Hello Friends,
Hope everyone is enjoying this late summer gorgeous weekend! No PEMA this summer, so lots of info to pass along. Hope you can read while sitting outside and enjoying your favorite beverage. 😊
Here we go….
Schedule/Staffing/ED Volume Stuff
- If you haven’t noticed, it’s getting busier!! A and B attendings please continue to huddle with charge nurse about opening and closing of spaces. On most Fridays and weekends (no bridge), ED Extension team should huddle a couple of hours before end of shift to make a plan. It is helpful for us to hear about ongoing challenges so we can continue to discuss in weekly operational meetings with nursing and continue to stress matching of resources.
- Screening – we have daily discussions with COPPS and PFCC (patient flow and capacity center) about floor screen and trying to balance the state of the ED with desire to take patients and expected inpatient discharges. If you are A/B and feeling the need to be on screen but not currently activated, please reach out to me or PAC as we try to thread that microscopic needle.
- Behavioral Health Screening – regardless of the state of the hospital, we will continue to screen for behavioral health patients from other ED’s. If you think we should still take based on age and location (for ex: 8 yo diabetic at Lawrence General), totally fine. On the flip-side however, even if followed at BCH, it’s okay to say no to the teenager in another emergency department. They have the same resources we do for placement.
- We may try to get a little jump on the Jan 3rd – March 30th schedule, so requests will be due October 1st instead of the traditional October 5th. Will send a subtly hilarious invite as always.
MRI/Anesthesia Things
- Sedated MRI’s – In an effort to streamline the communication between us and anesthesia for sedated MRI’s, there is now a listed person to call in the paging system (for now type in “Anesthesia” into the ‘Last Name’ section: listed under Anesthesia for Diagnostic Studies). During weekday banker’s hours this will usually be an NP direct dial. Off hours still the old method of calling 5-9111. Please feedback to me bumps in the road as this is a first effort to hopefully cut down on the runaround (and yes, trying to get them to change to typing into ‘On Call Now’ section like we do for most other services).
- Emergent/Urgent-MRIs – semi-related, MRI continues to be fully booked and getting emergent/urgent studies can be cumbersome (true across the entire hospital). We are working with radiology and neurology to make it easier to schedule outpatient urgent but not emergent MR’s (more to come soon). For now, when you are requesting an MRI from the ED, please CONTINUE to do the following:
- Call 5-6315 to get an idea of timing. If you get the sense that it’s going to be problematic (e.g. need an MR Vent check but can’t fit in for 4-6 hours), please consider alternative imaging.
- When speaking to MR (and anesthesia for sedated studies) – please be as specific as you can on the urgency. It’s okay to not know (after all that’s why we are getting the study!) – but giving a sense of what you are most worried about is helpful for them to prioritize all the different requests across the hospital. For example: “I’m most concerned for osteomyelitis or abscess and we are holding on antibiotics and disposition until we know the results of imaging. So I think the study needs to be done in the next 3-4 hours max.” They still may say no way, but at least then we can make an alternative plan.
Death Checklist
As it turns out, there are now parts of the death checklist we need to do electronically in EPIC that populate other systems for the hospital. The EPIC part to fill out gets activated when you click on the “Expired” button for disposition. A crack team is working hard to get that process streamlined and to match the death checklist. In the meantime, until that is ready please feel free to page me and/or the PAC for help navigating EPIC.
Uploading of OSH Images
Turns out since EPIC go live radiology could not upload images OSH images to PACS without a provider order. This has now been fixed. Please email me for continued issues.
Notifying Parents about Restraints
For any patient restrained (physical or medication), parents should ideally be notified as soon as possible after the event. However, given the operational challenges associated with evening and overnight shifts, here is a practical guideline based on time of restraint:
- Eve shift: Provider team (can be you, resident or APC) attempts to notify family. If no response, this needs to be signed-out as action item for daytime NP team.
- Overnight shift: Provider team signs out to daytime BH NP with specific action item to notify parents of restraint.
- If you receive information that a family specifically requests to be notified overnight, please attempt to contact them in real time.
Reverse Transfers from the Floor/OR
Not sure what’s in the air (mold?), but we’ve recently had a little bolus of patients being reverse transferred from the floor back to ED shortly after admission. In general, this should not be done for a whole variety of reasons. If there are extenuating circumstances or you think needs to happen for patient safety reasons, please discuss with charge nurse and it can be escalated to nursing leadership and PAC.
Homelessness
Just a reminder, we are no longer boarding homeless patients in the ED. If here for a medical reason, can evaluate and discharge (or admit if medically necessary obviously).
Open Fractures
If you have any suspicion a fracture could be open, please give single dose of IV antibiotics. No need to wait for ortho to weigh in in most cases.
Okay, that’s it folks, any and all above up for discussion in PEMA in couple of weeks, so feel free to email me if you think warrants a group conversation.
Happy Sunday Everyone,
Jason
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