Is Every Night Like This? The Call From H...L!

1. Is Every Night Like This?The Call From H...L! …A fictitious case for resident orientation

2. Sunday, 8:00 P.M You arrived in London yesterday and you are now on your first night of “call”. While hanging out on the ward at LHSC, University Hospital, you realize that you left your new Resident\Fellow Handbook with important information in it in the car…feeling apprehensive about going to the parking garage alone when it is dark outside, you…

3. Parking Garage After Hours • Try to be brave and go alone anyway • Use ‘the force’ to transport the package from the car into your hands • Call security to escort you to the car

4. Sunday, 8:30 P.M You are called in to emergency for a patient with abdominal pain and diarrhea. The person is also suffering fever and shortness of breath What will you do?

5. Fever and Shortness of Breath • Refuse to see the patient for fear of SARS • Put on the appropriate personal protective equipment • Ask for a Stryker suit

6. Sunday 8:35 pm • You begin assessing the patient • As you approach, the patient asks if you washed your hands What will you do?

7. Hand Washing A. Roll your eyes, give a glaring look and continue the assessment B. Respond with a demeaning “Yes, reinforcing the power differential in your tone. C. Respond with a polite “yes” and thank them for asking to recognize their right for infection control. Indicate that you will gladly wash them again if there is a concern

8. Sunday, 8:40 P.M As you are assessing the patient, the nurse walks in and tells you that he has tested as Clostridium difficile positive. What will you do?

9. Diarrhea and C Diff + • Wipe your hands on your greens and scream ewwwww, yuck! • Put on a gown. Isolate the patient as best as possible • Stop your assessment and refuse to see the patient

10. Presentation: Infection Control - Dr. M. John

11. Sunday, 8:45 P.M You decide that the patient needs admission because he has toxic colitis and is septic. You obtain consent for admission. Then you discover that there are no acute medicine beds available at University Hospital. What do you do?

12. No Medicine Beds • Try to recall the difference between Kentucky and Tennessee • Refuse to get involved • Call admitting to arrange a bed at Victoria Hospital.

13. Admission Guidelines You are the specialist resident paged to do a consult in Emerg. You assess and determine the patient needs admitted but not sure whether the current condition is related to the previous hospital stay or not. Your supervising physician has told you not to admit because your beds getting full with off service patients and the beds in Emerg are filling up. What do you do?

14. Admission Guidelines A. Listen to supervising physician order some tests but let the Emerg physician deal with it B. Admit them to your service anyway and hide when your supervising physician finds out C. Refer to the admission guidelines, page your supervising physician and discuss admission possibilities

15. Sunday 8:50 pm. • 68 year old man is day 4 post hospital admission. He was admitted with abdominal pain and is being investigated for ischemic bowel. • Over the last 2 hours his BP has been ~100 systolic. His baseline BP is 160/90.

16. CCOT • A. Assess and treat the patient • B. The patient is fine, BP is not that low • C. Call CCOT • D. 500 ml NS bolus, reassess in 6 hours

17. CCOT • Presentation: CCOT - Dr. Frank Rutledge, Jackie Walker, Jasna Gole

18. Sunday 9:00 P.M As you are finishing with this patient, you get a call from the floor. Mrs. Smith, 99 years of age, was admitted after she had choked on her birthday cake at the nursing home. When you get to the floor, the nurse informs you that Mrs. Smith was found unresponsive, and has a No Resuscitation Order in place. You declare that Mrs. Smith is no longer of this world. The nurse hands you a large envelope and informs you that you need to complete the appropriate papers and contact the appropriate parties. What do you do?

19. Mrs. Smith • Consult your Resident Handbook for helpful materials on what to do • Break down and call your grandma to ensure that she is o.k • Pronounce Mrs. Smith dead, fill out a death certificate and call the coroner

20. Presentation: Hospital Deaths and the Coroner - Dr. S. Wetmore

21. Monday, 2:00 a.m You are called back to emergency to see a weak and dizzy octogenarian with a medication list as long as the Charter of Rights and Freedoms! She has had a similar visit to the SJHC Urgent Care Centre in the last month. You believe that investigations done at that time would be helpful. What do you do?

22. Patient Information • Call the lab to get the old results • Drive to SJHC to check the patient’s record • Check Powerchart for the information

23. Monday, 2:00 a.m As you are reviewing the patient’s information, a nurse walks in with a 22 gauge needle in her arm, telling you that she was drawing blood from a multi-tattooed bar hopper. What do you do?

24. Needlestick Injury • Inform her of needlestick injury policies • Tell her to pull it out and stop bothering you • Cry, telling her that it looks awfully painful

25. Monday, 2:30 a.m You get another call from the floor. The senior medical student you are working with called to talk to you about pain relief for a patient. You ask him to order Tylenol. He needs your signature for the order to be processed. What will you do?

26. Student Orders • It’s only a Tylenol order…ask the student to sign it. • Ask the student to sign as a “verbal order” from you and go to sign the order as soon as you get a chance to return to the floor. • Tell the student not to bother you with simple orders in the future.

27. Monday, 3:00 a.m After further assessment you realize that your octogenarian can now go home and will need to ensure she has a safe way home. You inform the family that she can go home andtalk to the ER primary care nurse to arrange home care follow up and community support. You also realize that you need to dictate this case. What do you do?

28. Recording the Visit: Health Records • Call Health Records to get your city-wide dictation number • Use the senior resident’s dictation number • Wait until the morning and see if mom or dad’s secretary can do it for you

29. Monday, 3:30 a.m Enjoying this call thoroughly, you decide to try and find a call room to catch some sleep. You don’t know where the call rooms are After searching, you…

30. Find Me a Bed • Decide to crawl in next to Mrs. Smith • Read the resident handbook • Sleep? Sleep is for lightweights

31. Monday, 7:00 am You receive a call from your Mom. Aunt Ingrid has been taken to UH. The only information your mom has is that she had trouble breathing and she had chest pain. She wants you look up her information in the system to see you find out more information. After all the tuition she paid, she figures you can finally be of some help.

32. Privacy You decide to… • Use your log in and look up the information • Read the Resident Handbook • Tell your Mom that accessing your Aunt’s chart is a serious privacy breach

33. Presentation: Privacy - Ms. Beth Riggs

34. Monday, 7:30 a.m On the way to clinic you run into the attending physician who sarcastically tells you that he just congratulated the Smith family on Mrs. Smith’s 99th birthday, hoping that she lives 100 more. What did you forget to do?

35. Remember to • Save him a piece of cake? • Congratulate the Smith family yourself • Inform the senior resident and/or attending physician about Mrs. Smith’s demise

36. Monday, 7:47 a.m As you slink towards the clinic, the senior resident informs you that this impromptu meeting could have been much worse- your attending is known for wandering eyes and roaming hands As you recoil from the thought, you decide to prepare yourself in case this should ever happen to you. You decide that:

37. Harassment • Any form of harassment is intolerable, so you decide to familiarize yourself with harassment policies on hospital intranets as well as UWO policies on their site • Report the offending behaviour to any of your program director, department chief, PGE office, or harassment consultant • All of the above

38. Presentation: Office of Equity and Gender Issues - Dr. B. Lent

39. Monday, 10 a.m After this delightful on call experience, you are now re-contemplating your career, wondering if you can handle being a resident. You decide to call the PGE office and:

40. Post Call • Quit • Speak with Dr. Francis Chan, Associate Dean, Admission & Student Affairs • Curl up in a fetal position, crying mommy into the phone

41. Presentation: Admissions and Student Affairs Office - Dr. F. Chan

42. Monday, 12 Noon You have just finished meeting with Dr. Chan. You have a bite to eat and:

43. After Meeting with Dr. Chan • Feeling rejuvenated, go back for more • Sit in on an undergrad class to remind yourself about the good old days • Decide that you need to get involved and change the system, so you join up with PAIRO, the Resident Relations Committee (RRC) and various hospital committees • Go home!

44. On Your Way Home As you are on your way home, you wonder about how you are going to remember everything you’ve learned today. What are your options?

45. Learning • Refer to your purple Resident Handbook • Access the Resident Orientation website at www.londonhospitals.ca/medicalaffairs • Ask questions of your supervisor • All of the above

46. Reminders before we break… • Medicine Residents - pagers • N95 Mask Fist Testing / UWO ID cards • Sign up for Bus Tour of London • Parking for today. If needed pick one up at the registration desk • Light green evaluation sheets get a door prize!!! Please the registration desk to pick it up. • Join us at TJ Baxters at 7pm