oct2019

Best Practices Bottom Lines 1 (Unreachable patient) 1. When lab tests with delayed results (HIV, syphilis) are sent for a patient who is being discharged, make every effort to clarify: a. Best contact information or location of shelter b. Whether this is a secure number to leave a message c. The need to follow up specific results with a family doctor or clinic in case they are unreachable 2. When clinically significant lab results are received after the patient has been discharged and the patient is unreachable, consider the following actions: a. Leaving a message at the shelters for the patient to call/return to the ED b. Enlisting our social workers to track down the patient c. Contacting the patient’s family doctor d. Contacting public health to assist with patient notification 3. When you are unable to contact a patient who requires follow up for clinically significant lab results: a. Document your attempts to reach the patient and file with the chart b. Document this on the Clinical Notes section in EDIS for the date of the patient’s visit (do this ASAP to avoid being locked out of this feature for that date) c. Consider for the future how we can document our attempts more effectively with Connect Care Bottom Lines 2 (Difficult/surgical airway) 1. We need a cultural shift to anticipate and prepare for the worst for all intubations; the default approach should be that every intubation is a potentially difficult airway 2. Consider:

a. Always having the difficult airway cart in the room for intubations b. Always having an appropriately sized LMA ready c. Always having the Bougie on the bed rather than on the wall d. Always having a scalpel out (and consider carrying on shift) 3. Think about: a. Slowing down to be smooth and methodical b. Be willing to name “He who must not be named”- if you think it is a difficult airway then say so c. Balancing a learner’s needs with optimal patient safety 4. Practice: a. Bougie-assisted cricothyrotomies i. Don’t forget to dilate ii. Don’t just “dunk” the tube iii. Great resource: HTTPS://LITFL.COM/SURGICALCRICOTHYROIDOTOMY/