Clinical

Pre-Arrival Process

Pre-arrival allows you to use the FirstNet tracking board as an effective communication tool regarding which patients are expected to come the Emergency Department and what their presenting complaint is.  We will use this to replace the current system of writing down the details of a consult call on a random piece of paper.

Launch the Pre-Arrival form by clicking on the Ambulance icon at the top of the FirstNet window.

pa1-amb-icon

This opens the Pre-Arrival Form, as shown below. (click the image to enlarge)

pa2-form 

None of the fields are mandatory.  Fill in what you can from what you are told on the phone about the consult, and hit OK.

Thats it.  The patient should now appear on the tracking board - No need to run to triage with that little piece of scrap paper!

Once the patient arrives, the registration clerk will attach the pre-arrival form to the patients actual chart, so any notes you entered into the form will be available to the doc who actually sees the patient.

 

FirstNet Design Questions for HUGO

As part of HUGO, we are updating the Cerner codebase in the next couple of months, which will update both PowerChart & FirstNet. As a result, I was given the opportunity to see the "new code" in action, and was surprisingly pleased with the appearance. I most recently learned, however, that the we (the adult emerg docs) have decided to change a few things that make it look (IMHO) 1) ugly, 2) cluttered and 3) difficult to read. I grabbed a screenshot of the "generic Cerner" look and was hoping to get a consensus on whether to change things or whether people are happy with the status quo.

There are 3 poll items that I would like you to consider, after viewing the following images (click on the images to zoom in)

CERNER STANDARD VIEW (Click image to enlarge)

fn cerner

LHSC CURRENT VIEW (Click image to enlarge)

fn hugo

  1. Look at the difference between the font size (bigger) and weight (bold) and the background color (white vs. grey) of the rows on the tracking board between the Cerner "recommended view" and our LHSC view (as seen in the new code version.) I was told this was "voted on" by the adult emerg docs, but I can tell you no one asked me. I find the Cerner version much easier on the eyes. We are planning to upgrade all the systems to 21" widescreen monitors as part of HUGO, and hence side scrolling will not be an issue.
  2. The color of the tabs are RIDICULOUS and PAINFUL to look at. I would suggest changing them to more subdued colors, or even the colors we currently use on the online schedule. Of note, we are unable to change the color of the text on the tabs, making dark tabs hard to read (one of the many Cerner-isms that exist).
  3. There are too many tabs. While I understand the logic behind having the checkout tab, the situations where we need it are few and far between, and the clerks still have access to it if need be. It was suggested that we compile all tabs into one and simply make them all accessible via the tab dropdown. Unfortunately, this is not possible, and so the To Be SeenAll Patients andCheckout tabs must all be separate (a Cerner-ism). I suggest we ditch at least the Checkout tab.

You can find the poll questions here.

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Bed Block Strategies

Strategies in place to ease bed-block.....

1. Beds opening:

14 ALC beds opening at Parkwood Hospital
Parkwood Hospital is opening 14 temporary beds as a Home First transition strategy to help address LHSC alternate level of care (ALC) pressures in partnership with CCAC. The beds will be available from January 28 to March 31, 2013.

ALC Unit - Victoria Hospital - D6-300 
This temporary ALC unit will continue to be open, and move from under surgery to medicine.

2. Impact of patient access initiatives:

ED Decant Unit - Victoria Hospital - D6-400 (10 beds) 
As part of a pilot these beds opened in November 2012, and have had a positive impact on wait times for admitted medicine patients in the emergency department.

November - decreased wait time for Medicine patients of 2.6 hours
December - decreased wait time for Medicine patients of 4.2 hours

Patients move to this decant unit from the ED before being moved to an inpatient bed.

We will continue to keep you updated on the status of all our patient access initiatives.

Thank you for your continued dedication to safe and timely patient care.

LHSC Incident Management Team Update

The following update was circulated Friday Jan 25th from the London Health Sciences (LHSC) Incident Management Team to address ongoign bed access issues:

IMT updates can be found at: http://www.lhsc.on.ca/priv/action/imt/index.htm

1. Beds opening:

14 ALC beds opening at Parkwood Hospital
Parkwood Hospital is opening 14 temporary beds as a Home First transition strategy to help address LHSC alternate level of care (ALC) pressures in partnership with CCAC. The beds will be available from January 28 to March 31, 2013.

ALC Unit - Victoria Hospital - D6-300
This temporary ALC unit will continue to be open, and move from under surgery to medicine.

2. Impact of patient access initiatives:

ED Decant Unit - Victoria Hospital - D6-400 (10 beds)
As part of a pilot these beds opened in November 2012, and have had a positive impact on wait times for admitted medicine patients in the emergency department.

November - decreased wait time for Medicine patients of 2.6 hours
December - decreased wait time for Medicine patients of 4.2 hours

Patients move to this decant unit from the ED before being moved to an inpatient bed.

We will continue to keep you updated on the status of all our patient access initiatives.

Thank you for your continued dedication to safe and timely patient care.

Introduction to HUGO

Healthcare Undergoing Optimization


hugo logo

This is a brief introduction to HUGO Project (Healthcare Undergoing Optimization) - an initiative of the London Health Sciences Centre along with its regional partners.  It introduces the 4 basic components of HUGO, and outlines some of the major benefits of CPOE.

Go here to learn more.

ERNI Request

I have been asked by Medical records to remind all ED's about the requirement to fill in certain times on the ED Medical record.  These times are important for a number of reasons including the time to physician initial assessment, and the time it takes consult services to respond to our consult request.  It has significant impact on our funding and pay for performance initiatives.

I have included a copy of the chart outlining where we need to insure that the times are entered.

I would like to thank you in advance for your cooperation.

ED Physician ERNI Reminder

New Consultants 2012

We are excited to welcome 6 new Emergency Medicine Consultants to London.  All 6 of the below ER docs will start in July 2012.  We are also expecting 2 more Emerg Consultants to start in the next 6 months!  Please read through the new team members bios and join us in welcoming them to the team!

Dr. Baig Dr. Davis Dr. Gladwell Dr. Meiwald Dr. Ng Dr. Sharif
Dr. Mirza Baig Dr. Matt Davis Dr. Heather Gladwell Dr. Allie Meiwald Dr. Victor Ng Dr. Nadder Sharif

{slide=Read more...|close|noscroll|grey}Dr. Baig completed his medical degree at University Health Sciences in Lahore, Pakistan.  Mirza then completed his CFCP at the University of Toronto.  After his initial two years of training in Mississauga, Mirza moved to Saskatoon to pursue his passion of Emergency Medicine. His primary interests, among many, include Emergency Department Ultrasound and Toxicology. Besides working in an acute ED, Mirza likes spending time with his wife and family. Dr. Baig's mentors in London are Dr. Roy Roebotham and Dr. Munsif Bhimani.{/slides}

{slide=Read more...|close|noscroll|grey}After residing in Pickering, Kingston and Hamilton Ontario, Matt moved to London Ontario in 2007 to complete his residency in the Royal College Emergency Medicine program.  He completed a "fellowship" year in prehospital care at the Southwest Ontario Regional Base Hospital Program in his fourth year o residency.  This year further developed his interest in EMS and EMS research.  When not at work, Matt enjoys hitting up fresh powder on the mountains, traveling, cross country biking, winning big in Vegas and hanging out in the Old South.  Dr. Davis' mentors are Dr. Mike Peddle and Dr. Adam Dukelow.{/slides} {slide=Read more...|close|noscroll|grey}I am originally from Brampton, Ontario and attended the University of Toronto for my Hon. B.Sc. in psychology and life science. I then took time off to backpack and work overseas. I moved to London in 2005 to attend medical school at UWO and liked it here so much that I stayed for my CCFP and CCFP-EM training. My interests include medical education and travelling.  Dr. Gladwell's mentors are Dr. Christie MacDonald and Dr. Dawn Giffin.{/slides} {slide=Read more...|close|noscroll|grey}Allison completed her Royal College training in Emergency Medicine here in London but will always be a Newfoundlander at heart, which is where she completed her nursing and medical degrees. Her professional interests lie in medical education. Currently, Allison is kept busy building a house and planning a wedding, but she does look forward to enjoying her new found non-study time and simply spending time with friends and family.  Dr. Meiwald's mentors are Dr. Rob Sedran and Dr. Laura Foxcroft.{/slides} {slide=Read more...|close|noscroll|grey}Victor completed an undergrad and master's degree in kinesiology at Western University prior to medical school at the University of Manitoba.  Subsequently he returned to London to complete his family medicine and emergency medicine training.  His research and academic interest include primarily medical education, global health and musculoskeletal injuries in the emergency department.  In his spare time, Victor is an avid traveler and been to every continent at least once!".  Dr. Ng's mentors are Dr. Ram Reddy and Dr. Wanda Millard.{/slides} {slide=Read more...|close|noscroll|grey}Hello everyone! This is Nadder (pronounced nod-air).   I am very excited to begin this new chapter in my life and can't wait to meet you all soon!  Here are 10 facts about me... 1) born in Iran; 2) raised in Calgary; 3) hardcore Flames fan; 4) went to high school on Vancouver Island; 5) travelled through Europe and Australia after high school; 6) worked several "interesting" jobs before starting university; 7) 13 years of post-secondary education: undergrad at Western, grad at McGill, Med school at U of T, family medicine at U of A and EM at U of S; 8) triathlon is one of my interests, but so is beer; 9) my stomach was way flatter when I was more serious about triathlon and less serious about beer; 10) I am passionate about EM and hope to make meaningful contributions to the London group and the specialty at large in the future.. Dr. Sharif's mentors are Dr. Scott Anderson, Dr. Andrew Jones and Dr. Kelly Regan.{/slides}