Hello Folks and Happy Thanksgiving!
Hope everyone is having a fantastic holiday weekend and still enjoying the leftovers!! My personal favorite is the Gobbler Sandwich – some smoked turkey, stuffing, cranberry sauce on challah bread. Warm it up. Recommend.
Okay, roll yourself over for some light reading and enjoy…..
Vaccine Clinic Drum Beating
Please continue to default to opening vaccine clinic at 6pm. There should be an active discussion with charge nurse and A/B attendings if you are choosing not to open. If it seems like not enough appropriate volume, preference would be to open and expand the list rather than keep folks downstairs and use hallways (patients/parents hate hallways). If you decide NOT to open at 6pm, please, please, please have a plan to be at the ready to open within 30 minutes max of decision. That means designated person may need to sign out their patients!
Rabies Vaccines
Patients who need a rabies shot can follow up for ALL of them in vaccine clinic – no need to return to ED. Even if day 3 and 7 fall on a weekend, can be delayed and given in vaccine clinic. Discharge instructions reflect this, parents just have to call (thank you JKC!). Let me know if questions.
Housing Insecurity
See attached. Summary statement – homeless patients who require medical care, as always, should be registered, evaluated and discharged. If complex medical needs and homeless, can board in the ED. Parents with young infants (< 6 mos of age) can board in the lobby.
51-A’s
ED Social Work is not ALWAYS available on late evenings/overnights to help fill these out. When that happens, we (a provider) will need to file (example form attached) sometimes. The different scenarios below to help us think about it…
- Social work available – will file with provider input on clinical piece
- Social work not available and child not safe to go home, but no emergent need to file – can board in the ED until AM to wait for SW OR the ED provider may file the 51-A in real time if preferred.
- Social work not available, not safe to go home AND emergent need to file (i.e. concerns for other siblings at home) – the ED provider files emergently online.
- Social work not available and child safe to go home – the ED provider completes appropriate section of the 51-A (attached and will put on PEM website) and emails it to: EDSWsupervisor-dl@childrens.harvard.edu. The email to SW needs to include contact information for the provider who will be available to help with questions about the 51A. SW will then be able to complete the 51A.
Helpful website: https://www.mass.gov/how-to/report-child-abuse-or-neglect-as-a-mandated-reporter
Cardiac Patients
For awareness – if there is a cardiac patient in the ED that needs admission to the floor and the ACCU (i.e. cardiac floor unit) is full, the cards team will try to put those patients in the CICU if there is space. Feel free to remind cards fellow if patient is boarding.
Who to Page for Admissions
After 5pm for PHM admissions, there is a team on call. Listed FIRST in the paging system. Page them not the primary team.
Pulmonary Embolism Response Team
Mentioned in PEMA, reminder that a Pulmonary Embolism Response Team (PERT) has been created for patients with intermediate and high-risk acute pulmonary embolism and hemodynamic instability. Gets a bunch of people on a phone for a conference call and they help guide evaluation and management. Call 5-5555 to activate.
Okay, that’s it folks. If you are traveling today – safe travels. If you are home today – I’m jealous!!!!
Happy Thanksgiving and back to the grind!!
Sincerely,
The Operations Team
Additional information:
Adult Psych in the ED
Mentioned in last PEMA … and after long discussions with BWH, if there is an adult psych patient (age >/= 19 years old) presenting to our ED that needs a mental health evaluation AND you are acutely worried about safety (i.e. they may harm themselves or others imminently), we will need to section them and transfer by ambulance only. In other words, cannot go via the bridge if you think might do something on the way.
Attached in depth algorithm which will also be on website (Thank you Nilli!!).
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