ED Muskoka Physicians - Living the Dream

Cellulitis care

Hi all again,

Mark and I have recently chatted about Cellulitis care in our ED’s
Practice is varied and I have a hard time following what each of us are doing.

Another example arose yesterday…Kirstin and I talked about a patient that I had already discharged from the ER a few minutes prior and I had changed from him from IV to oral antibiotics. There was a relevant wound swab with sensitivities in Adam’s mailbox! I had no idea that this had been done!! Emma had seen the gent on his last visit. Adam on his first visit. Now me. Then seeing Roy on monday coming up. Oh boy….

The po clindamycin alone was not enough and so I tracked him down and added cipro to get his two bacteria covered!!

My point is that following these cases is hard for us all.
Just thought I should open this discussion for people to comment, help make a protocol maybe?, talk about further at our group meetings?

Intersting article attached here too…older article but not sure there is more recent comparison…

Just to add to the discussion…

follow-up/documentation

Please document all your follow-up of results in cerner ( make a progress note) or write and have scanned into chart.
It helps cover you and helps with patient care.

patients calling

Hi all,

Health records in both sites are getting many calls form patients asking for results of tests done in ER.
Patients are consistently telling staff that a doctor or nurse has told them to call in three days or so to get results!

Hospital staff can’t give out results over the phone so patients are getting upset and time is being wasted.
Please if you are doing this please change your practice .
If I am worried about a test or awaiting a culture I call/follow up with the patient myself or I have them call their family doctor/NP even if that person is out of town. Their primary care can help you with this! Yes – I know – many don’t have primary care….

Please don’t put our hospital staff in this predicament though please.

PA

Hey Hunstville Ed docs
Bob called in and is away sick this week.
just fyi

Admission plans

I have been asked by both team leads to remind MD’s admitting patients to just ask the team lead in either site where you are admitting a patient to before you call a new MRP.
This will ensure you know what site a patient will be getting admitted too!
Lots of patients recently going to best bed available ( and shifting sites)

It will save you time and extra calls.

Thanks
John

KING vision demo

Reminder – today 1:30 to 2:30 Bracebridge ER and 3:30 to 4:40 Huntsville
is King Vision demo by company rep in both Er’s.
Stop by for a quick orientation!!!
They are now in both ER”S!!

J

radiology difficult contact

Hi all,

Several of us had had some issues reaching certain radiologists recently.

Dr Pui is one… – if her cell number doesn’t work then call the “MR” number at the top of the radiology weekly list.

If you can’t reach a radiologist in all the ususal ways we try… Dr Peter Chait ( as chief rad) suggest call him on his
cell – 416-417-1928 .

John

HDMH traige move?

I just learned yesterday that nursing has put forward a proposal to the hospital to move traige into the existing space of FT 1 and FT2.
This would eliminate FT1 and FT2.

They want to so this before summer.

Main motivations..
1) safety of triage nurse as then they are ” in” the ED department behind locked door.
2) the traige nurse then can more easily help with care of patients in the ER ( float to care) when not in triage. This would increase nursing hands to help with care.

Bob and Sara have been involved some with Diane George on this one. I haev not been involved till now.

If you have ideas about how to re purpose other space the ER to help flow then please speak up or if you have thoughts on this please speak up.

I have had some discussions re puposing Bob’s space, quiet room, and maybe capturing space in the back entrance as well.

John

Sedations/scope of practice

If you sedate a patient then you are responsible for the patients airway and all issues related to sedation. I beleive this is clear as standard of care.

Nurses or allied health should not be asked to work outside of their scope of practice. This has happened in the ER and we should each support one another to work within our scope of practice.

Nurses should not be asked to push medications (ex. propofol) and left with a deeply sedated patient on their own.

Any questions please feel free!

thank you
John

Admits turned down

If anyone has an orphan doc or family doc say that they will not accept an admission …

We have had some recent cases in both sites!!!

My suggestion is please just say ” I understand you don’t think this patient does not need to be admitted but since I do and I can’t come up with an appropriate care plan other than admitting I appreciate you coming to assess the patient and help plan alternate care”

WE ARE ALL stressed and feeling the heat …I am not trying to be mean or unprofessional…but a consistent message to our peers is why I post this.

I am not suggesting using this line for areas of care that the receiving MD may feel out of their scope ( like with internal medicine issues and we have no bloody internal medicine support again in Bracebridge) but for routine admits…

A few of us felt just some consistent scripting may be helpfull…..