ED Muskoka Physicians - Living the Dream

discharge instructions

Please use the d/c instructions as much as possible – written- and hand yellow sheet or copy to patient!!

I just finished two more complaints that the d/c sheet would have likely avoided or been my defence /your defence to the patient issue!!

Also – I chart when patent refuses the written d/c sheet which means I offered to write things out for them and they declined!!


airway carts/crash carts

Looking for one or more MD volunteers to be part of standardizing the airways carts and crash carts in both hospitals !!

This little working group including nursing and RT input will start when the new airway carts for the second floors ( to be put in ICU at SMMH and on East at HDMH) arrive!

We need to streamline the handles for laryngoscopes and organization of whats in the carts!! This was one of the feedback points from a recent trauma case at HMDH so lets make it happen!

Please email or tex me your interest.

Happy New Year

Hope everyone is getting a little downtime/family time over the holidays.
Just wanted to say an early Happy New Year to each of you.



It recently was brought up, and then discussed at the ED committee level, about pitfalls of communication and methods to communicate information of interest to staff in both ED’s.

Communicating key points of interest to members is a challenge… as what may be very important to one member is totally not relevant to another.

I try to communicate out what has a big clinical impact or will change your world in the practice of medicine without boring you.
I also try to communicate out things that may be of interest or has been of interest in the past ( like flooring changes in HDMH or parking changes in SMMH). I mention these examples specifically as they may seem silly to some but created a lot of debate and spitfire for others!!

Moving forward…
All ED committee minutes when finalized will be on this website. They also will be in sharepoint.
Team leads at both sites will include all ER MD’s in their update emails ( like happens in HDMH by Sara now).

I enjoy these team lead updates and taking the 30 seconds to a minute to scan them and then read what I need is huge value.

Likewise if you encounter an issue that you want to communicate out please use the website and get it out!!
or talk to me and I am happy to engage.

Further – If you have ideas about efficacy, practice improvement, quality improvement , flow ideas, etc don’t hold back but get them out there and lets see how we can carry them forward ( or you can carry them forward!)

ED secure room renovation

Hi all,

Funding was just approved on monday by senior team to proceed with the secure room renovation in both sites starting in January 2019. The initial budget of 300 thousand per site was blown out of the water with the initial quote for both sites together at 1.2 million.
The hospital has allocated some quality /facility improvement funding to help fund this new huge price tag.. and the foundations too have added more money to make this happen.

Firm completion date no later than may long weekend 2019.

Both ER’s will have temporary secure rooms ( in existing room one (HDMH) and in existing minor room( SMMH) ).

SMMH will not have rooms 3.4.obs 3 and isolation rooms during the renovation and ultimately will see this space become a secure room and a “flex room”.
Main difference is the flex room will have medical gas , suction, etc as in any other routine care bay.
HDMH will not have rooms 10, eye and 8 during the renovation and will see this space become two rooms as above.

Each room has its own tiny washroom and there is a dedicated observation area outside/between the rooms.
Tons of work/research has gone into the design, structure,best layout in the rooms, security, etc. Stacey and Bill where involved in the early mental health working group that this came out of. Stacey has continued work on the mental health construction room side of things too. Nursing leadership and admin and facilities have dedicated a lot of time to this project too.

In the short term trauma one in SMMH will be divided into two bays and cast room supply room will be changed to clinical space for seeing patients.

In Huntsville we should anticipate more use of trauma one to see patients in the short term and long term.

LONG TERM..we will be better equipped to have a safer environment for patients and staff when a secure room is needed ( which is daily presently). Downside we will ultimately be loosing some stretcher spaces in both ER’s. SMMH down two stretcher spots. HDMH down one stretcher spot.

This issue is huge and not to be taken lightly. ITS huge.

We will continue to look for space to have stretchers ( as an example..perhaps our flex room could hold two stretchers most of the time?, maybe trauma one in SMMH is ideal for longterm use for 2 stretchers most of the time?,etc). We also will need to continue to improve our flow of patients to inpatient beds and out or the ER and actively switch patients that are appropriate out of their bed to a chair if/when appropriate …etc…

If you want more information in anyway please ask. Lots of communication to go out to partners about this renovation and reduced capacity too.


bill C 46/OPP blood draws


Hi all,
Yesterday dec 18 2018 an amendment to the criminal code came into affect.
The new Bill is attached here and worth a read.

Specifically – police can request a blood draw of any individual with out a court order now. It also doesn’t have to involve an MD necessarily although access to lab technicians after hours currently has to involve an MD in our setting.
If you refuse to help in this process there can be legal issues for you ( read the Bill).
I was made aware of this change last week and met with OPP in Huntsville on friday to read this over with an officer and try to understand its impact.

I have discussed and shared with Esther Millar, Ellen ( head of lab) and Harold Featherston (senior admin over lab). I have also shared with Melissa Imrie.
The hospital has engaged their legal department to vet this and try to then come up with a plan to minimally involve , or not involve, ER. Although currently the only access to after hours lab services the OPP has is through our ER’s.

I haven’t seen any communication come to me from the CMPA around this so plan to call then today.

Blood draws typically are for alcohol ( when breath test refused or can’t be done for some reason) and the the patient agrees to blood under the OPP jurisdiction. Although to us or lab we don’t need to get involved in the “why/what” at all.
OPP brings a kit for the blood for legal reasons. The form inside needs to be signed by either the lab tech and/or the MD to keep you out of court. Unfortunately the current paperwork is not up to date with the Bill so OPP are supposed to know to modify the paperwork and reference this Bill while they are waiting for new paperwork to come.


Morning all,
This is the week of accreditation so just a heads up/reminder!

Kirsten and Adam I expect you maybe working this week when the surveyors will be dedicated to the ER ( me too).

ALTHOUGH..They could walk through the ER or see any of us in the hall at any time!

Most hot ER topics – BPMH ( how do we do PMH and med orders with admission), What is our role as ED doc in Code orange ( team lead) , how is our access to specialist care, etc!

Best not to focus on negative things but how we create a safe environment for our patents ( Ie they don’t want to hear about our issues with plastics as an example)….

Admissons of patients with NP primary care

Hi all,

if you are admitting a patient with a primary care NP to Bracebridge please ask…

Do they know what MD they are assigned too? ( all have been assigned to a MD and should have a card with that). This is not true of the patients at the NP led clinic in Huntsville as they are a different model of primary care ( L Lefebvre, A Kitchen, M and C Dove, A Erickson).

if that MD looks after inpatients then you may be admitting to that MD ( or the MD covering) instead of orphan MD.

if patient doesn’t know what MD they are rostered to then a phone call to the NP office may provide that.

In Huntsville ( with our inpatient system) this is not needed.


march break locum

Hi everyone,
an MD couple may be able to do some locum work during march break.
If you are interested in giving up shifts that week please let me know!

They are interested in summer locum work too so if anyone planning to cut back or wants specific time off please consider voicing that now too!

Radiology contacts!

Hi all,

Please start to use the electronic schedule for who to call when you need to speak to a radiologist.
There is a permananet link on the MAHC homepage (right hand bottom MAHC radiologist schedule).

So – just click on internet – get our homepage which is the default and then one click shows you who to call.

This is the most up to date radiologist list always!!
We have had a few calls ( and delayed return calls) recently due to not using the most up to date schedule.

If you can’t find just ask me and I will show you.

We will soon be getting rid of the paper schedules…SOON!…as they are impossible to keep up todate

Just like we use medevison as our most up to date schedule ..this is what the rads use and they have asked us to only use this schedule as the one you trust.