via ROERS when
completing radiology request for patient
Fol ow fast-track flowchart staff members roles
MRT role
Orderly role
Nurse role
Pre chest x-ray:
Pre chest x-ray:
Ensures the patient
Pre chest x-ray ensures:
Receives handover from monitoring
meets fast track criteria
Phone the AED
room/HDU nurse
Gives patient handover to
Monitoring Co-ordinator’s
Checks wristband to verify correct
the orderly when transfer
Cel phone or ACA
patient
to radiology organised
staffbase to confirm that
Removes monitor from docking station
If the patient is monitored,
the patient is suitable for
If the patient is on oxygen, connects to
ensures leads are
fast-track
portable oxygen
straightened to one side
Radiology room wil be
under the gown, not
available immediately on
tangled or through sleeve
patient arrival
Clamps or luers off IV
Contacts radiology
fluids
orderly to col ect the
The radiology orderly transfers the patient
If the patient is on 02
patient
immediately into the x-ray room
checks that flow meter at
correct level
Fast-track patients should not be left in
Updates Whiteboard eg
any waiting area
"@ x-ray"
During the procedure the orderly remains
During the chest x-ray:
During the chest x-ray:
in L2 x-ray waiting until the patient
Able to activate the ADHB
Be available to assess
procedure is completed
emergency system if the
the patient during x-ray or
patient col apses
answer any queries from
Contacts the AED/APU
radiology
CCN at any time if there
are any concerns with the
patient
Post chest x-ray
Post chest x-ray
When x-ray completed
The radiology orderly transfers the
Checks the patient is
inform the radiology
patient back to AED/APU monitored
stable, pain free, 02, IV,
orderly to return the
bed space immediately the x-ray is
monitor etc
patient to AED/APU
completed
Updates whiteboard with
monitored space
Re-docks monitor correctly
“x-ray completed”
If the patient is on oxygen, connects to
wal 02 outlet
Gives the patient the nurse cal bel /
lowers bed
Informs nursing staff members of
patient's return
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 6 of 7
link to page 1
If printed, this document is only valid for the day of printing.
16. Supporting evidence
Lin, A., Kerr, D. & Kelly, A. (2007)
Is cardiac monitoring during transport of low risk chest pain
patients from the emergency department necessary? Emergency Medicine Australasia, 19(3),
229-233.
Medical Council of NZ
NZ Medical Radiation Technologists Board
17. Legislation
Health Practitioners Competence Assurance Act (2003)
18. Associated Auckland DHB documents
Health & Safety
Health Practitioner's & Registered Social Worker Competence & Reporting Obligations
Infection Prevention & Control
Medications - Prescribing
Professional Development & Recognition Programme for Nurses
Auckland DHB resources
Early Warning Score
19. Disclaimer
No guideline can cover all variations required for specific circumstances. It is the responsibility of
the health care practitioners using this Auckland DHB guideline to adapt it for safe use within their
own institution, recognise the need for specialist help, and call for it without delay, when an
individual patient falls outside of the boundaries of this guideline.
20. Corrections and amendments
The next scheduled review of this document is as per the document classification table (page 1).
However, if the reader notices any errors or believes that the document should be reviewed
before the scheduled date, they should contact the owner or th
e Clinical Policy Advisor without
delay.
Back to Contents
Radiology-Fast-Track-Chest-X-Ray-AED-and-APU_2018-02-13.docx
Page 7 of 7
