UPDATES! 4/28/13

4/29/13

1. HOCO FIRE DEPT EXPOSURE - Captain Michael Stoner from Fire Department called me this week. He said he is the infection control officer for Ho Co Fire Department and his cell phone # is 443-398-0484. He is available 24/7. According to him, we should contact him whenever Ho Co Fire Department crew is exposed to body fluid and seen in ED.

2. Effective Wednesday, May 1, 2013, EMS is converting to eMEDS. This is a paperless system.

What this means…

We will no longer receive a paper report /run sheet from EMS. We will have to logon to access and print the information. The Charge Nurses and PCAs will be given access to do this.

It is the expectation that all Priority I patients will have a report done (in the system) before EMS leaves the hospital. There may be occasions when EMS leaves the hospital before completing a report for priority II and III patients. If this is the case, they will give us a written “summary” (similar to their current “stat pad”) before leaving the hospital. This will contain any pertinent information about pre-hospital treatment, etc.

Moving forward, it will be our responsibility (Charge Nurse or PCA) to print the EMS reports and include them with the patient’s chart.

Please see myself or Robin if you have any questions.

Thank you,

Giuliana

4/7/13

1. BAT PROTOCOL - Apparently there have been some recent issues with ED providers calling the wrong people when considering giving TPA to a stroke patient. Remember to always page the "BAT" (brain attack team) neurologist to discuss possible TPA. This is different than the HCGH on call neurologist, and different than the JHU "stroke attending".

Sorry it is confusing, but please remember to page the "BAT" neurologist when considering TPA use, and always document the conversation in your chart.

2. UNION TRANSFERS - Since last month the "Hand Center Union Memorial" will set up transfers and make all the arrangements, even connecting with the accepting attendant. Call 410-261-8100 (just like the Hal line and Express care) to make set up possible transfer to Union. Fax face sheets to 410-554-6544.

3. EKG SIGNATURES - you must put a time next to your signature when reading EKG's.

4. ESTIGRAMS ON HOSPITAL COMPUTERS - with the EPIC installation on each computer, when you press f4 to 'get' the list of templates for downcodes it will log you out. Instead, click on 'Get' in the lower right hand corner. Click on 'Text' and in the blank text box, press f9 like you normally would. Alternatively, if you "log in" or "sign in" into the computer using your JHED ID and pw, you can use the original process of f4.

5. EPIC TIDBITS - The new 'Call Made' will be called 'ED Decision to Admit'. It will be an actual order that you place once you've made the decision. This is important for 2 reasons... 1) This will be CMS measure that is reported 2) It will actually generate a bed request in the hospital (an added advantage over the current 'call made').

I've fielded questions about EKGS, discharge summaries, FORM FAST, etc. EKG images will be still be available via a link to Pyramis (current workflow remains intact). Discharge summaries and some lab data, etc will be migrated over from the last 3 years (but no more). FORM FAST will remain the source for AMA, procedure consents, blood consents, etc.

FINALLY, MOST OF THE JHEMS STAFF HAS YET TO TRAIN AND WON'T UNTIL 5/23 OR 5/29 WHICH LEAVES LITTLE TIME TO PRACTICE IN THE PLAYGROUND. WHILE TRAINING IS ESSENTIAL, PLAYING AROUND IN THE TEST ENVIRONMENT WILL GIVE YOU ALL AN ADDED ADVANTAGE. HOPKINS HAS AGREED TO GIVE ACCESS TO THOSE TRAINING LATER, I WILL BE SENDING YOU THE INFORMATION TO LOG IN SHORTLY. PLEASE TAKE ADVANTAGE. I AM HAPPY TO SHOW YOU THE BASIC PROCESSES... AND, OF COURSE THE ONLINE TUTORIALS ARE AVAILABLE.

Plenty to come..

3/5/13 - Radiology and Miscellaneous Updates

1. INTRACRANIAL BLEED DISPOSITIONS: The quantification of blood volumes on head bleeds will not be automatically dictated into the PACS report ,at this time. If you need to know the volume to decide about admission, this should be done in concert with the intensivist involved in the case.

2. PRELIMINARY RADIOLOGY RESULTS ENTRY - After 6 pm when there is one radiologist on duty, the providers will be responsible for entering comments into PACS on any study where the patient is being discharged before a voice clip has been entered . This is for both normal and abnormal reads. This will close the loophole where a patient is discharged by a provider with a preliminary "normal study" , but later read as abnormal by the radiologist.

3. ULTRASOUND ORDERING - Orders for ultrasounds on any pregnant patient should be entered as an US OB, not as a US female pelvic. US has also asked that we change an order from stat to routine for any study that can wait until after the patient goes to the floor. This will decompress the US techs and speed up your "necessary" studies.

4. PREGNANCY AND IMAGING - If you are sending a known pregnant patient to radiology for a study, the provider must fill out a consent form . The patients will not be consented by the radiology technicians and may be sent back to the ED. I am also told that the quantity of radiation used in head and cervical ct's have been significantly reduced due to recent improvement of technique and shielding.

5. MRI HOURS OF OPERATION: The current MRI hours are M-F 8a-11p , and S/S 8a-7:30p. There is no on call MRI tech after those hours.

6. Methadone and Buprenorphine - As a practice, we do NOT provide any methadone or buprenorphine unless we are contacted directly by a verified addictions center with a legimitate reason for patient missing a dose.

1/18/12

1. SHIFT Length change - As you may have noticed, the pm1 shift has been changed from 4-1a to 4-12a.

2. TSHEET SIGNATURES: There is a new t-sheet format for the first page and signature lines. The Joint Commission mandates that every entry in the medical record must be dated and timed, along with signature -- Epic will handle this electronically, of course. In the meantime, we have to write in the date/time on the first page of each t-sheet above the chief complaint box, as well as write in date and time for each signature on the back page.

3. PNEUMONIA a. if the patient is currently seen at any healthcare facility, including nursing homes, dialysis, or the like (but not assisted living), the diagnosis is "healthcare-acquired pneumonia" rather than "community-acquired pneumonia (CAP)", so please write "health-care-acquired pneumonia in the discussion block or diagnosis line; b. always use the meditech order sets for choice of antibiotic for CAP; c. if you order blood cultures and antibiotics, let the nurse know that this is a pneumonia patient, so that they can confirm the timing of blood cultures being scanned before antibiotics given.

4. CALL SCHEDULE Please forward Walt a write-up of your concept of how we should construct an emergency coverage program. It would be helpful to have something in writing from everyone that can be circulated for comment. We need to move forward soon with emergency coverage.

5. CONSULT CALLS: only call consultants for immediate emergency management assistance, such as management of refractory arrhythmias, etc. If the consult will only serve to guide inpatient management, the conversation should be between the two docs who will be managing the patient on an inpatient basis: the admitting doc and the consultant, who should speak directly.

6. PACS AND AMCAS - A new application, AMCAS, installed on all the PC's in the clinical area, allows you to see the workload for nighthawk radiologists -- you can see where your study is in the queue, see its status (pending, being read, or already read), and read a report, if already read, instead of waiting for the fax. This is particularly helpful in verifying that ultrasound images have been transmitted to nighthawk for read.

7. NEW STROKE DRUG :For stroke patients in the 3-9 hour window, not eligible for tPA at HCGH, you can still contact the stroke attending to see if the patient is eligible for a study drug that can be given at JHH. The trial is called DIAS, led by Dr. Urrutia. All you have to do is discuss this with the HAL line, Dr. Urrutia or colleague. We may have an iPad with a Skype app for the neurologist to discuss it with the patient or family. If a patient qualifies, HAL will arrange for the patient to be transferred to JHH.

8. EPIC AND VACATION - June 1, 2013 is the big-bang roll-out date for EPIC. Since we will all be new to electronic documentation, please try to minimize vacation and off requests for that month only.

9. STEMI- For possible STEMI's: if the ECG is questionable, activate first always, then "call off the dogs" if you determine that the activation wasn't warranted. We are held to a standard of activation within 5 minutes of completion of the ECG.

10. PSYCH HOME MEDS IN POM. Remember when you are placing home medications for psych patients to place it in POM so they don't drop off. This is the same process as you entering holding orders.

12/14/12

1. Patient First CRISP data - Patient First will be sending laboratory data, and maybe EKG data, for all patients that are sent to an ED. Remember to login to CRISP for such data if you so desire. Once such data is given to CRISP, it will remain in CRISP. The upshot is that you can view important lab data from (eventually) months and years earlier.

2. HIM representative- The Health Information Management hospital committee is looking for more physician representation. The meeting is held at 7 a.m. on the first Friday of every month. The committee focuses on physician compliance with dictated charts, verbal co signatures, etc. I am currently unable to regularly attend these meetings. If you are interested but are worried about your attendance, I can split meetings.

3. CIMS contact - please contact CIMS using their pager moving forward. Call for emergencies or if you have not received feedback for an admission text in a timely manner.

4. EPIC presentation - For the January JHEMS meeting, I will be demonstrating EPIC functionalities and be fielding questions/concerns, etc. Please try and attend.

10/11/12

1. PROCEDURAL SEDATION - Please document the start and stop times on your T sheet. This is a compliance issue. You can refer to the nursing flowsheet or simply ask the nurse for the exact times. If you do not do this, MAS (our billing company) will be sending you an Estigram. Thanks.

2. BRAIN BLEEDS - See the home page for guidance on when to keep certain brain bleeds at HoCo. This should save us quite a bit of hassle for insignificant or catastrophic hemorrhage.

3. PSYCH PATIENTS' HOME MEDICATIONS - Please enter the home medications that are necessary upon seeing the patient. Unfortunately, this burden often falls on the charge doc much later and when the grasp of the patients' medical conditions is not as strong.

4. SMOKING CESSATION - If you perform 3 minutes or greater of smoking cessation for a patient, please document so in the progress notes section of your Tsheet. If performed, we may bill.

5. RESIDENT SIGNUP PROCESS -- All ED docs will sign up in meditech for resident's patient prior to discharge/admit. Any patients that this is not done for should have their charts pulled and the t-sheet signature looked at. This is important because the hospital is unable to bill patients if they do not have an attending of record. They obtain this information strictly from Meditech. Thanks.

8/7/12

1. Occupational exposure followup - If an employee of HCGH has a work-related injury or illness, they should be given "Occupational health - HCGH" as the organization to follow-up with. It's under the "Resources" tab in the discharge routine.

2. Bridging Orders - Please do not use abbreviations when filling out an admission diagnosis for bridging orders. For CVA, type Stroke..HTN, hypertension, etc.

8/2/12

1. Preop order set - The department of surgery has put together a single order – “PREOP” (prepare patient for surgery). This bundles all the nursing orders necessary to get a patient ready for the OR. Before a procedure, a surgeon may ask one of us to enter “PREOP”. I think the go-live is this week some time.

2. Stroke certification CME - If you did not go to our Stroke education day earlier this year you need to do 4 hours of education on your own. The Stroke committee is asking me to ask all ER docs to have it done by September 1.

2. Starting September 1 you can keep small ICHs (less than 30cc, no intraventricular hemorrage) in our ICU rather than transferring them out.

3. We not have 23% "saline bullets" available at our pharmacy in the rare case you have a patient that is herniating that you are waiting to transfer out (you can get guidance about when to use this therapy from the Hopkins stroke attending on call).

3. Numerous admission guide updates have occurred. Please check every time until we achieve some stability.

4. CT table weight limits - 400 lbs for chest, abdomen, and pelvis studies, 450 lbs for others. Radiology is iin the process of evaluating CT scanners to replace the Toshiba 4 slice.and the limit will be closer to 500 pounds.

6/25/12

1. IV Contrast for CT - If a patient is not able to provide verbal consent for IV contrast, please try and consent them prior to going over for CT. The form is printable from MEDITECH and we will have some blank forms at the PCA desk.

2. 30 minute rule - It is now a matter of policy that the hospitalists must respond to pages within 30 minutes. If not, you are able to admit to another provider/CIMS

3. CRISP - don't forget sign up for training and obtain access. This is clearly beneficial to our practice and our patients' care. Go the main JHEMS.org screen to click on links for training.

4. There are two docs at Lorien, Abbas and Wolokolie. They should be admitted to Suzan Abdo's service moving forward.

5/22/12

1. Ramesh Sabapathi - see the top of the admission guide for Ramesh Sabapathi's home number if you cannot reach him. We will be discussing the need for a single contact point moving forward.

2. When "x" doesn't call back... - As regularly occurs, often times the admitting physician takes a while to call back. If you have waited a long time, CIMS has agreed to admit patients if they are able (they are not busy, their service is not overwhelmed). You will have to contact the administrator on call (Anirudh, Mindy... number found on hospital admit page). Please be sure if you have tried all methods of contact before asking CIMS to admit.

3. Appropriate service - With all the recent admission guide changes, please consult the admission guide for all patients when deciding whom to call. The number of patients incorrectly admitted has spiked. If you find the guide is incorrect, please send me (Samit, sdesai101@gmail.com) a quick email so that I can update it.

5/3/12

1. RAMESH SABAPATHI - Dr. Sabapathi has given his home phone number to the PCA. If you're having trouble contacting him, have the PCA call him.

2. NEW ADMITTING RELATIONSHIP - Laurel Internal Medicine will now be admitting to CPCA (Kanamuru, Vancha, Bavani). These MDs are Maggin, Margolis, Moy, Tadikonda, O'Brien.

4/24/12

1. NEW DOC AT TURF VALLEY - There is a new physician at Encore at Turf Valley known as Dr. Runs. His patients should be admitted to Dr. Abdo.

2. LIST OF DRUG SHORTAGES - Sodium bicarbonate is now on backorder. Please exercise caution when using the drug (especially in futile code situations).

3. CIMS OVERNIGHTS - Starting this week, CIMS will have two overnight providers to take admissions.

4. CRISP - If you are having trouble getting trained or obtaining a username and password for CRISP, please email me. Starting this summer, Patient First in Columbia will be sending data to CRISP. This should help us tremendously with prior lab data and EKGS.

4/11/12

1. NEW CARDIOLOGY GROUP - MidAtlantic Cardiology is now Maryland Cardiovascular Specialists. MCS will, effectively immediately, be covering for all of their patient as well as for Seton Medical Group. See the Admission Guide for further cardiology consultations.

The cardiologists in the practice are Marty Albornoz, David Wang, Jonathan Safren, Vineet Dua, Jeffrey Cole, Russell Hillsey, Carlos Ince, Frederick Kuhn, Raymond Plack, Stephen Plantholt, Matthew Voss, Shannon Winakur. I will add these patients to the Admission Guide so that you know to call them for Cards consults or admissions related to a cardiology complaint.

Their ASCOM line will be X2840. This will be on the ASCOM #s hyperlink on the left sidebar. Dr. Albornoz has given us his cell number is case of emergencies 410-227-1933/ pager 410-351-0156.

2. KAISER- All Kaiser patients will be admitted to CIMS, effective immediately... not Dr. Nyanjom and his group of physicians. Some CIMS providers are still not completely aware of this switch, direct them to this page for confirmation.

4/9/12

1. Stroke CME - New Stroke dates are MAY 12TH AND JUNE 9TH.

2. KUB for kidney stones- Please order KUBs for all patients with a kidney stone. It allows the urologists to track the stone's progress without having to repeat CT, etc.

3. EPIC UPDATE - Go-live date is on schedule. We are currently redesigning EPIC to fit our specific workflows. We will be having an EPIC demo at an upcoming department meeting.

3/21/12

1. Stroke CME- Just wanted to remind you about the two stroke education days coming up. they are both 8a-noon on saturdays. april 14th and may 12th. it is the same material at both of them. if you go to either you are done with your stroke education for the year - otherwise you need to do some education on your own. just try to save the time if you are interested, i will fill you in on details as we get closer.

Rob

2. Maryland Primary Care (Levine et al) have switched admitting service to Nyanjom's group (the new Patuxent, Vlad R., etc.). Please continue to consult the Admission Guide for any future admissions as it constantly changing.

3. Productivity Site: https://emweb.jhmi.edu/apps/jhems

4. KAISER ADMITS - Kaiser patients should now be admitted to CIMS, not Nyanjom.

3/13/12

1. Admission Guide changes. Dr. Kazlow will now admit to CPCA (Kanamuru, Bavani, Vancha). Dr. Sadiq will admit to Mbonu.

2. CRISP- Chesapeake Regional Information System for our Patients is here. Basically, you will be able to access health information (encounter data, labs, radiology, discharge summaries) for patients at all Maryland facilities. The system is only starting, so data for Howard County is sparse. This should change with each coming month as Laurel and other local hospitals come online. Patients do have a right to "opt-out" of this program.

We are currently training a few superusers. We'll then extend the training and access to the group in the coming weeks. I'll be demonstrating the portal over the next few days if I see you.

3. Please use "Call Made" for all patients you will be admitting, regardless of whether or not the admitting physician will soon see the patient. It captures important data for us as well as reporting data for the hospital.

4. Please read 'Patient Care Plans' for patients who are flagged with the 'RMCCI' tag (this is found under their name on the tracker). It is important for the practice to have a fairly consistent approach to noted drug seekers. Beyond that, however, there are patients for whom we have included important medical information (need for hydrocortisone, etc.)

5. Please ensure that psychiatric patients receive a proper medical signout. We had a case of delirious psych patient with an untreated UTI.

2/19/12

1. NAQVI/ABDO - Fatima Naqvi is the new medical director of Lorien. She has requested all of her patients be admitted to Suzan Abdo. This information is in the Admission Guide.

2. Radiology conversation - If you need to speak with a radiologist and are too busy to run back to the reading room, call X7914. John Dunn,

radiology director, has told his techs to go across the hall and tell the radiologist that you need them.

3. PAIN/NAUSEA ORDERS - Please add pain and nausea medications to bridging orders, as necessary; there have been multiple instances of patients arriving on the floor without these issues covered.

4. PREGNANT WITH MEDICAL PROBLEM - There is no existing policy for which admitting service a pregnant women will be placed. It should be a case by case problem between the OB physician and hospitalist with your input. More complicated medical problems (sick sepsis, PE) may be better served on the medicine service.

5. EPIC update - We are in the reengineering process with EPIC, ensuring that the software fits our existing workflows. We've also had the benefit of seeing how each hospital (Sibley, Suburban, JHH, Bayview) addresses various problems, given that the ED module will more or less be the same across the sites. I will be providing more frequent and detailed updates as the go live date approaches (July 2013, subject to change).

2/6/11

1. Neuro Consults - Dr. Gunawardane is apparently free for in house neuro consults. She has offered her cell phone. The PCAs should have her cell phone. Consider it as another option. Her cell is 4103713682.

2. New hospitalist - Dr. Rakhmanin is a new physician joining Patuxent, the name of Dr. Nyanjom's hospitalist group (the former group of Kanamuru et al).

3. Infectious Disease clinic - Dr. Gopinath has made Walt aware that her group (Kopack, Landrum, et al) are expanding their clinic and will have availability for same day clinic referrals.

1/27/12

1. MAJOR DRUG SHORTAGES - Etomidate is no longer available due to drug shortages. We have numerous options for sedation during RSI including Propofol, Ketamine, or Versed. THE NURSES WILL NOT ADMINISTER PROPOFOL. YOU WILL HAVE TO PUSH THE DRUG just as we currently do when patients need sedation after intubation.

"Propofol (1 to 3 milligrams/kg IV) has several potential benefits as an induction agent, including rapid onset and recovery, and strong antiseizure properties. Boluses of propofol can cause hypotension and should be used with caution in patients with a labile blood pressure or inadequate fluid resuscitation". From the newest edition of Tintinalli.

IV REGLAN AND ZOFRAN on running on short supply as well and we likely not have stock until March. Please use oral medications when possible during the next few weeks in February.

2. EMERGENCY PETITIONS - EPs must be filled out by a physician. You don't have to answer every question on the front page, but you do have to specify why the patient is in danger to self or to others. You must also sign the second page and write your license number. The psych techs or mid-levels cannot complete EP's or they become valid.

3. LWBS - We have moved the responsibility of reviewing the LWBS charts to the 10am SA1 physician, instead of the 4pm SA2 physician. On weekdays, Rosemary will get the charts from triage and hand them directly to the doc responsible; on weekends, it’s the responsibility of the doc to get them from triage.

1/6/12

1. Dr. Shaoib Hashmi - Dr. Hashmi has taken over Dr. Francis Bruno's practice. These patients will still be admitted to Geh until further notice.

2. LWBS - Please do not forget to look through the LWBS charts on your 4-12 shift.

3. Psych rounding - Our rounding on Psych patients has dropped off considerably. When you are working a 7a-4p shift, please find time to write a progress note on every psych patient that was signed out to you (not patients you picked up, of course). Place these notes the way you would add any addendum with our downcodes.

4. Meeting with Walt - In the second half of January, please find a time to meet with Walt to discuss any important concerns or suggestions you may have with the practice. It will be a good time to review major departmental initiatives as well as individual RVU production and Press Ganey stats.

5. CALL MADE - There has been a dropoff in the use of the CALL MADE. Remember this is an important indicator for us to hold the inpatient services' feet to the fire but it also serves the important purpose of collecting data for one of the core measures that the hospital must report to JCAHO.

12/16/11

1. CALL MADE - Please click on “call made” for ALL admissions, even if there is no delay or you will be entering bridging orders. The Joint Commission (JCAHO) has begun to evaluate a hospital measure of overall throughput, which will be a big help to the ED. The hospital is tasked with monitoring the time of “decision to admit”, and “call made” is our method of indicating the timing of the decision to admit.

2. STROKE CME - I just wanted to give you all one final reminder that you have to have done 4 hours of stroke education for calendar year by December 31st. Susan Groman is going to tally it all up on that day so be sure to have your 4 hours done by 12/31. (If you were at the stroke education day then you are done). Please email (or give to me) at rob_albrecht@yahoo.com the confirmation of your education activity.

3. KETOROLAC/TORADOL - There is a national shortage of ketorolac injection. We have exhausted our supply of 60 mg vials, but we do have some 30 mg and 15 mg vials. We are getting an additional supply of 30 mg vials from JHH downtown.

4. SUZAN ABDO - Dr. Suzan Abdo will be away from Sunday, December 18 through Sunday, December 25, 2011. During her absence, Dr. Mateen Awan will be covering her patients. Dr. Awan can be contacted at (410) 992-9355 .

12/5/11

1. NEW ANESTHESIA DIRECT LINE - Dial 2911 if you need stat anesthesia airway assistance. You will find this number on the ASCOM list as well.

2. ACETONE, SERUM TEST - Unfortunately, there is a national shortage for the reagents needed to run a qualitative serum acetone test. You can send a beta hydroxybutyrate (one type of ketone produced during DKA) however it is a send out and has a 24 hour turnaround time. The urine ketone test is still present. Use the anion gap, as always, for clinical determinations of DKA.

3. CREATININE BEFORE CONTRAST - Please be sure that all patients have a serum creatinine before they go for an IV contrast study. There have now been a few cases of young patients with elevated levels prior to creatinine. This will affect very few pts as almost all receiving such studies have a bmp/cmp sent.

4. ADMISSION GUIDE UPDATE - Please note a few additions to the Admission guide. Drs. Kendra Kay, Rita Pabla, and Gulshan Nazir will now be admitted to CPCA (old Patuxent). If you want to have Padder's cardiology admit a low risk chest pain, CPCA is willing to admit for them as well.

11/30/11

4/1/11

PSYCH: The am1 doctor should see and document a progress note on all psych patients that were signed out. The ideal time to do this would be between 3-4p when there is overlap. A meditech template will be created shortly for documentation.

1. NEW BILLING SYSTEM - Set to go live on Monday at 9:00am

2. COVERAGE - Dr. Sabapathi will be covered from 4/1/11 to 4/3/11 at 8 pm. by Dr. Shakunmala Gupta

3. URINE CULTURES - Please send urine cultures with every positive urinalysis. Our local resistance patterns make Cipro/Bactrim essentially a coin-toss, and the cultures are important for guiding therapy. Macrodantin (Nitrofurantoin), though static and not bactericidal, is still good coverage.

4. RESTRAINTS - If a patient is placed in either restraint or seclusion, you must document face-to-face evaluation within one hour of the beginning

of seclusion. You can write next to your signature on the restraint form, "Pt. seen by me at this time". We've done really well on this as

a practice over the past couple of years, but had a significant decline recently.

5. ASA SCORES AND PROCEDURAL SEDATION - We've had a decline in documentation of ASA scores on moderate sedation evaluation forms. As we move forward with deep sedation as procedural sedation, it's more important than ever that we pay close attention to this detail. Please complete the online training by Wednesday (give certificate or main screen printout to Walt) in order to be credentialed in deep sedation = ability to use Propofol.

6. BASE STATION - Remember to complete your yearly Base Station training. Rosemary has the DVDs in her office. This will need to be completed in 2 weeks.

3/22/11

*******PSYCH UPDATE********:

DUE TO SOME MAJOR COMPLAINTS AND A GENERAL UNDERSTANDING OF GAPS IN OUR PSYCH PROCESS, WE WILL BE CREATING A NEW PROCESS, WITH DETAILS TO COME. Unfortunately, patients are staying days without seeing a doctor save the first encounter. Our signout process will need to be revamped.

STARTING IMMEDIATELY, PLEASE WRITE ROUTINE MEDS FOR ALL OF YOUR PSYCH PATIENTS AT THE TIME OF SEEING THEM. There have been complaints about patients not receiving their routine medications during a protracted psych ED stay PLEASE SIGN UP FOR ALL PATIENTS IN THE PSYCH AREA IF YOU HAVE RECEIVED SIGNOUT .

*******************************************

1. PROCEDURAL SEDATION UPDATE - We are just a few weeks away from being able to use Propofol/Etomidate for procedures. Just wanted to remind you that if you want to use it you have to do the education entitled "Procedural Sedation for Non-Anesthesiologists". First go to https://portal.johnshopkins.edu then logon, go to "my learning" and then do a search for the title above.

To pass the course you have to do an 80 question test at the end (and get 80% correct), but all of the questions are exact replicas of the practice questions you have throughout the learning modules. So pay attention to the practice questions and the final test will be quick and painless.

2. STROKE EDUCATION -- I have become our "stroke liaison". My main job is to ensure everyone is properly educated so the hospital maintains stroke certification. We all have to do 4 hours of stroke education in the 2011 calendar year. It can be lectures, online lectures, or any conference that is relevant. Just keep track as you go. If there is enough interest, I will put together a 4 hour lecture series that we can all run through together. Let me know your guys' thoughts when you see me.

-- Rob

*******************************************************************

3. ADMISSION COVERAGE CHANGE - Effective immediately, patients of Randal Reisett and Jonathan Fish will be admitted to CIMS. The admission guide has been updated.

4. REG NOW - Please notify the nurse to discharge a patient after clicking "reg now". For some patients, the status bar defaults back to 'in room' and they remain in the room without being discharged. There is no ready fix within MEDITECH to default into 'Pend Dep'

1. OUTPATIENT STRESS TESTS - Referrals to CSCM (former HPV) are now made for next-day evaluation, not next-day stress testing. Per discussions with their leadership, the will agree to see the patient in the office on the next business day, then their cardiologist will order further evaluation, including stress testing if indicated. We should continue to complete the CSCM referral forms in the providers drawers on each side, but only check “Cardiology Consultation”. If you anticipate probable stress testing, advise the patient to remain NPO after midnight, as usual.

2. AM2 FLEX SCHEDULING - The Tues-Fri 10am-6pm shift is frequently starting behind the curve. The 7am (AC1) doc has become inundated more often than not recently. As of this week, we will begin to flex to 9a-6p as necessary. At 8am, the 7a doc will make a decision about the need to call the am2 doc in at 9a versus the standard 10a.