ED Muskoka Physicians - Living the Dream

smmh internal med

Hi all,

A small group met this morning in follow-up to the request put forward to admin and COS in a letter penned to Natalie by Kersti that was distributed recently….

Jan Goosens, Sanjay Jinal, Dave Johnstone, Mel Mar, Marty O, Sandi Adamson and Karen Fleming. All by video or phone.

All agreed in principle to the algorithm distributed about IM support sent out recently by Jan.
All agreed a phone call to the IM on call in Huntsville to problem solve how support can be obtained , or patient transferred if capacity exists, is the first step .

Risk stratifying the patient can be done with MRP and IM feedback.

In principle all agree that if HDDM is over capacity then either criticall may need to be called or if possible gridlock may apply and a patient could potentially be moved to SMMH if that makes capacity for an appropriate patient to go to Huntsville.

Nothing new I think really but at least ongoing discussion is always helpfull.

Discussion around renumeration of internists ensued.

Please always send a copy of the patient demographics to any internist giving phone advice as they need this to bill a telephone consult if appropriate.

Any questions please ask.

John

smmh ecgs

Hi SMERPS’s

If anyone has reviewed an old ecg that just got reported ( due to delay noted and posted recently)…..and identifies a case that this “late report” changes care…please let me know MRN and example!!!

Any “miss” like this I want to know about and feed back to senior admin. as they have asked about it.

questions? pls ask

thanks
John

ecg back log

Hi everyone,

So..Dave Johnston just recently read over 200 ecgs from SMMH with some dating back almost a year.

Heads up to look at dates as these come back to your mailboxes.

These eggs where mistakingly being put in a folder and never entered into cerner and then never getting interpreted by internal medicine. It was totally dependant on who did the egg and who entered the test into corner or so I’m told…

I had no idea and I expect none of you did either.

The process of entry into corner has been fixed and this should never happen again i’m told. I have expressed our concern to all parties over this happening!!!!!

These are ecgs that you should have seen in the ER but never would have received the formal interpretation.

John

journal club sept 21st

Journal club !!! HDDMH and SMMH!!!
all mds welcome!!

sept 21st 6- 9
John’s house, 677 sky hills road just off ravens cliff
take ravens cliff road ( muskoka 2 on highway too) west to sky hills.
turn left on sky hills.
we are on left 3 km in.

it won’t be snowy yet so my driveway should be okay.

Please rsvp to me so I can have food/beverages on hand. rsvp no later than sept 14.
perhaps some MDs want to carpool to enjoy a little wine!

John

out of country narcotics

Hi all,
Just a little reminder..
If someone out of country or doesn’t have a valid healthcare….

You need to put drivers license number/passport number ( some valid picture id) on narcotic prescriptions.

There have been several calls about this recent.

John

Stocking/Supply issues at HDMH

For HDMH staff – I am meeting with Kathy next week to chat about stocking in the ER. I have heard concerns about inconsistent stocking of certain items and have run across a few frustrations myself this summer so we are just going to do a walk-through the department to identify certain areas that need attention/feedback to our nursing staff who work through these re-stocking tasks at night.

Please let me know if you have areas of concern. My current list includes:

-Suture carts – ensuring they are stocked the same & with adequate supplies for busy days, including 25g 1 1/2 inch needles and adequate drape supplies if using the new utensil-only suture kits.

-ENT cart – plastic ear curettes, lido spray, cotton balls & cup, possibility of stocking otrivan or similar ?

-Trauma carts – ensuring radial & femoral art lines are clearly labelled and BOTH stocked along with supplies/tubing to set them up; creating a central line kit with all the materials needed (including sterile probe covers, chlorhex sponges, flushes, caps, tegaderm, mask & gown all in one bag);

 

Any other feedback? Thanks

Kirsten

Criticall documentation sheet

Hello again,

It was requested by our internal medicine colleagues at rounds a few months back that we clearly document our conversations with specialists (especially neurosurgeons) via Criticall on the chart of patients that are being admitted for monitoring at our hospitals.  Specifically, the inpatient doc needs to know who we spoke with and their recommendations for follow-up. This information too easily gets lost in the busy ER chart, so I have created a template sheet to use that will hopefully make this easier (and remind us what to ask on the phone!).  It can be used for other specialist consults as well (i.e. ortho) and should be stickered and included in the patient chart.

Copies of these template sheets can be found in the drawer to the right of the physicians desk in Huntsville under the (scribbled) label “Criticall”.  I will be bringing copies to Bracebridge today to include in the physician resource drawer there too. Please let me know if you have or hear feedback about these forms – is there any way to make them better/more useful?

Kirsten

HDMH Backup sign in Binder

Hi all –

As discussed at our HDMH ER group meeting, I have created a binder with ‘sign-in’ sheets in order to help us document our back-up calls.  It is a white binder, clearly labelled, located on the shelf behind the ‘captain’s chair’ .  When you are called in on back-up, please remember to grab this binder and sign in. It should be fairly self-explanatory (name, date, time, reason for call-in i.e. how many patients waiting). The more we remember to do this the better our data will be!

This should help us defend our back-up usage if god-forbid the ministry ever tries to claw back our funding, and it may be able to help us identify some trends about our high-needs times.

If the Bracebridge group is interested in doing something similar let me know.

 

Kirsten

holiday/leaves

Hi everyone,

In looking ahead to the next year there are a few docs who would like to be away for a month or so for a variety of reasons.

In the interest of planning Kirsten and I feel that putting up a master sheet /board/calendar may be a huge aid to not have many overlap leaves if possible.

Individuals can write up the times they are hoping to be away and that then means that it may help avoid many away at one time.

A GOOD EXAMPlE…is if I know that 3 docs are away at the same time ( say even for a week) then rather taking the same week of I would /could consider taking different week off….

Any one against this?

All would have to think about using or it won’t really work….

If okay then I will just put a board or calendar in each site in the call room…!?!?

thoughts?

John

SMMH NP

Hi SMMH ,

Jen is now on early mat leave which was unplanned.
Kate is our new NP that has been hired but will not be done training till near the end of July!
There will be a small gap in NP coverage so be aware.
Hang in there!
John