For DEMT Terence Yuen – Teaching 5/7/17
VFRAC – virtual fracture clinic
Update from Becky Pile ED physiotherapist
3 months running now
VFRAC reviews all referrals next day and then funnels cases:
- Direct to OT
- To ‘traditional’ fracture clinic + organizes repeat imaging
- conservative VFRAC management – simple fractures for phone management and LMO follow-up
Can manage other acute injuries eg. Achilles rupture
VFRAC needs to be booked for next day – please tell your clerk
No limit on booking numbers
Already a reduction of about 26% diverted from fracture clinic
Patient satisfaction information survey pending – being collected now
Adults only so far – no paeds
Clinical risk management and clinical governance
Dr Lucia Le Kim – deputy director with Dr Terence Yuen
Governance includes:
- policy
- Education
- Clinical guidelines / protocol
- Systems: escalation pathways / codes / mandatory competencies / credentialing
- Audit / review / quality / outcomes / KPIs / M+M / satisfaction / Riskman / in-depth case reviews / adverse events
All clinicians as they progress through their careers should develop an awareness of wider process of healthcare delivery in the hospital context, over and above individual patient cases
Risk
- Seen risk – eg. the patient you have seen who is unwell
- Assumed risk –
- Unseen risk – ie unseen waiting room patients and any patient who you have not personally reviewed
Traps
- Assumptions: interpretation of case / interpretation of investigations
- Interpretation of clinical stability
- Diagnosis momentum
- Geographical blindspots – eg. EOU / EDIS filters (clerical risk)
Failsafes
Eg. Chest pain: ECG to be seen by senior / EOU consultant review /
Mitigate risk by good communication
Avoid premature labelling / diagnosis
Take actions to re-stratify risk
- Re-utilize resources
- Reallocate resources
- Retrieve additional resources
Victorian forensic paediatric medical service (VFPMS)
Dr Bindu Bali
Paediatric arm of adult forensic service
Mandatory reporting – suspicion of physical or sexual abuse; not mandated to tell the family per se
Social work / IRS support to support clinician or family / access to phone
Issues regarding confidentiality if contacted by DHHS
Safety concerns can trump privacy legislation however it is a grey area
Admission often necessary to facilitate further survey but if no further medical needs exist then DHHS is responsible for safe accommodation
RED FLAGS: household violence / heavy use of drugs + alcohol / serious mental illness / child’s vulnerability (eg premobile / preverbal)
Bruising:
- Do not try to interpret
- Describe only
- Consider red flags : away from bony prominences / TEN – torso / ears / neck / if not fitting developmental stage
Journal club: EGDT and meta-analyses
Dr Ashley Loughman – see presentation here
Early goal directed therapy
How to assess meta-analyses
PRISM metaanalysis
- Prospective collection to ensure uniformity
Metaanalyses
- Theoretically pool information to get closer to the “common truth”
- Increases external validity
- Cons: inclusion biases / lack of negative studies / agenda driven bias / poor quality of original papers