This is a lecture by Dr. Pamela Fry and Dr. Alison Haddock from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
For more course tutorials visit
www.newtonhelp.com
Max Points: 20.0
The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
GEMC- Case of the Week #1- for ResidentsOpen.Michigan
This is a lecture by Pamela Fry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Midlevel Operations: Exploring New Expsoures with Allied Health ProvidersSedgwick
Jayme T. Vaccaro, J.D.
Director, Professional Liability Claims
Sedgwick Claims Management Services, Inc.
Jayme.Vaccaro@sedgwickcms.com
www.sedgwick.com
For more course tutorials visit
www.newtonhelp.com
Max Points: 20.0
The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
GEMC- Case of the Week #1- for ResidentsOpen.Michigan
This is a lecture by Pamela Fry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Midlevel Operations: Exploring New Expsoures with Allied Health ProvidersSedgwick
Jayme T. Vaccaro, J.D.
Director, Professional Liability Claims
Sedgwick Claims Management Services, Inc.
Jayme.Vaccaro@sedgwickcms.com
www.sedgwick.com
SBAR report to physician about a critical situation S .docxanhlodge
SBAR report to physician about a critical situation
S
Situation
I am calling about <patient name and location>.
The patient's code status is <code status>
The problem I am calling about is ____________________________.
I am afraid the patient is going to arrest.
I have just assessed the patient personally:
Vital signs are: Blood pressure _____/_____, Pulse ______, Respiration_____ and temperature ______
I am concerned about the:
Blood pressure because it is over 200 or less than 100 or 30 mmHg below usual
Pulse because it is over 140 or less than 50
Respiration because it is less than 5 or over 40.
Temperature because it is less than 96 or over 104.
B
Background
The patient's mental status is:
Alert and oriented to person place and time.
Confused and cooperative or non-cooperative
Agitated or combative
Lethargic but conversant and able to swallow
Stuporous and not talking clearly and possibly not able to swallow
Comatose. Eyes closed. Not responding to stimulation.
The skin is:
Warm and dry
Pale
Mottled
Diaphoretic
Extremities are cold
Extremities are warm
The patient is not or is on oxygen.
The patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours)
The oximeter is reading _______%
The oximeter does not detect a good pulse and is giving erratic readings.
A
Assessment
This is what I think the problem is: <say what you think is the problem>
The problem seems to be cardiac infection neurologic respiratory _____
I am not sure what the problem is but the patient is deteriorating.
The patient seems to be unstable and may get worse, we need to do something.
R
Recommendation
I suggest or request that you <say what you would like to see done>.
transfer the patient to critical care
come to see the patient at this time.
Talk to the patient or family about code status.
Ask the on-call family practice resident to see the patient now.
Ask for a consultant to see the patient now.
Are any tests needed:
Do you need any tests like CXR, ABG, EKG, CBC, or BMP?
Others?
If a change in treatment is ordered then ask:
How often do you want vital signs?
How long to you expect this problem will last?
If the patient does not get better when would you want us to call again?
This SBAR tool was developed by Kaiser Permanente. Please feel free to use and reproduce these materials in the spirit of patient safety,
and please retain this footer in the spirit of appropriate recognition.
Guidelines for Communicating with Physicians Using the SBAR Process
1. Use the following modalities according to physician preference, if known. Wait no
longer than five minutes between attempts.
1. Direct page (if known)
2. Physician’s Call Service
3. During weekdays, the physician’s office directly
4. On weekends and after hours during the week, physician’s home phone
5. Cell phone
Before as.
students often do not remember or are not able to apply a large amount of the content they learn in the classroom. Strategies to increase retention and critical thinking were presented. Brain-based learning and active learning methods work together with increased faculty-student interaction to improve both cognitive and affective learning. Specific examples from the undergraduate nursing classroom were noted and explained. Experiential learning, clinical reasoning scenarios in the classroom, roleplay, audio/visual aids, case studies, learning with peers, and deliberate practice with feedback were some examples of active learning covered in this presentation. Allowing repeated sessions for practice and time for reflection were other strategies that the presenters found helpful. Creating a climate of warmth and reducing threat in the classroom was emphasized as essential for increasing student learning and retention.
This is a lecture by Dr. Pamela Fry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Learning Telehealth in the Midst of a PandemicJohn Gavazzi
This presentation outlines the basics of beginning to work with patients via telehealth. The workshop offers both pragmatic and technical assistance to start working with patients at a distance or online
This is an open book” test with regard to CPT and ICD-10 coding booblossomblackbourne
This is an “open book” test with regard to CPT and ICD-10 coding books.
Question number 1-
Please identify the words in the following statement that match at least 4 of the HPI (history of present illness)
elements identified below:
Patient was admitted yesterday with severe asthma exacerbation. She had been trying to
maintain with her inhaler but continued to worsen over the last 24 hours before admit. She
has had 5 breathing treatments and been on 4Lpm O2 for the last 12 hours and now has a
stable 90% sats. ORA she decreases to 78-70%. She has been around her boyfriend’s cat a
lot lately and feels this may have triggered this attack.
Quality ____________________ Modifying Factors ___________________
Context ___________________ Timing ___________________
Duration __________________ Severity __________________________
Question number 2-
Please identify the Level of Medical Decision Making (MDM) in the following statement:
1. Chest pain- new since last visit
2. DOE (dyspnea on exertion) - worsening
I have discussed this with him, and we will screen for ischemia with stress myocardial
perfusion imaging. If Abnl test, then this may represent a high probability for CAD and angio
should be considered. If test is low risk, then may follow syndrome clinically, and seek other
causes of chest pain. The patient was instructed to avoid strenuous physical activity until
complete stress test results are known.
F/U OV the week after these studies to consolidate eval and recommend further investigations
as indicated.
Low __________ Moderate _________ High___________
2 | Page
Question number 3-
Please select the level of History (HX) documented in the following statement:
Patient comes in today complaining of 4 days history of cough and congestion. No Fever,
Chest pain or dyspnea. Cough is mildly productive. He has been using Sudafed and Nyquil
with some relief.
Past Medical History-Seasonal allergies
Past Surgical History-tonsillectomy
Past Family History- Asthma---Father and Brother
Smoking status: Smokeless tobacco: Alcohol Use:2 drink(s) per week
Allergies-Cephalexin/Penicillin’s- Rash
Review of systems: Positive for malaise/fatigue. Positive for cough and sputum production
(scant, clear). Negative for shortness of breath and wheezing. All remaining 10 point ROS and
are negative.
HPI- # of Elements__________ PFSH- # reviewed_______ ROS- # of systems ________
History Level __________________
Question number 4-
Please select the level of Exam Both 95 and 97 guidelines documented in the following statement:
Constitutional: He is oriented to person, place, and time. He appears well-developed and
well- nourished.
Head: Normocephalic and atraumatic. Right Ear: Tympanic membrane normal. Left Ear:
Tympanic membrane normal. Nose: No mucosal edema or rhinorrhea.
Mouth/Throat: Oropharynx is clear and moist and mucous membranes are normal. Eyes:
EOM are normal. Pupils are equal, round, and reactive to light.
Neck: ...
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
More Related Content
Similar to GEMC: Conquering the Sign-Out Challenge: Resident Training
SBAR report to physician about a critical situation S .docxanhlodge
SBAR report to physician about a critical situation
S
Situation
I am calling about <patient name and location>.
The patient's code status is <code status>
The problem I am calling about is ____________________________.
I am afraid the patient is going to arrest.
I have just assessed the patient personally:
Vital signs are: Blood pressure _____/_____, Pulse ______, Respiration_____ and temperature ______
I am concerned about the:
Blood pressure because it is over 200 or less than 100 or 30 mmHg below usual
Pulse because it is over 140 or less than 50
Respiration because it is less than 5 or over 40.
Temperature because it is less than 96 or over 104.
B
Background
The patient's mental status is:
Alert and oriented to person place and time.
Confused and cooperative or non-cooperative
Agitated or combative
Lethargic but conversant and able to swallow
Stuporous and not talking clearly and possibly not able to swallow
Comatose. Eyes closed. Not responding to stimulation.
The skin is:
Warm and dry
Pale
Mottled
Diaphoretic
Extremities are cold
Extremities are warm
The patient is not or is on oxygen.
The patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours)
The oximeter is reading _______%
The oximeter does not detect a good pulse and is giving erratic readings.
A
Assessment
This is what I think the problem is: <say what you think is the problem>
The problem seems to be cardiac infection neurologic respiratory _____
I am not sure what the problem is but the patient is deteriorating.
The patient seems to be unstable and may get worse, we need to do something.
R
Recommendation
I suggest or request that you <say what you would like to see done>.
transfer the patient to critical care
come to see the patient at this time.
Talk to the patient or family about code status.
Ask the on-call family practice resident to see the patient now.
Ask for a consultant to see the patient now.
Are any tests needed:
Do you need any tests like CXR, ABG, EKG, CBC, or BMP?
Others?
If a change in treatment is ordered then ask:
How often do you want vital signs?
How long to you expect this problem will last?
If the patient does not get better when would you want us to call again?
This SBAR tool was developed by Kaiser Permanente. Please feel free to use and reproduce these materials in the spirit of patient safety,
and please retain this footer in the spirit of appropriate recognition.
Guidelines for Communicating with Physicians Using the SBAR Process
1. Use the following modalities according to physician preference, if known. Wait no
longer than five minutes between attempts.
1. Direct page (if known)
2. Physician’s Call Service
3. During weekdays, the physician’s office directly
4. On weekends and after hours during the week, physician’s home phone
5. Cell phone
Before as.
students often do not remember or are not able to apply a large amount of the content they learn in the classroom. Strategies to increase retention and critical thinking were presented. Brain-based learning and active learning methods work together with increased faculty-student interaction to improve both cognitive and affective learning. Specific examples from the undergraduate nursing classroom were noted and explained. Experiential learning, clinical reasoning scenarios in the classroom, roleplay, audio/visual aids, case studies, learning with peers, and deliberate practice with feedback were some examples of active learning covered in this presentation. Allowing repeated sessions for practice and time for reflection were other strategies that the presenters found helpful. Creating a climate of warmth and reducing threat in the classroom was emphasized as essential for increasing student learning and retention.
This is a lecture by Dr. Pamela Fry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Learning Telehealth in the Midst of a PandemicJohn Gavazzi
This presentation outlines the basics of beginning to work with patients via telehealth. The workshop offers both pragmatic and technical assistance to start working with patients at a distance or online
This is an open book” test with regard to CPT and ICD-10 coding booblossomblackbourne
This is an “open book” test with regard to CPT and ICD-10 coding books.
Question number 1-
Please identify the words in the following statement that match at least 4 of the HPI (history of present illness)
elements identified below:
Patient was admitted yesterday with severe asthma exacerbation. She had been trying to
maintain with her inhaler but continued to worsen over the last 24 hours before admit. She
has had 5 breathing treatments and been on 4Lpm O2 for the last 12 hours and now has a
stable 90% sats. ORA she decreases to 78-70%. She has been around her boyfriend’s cat a
lot lately and feels this may have triggered this attack.
Quality ____________________ Modifying Factors ___________________
Context ___________________ Timing ___________________
Duration __________________ Severity __________________________
Question number 2-
Please identify the Level of Medical Decision Making (MDM) in the following statement:
1. Chest pain- new since last visit
2. DOE (dyspnea on exertion) - worsening
I have discussed this with him, and we will screen for ischemia with stress myocardial
perfusion imaging. If Abnl test, then this may represent a high probability for CAD and angio
should be considered. If test is low risk, then may follow syndrome clinically, and seek other
causes of chest pain. The patient was instructed to avoid strenuous physical activity until
complete stress test results are known.
F/U OV the week after these studies to consolidate eval and recommend further investigations
as indicated.
Low __________ Moderate _________ High___________
2 | Page
Question number 3-
Please select the level of History (HX) documented in the following statement:
Patient comes in today complaining of 4 days history of cough and congestion. No Fever,
Chest pain or dyspnea. Cough is mildly productive. He has been using Sudafed and Nyquil
with some relief.
Past Medical History-Seasonal allergies
Past Surgical History-tonsillectomy
Past Family History- Asthma---Father and Brother
Smoking status: Smokeless tobacco: Alcohol Use:2 drink(s) per week
Allergies-Cephalexin/Penicillin’s- Rash
Review of systems: Positive for malaise/fatigue. Positive for cough and sputum production
(scant, clear). Negative for shortness of breath and wheezing. All remaining 10 point ROS and
are negative.
HPI- # of Elements__________ PFSH- # reviewed_______ ROS- # of systems ________
History Level __________________
Question number 4-
Please select the level of Exam Both 95 and 97 guidelines documented in the following statement:
Constitutional: He is oriented to person, place, and time. He appears well-developed and
well- nourished.
Head: Normocephalic and atraumatic. Right Ear: Tympanic membrane normal. Left Ear:
Tympanic membrane normal. Nose: No mucosal edema or rhinorrhea.
Mouth/Throat: Oropharynx is clear and moist and mucous membranes are normal. Eyes:
EOM are normal. Pupils are equal, round, and reactive to light.
Neck: ...
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jessica Holly from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Sickle Cell Disease: Special Considerations in Pediatrics- Resident Tra...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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GEMC: Conquering the Sign-Out Challenge: Resident Training
1. Author(s): Pamela Fry and Alison Haddock, 2011
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terms of the Creative Commons Attribution Share Alike 3.0 License:
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4. • Statistically, the most dangerous time for an ED patient
• Communication failures figure in 25–67% of adverse
events (from US studies)
• New providers are not aware of patient s specific
presentation and problems
• Clinical situation / physical exam is dynamic – may
worsen
• Balance efficiency with sufficiency – need enough
detail to provide optimal care during the next shift
• Most dangerous patient is everything is fine
• Difficult to get enough information from fatigued/
hurried physician
Dangers of sign-‐‑out
5. #1. Provide information to allow oncoming provider to
deliver adequate care to patient during next shift
•
•
•
•
Must learn basic essentials on every patient
Identify sickest patient(s) in department
Anticipate potential problems with patient care – discuss
appropriate interventions
Discuss pending studies/consults/results
Function of sign-‐‑out
6. #2. Create a to-‐‑do list
•
•
•
Each patient should have planned disposition
List should include all necessary items before patient can be
dispositioned (imaging, consults, family issues, etc)
Explain reasoning behind each pending item to allow optimal
decision-‐‑making
Function of sign-‐‑out
7. #3. Opportunity to phone-‐‑a-‐‑friend
•
•
•
If unsure of the diagnosis or plan, can discuss presentation and
results with a colleague
Fresh set of eyes may discover overlooked exam or history
points
Chance to review complete set of available results
Function of sign-‐‑out
8. #4. Point of patient re-‐‑evaluation
•
•
•
•
•
Able to reassess patient at bedside
Repeat most relevant exam points
Review current vital signs and any trends recorded by nursing
staff
Look for any red flags that show current disposition may not
be adequate
Avoid being locked in to initial diagnosis
Function of sign-‐‑out
9. #5. Teaching moment
•
•
Time to review interesting physical exam and radiology results
Opportunity for senior residents to teach and junior residents to
learn (peer education)
Function of sign-‐‑out
10. • 68yo F with no sig PMH p/w fever and altered mental status
• Family reports fever for past three days
• Denies cough, dysuria, headache, neck pain
• Physical Exam
• T 37.5, HR 120, BP 90/60, RR 30, SpO2 85% on RA
• GCS 14/15
• Crackles in the bases on lung exam
• Remainder of exam largely unremarkable
Case #1 – History/Exam
11. •
•
•
•
•
•
IV in R antecubital fossa
Placed on 2L O2 via NC à SpO2 to 90%
1L of IV NS infused à HR 115, BP 100/70
Given dose of ceftriaxone for fever, sepsis
CXR, UA, CBC, chemistries pending
Foley placed with clear UOP
Case #1 – Initial
Management
12. • 68yo F with fever being treated for pneumonia with ceftriaxone
• Improved after fluids
• Plan admit to medicine
Case #1 – Sign-‐‑Out A
13. • 68yo F with no sig PMH p/w fever and altered mental
status, GCS 14; arrived this AM
• Treating with ceftriaxone due to concern for PNA with
crackles on exam and low SpO2
• CXR and UA are pending to look for source of infection
• No headache/neck pain/meningismus so do not
anticipate need for LP
• Concern for sepsis due to low BP and elevated HR
• Course thus far
• Received 1L IV NS with some improvement in vitals –
needs ongoing active resuscitation with IV fluids; could
require pressors
• On 2L O2 via NC, may need increasing O2; check SpO2
frequently
• Pending actions:
• Review CXR and UA; CBC and chemistries
• Call to Medicine once results return; consider ICU or
pressors if persistently hypotensive
Case #1 – Sign-‐‑Out B
14. • CXR with RLL infiltrate
• Urine dip leukocyte negative
• CBC shows Hgb of 6.8
• Dr. A doesn t check the labs because unaware of
pending labs
• Dr . B contacts family regarding blood donation
• Electrolytes WNL; Creatinine elevated
• BP drops to 70/40, SpO2 82%
• Dr. A doesn t check VS during shift, unaware
that patient required such care
• Dr. B checks every few hours; rapidly provides
facemask O2 and repeated IV boluses
Case #1 – Next Shift
15. #1. Provide information to allow oncoming provider to
deliver adequate care to patient during next shift
•
•
•
•
Must learn basic essentials on every patient
Identify sickest patient(s) in department
Anticipate potential problems with patient care – discuss
appropriate interventions
Discuss pending studies/consults/results
Function of sign-‐‑out
16. • Pt with AMS and seizures
• hasn t seized in a few hours
• anticipate appropriate treatment for seizures next shift
• Pt with DM and pneumonia
• noted to be hypoglycemic on home regimen, now on
adjusted lower doses
• anticipate treatment for recurrent hyperglycemia
• Pt with decreased respiratory drive after iatrogenic opiate
excess
• improved after first dose of naloxone
• anticipate possibility of recurrent drowsiness
• Pt with bandaged fractures
• anticipate need for oncoming resident to know if open
and discuss with trauma
Quickie Examples
17. #2. Create a to-‐‑do list
•
•
•
Each patient should have planned disposition
List should include all necessary items before patient can be
dispositioned (imaging, consults, family issues, etc)
Explain reasoning behind each pending item to allow optimal
decision-‐‑making
Function of sign-‐‑out
18. • 55yo F with hx of COPD p/w difficulty
breathing
• Worsening cough and SOB over past three days
• Not improving with inhalers at home
• Has hx of anxiety and feels anxious now
• Exam
•
•
•
•
•
HR 125, BP 118/79, T 37, RR 22, SpO2 86% on RA
Thin, older F in mild resp distress
Diffuse expiratory wheezes on lung exam, tight
HR tachycardic and regular, strong pulses
Remainder of exam unremarkable
Case #2 –History/Exam
19. • Placed on O2 via NRB
• Started on albuterol nebulized treatments q20min x3
with improved air entry
• Pt states feeling slightly beler but not at baseline
• CXR without evidence of PTX or PNA
• EKG shows sinus tachycardia
• Given 1L IV NS for tachycardia, BP WNL
Case #2 – InitialManagement
20. • 55yo F with hx of COPD p/w SOB, presumed COPD
exacerbation
• Air entry improving after NMTs, persistent wheezes
• CXR benign
• Tachycardia noted – differential discussed
• EKG WNL
• Pt has seen pulmonary and cardiac specialists as
an oupt within past 3 weeks and been tachycardic
from 100-‐‑120
• Normal BP
• Normovolemic on exam
• No significant risk factors for PE and exam c/w
COPD
• Likely secondary to repeated albuterol doses
• Anticipate admission to medicine
Case #2 – Sign-‐‑Out
21. • Peer resident receiving sign-‐‑out: Let s go look at
her.
• Notes thin woman with fine hair and anxious
appearance
• Fine tremor also noted (pt states albuterol always
makes me feel shaky )
• Asks if she has received a workup for
hyperthyroidism….
• TSH and free T4 added on to ED labs
• Pt found to be in thyroid storm
Case #2 – Sign-‐‑Out
22. #3. Opportunity to phone-‐‑a-‐‑friend
•
•
•
If unsure of the diagnosis or plan, can discuss presentation and
results with a colleague
Fresh set of eyes may discover overlooked exam or history
points
Chance to review complete set of available results
Function of sign-‐‑out
23. • 69 yo man 5 weeks s/p craniotomy for subdural
hematoma presents from his nursing home with
fever and AMS that started this morning.
• PMH: TBI with expressive aphasia and subdural
hematoma
• Physical Exam:
– T 37.5, HR 99, RR 16, BP 105/67, O2 98%
– General: Pt lying on stretcher, occasionally
answering yes/no questions
– Heart: RRR, no m/r/g
– Lungs: CTAB, no w/r/r
– Abdomen: Soft, NT/ND, no masses, no
organomegaly
– Neurologic: A/O x0, evidence of expressive
aphasia, per old records appears to be at
baseline
Case #3 – History & Exam
24. • Fever work-‐‑up initiated
– UA negative, culture pending
– CXR with no infiltrate
– Blood cultures pending
– No indwelling lines/ports, no immunosuppresants
• Non-‐‑contrast Head CT shows no change from post-‐‑op head CT
done 5 weeks ago
– No new findings, but also no improvement
• Neurosurgery consulted
– State that head CT results would not account for AMS/fever
Case #3 – Initial Management
25. • 69 YO man with fever/AMS 5-‐‑weeks s/p
craniotomy presents from NH
• No fever in ER (checked orally only)
• Mental status appears at baseline per chart
• UA, CXR negative
• Blood and urine cultures pending
• No change on head CT
• Cleared by neurosurgery
• Plan: discharge patient back to NH with no
antibiotics since no source of fever and not febrile
here, will notify NH if cultures positive, pt likely
has a viral illness
Case #3 – Sign-‐‑Out
26. • On-‐‑coming resident questions absence of LP for fever and AMS patient
with recent brain surgery
• Out-‐‑going resident explains that they think pt is at baseline MS, and no
fever in ER, so no further work-‐‑up done
• On-‐‑coming resident still feels uneasy and goes to evaluate pt after
rounds
• Wife at bedside saying pt not at baseline
• Rectal temperature: pt febrile
• LP performed and + for bacterial meningitis
• Pt started on IV antibiotics and admiled to ICU
• Pt survives to discharge
Case #3 Sign out
27. #4. Point of patient re-‐‑evaluation
•
•
•
•
•
Able to reassess patient at bedside
Repeat most relevant exam points
Review current vital signs and any trends recorded by nursing
staff
Look for any red flags that show current disposition may not
be adequate
Avoid being locked in to initial diagnosis
Function of sign-‐‑out
30. #5. Teaching moment
•
•
Time to review interesting physical exam and radiology results
Opportunity for senior residents to teach and junior residents to
learn (peer education)
Function of sign-‐‑out
31. Round at the bedside
How to Optimize your
Sign-‐‑Out
38. Additional Source Information
for more information see: http://open.umich.edu/wiki/CitationPolicy
Slide 28: Anonymous KATH patient
Slide 29: X-rays of an anonymous KATH patient
Slide 37: Photo by Pamela Fry and Alison Haddock