WORKSHOP 1 Objectives Orientation overview Department orientation Work flow RACE team RME Fast Track Physician consults Charting and documentation Orientation Overview Business Office orientation ID: 382579
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Slide1
MLP ORIENTATION
WORKSHOP 1Slide2
Objectives
Orientation overviewDepartment orientationWork flowRACE team
RME
Fast Track
Physician consults
Charting and documentation Slide3
Orientation Overview
Business Office orientationHospital Orientation New Employee Orientation (guideline)Epic
MHS
training + provider
oreintation
Workshop 1
Workshop 2
Shadow + Mentorship shiftsSlide4
New Employee OrientationSlide5
Workflow
Sign into EpicASCOM phoneHuddle with charge RN and attendings
Objectives shift specific / location specific Slide6
TG WorkflowSlide7
Tacoma General 10-8p
1000 – 2000ESI 4 and 5 patients in Fast TrackSigns up as attending
Waiting room
RME
of patients
Signs up as attending then “end assignment” in Treatment Team tab
Turns patient
RME
status on track board
Physician extension tasks
Laceration repair
Procedures
Consultation
Dispositions
Re-assessments Slide8
Tacoma General 2p-12a
1400 – 0000 (Huddle) RME WTBS patients in main ED (sickest first) if unable to be seen by physician
Signs up as attending, gets taken over by attending
RACE Team
Signs up as attending then “end assignment” in Treatment Team tab
Turns patient
RME
status on track board
ESI
2, then 3 by LOS
If all 2 and 3 done, treat and street
ESI
5
Assist with Fast Track
ESI
4 and 5 patients
Co-management of patients with physician in main ED
MLP
signs up as PA or
ARNP
in
MLP
column Slide9
RACE Tacoma GeneralSlide10
RACE AllenmoreSlide11
RACE CovingtonSlide12
Rapid Medical Evaluation
Assign as attendingLabel as RME
Brief
H&P
Labs + Imaging
Comfort medications
Consult as neededSlide13
Fast Track
Verb… not nounGoal evaluation <80 minESI 4 + 5Seen independently, consult
prn
RN + tech
Focus on oral medications and limited workupsSlide14
Co-manage patients
Initially assigns as attendingPerform H&P
Initiate labs + imaging
Consult attending early
Change assignment to PA or
ARNP
once consulted
Re-consult after workup complete to discuss managementSlide15
Mandatory Consultation
ESI 1 or 2Unstable VS
HR
>110 or <50
SBP
<100 or >220/120
RR >24 or <8
Pulse ox <95% (unless baseline)
Abdominal pain >50
yrs
old
Altered mental statusSlide16
Active / uncontrolled bleedingAnaphylaxisChest pain >35
yrs oldCVA / TIAJoint dislocation (other than digits)
Falls associated with near syncope / syncope
Open fractures
Mandatory ConsultationSlide17
Pregnancy with abdominal pain or bleedingPost surgical complicationsProcedural sedation
SOB with abnormal vital signsTelemetry indicatedUnexpected (non-follow up) return visitPediatrics <12
mo
, or <3
yr
with fever
Mandatory ConsultationSlide18
Consultation
Start with reason for consult: run it by you, ED consult, asking for admit.ED presentations: ok to not be sureConcise presentations
Other consultants: specific questions.
Know what you wantSlide19
Consult case 1
22yo M c/o abdominal pain. Constant, began 4 hours ago, radiates to R testicle.No PMH/PSH/meds/allergiesVS 140/92, HR 115, RR 30, T 37
Exam: R testicle swollen and painful.
Labs: normal. US no flow to R testicleSlide20
Consult case 1
Dx:HPI:Plan for care?Reason for consult?
Present to the ED attending
Present to consultant. Slide21
Consultation case 2
51 yo man c/o left lower leg pain and swelling for 4 days. PMH: DM, HTN
PSH: none
Meds: insulin,
lisinopril
VS: 130/80, HR 130, RR 22, T 38.2
Left leg swollen, red, hot to touch.
WBC 20, lactate 4, glucose 600, AG 30, Co2 10Slide22
Consult case 2
DX:HPI:Plan for care?Reason for consult?
Present to the ED attending
Present to Consultant. Recommends discharge after insulin bolus and single dose of IV antibiotics.Slide23
Consult case 3
25yoF presents to c/o back and leg pain that began several hours after an intense crossfit workout.
No PMH/PSH/meds/allergies
HR 90, BP 120/80, RR 18, T 37
Exam: uncomfortable. Moderate
paraspinous
tenderness.
Neuro
exam normal.
Labs: CBC/CMP normal. UA +
heme
, no RBC, CK 4,000Slide24
Consult case 3
DDX:HPI:Plan for care?Reason for consult?
Present to the ED attendingSlide25
Consult case 4
45F HA x3 days. Sudden onset 12 hours ago. +vomiting and photophobia. Worst HA of lifePMH: migrainesVS: 192/120, HR 88, RR 20, T 37
Exam: uncomfortable, otherwise normal
CT head: negative
LP: +
xantochromia
, + 100,000 RBCSlide26
Consult case 4
Dx:HPI:Plan for care?Reason for consult?
Present to the ED attending
Present to consultant. Slide27
Specialist Consult
Consult ED attending firstMedicineMore detailed information
Tell the story of the patient’s problem
Review recent admissions, clinic visits, imaging
Surgery
Ask your question first
Brief presentations
Review prior surgeries, admissions
Cedar group is different than
ACSSSlide28
Charting and Documentation
Chart at appropriate level (3 – critical care)Don’t forget PMH,
PSH
,
FH
,
Soc
, etc…
HPI
:
OPQRST
MDM
Initial impression,
DDx
Workup and impression of objective data
How this supports /
refuts
your
DDx
reassessment
Final impression and treatment planSlide29
Resources
PSR websiteEGO charting tips and tricks
Pdf
of previous education lectures
Textbook
An Introduction to
Clinical Emergency
Medicine
Education Website
Tecpedu.net
Fundamentals of Emergency Medicine
Resident Page
Procedures
CME
BlogSlide30
From Here
Workshop 2Procedural Select evaluation dates30 day, 90 day
Reach out to mentors / sponsors
Set date and agenda
Review onboarding materials Slide31
Questions
Epic questionsDot phrasesPreferencesMacros
Workflow