Nov' 23

Here are your November operations updates:

Doc box seating arrangement/End of Shift Evaluations:

Please see earlier email from me about latest seating arrangement. Please complete end of shift evaluations for residents who you work with as it is vital for resident growth and advancement.

Animal Bite Form ("Ruff Bite Form"):

In short, we will no longer be filing paper animal bite forms and will use this method instead. We will also put instructions on the lluemresidents website. See email from Dr. Rossie for more.

Scheduling:

January 2024 schedule should be out soon. Please email Amye Farag with any late requests for February. Everyone will be overscheduled due to staffing constraints but should have most requested dates off.

Procedure Documentation:

It is critical that all procedures, even minor ones, are documented, even if they are removed in the same ED visit. This includes but isn't limited to rhino rockets, sutures. Please include laterality when relevant and also please document that a time out was performed prior. 

Sepsis Order Set:

Changes are coming to the order set, please stay tuned. More from Eric Chao in the future. 

Stroke Order Set:

Please order the stroke order set on patients which have been accepted for transfers. These orders should be opened and signed at the time of transfer acceptance. This helps prevent delays in imaging upon patient arrival. 

MRIs in the ED:

There are two MRI orders in the ED which do not require admission or OBS orders prior to completion. One is MRI for cauda equina (search cauda equina to find the right order). The other is MRI for occult hip fracture (generally should be used after XR and CT are inconclusive and there is still high clinical suspicion for hip fracture. 

If you call MRI, they are often able to get the scan done faster. 

Blunt Cerebrovascular Injury (BCVI):

There are protocols for BCVI management in the ED resuscitation rooms as the ED . There is no need to routinely consult vascular surgery for BCVI. If you have a patient with BCVI, regardless of if they were trauma activated or not, please use ACS/trauma team as the managers of these injuries. They also help with outpatient follow up for repeat imaging as indicated. 

Neurosurgery Patient Admissions: 

For most neurosurgical patients who require ICU level of care, those patients will be admitted to SICU either by neurosurgery or ACS in the setting of trauma, and to NMCCS for non-traumatic ICU neurosurgical patients. 

For floor level of care patients, these patients will be admitted to medicine though on occasion they may be admitted to neurosurgery. Do not be alarmed if you are asked to admit a neurosurgical patient to medicine. 

Bronchoscopy in the ED:

We have been reminded that general EM privileges and credentialing do not include bronchoscopy. Unless you are specifically credentialed to perform bronchoscopy (EM/ICU attendings) please do not perform it. If emergent bronchoscopy is needed please contact the MICU attending. For now, if you are using bronchoscopy to aid intubation that is fine. Please do not pass the carina into smaller airways.