ED Muskoka Physicians - Living the Dream

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…..

Stroke protocols

Hi All,
Emma and I attended the EVT meeting last night as Huntsville looks at if/how it can support the process the province is trying to role out. NNT of 2 with right criteria to consider.

On that – please let me know at my mahc email (john.simpson@mahc.ca) the MRN and initials of any patient that is automatically excluded with EMS arrival using out stroke protocol criteria.

I have an upcoming meeting with EMS to try and reduce the false positives brought on stroke criteria to Huntsville ED and any real examples can help.

thanks
John

lab critical results at night!

Hi all,
The lab critical result pathway has been modified slightly…

Between 11pm and 7 am if a critical lab/micro result comes available ( blood culture, csf result, etc) ordered through the ER and the patient was sent home….

The result will be called direct to the ER doc at the treating hospital site. Please take this result and decide on appropriate action. May need to call patient in middle of night? or call the ordering doctor in the am? or call the family doctor in the am and confirm they can follow it up? I would suggest always letting the ordering MD know that a result has come up and how it was handled.

Just a few examples. Please then document what you did. I just document these things directly in the cerner chart of the patient as a clinical note.

This supports good patient care and supports each other as docs.
If you wish to review the full lab/micro curtail result pathway please just look on sharepoint or I can get it sent to you.
thanks
John

White demo sheets

If you see the white demographic validation sheets not done in a chart of patient you are seeing..
Either..
1)give to ward clerk to do when available
2)give to nursing to allow them to delegate the task or do themselves
3) do it yourself! It takes about 20 seconds maybe…
even if you just validate the phone number it may be super helpfull later when soemone needs to call them!

Nursing is supposed to take responsibility to do when ward clerk not there but soemtimes I find just easier to do myself.

This sheet was created to flag info because of patient that was never contacted ( about his positive bllod cultures from which he died) due to lack of info to reach or find him. Same reason for the new line on the d/c sheets reminding yuo to get a contact number.

John

summer plans

Hi all,

Please start thinking ahead if you have ideas to help us all to manage the upcoming summer boom!

I am meeting with radiology to try and plan re early morning CT’s, ensuring ultrasound coverage as good as can be, etc!

We could use the 6 hours overlap money differently if wanted? maybe do 4 hour overlap shifts and then have shift overlap other days instead too…
These kind of thoughts…

Novel ideas of flow/efficiency may be lurking in your head so thing about brainstorming with all!

John