Emergency Medicine Grand Rounds

Thursday Sept 22 @ 0900-1000

Academic Practice Rounds

Dr. Matt Davis & Dr. Karl Theakston

University Hospital Auditorium B

Latest News

Referral Guide
30 August 2016

Allergy

Inpatient- No inpatient admissions, but there is a city wide consultant available by pager for urgent questions

Outpatient- Allergy outpatient clinics available. Referrals are faxed

Cardiology

Inpatient- Admission at UH, VH. Syncope secondary to arrhythmia, and isolated CHF are referred to cardiology in addition to ACS.

**Special note re: STEMI- Page code STEMI pager (VH, UH, UCC) and speak to interventional cardiologist on call. All STEMI patients requiring catheterization are transferred to the cath lab at UH**

Outpatient- AFib/anticoag clinic-referral faxed

London Cardiac institute Arrythmia service and General Cardiology- referral faxed

Dr. Thibert- Stress test and Holter monitors- referral faxed. Usually very timely follow up

Cardiac Fitness Institute- stress tests and consultations- referral faxed

CHF clinic- referral faxed

 

CVT- Inpatient- direct admission at UH only.

 

Dentistry-

Inpatient- Admission available at UH, VH and UCC for OMFS and dental patients.

Outpatient- Semi Urgent cases can be discussed with the dental resident on call and the patient can be seen in their clinic often same or next day.

Less urgent cases- patient can call 519-661 3326 for an appointment at the UWO dental clinic

 

Dermatology

Inpatient- no admission or available consultant for inpatients

Outpatient- outpatient clinic referral forms available on FRED and are faxed. May be lengthy waits. Urgent Medicine clinic may be more appropriate if timely follow up required

Endocrinology-

Inpatient- No admissions to endocrinology. Consultant physician available by pager for urgent discussions if needed

Outpatient- General endocrine clinic and Diabetes clinic referral forms are faxed and available on FRED

 

ENT-

Inpatient- Admission available at UH, VIC and UCC

Outpatient- Clinic referral forms are faxed and available on FRED

 

General Surgery-

Inpatient- Admission at VH, UH

Outpatient- Referral is faxed to consultant on call

 

Gastroenterology-

Inpatient- Admission at UH only. At VH referrals would go to medicine however there is a GI resident available for urgent GI consults at VH (ie. Upper GI bleed or esophageal FB)

Referral criteria for admission to GI service at UH: Esophageal FB, Pancreatitis, GI bleeds, Hepatitis or liver failure in a non transplant patient

Hepatology does have admission privileges (Admission at UH only)

Outpatient- Urgent GI clinics are booked at VH. A referral form is faxed at UH

Outpatient criteria: criteria for the Urgent GI Clinic is as follows (March 2014):
Overt GI bleeding (ie. melena, hematochezia)
Anemia requiring transfusion
Dysphagia of recent onset
Upper abdominal pain refractory to proton pump inhibitors
Lower abdominal pain with recent onset change in bowel habit
Obstructive biliary disease
Severe diarrhea lasting more than one week
Vomiting with evidence of acute kidney injury
Acute pancreatitis

 

Hematology-

Inpatient- VH- direct admits under Heme/Onc. UH no direct admits. Cases requiring transfer to VH for admission could be discussed with the consultant on call. Otherwise admission at UH would go to medicine.

Outpatient- Thrombosis clinic- pager 18558, covered 24/7 for phone advice and referrals except weekends which is covered by general heme. Often will be given a next day appointment time directly via the phone conversation. If very late/early am and routine next day follow up is required, referrals can be faxed (rather than speaking to someone directly) and the patient will receive a next day appointment.

 

Infectious Disease-

Inpatient- no direct admission at either site but a consultant is available by phone for cases that need urgent advice

Outpatient- Cellulitis clinic- services all three sites, run out of St. Josephs hospital. Seen the next day at 7:30am including weekends and holidays. Referral is found on Quick Orders page. ED physician to order initial IV Antibiotics and blood work.

Non Cellulitis ID follow up- fax referral to ID consultant on call

 

Medicine-

Inpatient- Admission at UH and VH, referrals go through the senior medical resident (SMR)

Outpatient- Urgent Medicine Clinic- Appointment times are booked prior to patient discharge at UH and VH. At UCC the referral form is faxed

 

Nephrology-

Inpatient- Admission at VH only. Nephrology admits all patients on dialysis unless clear indications for urgent or surgical intervention by another service. Ie. pneumonia or NSTEMI in a dialysis patient would still get admitted to nephrology.

No direct admission at UH. Admissions would go to medicine, nephrology does cover UH for urgent dialysis and can be paged directly concurrently with medicine

Outpatient- No outpatient clinic available to ED.

 

 

Neurology-

Inpatient- (General) Admission at UH only. Neuro cases at VH are often admitted to medicine. Transfer to UH from VH for admission may be indicated ie. thrombolysis, carotid or vertebral dissection, seizure being actively followed by epilepsy service. There is a neurology resident and consultant available for urgent consults at VH

Inpatient (Stroke)- Stroke pager activates: VH (acute stroke consultant and neuro resident at Vic). UH- stroke consultant, resident, Tpa nurse, CT tech and charge nurse, neurorads consultant or fellow, stroke fellow

Outpatient-Urgent neurology clinic- page neuro consultant on call during the day if unsure if case appropriate for urgent neuro or in whom you want to ensure must be seen urgently

Community neurologists for less urgent neuro problems- referrals are faxed and available on FRED

First seizure clinic- referral is faxed

Urgent TIA clinic- referral form includes criteria for ordering ED CTA, check info and provide details for better triage of TIA patients

EMG/NCS- referrals are faxed and available on FRED

 

Neurosurgery-

Inpatient- Admission at UH only. Resident available for consultations at UH and VH

 

Obstetrics and Gynecology-

Inpatient- Admission at VH only. Transfers from UH to be seen same day by OB/Gyne at VH must go through the consultant.

Outpatient-EPAU- Early pregnancy assessment clinic for first trimester pregnancies. Appointments are booked by the clerks prior to patient leaving the department

MIG(Minimally invasive Gyne Clinic)- specific referral form is faxed

General OB/Gyne- Generic referral form is faxed to consultant on call.

 

Oncology-

Inpatient- Admission at VH only. Oncology patients at UH are often appropriate for transfer to VH. The majority of cases will be referred to medical oncology. This is discussed with the consultant on call. Patients with hematologic malignancies are referred to the hematology/oncology service. Patients during or within 4 weeks of chemotherapy or radiation are appropriate for referral to oncology.

Radiation oncology- admission for patients who have recently received radiation and the reason for referral for admission is radiation related.

There is a Rad Onc and Med Onc consultant on call for the rare cases that require outpatient referral only

 

Opthalmology-

Inpatient- Inpatient admissions at UCC only

Outpatient- Optho resident is paged for all referrals and a time is given in the emergency eye clinic at St. Joes (usually same or next day). Clearly non urgent referrals (ie. non resolving chalazion) can be referred directly to consultant’s clinic who specializes in that area, but as that may be hard to know, the optho resident on call can provide guidance where to refer the rare specific cases that need optho referral but not at the urgent optho clinic

 

Orthopedics-

Inpatient- Admission at VH, UH and UCC (HULC). Patients may be transferred between sites depending on nature of consultation. Page the Ortho resident on call.

**Special note re: spine. Spine consultations go to Ortho Spine (VH) and Neurosurgery (UH). Occasionally there is no ortho spine on call and referrals at VH will still go through neurosurgery.

Outpatient: general Orthopedics: VH and UH referrals are faxed

Sports Medicine- outpatient clinic available through Fowler Kennedy. Referrals are faxed

Peds ortho- referrals are faxed

 

Plastics-

Inpatient- direct admission available at VH, UH and UCC (depending on nature of admission and plastics consultant on). City wide coverage. Page Plastics resident on call for admissions/consults

**Special note re: hand injuries (carpals and distal). Injury proximal to carpals is referred to Ortho unless at UCC which would be referred to HULC)**

Injuries requiring urgent attention- plastics at VH, UH (city wide coverage after hours) and HULC at UCC (all upper limb).

Outpt- hand injuries referred to Plastics at VH (appointment is made by clerks prior to discharge) and UH (referral is faxed) and HULC at UCC (referral is faxed)

Non hand plastics outpt is referred to Plastics at VH, UH and UCC respectably.

 

Psychiatry-

Inpatient- VH only. Referrals from UH for admission speak to the CEPS nurse (daytime hours) or psychiatry resident (evening/night) on call

Outpatient- Urgent psychiatry clinic- Currently (as of March 2015) outpatient appointments are screened with a phone call to the patient prior to being booked. The phone call is scheduled prior to discharge. Exceptions are made for those without a phone.

 

Respirology-

Inpatient- Admission at VH only. Criteria for direct admission: COPD/Asthma, undifferentiated pleural effusion, often only if patient already followed by a respirologist . Admissions at UH go to Medicine

Outpatient- General respirology clinic- referral faxed

Asthma and Allergy clinic- referral faxed

 

Rheumatology-

Inpatient- no direct admissions. Consultant is on call for phone discussion if needed

Outpatient- Rheumatology clinic- referrals faxed

 

Trauma

Inpatient- VH only

Activating the Trauma team via switchboard pages: TTL, general surgery junior and senior, CT/XR, trauma nurse, CCTC charge nurse, and anesthesia. The TTL and General surgery team are expected to respond

Outpatient- Trauma clinic is available to follow those discharged from hospital but not directly available via ED referral

 

Urology-

Inpatient- direct admission available at VH, UH and UCC

Outpatient- General urology- referrals are faxed

Renal colic- a specific renal colic referral form is available. Most patients will be seen within 4 weeks. Follow up will occur in 2 weeks in the presence of a stone >8mm, hydronephrosis, underlying renal impairment and multiple visits. Please note, urology requests a KUB and urine culture performed before referral.

 

Vascular/Thoracics-

Inpatient- direct admission at VH only. Cases at UH may require urgent transfer to VH and this is discussed with the Vasc/Thoracics fellow on call.

Outpatient- Referrals are faxed. Referrals requiring urgent follow up (ex. Lung mass)- discuss with thoracics fellow on call to ensure timely follow up

Dr. Nick Federman and Dr. AJ Seong: Rethinking the 3-hour troponin
29 June 2016

Drs. Nick Federman and AJ Seong discuss the 3-hour troponin in the emergency department. Is it time to rethink this common practice?

This video is licensed Creative Commons Attribution-ShareAlike 4.0 International License

Dr. Mel Kahan discusses opioid use disorders in the ED
06 June 2016

Dr. Mel Kahan discusses opioid use disorders in the emergency department.

For more information, see: https://emlondon.ca

This video is licensed Creative Commons Attribution-ShareAlike 4.0 International License

Ashley Voss-Liebig: Responding to stress
18 May 2016

Ashley Voss-Liebig is a critical care RN and rescue specialist out of Austin Texas with many years of flight experience including time as a Combat Medic. In this grand rounds, she discusses how emergency responders deal with stress and how to improve our responses.

This video is licensed Creative Commons Attribution-ShareAlike 4.0 International License.

Welcoming the New FRCP Cohort!
03 March 2016

Congratulatulations to the newest three members of the Royal College Emergency Medicine Program: John Teefy, Eric Leci & Michael Blaszak!

Western continues to have an excellent reputation for training in RC-EM, and boasts the largest number of enrolled EM trainees nationally, a direct reflection of our enthusiastic mentorship and hard work.

We look forward to working with our new residents on July 1st!

Toxicology Half-Day Material
28 February 2016

Below are links to the toxicology half-day PowerPoint presentations.  Dr. Hoffman was happy to provide his material provided that it was only shared internally.  Please do not share the links or the material outside of the division.

Dr. Riggan - Tales from Bellvue

Dr. Hoffman - G.I. Decontamination

Dr. Hoffman - Hot Topics in Toxicology