Hello friends and Happy Sunday Evening.
Hope everyone enjoyed this crisp fall weekend and go to see the beautiful sunset … at 3:30pm today. K Here’s your late Sunday night installment of Operational Update. Happy Reading!
The Schedule
Jan 3 – Mar 31 schedule should be out in the next few days. Thank you all who offered to do an extra shift this block in exchange for one less in the future. For most nights, we will have enough flex MD’s to open Fegan and still have a flex MD downstairs. Bridge standard on all weeknights except Fridays. Weekends are still … a struggle … so any moonlighting will be much appreciated! Incentive moonlighting plan still in effect!
Team (Tabs) Reorganizatiopn
To standardize which rooms belong to each team and to facilitate MD/nursing communication, we are making some changes to the Team Tabs. On the morning of 11/4 (tomorrow!!), we will introduce the following Team Tabs (changes highlighted in yellow):
To summarize:
- Team E will be eliminated and absorbed into Team A & B.
- The hallway beds that are typically used will be absorbed by Teams A, B, & D and should be filled equally.
- There will be a hallway tab that incorporates rarely used hallway beds (14-20).
- Triage rooms will be a separate tab.
- Team C will be predominantly boarders usually and should be a shared responsibility by Team A & B.
- The ED Flex role when in the main ED should go where needed at the direction of A/B attendings (i.e not necessarily see patients on one team).
Reach out to Andy/Jason with any feedback to these changes in the coming weeks, we’re ready for it… sort of! 😊
PA/NP Ketamine Sedations – Pilot Program
There is a small group of PAs and NPs who will soon begin performing ketamine only sedations for ASA I & II patients in the ED. This group has completed some training, but will look for opportunities to complete their required number of supervised sedations (which must be performed with an Attending/TYF present for the entire procedure) during shifts. Please let Andy know if you have any feedback or questions.
Mycoplasma (courtesy Neuman!)
Want folks to be aware of increasing rates of mycoplasma pneumonia across the US.
The IDSA recommends adding a macrolide antibiotic to amoxicillin for school age children with CAP treated in the outpatient setting. Given the high rates of mycoplasma infections in the US, I would encourage using both amoxicillin and azithromycin for children diagnosed with pneumonia.
IV Access Algorithm
Attached new IV access algorithm rolling out in the ED soon, can find it on BCHPEM (ClinicalàAlgorithms/Protocolsà“IV Access Algorithm”). Highlights as follows:
- Bedside nurses will be use Difficult IV Access (DIVA) score to guide how many attempts to make before marshalling more resources (tapping a second RN for help, paging IV team, discussing a potential US-IV by one of our MDs)
- Huddle with the ordering provider if no access 45 minutes from an IV order
- Please reach out to Caroline and Bobby for feedback
Okay, that’s it team! See you all soon!
Jason
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