October 2023

Hey everyone, 

Here are your October operations updates:

ED Transfers: 

Trauma: Please remember to use the trauma transfer note template (opens when you open chart from the “ED transfers in tab”)

Aortic Dissections: 

Please remember to call vascular or CT surgery depending on the type of Aortic Dissection prior to accepting them as transfers as there is often grafts that need to be found and supplies arranged in addition to the usual service capacity. The heads up really help both CT/Vascular surgery. 

BMC: 

There are two important orders you will be asked for when transferring patient to BMC by LLU transport team. One is an order to transport, the other is one for restraints. When transporting via AMR, they do not need a restraint order. It is only needed for LLU team. 

ECGs:

ECG order should now have click boxes now for indication instead of free text. 

Advanced Urgent Care (AUC): 

AUC to ED transfer order: 

There are now two orders to please use when transferring from AUC to the ED. Please use them!

Transfer to ED, AUC only (higher level of care): Needs cardiology, ACS, etc

Transfer to ED, AUC only (bed/team capacity): USE when no physical beds available at EC for admission or admitting team is capped.

Admitting to Family Medicine: We have obtained a list of FM provider direct contact info for admission/consult discussions (to avoid burning consults which are not ultimately admitted as currently consults are counted as part of the admission cap). They ask that we don't call for management/treatment plans. Numbers are in our online operations manual and printed and placed in red binder for providers. Hopefully when Voalte is fully launched, it will be more streamlined. Also working on getting more details on Fam med cap and admission criteria guidelines from Fam med ( for electrolyte abnormalities, etc), more to come.

Patient Volumes: weekend volumes are going up 10-20% past few weeks and anticipate further rise during winter months so added extra volunteer shifts for doctors 11a-8p, starting Oct to Dec. Any help appreciated, available on Shiftadmin and even partial (aka Princess shift), let Amye know.

RVPs: After discussion with admin, insurance has better payout for RVP in outpatient setting so we got the green light to perform RVPs at provider discretion even for stable patients being discharged. They are even working on outpatient self-swab set up through maybe Redlands urgent care or somewhere? More to come. For the ED, please do not order RVP routinely when able as the cost is much higher. 

Sickle Cell Pathway: For patients with sickle cell pain crises, providers may give up to three doses of IV narcotics prior to admission request. Please assess patient for admission after the second dose of IV narcotics. Please let the patient know that if plan is for admission after 3rd dose that patient will be started on PCA pump. Please call the team who will be admitting the patient to place orders for PCA pump for the patient.  

Metal Instruments:  There have been issues with OR instruments being thrown in the trash by providers. Please do not throw away ANY metal instruments (even disposable ones) at AUC. After procedure, please only dispose of scalpels and sharps and leave all other instruments for nursing to sort out what needs to be send for sterilization vs discarded.  

Ortho:

Ortho has asked to be consulted for all native hip dislocations prior to reduction to help with imaging/operative planning. They should not be taking the reduction away from the ED team. Please consult them prior to hip reduction!

Speech Microphones:

SpeechMics for MModal are scheduled for installation this Friday, Oct 20.  We will continue to look at solutions to lock them down, but for now they will not have cable locks  (hoping with many more in place they don’t walk).

New ID badges: 

FMG will receive badges around Oct 30/31, and they will be distributed Nov 1-17.  The activation and distribution is a bit complicated, so we won’t be able to leave them on units or in mailboxes, as they are required to be handed out and activated at the same time.  Everyone will hold on to their old badge for 2-4 weeks to ensure smooth transition.  More to come on the when and how of distribution.

Open Enrollment: 

Open Enrollment for FMG providers will occur November 1-30. Please be watching for instructions from FMG Communications emails.  Benefits selections are made on PayChex Flex, and the only item that has to be renewed each year is the Flex Elect program annual dollar deduction.

Tuberculosis FAQ:

See Attachment

From ED Communication RNs’ Office: 

Controlled substances: Many prescriptions for controlled substances (benzos/narcotics) are not able to be filled at many community pharmacies. Please send prescriptions for these types of medications to the LLU hospital pharmacy or call the desired pharmacy to check before you send. 

Ambulatory referrals: Please place referrals as urgent or STAT from the ED if you want prompt follow up as many patients with “routine” selected are being set up for appointments up to a year away. Thanks!

Christmas Party (details below): 

Dec 3rd, 6-10pm. Flyers in ED

Disaster Drill (11/16):

Our final disaster drill of 2023 is coming up on Thursday, November 16th at 0830-1200. We will be setting up the decon/hazmat tent(s). This is a hospital wide, full scale disaster drill.  We would love to have staff participation. If you are interested, please sign up in the radio room or reach out to Charnell, Erin, or Senaida (cc’d).

ROYGBIV911 schedule feedback:

Thanks to those who have sent us email feedback on the new staffing schedule. We hear you and are looking to make changes to smooth out rough edges. As we are two weeks into the process, we are still gathering objective data along with your impressions. Please keep sending us feedback!

Fun fact of the day:

Jupiter is the fastest spinning planet in our Solar System rotating on average once in just under 10 hours.