Clinical Updates
- 01/12/2018
- Discharge Planning for Vulnerable Patients - Homeless patients!
- During this period of severe weather, we have become more thoughtful about the importance of detailed discharge planning for vulnerable patients: patients with mobility concerns, homeless patients etc.
- Per current best practice, prior to discharge for all ED patients...
- Please assess patients for vulnerability? Any mobility concerns? Does the patient have shelter?
- For any concerns, please engage social work and case management, when available and review their recommendations prior to discharge.
- If there are transportation concerns, please use our “cab voucher program” as appropriate
- Please provide cab transportation to Shelters, for homeless patients, during inclement weather.
- Cab Vouchers can be coordinated by our ESC team.
- Safe Ordering practices for PRN Opioid/Benzodizaepine Orders.
- We’ve had a few near-misses related to “indefinite” PRN orders of opioids or benzodiazepine medications for patients – particularly those with long ED length of stays.
- Please make sure – prior to writing the PRN order, that you
- ... carefully consider the patient’s clinical status, are comfortable that the patient dose has stabilized, and have a reasonable sense of a safe dosing strategy for the patient.
- Ordering a PRN dose early in the patient’s care – without understanding what the patient’s narcotic needs (or sensitivity) may be – can be an unsafe practice.
- ... consider placing a limit on the number of doses the patient can receive.
- 1 mg q1hr of dilaudid–PRN severe pain –may result in concerning cumulative doses after a few hours
- 1 mg q1hr of dilaudid- PRN severe pain x 4 doses - limiting the doses may result in safer strategy
- Central Line Safety Safe
- Per Hopkins Policy – please continue to utilize the checklist. This is expected with all non-emergent lines.
- Be aware, per current policy, prior to using a central line, you must confirm venous placement.
- Obtaining a blood gas is the most practical acceptable option in our department.
- The other options include Transduce CVP, Assess fluid column response, or Fluoroscopy.
- 06/20/2017
- Early Team Posting/Sign-out Pilot – Starting Today!
- To help facilitate earlier sign-out by providers who know the patient best, we will be piloting a new medicine posting process.
- You will receive notification (from the Shift coordinator – through the comments column) regarding “medicine” teams assignment.
- After receiving the notification, please call the assigned medical team, and give sign-out.
- As is currently the practice – do select “sign-out” completed in bed management section.
- When the bed is posted, the practice will be similar to current – with a green smiley face appearing to signify a ready bed.
- Please do send update to house-staff, if there are any clinically relevant or important updates.
- We very much look forward to your feedback regarding this pilot.
- Shelters – Homeless Patients in the Waiting Room
- Increasingly, providers are allowing “homeless patients” to stay in our waiting room ‘until the morning’.
- The rationale is that some shelters close at night.
- While that may be the case, our Social Work and ESC Coordinator/Supervisor (who help in support of social work mission during the overnight) – can help patients find shelter.
- If a patient’s care is compete, but there’s concern about housing. Please discharge the patient – and send to internal reception area. There Social work or ESC Coordinator can help facilitate appropriate housing resources.
- Vent Changes in the ED
- To minimize patient safety events, and to ensure compliance with hospital policies, our Respiratory Team are asking that we refrain from making modifications on the BIPAP/CPAP equipment,
- If changes need to be made, select and place the appropriate RT order in EPIC.
- While RT is committed to making sure that they are appropriately responsive, if there are delays and or you have any concerns- please do share with us.
- Hallway Bed Naming
- For safety reasons, we are working on creating more formal – distinct hallway beds in EPIC.
- However, until then, we are temporarily asking that our Shift Coordinators or designees – in the Comments Section, highlight the patient’s location.
- Using the nomenclature – For example: RS Hall by 18.
- Please encourage our teams to make sure we adhere to this practice.
- 03/10/2017
- Conditional Discharge Process– March 14th Go-live!
- In caring for patients, we often reach a point when we are almost ready to discharge a patient- except for one more thing...
- Because of the nature of our practice, we sometimes get distracted and this in turn delays discharge of appropriate patients
- SOLUTION: We have created a Conditional Discharge workflow to help in these situations!!!
- If patient has ONE condition -
- That is a binary, straightforward decision point,
- That doesn’t require nurses to diagnose or make clinical assessments outside of their scope of practice
- Then, you can select the conditional discharge row in the Discharge Navigator, and add appropriate details with the notes section.
- Prior to selecting the conditional discharge order, You MUST have already…
- Completed and signed the patient discharge paper work and prescriptions;
- Discussed with the patient that they will be discharged, if clinical conditions are met, and may not see you again;
- Given the patient (family) a final opportunity to ask questions as needed.
- The nurse, will review the conditional discharge requirements, and if met – will document as such, and discharge the patient, accordingly.
- Please see workflow below for further information and details about the workflow.
- We very much look forward to appropriate utilization of this tool – to help improve efficiency – and care of discharged ED patients.
- Reverse Triage ICON! Available Now!
- In an attempt to expedite the care and evaluation of our Hallway Level 2 and Sick Level 3/4/5 patients, we are implementing a Reverse triage process for North patients.
- Specifically, we are asking that you attempt to identify 1-2 Patients at Rounds – and throughout your shift, who no longer require a “room” for their ongoing care.
- These patients, if needed, may be moved to a Hallway or EACU or South B as available, to make room for more critical patients.
- Please select Reverse Triage in the Bed Management Tab – Creates an Icon of a patient with a green arrow.
- The shift coordinators will use this ICON to identify patients that can be moved out, when needed, for an undifferentiated or early care- hallways Level 2 or Sickle Level 3/4/5/ patient.
- Johns Hopkins – CRISP and Single Sign-on Integration – March 13th!!!
- You will now be able to long onto crisp using your JHED ID and single sign-on process through new URL: https://crisp.johnshopkins.edu
- Log-on Access will be maintained through your EPIC security profile – which means no extra work on your part!
- CRISP Links will be updated in EPIC and on our department website and clinical work-space.
- This should allow you to more easily use the Prescription Drug Monitoring Program Features within CRISP
- As previously, CRISP should only be used for clinical care purposes only!
- 03/06/2017
- Accidental Hypothermia – ED ECMO
- We’ve had some recent challenges activating ECMO in the ED. Onpreliminary review, we identified that the PING ECMO pager link is NOT functional.
- If ECMO is needed, please Page CT surgery through 3-1109 or you can also call HAL line (59444) and request the CT surgeon on call.
- We are working institutionally on creating protocols around ECMO activation to help streamline the process and clarify activation criteria.
- Central line Checklist
- Per Hopkins policy, all central lines that are placed non-emergently, should be completed using an observer completed central line checklist.
- Any lines placed – without the checklist - will be considered “dirty” and likely removed.
- When placing central lines, please call and involve the CT tech who are trained observers, to help complete the checklist.
- You can call the Nursing Supervisor as needed to help coordinate.
- HCV – Reflex Testing
- Starting March 13th – we will be initiating HCV RNA reflex testing – so that our laboratory – after resulting a positive antibody screen, can immediately complete appropriate RNA testing.
- The impact on ED workflow will be minimal – our phlebotomy teams will draw an extra tube of tube with HCV antibody tests.
- And while the current HCV box may change slightly, there will be no additional clicks to your workflow.
- We appreciate your engagement and support for our highly relevant and important public health programs at JHED.
- 02/10/2017
- Transfusion in Women of Child-Bearing age.
- We’ve had a few cases where O negative patients have received RH positive blood.
- As part of an institutional review, we’ve identified the need for uncrossed O negative blood in our ED Kiosk and will begin stoking a few units starting February 14th.
- To be clear, O negative is in very short supply and we ask that its used judiciously and only as indicated.
- To recap best practices regarding transfusions as relates to RH:
- Please send a type and screen if any concern for significant bleeding. (Don’t expect this to be done routinely at RAP, screeners don’t generally have the ability to adjudicate if a bleed is significant)
- Check patient records for their RH status (look in lab section, CRISP); Ask the patient.
- If the patient needs emergent transfusion, and is of child-bearing age, and if the patient is RH negative or unknown, please use our Uncrossed Trauma NEGATIVE blood.
- BAT– Stroke Patients
- We have streamlined our Nurse Triage Policy so that patients are now designated BAT’s if last seen well < 6 hours – this is to allow improved focus on patients with intervenable pathology.
- Your continued focus on ensuring a Door to TPA start time of < 60 minutes is appreciated!!
- Also, please note– as was previously the case on paper, the Neurology Resident is the one that enters the TPA order and is allowed to do so in EPIC.
- Prior to entering the TPA order, the neurology residents must notify the ED attending and can only proceed with the ED attending approval.
- PCA in JHED
- We have successfully utilized PCA in the treatment of sickle cell patients in the EACU.
- There have been a few requests to use PCA outside of that narrow context – specifically, for patients with oncology diagnosis.
- As patient care is our top priority – we would like to clarify that PCA is allowable in the JHED in that context with specific guidelines/restrictions
- The Clinical team have huddled and are in alignment regarding the appropriateness.
- The Nursing Supervisor is notified.
- The Bedside Nurse is competent in the management of PCA
- The PCA orders are placed by the ED attending – FYI (As previously, we strongly discourage the use of continuous dosing strategies and recommend only bolus dosing).
- EPIC Hyperspace Report: Nursing Documentation in EPIC
- To improve your ability to see important nursing documentation, we’ve created a hyperspace report : RN Documentation/All FLowsheet Data for you!!
- Please add to your Trackboard and Snapshot reports.
- 10/17/2016
- South B Overnight – Attending Coverage
- South B Utilization is key to ensuring that our sickest (ED bed) patients are not in the Waiting room.
- As such, starting Monday Overnight, we will be implementing South B Overnight Utilization project. Specifically, we’ve asked our shift coordinators – when needed, to utilize South B beds on the overnight for “stable dispositioned patients.” These patients will be expected to be managed by the respective Overnight red and blue attending per bed placement. There will be one nurse staffed in the area with max of 4-5 patients.
- The evening South B resident is instructed to sign-out patients to the overnight Attending prior to leaving.
- Again, thanks for your flexibility and engagement.
- RAP Team Efficiency - CNA/RN Training
- We’ve heard your feedback and concerns regarding the need for improved efficiency during your RAP shift – specially as relates to improved coordination with the clinical support team.
- We have now started a renewed training to our CNA team in particular – they are being instructed to “NEVER HAVE A PROVIDER WAITING TO SEE THE NEXT PATIENT…”
- Specifically, they’ve are instructed to move patients (out of the room after they’ve been evaluated and creatively as needed) so that you always have a “patient” available to be seen.
- Additionally, we’ve instructed them that your goal is to see at LEAST 2 patients per hour in your disposition shifts and to support you in that goal.
- Please reinforce these goals with your CNA and clinical team at the start of your shift - and empower them to make decisions that help you meet these through-put goals.
- We are specifically monitoring the teams in regards to these guidelines; so – your ongoing feedback is very much appreciated!
- Minimizing Level 2 patients in the Hallway – Reverse Triage
- In our efforts to improve North Through-put and minimize numbers of level 2 patients in hallway, we are asking that you continue to identify patients that are can be “reverse triaged” to hallways, EACU, South B, or other areas of the department to make space for sick level 2 or 3, patients.
- Please continue to use the “Bed Management Tab” and Select Nurse Recommended to identify these patients.
- We are hopeful that every sign-out rounds we identify at least 2-3 patients per team that can potentially be reverse triaged when needed.
- 08/31/2016
- ED Sepsis SAT Checklist
- New SAT Protocol to focus on Hypotension
- We have updated the indications for activating a SAT. This is to help ensure that we have appropriate resources immediately available for patients that are often our sickest…
- Going forward, SAT will be called for:
- all patients presenting to triage with hypotension and
- for patients who evolve hypotension (without clear explanation, like receipt of vasoactive medications immediately prior.)
- Please note – similar to HAT – SAT patient may be cared for in any North Bed. As always, the sickest patients, will be managed in our ICU or Critical Care Bay locations.
- You will be asked to make the determination if the team will continue on the SAT (rule out Sepsis) pathway or if it is clearly NOT a Septic patient.
- If yes, there’s a concern for sepsis; Please institute Sepsis checklist protocol; see attached Sepsis Checklist.
- If no, You will sign off on the checklist that the patient is not septic. Please make sure your EPIC clinical documentation reflects that you do not believe the patient has a new suspected infection.
- If maybe, you can think further about the patient – but within 15 minutes – you will be asked to commit to a decision.
- Ultimately, in light of our new Sepsis Core Measure and clinical care excellence, there’s increased emphasis on sepsis management. As such, we are increasingly focusing on ensuring that the patients who are likely sickest (those in potential septic shock) get the benefit of appropriate care!!
- New ED Intracranial Hemorrhage Order-set
- In collaboration with the Department of Neurology, we have created a new order set for patients with intracranial hemorrhage.
- The order-set contains many common orders including serial neurology checks, and also reversal guidance – for Coumadin, Lovenox, and Newer Oral Anticoagulants.
- Hopefully, you find this helpful to our practice. As always, very much appreciate your feedback.
- ED Intent to Admit to Psychiatry Order
- Please continue to place this order for patients that (after discussion with our psychiatry consultants) that we are in agreement need admission (even if to outside facility.)
- We have updated the glitch – so the ICON should no longer disappear.
- This allows us to continue to track boarding for our hospitalized psychiatry patients and to advocate for appropriate resources.
- DO NOT place a regular admission order for psychiatry patients. This triggers billing and compliance challenges!!
- Consultants and Active Orders on ED patients
- Just a reminder, it is our ED policy and hospital policy, that only members of the ED care team (actively caring for a patient) may write active orders for the patients while they are in the ED.
- There are a few rare exceptions, for trauma and stroke patients – with clearly delineated parameters.
- We are bringing to your attention because we’ve had a few patient safety incidents regarding consultants putting active orders on patients in the ED.
- If you notice this occurring, please submit a HERO and or notify myself, Drs Peterson or Hill.
- In order to ensure the safest care environment for our patients, we are motivated to discourage this practice.
- 08/11/2016
- Suspected Zika Case Management
- Per Maryland Department of Health Guidance – Consider testing in symptomatic patients within 3 weeks of symptoms or exposure.
- Although be aware, zika testing is recommended in all pregnant patients and may be recommended in non-pregnant patients 3-4 months from exposure of sympotms onset.
- See algorithm
- If suspected, Call DHMH Zika Team at 410-767-6700 for approval for testing. The testing is not done through Hopkins Lab but at DHMH/CDC labs.
- Back up number 410-795-7365 – if first number delayed.
- Sepsis Core Measure - HIGH PRIORITY!!
- We are still failing the measure Hospital wide. June Compliance ~50% - which is somewhat of an improvement but far from our goal – 80%
- Much of the core measure failure cases occur in the ED!!
- Biggest area of focus!!!!
- Please use the Saline 30cc/kg Order - This ensures that we administer the correct fluid bolus (See the Quick List Orders)
- Please Use the SEPSIS Orderset - This ensures correct antibiotic administered
- For patients with hypotension OR lactate > 4, please complete the Perfusion Reassessment note. This can be found ED Sepsis Navigator
- PT Consult in the ED
- This is currently a limited resource; as such, the ED PT team focus is on “appropriate discharge assessments.”
- If a patient is already admitted, please defer PT team engagement to the inpatient PT team.
- For patients receiving a PT consult, please always concomitantly page Case Management. Our Case management team – in consultation with PT, can help complete full evaluation for discharge assessments, and identify resources to support comprehensive discharge plans.
- 07/13/216
- Admissions - ICU EPIC Admissions
- Please place orders for the ICU services as you make the consult to the ICU
- Please add in special instructions details about the admission. Example: Pending ICU consult. May also be appropriation for MPC.
- This will allow us to better capture our ED decision to admit, and get Bed management involved earlier for better identification of ICU bed demand.
- Hemo-Dialysis in the ED is very STRONGLY DISCOURAGED.
- Whenever, a request for HD in the ED is received, please huddle with the shift coordinator, attending, primary provider to ensure all are on the same page.
- Notify, the Administrator on Call prior to initiation of dialysis in the ED for approval.
- While there can be exceptions, we strongly believe the exceptions to the rule above should be rare. Patients should generally be dialyzed in the renal suite or on the wards.
- Sepsis Core Measure - HIGH PRIORITY!!
- We are still failing the measure Hospital wide. May Compliance ~30%
- Much of the core measure failure cases occur in the ED!!
- Biggest area of focus!!!!
- Please use the Saline 30cc/kg Order - This ensures that we administer the correct fluid bolus (See the Quick List Orders)
- Please Use the SEPSIS Orderset - This ensures correct antibiotic administered
- For patients with hypotension OR lactate > 4, please complete the Perfusion Reassessment note. This can be found ED Sepsis Navigator (see attached Image)
- 06/13/2016
- 04/25/2016
- NEW Provider Hand-off Complete Notification!!!
- Currently, it's unclear to our nursing colleagues when Provider hand-offs occur, and this sometimes results in patient transport delays.
- We have now built a new EPIC notification flag to streamline the process.
- This can be assessed under "Bed Management Tool" - (ie the section where providers currently make EACU bed requests).
- So, going forward, after you have completed a hand-off or discussed with an appropriate consultant who have accepted the patient, please select "Admit/Hosp Obs Provider Report Complete"
- This adds a green check to the bed request column and lets our nursing team know that the provider report has been completed.
- Voicemail Messages and HIPAA
- Messages may be left on a patients voice mail, but only the minimum necessary PHI (protected health information) may be left on a voice mail.
- Acceptable PHI include - patients first and last name, date and time of a Johns Hopkins appointment, physicians or other clinicians name, and clinic or department name.
- DO NOT include clinic name if it conveys a particular medical condition (- ex. HIV clinic.) In that case, okay to use Johns Hopkins.
- Do not leave tests results or other very specific health information on a voice mail.
- If any questions please see Hopkins HIPAA website for more information: http://intranet.insidehopkinsmedicine.org/privacy_office/privacy_topics/ways_to_communicate.html
- Multi-disciplinary Debriefing in Critical Care
- Thanks for your commitment to our department Debrief Pilot
- The goal is to help to help improve department team work and collaboration!
- 02/19/2016
- EPIC - Electronic Add On Lab Request PDF
- We can now ORDER add-on lab requests for specimens in the lab through EPIC without calling the lab.
- Before using this order, make sure you have a sample in the lab.
- In manage orders - Search "Add on"
- Please note currently available only through FACILITY LIST selection... (this will be updated shortly).
- Pay attention to processing feedback information - the lab will communicate through those messages to let you know if specimen sample is insufficient etc.
- Low NIH stroke score and TPA
- AHA/ACC guidelines allow for the use of TPA in patients with low NIH stroke score patients- as there is some evidence that some of these patients have significant disability at 3 months and beyond; that is not perfectly well predicted by their initial presenting score.
- Demaerschalk et al; Intravenous Alteplase in Acute Ischemic Stroke. ACC/AHA 2016 (PDF)
- As such, the guidelines suggests TPA is likely indicated for patients with mild NIH scores if the patient have significant disability (ex. Score 1-2; but severe aphasia.)
- However, the decision to administer is complicated. In low NIH score patients, please...
- Complete good exam
- Review and discuss the question of "meaningful disability."
- Review Inclusion/Exclusion Criteria.
- Have low threshold for ED Attending to Stroke Attending conversation - to adjudicate what's the best recommendation for the patient.
- Collaborate to ensure appropriate consent with patient and family and ensure full discussion of risk/benefit.
- As always, if any concern, please feel free to contact us for clarification as needed. (410-502-5142)
- TIA/Minor Stroke Pathway (Research Study- TOP SAILS)
- For some of our patients with TIA/Minor strokes, we are collaborating with our colleagues in Neurology on a IRB approved research study.
- These patients may receive an MRI in ED, and neurology evaluation and if meet specified criteria, may be discharged for further outpt management.
- The goal of the study is to evaluate the efficacy of outpatient management for appropriately selected TIA/Minor stroke patients.
- Please note the patients are consented and very closely monitored in the outpatient context.
- 01/29/2016
- Sepsis Core Measures - HIGH PRIORITY
- The ED (like the rest of the hospital) is often failing the Sepsis Core Measure.
- Our biggest failures are reordering the Lactate and completing the Perfusion Reassessment note.
- Under Left column - "More Activities" in a patient's chart - there's an ED Sepsis tab with all the tools to help you meet the measure
- If lactate is abnormal (>2) - use the lactate BPA Popup box to allow you to re-order the lactate. Or just reorder through manage orders. You can change time - or add special instructions that the repeat lactate should be sent after fluid complete.
- The EPIC perfusion/reassessment note can be found under ED sepsis Tab. This must be completed after fluids are completed; Partner with your nurse to notify you when fluids are administered
- ED Echos
- Please remember, in addition to ordering in EPIC - you must put in a page into PING - at "ED ECHO." This allows the Echo team to prioritize the case. Otherwise, the echo can be significantly delayed.
- Earlier ED Attending Engagement with Level of Care/Appropriate Service Decisions and Conflicts
- As part of our gradual implementation of the "Command Center..." we need the residents to more actively engage attendings in level of care and appropriate service decisions.
- There are escalation pathways being implemented - but all start with your attending engagement.
- Please let your attending know early about these decisions/issues.
- ED Syncope Protocol
- Reminder - patients with PACEMAKERS/DEFIBRILLATORS - should almost always be enrolled into protocol - as we have the ability to interrogate the devices and engage EP Cardiology team - via the new consult approach to evaluate the syncope patient. If any issues with the consult - I can be reached at 25142.
- See pathway - Syncope
- If any questions or concerns - please notify Drs. Parisi, Saheed or Mistry
- 12/04/2015
- New Admission Order
- As many of you are aware - there is a new admission order
- Admittedly, this has caused some confusion and frustration. See tips below to help better manage the new order.
- Few Tips:
- For most service/teams - you no longer need to enter the service - if you enter the Attending Name - their service will auto-populate!
- Example David Efron - Acute Care Surgery populates (aka Halsted)
- For Medical Services (where we use "Service Attending") - Select the service and the level of care and that's it... The admitting team will sort out the rest...
- Examples:
- For MPC: Select- Admitting Attending: Service Attending; Service: Medicine; Level of Care: IMC
- For PCCU: Select- Admitting Attending: Service Attending; Service: Cardiology; Level of Care: IMC
- For MICU: Select- Admitting Attending: Service Attending; Service: Medicine; Level of Care: ICU
- For CCU: Select- Admitting Attending: Service Attending; Service: Cardiology; Level of Care: ICU
- We are aware that previous functionality is having issues including the comments section not printing out properly, inability to view the order details through the admit hyperspace report, inability to put in special needs, and the broken automatic alert link to isolation parameters are not functioning properly. And we apologize for that. The EPIC teams are working on correcting these issues.
- EPIC Sepsis Build Updated
- Most of you are now aware of the new requirements (Sepsis Core Measure) that encourage appropriate treatment for patients with Severe Sepsis and Septic Shock
- We have a series of new EPIC tools to help you meet that requirement
- EPIC - Potential Sepsis Orderset - allows for easier ordering of the requirements
- EPIC Sepsis Alert Advisory - that pops up - for patients that meet criteria - 2 SIRS and One sign of End Organ Dysfunction
- Clicking on the alert simply takes you to the ED sepsis Navigator and does not mean you are acknowledging that the patient has Sepsis. (The ED Sepsis Navigator can be reached from the "More Activities" on the left hand bottom of your navigator options.
- The Navigator is designed to show you parameters triggered the alert
- You then have to answer Sepsis Screening Questions
- We do understand that if you access the chart on accident or briefly, it's difficult to back out of the BPA Sepsis Alert. We are working to change that soon - to allow you to select an option for "chart review only."
- EPIC Reorder Lactate Advisory - This is a BPA alert that pops up for patients with abnormal lactates who don't have a repeat lactate order
- EPIC Perfusion Reassessment Note - Found through the Sepsis Navigator, this documentation must be completed on all Sepsis Patients who have persistent hypotension despite fluid hydration
- Staff Support for Stressful Events
- Please remember the R.I.S.E Team (Resilience in Stressful Events) as a resource
- Providing employees with multidisciplinary, peer-to-peer support in a nonjudgmental environment at The Johns Hopkins Hospital
- Mission is to provide timely support to employees who encounter stressful, patient-related events
- Free, confidential and available 24/7 at 410-283-3953 or PING: Rise Team
- 11/20/2015
- PRN orders without a maximum number of doses are unsafe! – Warning
- Currently, one is allowed to place a PRN order without a maximum number dose cap.
- This is a safety issue. One particular order was written - Dilaudid 2 mg q1 hour PRN pain – and the patient received a concerning amount of pain medications over their duration in the ED.
- We STRONGLY DISCOURAGE this practice!
- For every PRN medication order – please put a maximum number of doses that can be administered.
- Good Documentation practice – be wary of the MACRO tool
- We’ve had an increasing number of recent billing denials for our Critical Care cases.
- After a review, one concerning reason is because of “inappropriate documentation.”
- In one example, a patient was documented as having “Pulmonary/Chest: Effort normal and breath sounds normal.”
- Notably, the patient presented for respiratory distress and was intubated.
- One strategy is to AVOID USING MACRO’s and to not use any stock statements in systems that is abnormal
- For example – in the above case, free text the entire cardio-pulmonary exam as it would be obviously abnormal.
- Quality documentation is an essential part of quality care!
- Diabetic Foot Infection – Vascular Surgery has a new Diabetes Wound Care Service
- While some of these patients may have historically gone to orthopedics or medicine, we want to clarify that Vascular Surgery Team has a new service to manage these patients.
- If there’s a need for admission, consult Vascular surgery.
- Their service have also made access to their clinic available through our JHED Care Linkage Program.
- You can call our ESC scheduler at 41193 for an outpt appointment to Vascular Surgery Diabetic Clinic prior to patient discharge.
- EPIC Tips – Quick List Tab under the Manage Orders Section
- There’s a quick list section under the manage orders sections that allows you to multi-select multiple orders.
- We’ve put into this section the most frequently ordered labs/tests.
- This should help with initial ordering of lab tests.
