Great ideas and making things better

I heard Dr. Dylan Blacquiere speaking on the radio while driving home after one of those busy D2 shifts on Friday, and it really cheered me up to hear him describe how we all in Saint John are leading the way in managing acute stroke care. http://www.cbc.ca/player/play/1152508483846
From EMS, through Emergency Medicine, diagnostic and intervention radiology, internal medicine and neurology, Saint John Regional Hospital (probably more appropriately Saint John University Hospital) provides a world class service for stroke patients in New Brunswick.
This got me thinking about many of the other innovations and ideas that we continue to push forward locally, especially relating to emergency medicine, and how important it is not to let ourselves become disillusioned by busy shifts, perceived administrative inertia, perceived injustices, crowding and many of the negatives we face, and will likely continue to face for sometime.
To name but a few, we can be proud of the integrated STEMI program we have from EMS to Cath Lab, the Point of Care Ultrasound program that leads in this nationally and beyond, the new Trauma Team leadership program, the patient wellness initiatives such as the photography competition corridor that make things just a little brighter for patients, the regionally dominant and growing simulation program, the regional and local nursing education programs, the nationally unique and hugely popular 3 year EM residency program, the impact of our faculty on medical education at DMNB, the leading clinical care provided by a certified faculty of emergency physicians, our website, our multidisciplinary M&M and quality programs, many of the research initiatives underway including development of an ECMO/ECPR program with the NB Heart Centre, improving detection of domestic violence, innovations around tackling crowding, preventing staff burnout, better radiology requesting, encouraging exercise prescriptions, and much more.
I was particularly impressed how Dylan explained the integrative approach that was required to improve stroke care, and how that was achieved here. There are many other areas that we can also improve, innovate and lead in. Every day we see ways to make things better.
I hope that at this point in our department’s journey, we can continue to make the changes that matter, for patients, our departmental staff, physicians, nurses and support staff alike.
I encourage all of us to think of one area we can improve, to plan for change and for us all to support each other to achieve those improvements. Some of our residents are embarking on very interesting projects, such as designing early pregnancy clinic frameworks, models to improve performance under stress, and simulating EMS ECPR algorithms – all new innovations, not just chart reviews of what we are already doing. I encourage us all to support them, and others with these projects, and to begin to create innovation priorities for the department.
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In Situ Simulation Report

Thanks to Dr. James French for this informative post

Report from In-Situ Sim SJRHEM December 2017


The Case:

Mr. Jeffs is a 60year old male with 1 hour of chest pain, he brings himself to the ED, is triaged and bought in to trauma. Past medical history, hypertension. Medications, Perindopril 4mg with no allergies. He presents with an Acute Myocardial Infarction and then goes into cardiac arrest (which was always going to happen) requiring ACLS. After ROSC he requires intubation, thrombolysis and ongoing critical care…..

Discussion Points

When the “shizzel” hits that fan it’s really hard to use closed loop communication but especially important.
When patients get worse rapidly (cardiac arrest is pretty “rapidly”) then by definition they will need lots of safety critical procedures and medicines administering rapidly. This will also be associated by an immediate adrenal response by many of the people in the room (I’m sure even our most experienced physicians would admit to feeling it when people get really sick). Teams who are adrenalized will suffer a certain amount of tunnel vision and auditory exclusion i.e. they won’t be able to see or hear things as well. Closed loop communication is designed for people working under these conditions to address these challenges. The person making the request gets an answer from the person they are speaking to, and most importantly gets the order repeated back to them. Close the loop to prevent the poop! Watch the video for a comical example of closed loop communication! https://emergencypedia.com/2014/11/13/8227/

Being Adaptable

Emerg Teams are highly adaptable. This case required a nurse to do an ECG as there was no ECG tech available. Well done!

 

Resuscitation and dose adjusting in Rapid Sequence of Anesthesia:

The induction or sedative dose should be reduced in the following circumstances:

  1. When there is hypotension
  2. When the pulse is greater than the systolic blood pressure.
  3. If there is significant comorbidity.
  4. Severe metabolic impairment from DKA, overdose, sepsis or prolonged seizure activity.

Please see the table below for examples.

The patient should also be resuscitated to a point that is appropriate for the case before the administration of drugs. In a shocked trauma patient this could be the administration of blood and splinting limb fractures. In a patient with septic shock this could be giving a fluid bolus and starting vasopressors. For More information on RSI in really sick people see this site. https://emcrit.org/racc/hop-mnemonic/

 

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New SJRHEM Dalhousie Course – Debriefing Skills for Simulation – The Basics

New SJRHEM Dalhousie Course – Debriefing Skills for Simulation – The Basics

When Is It?

8th-9th February 2018

Who is this for?

If you are interested in using simulation for education in healthcare, then this is for you! We aim to give you the basic skills needed to start debriefing in your own institution. This is a practical course with lots of opportunities to debrief.

 

 

Download (PDF, 260KB)

 

 

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New SJRHEM Course – Debriefing Skills for Simulation – The Basics

New SJRHEM Course – Debriefing Skills for Simulation – The Basics

Who is this for?

If you are interested in using simulation for education in healthcare, then this is for you! We aim to give you the basic skills needed to start debriefing in your own institution. This is a practical course with lots of opportunities to debrief.

 

Download (PDF, 254KB)

 

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SJRHEM Photo Contest 2016

We are very excited to announce the 2016 SJRHEM Photo Contest. This photography competition is open to all personel who work in the Saint John Regional Emergency Department in any role including clinical, admin, support, volunteers etc.

The themes of this competition mirror our mission statement and now include a new ‘open’ category:

CARING, RESPECT, INTEGRITY AND FAIRNESS

WHILE WORKING AS A PROGRAM TO ACHIEVE EXCELLENCE

Our aim is to improve the look and feel of our facility, for both staff and patients, by decorating the walls and corridors with high quality, thought inspiring photographic artwork that reflect the themes above.

CARING

Genuine concern for the well-being of others

caring


RESPECT

The dignity of all people

respect


INTEGRITY

Honest with strong moral principles

Dalai_Lama_1430_Luca_Galuzzi_2007crop


FAIRNESS

Making judgments that are free from discrimination

fairness


New OPEN CATEGORY

Landscapes, Architecture, People, Animals etc

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There will be a winner for each category and an overall winner. All will receive a framed print of their winning photo. The overall winner will be awarded the “Winner of the SJRHEM Photo Contest 2016” award.

The closing date for applications is October 10th 2016.

Click Here for More Information (Rules, Entry Forms etc)

Each entry must be accompanied by a separate application form and necessary consent forms.

Each entry must be emailed to :admin@sjrhem.ca  (subject: photo contest) or via online entry below

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New Brunswick Emergency Medicine – Regional Simulation – Season 3

For those of you who missed season 1 and 2, I’m sorry to say they are not on Netflix! However its not to late to get involved in this most awesome of programs….. (and all relevant material will be available for download on the simulation program page)

Total respect for Dr James French who has developed this program from the start. With the support of  Nurse Educators – Kim David and Debra Pitts, Dr French has delivered a program that has really made a difference to the quality of Emergency Care provided in our region.

The level of local engagement is amazing, including all levels of nursing, paramedics, respiratory therapists and physicians. This is clearly a result of the detailed preparation and enthusiastic delivery by Dr French and his team, but also reflects the commitment to improving emergency care by the participating clinicians.

 

IMG_4309

 

This week the program visited the Sussex Health Centre, on a day when a winter storm had closed all the schools, but despite this, we had a full multidisciplinary attendance. A number of simulations were run over the course of the day, addressing certain aspects of the program’s Needs Analysis and also the relevant regional policy/protocol updates.

This method of practising for high acuity low occurrence events has wide support in the medical literature and has been adopted in all modern EMS systems. In a confidential, supportive environment, the process issues are explored, modified and perfected. Some of these issues ( Regional transfer, EMS ventilatory support, post-cardiac arrest  thrombolysis) will form the basis of future posts on this site.

Attached are a couple of the many resources being developed by this program:

Introductory Lecture

Download (PDF, 5.59MB)

Awesome Checklists

Pre anesthetic checklist 2013

Download (PDF, 1.96MB)

 

 

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Academic Emergency Physician – Knowledge Translation, Dalhousie University, Saint John, NB

Join the team in the Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada. An exciting opportunity to combine a 0.25 FTE role as lead for Knowledge Translation, with 0.75 FTE clinical time, at this teaching hospital and Level 1 trauma centre. See below for job details and explore sjrhem.ca for program details.

 

Download (PDF, 376KB)

Download (PDF, 388KB)

 

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Dr James French Presents – Elephant Trauma Rounds

An excellent presentation from Dr James French at Trauma Rounds this morning.

Take home messages:

  • New Brunswick needs a ‘Multiagency Trauma Research Registry’ in order to understand the problems and develop systems to address those problems
  • All doctors that work in Emergency Departments in all hospitals need to have ATLS certification at a minimum
  • Major Trauma is a relatively rare event. Training for major trauma must involve simulation. Simulation helps clinicians to become experts at managing rare events.
  • Most trauma deaths in New Brunswick occur in the 1st hour. The average transfer time to a Level 1 Trauma Centre is >1hr. Dr French welcomes the introduction of Advanced Care Paramedics in New Brunswick, but suggest that further Critical Care Paramedics skills are needed to perform the the emergency interventions required to reduce this early mortality.


Multiagency Trauma Research Registry

We already have some NB data on trauma cause and location. Download Dr Benoit Phelan’s  research poster here.

FloaterWindow_and_Benoit_Phelan_-_Phelan_-_ResearchDay2015_pdf__page_14_of_23_

But we could do better. See this online visual database as an example of how it could be done.

Benoit_Phelan_-_Phelan_-_ResearchDay2015_pdf__page_4_of_23_


 

Simulation

Preparing for rare events (dealing major trauma is a relatively rare event for individual physicians and paramedics) requires ‘deliberate practice and mastery training’. Doing it again and again, practicing pitfalls, analysing mistakes, learning how to do it perfectly. The only way to do this is with simulation. Simulation needs to look and feel as close to reality as possible. Dress up – Cosplay!

Cisco_WebEx_Meeting_Center


Check Lists

How often have you struggled to quickly get your hands on the right equipment for a emergency procedure? Process mapping and planning assist in the development and maintenance of a system. Checklists augment clinical knowledge and training but do not replace it.

Cisco_WebEx_Meeting_Center 5

Post RSI hemodynamic instability is common. Following a checklist can help to reduce complications of infrequently performed procedures.

Cisco_WebEx_Meeting_Center 3

Cisco_WebEx_Meeting_Center 2

 

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SJRHEM Simulation Program Innovation Recognised

Dr Jo-Ann Talbot recently participated in a Q&A session with freelance journalist Jericho Knopp on the subject of our incredibly successful simulation program. Dr Talbot gave an interesting insight into the history of our simulation program and its innovative developments. This Q&A was part of a 10 part series published by Jericho Knopp, including other interesting  stories for example: developing a risk assessment tool to prevent domestic violence.

A Q&A with Dr. Jo-Ann Talbot, helping implement SIM technology in emergency medicine

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Happy Birthday SJRHEM.ca

Our website is celebrating it’s first anniversary today!

Despite this being essentially an SJRH EM website for our own consumption we have seen steady growth in our audience over the last 12 months. When we first went live we received an average of 15 sessions (website visits by different users) per day and are now receiving an average of 30 sessions per day. Over the year these users have viewed 26,318 pages.

Our website now has over 200 pages and posts including all our guidelines, reports from M&Ms, Rounds and Journal Club. There are also numerous useful documents within the Program filestores. It continues to grow every week. So please visit often to see the new content.

The Calendar and Schedule pages are very popular amongst the website visitors. Have you added these shortcuts to your mobile device yet?

As ever I’m always looking for any suggestions for improvement and also any ideas for content.

I’ve attached a google analytics report summary of the year below.

This website is a reflection of the hard work and productivity of all members of the SJRHEM Team, including those who worked tirelessly in the development of our clinical and academic programs, those who provide excellence in patient care, those who have championed our profile in medical education and research and all other members of the multidisciplinary team who support us on a daily basis in the work that we do.

Many thanks for your support.

David

SJRHEM Website Editor

Analytics All Web Site Data Audience Overview 20140412-20150414

 

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The four agreements – Don Riguel Ruiz

Agreement 1

Be impeccable with your word – Speak with integrity. Say only what you mean. Avoid using the word to speak against yourself or to gossip about others. Use the power of your word in the direction of truth and love.

 

Agreement 2

Don’t take anything personally – Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering.

 

Agreement 3

Don’t make assumptions – Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama. With just this one agreement, you can completely transform your life.

 

Agreement 4

Always do your best – Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best, and you will avoid self-judgment, self-abuse and regret.

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