Course: Observation and Clinical Decision Unit Medicine _ Course Number: 2104

Transcription

1 Curse: Observatin and Clinical Decisin Unit Medicine _ Curse Number: 2104 Department: Faculty Crdinatr: Department f Emergency Medicine Ashley Haynes, MD Mani Alavi, MD Assistant Faculty Crdinatrs: Hspital: (Lcatin f rtatin) Emergency Department Observatin Unit, Parkland Memrial Perids Offered: 1-12 Length: 4 weeks Max # f Students: 1-2 First Day Cntact: Lisa Hammnd Lisa.Hammnd@utsuthwestern.edu First Cntact Time: First Day Lcatin: Prerequisites: 9 Gld ED Observatin Unit Cnference Rm Cmpletin f all cre Clerkships Curse Descriptin This rtatin is designed t intrduce a fundamental understanding f bservatin and clinical decisin units in evlving health care envirnments. Utilizing skills and knwledge learned in cre clerkships, the MSIV student will be expsed t incmpletely differentiated patients being managed by evidencebased, prtcl-driven care plans. A distinct appreciatin f the bridge between acute utpatient presentatins and inpatient care can be accmplished thrugh a multi-disciplinary team based apprach. Gals Objectives Assessment methds Patient Care: Assessment and Management 1. Students will learn hw t use gal-based care prtcls in the management f admitted patients frm ED and ther utpatient based services. 2. Observatin f natural histry f disease frm 1. Assist ED bservatin unit prviders, residents and faculty in care f admitted patients under current bservatin unit prtcls.

2 undifferentiated state thrugh final decisin making using tempral landmarks f up t 24 hurs Medical knwledge: 1. Understand the basic frmulatin, structure and management f bservatin and clinical decisin units. 2. Recgnize applicatin f specific evidence based prtcls fr cmmnly admitted medical prblems t these units 3. Learn t adapt, revise and review currently accepted prtcls t lcal institutinal services and capabilities. Interpersnal and cmmunicatin skills: 1. Cmmunicate with patients, family, and staff, thrughut length f stay fr patients n unit. 2. Develp effective written and verbal skills with bservatin unit prviders, faculty and cnsulting services regarding all patient care. 1. Demnstrate and explain the utility and limitatins f the mst cmmn bservatin cnditins and prtcls specifically: Cngestive Heart Failure Asthma/COPD Chest Pain Cmmunity Acquired Pneumnia (CAP) Electrlyte Disturbances Pyelnephritis Dehydratin 2. Demnstrate the utility and limitatins f institutin specific prtcls such as: a. Pst prcedure care b. Anemia c. Crtalid Snakebite d. Pancreatitis e. Gastrintestinal Bleed f. Diverticulitis g. Minr Intracranial Hemrrhage (ICH) h. Syncpe i. Aseptic Meningitis j. Cncussin k. Transient Neurlgical Attack l. Txiclgy Admissin 1. Perfrm histry and physical examinatins while develping care plans alngside f bservatin unit prviders and faculty 2. Assist prviders and faculty in apprpriate verbal and written dispsitin f patients thrughut and in cnclusin f bservatin perid. Practice Based learning and Imprvement:

3 1. Systematically use CQI methds and persnal feedback perfrmance as a basis fr imprving selfknwledge regarding bservatin medicine. 2. Develp methds f assimilating cutting edge tpics in bservatin medicine using evidencebased medicine review, nline resurces and peerreviewed jurnals. Prfessinalism: 1. Develp behavirs respectful f patient cmfrt, safety and privacy while present n the bservatin unit 2. Present self as prfessinal health care team member assisting and interacting with ther members f the multidisciplinary bservatin unit team Systems based practice: 1. Understand the value and use f bservatin units lcally within a slitary institutin and glbally acrss health care systems 2. Learn abut the integratin f bservatin medicine services frm ecnmic, persnnel management and strategic planning perspectives. 1. Participate and cntribute t scheduled QA review f all pertinent cases dne with prviders, residents and faculty during bimnthly cnferences. 2. Mastery f utilizing references such including cre text specifically Rsen s Chapter 195 Observatin and Clinical Decisin Units, and Graff s The Textbk f Observatin f Medicine: The Healthcare System s Tincture f Time, alng with ther prvided resurce materials. 3. Participate in real time and scheduled evaluatin sessins by bservatin unit prviders, residents and faculty. 1. Demnstrate prfessinal appearance and behavirs tward patients and medical clleagues 1. Demnstrate examples and applicatins f bservatin medicine in the US and ther parts f the wrld. 2. Prvide real evidence f ecnmic, safety and quality effects regarding patients, payers, and expected clinical utcmes utilizing bservatin medicine principles III. Methds f Instructin: Didactic:

4 1. Attend scheduled student bservatin medicine principles and clinical lectures 2. Participate in bservatin medicine jurnal club by reviewing and critiquing at least ne recent, relevant article at mnthly ED bservatin peratins meeting 3. Read and review in their entirety, prvided cre texts and web-based resurces in bservatin medicine 4. Cmplete nline curse cmpetency badge exercises prvided in Mdle 5. Participate in system CQI sessins with ED bservatin prviders, residents and faculty as scheduled. In additin, Lead Observatin Unit faculty (Pease, Salazar) may invite students t attend ther hspital based quality assurance events regarding bservatin medicine service area. These mnthly meetings include Adverse Event and EMTALA cmmittees that cncern bservatin unit medicine functins. 6. Attendance at Emergency Medicine cnferences Thursdays n weekly basis Practical Learning 1. Participatin in bedside walking runds with ED bservatin prvider s residents and faculty as they ccur daily 2. Patient cntact hurs spent n the ED bservatin unit, which includes the ttal f assisting prviders in additin t hurs under the direct supervisin f bservatin unit residents and faculty Schedule 1. Day ne f each blck will include rientatin t the unit 2. 9 hur clinical shifts spread ut ver 28 day blck shifts required 4. Shift times are r a. Pre-rund prir t AM attending perfrming their clinical teaching runds. b. Accmpany prviders in evaluatins f patients physically brught t the bservatin unit. c. Perfrming and charting initial interview with patients in queue t cme t the bservatin unit frm the ED. d. Participate in nging patient care frm admissin t discharge frm the bservatin unit. e. Specialty service cnsultatin (i.e. Cardilgy, Neursurgery, etc.) will create additinal student learning experiences as the student cnfers/interacts/runds with these specialty services n individual bservatin unit patients. f. Participate in the stabilizatin f decmpensating bservatin unit patients with multi-disciplinary prviders (EM Attending s, Rapid Assessment, Cde and MICU teams). Curse Requirements 1. Cmpletin f all 3 rd year clerkships 2. Attendance and participatin at all structured bservatin medicine meetings and EM residency cnferences. 3. Review ne cre and ne institutinal prtcl and prvide the fllwing in written frm t bservatin faculty. These tw prtcl reviews need t be submitted prir t the cmpletin f the 4 week perid fr faculty t assess and prvide feedback regarding the submissins a. Evidenced-based literature supprt fr such a prtcl b. Discussins abut the ecnmic, quality and safety aspects f said prtcls

5 IV. c. Prvide and prpse future directins and mdificatins based n research regarding existing prtcls. d. Assist all prviders, residents and attending s in the care and management f patient n the ED bservatin unit fr required patient cntact hurs. e. Critically appraise, present and discuss an article relevant t bservatin medicine at mnthly bservatin services Nurse Practitiner meeting. Methd f evaluatin f students and requirements: 1. Pass/Fail grading structure 2. Cmpletin f written schlarly review f ne cmmn and ne institutin specific prtcls. T be evaluated and feedback prvided by the bservatin unit faculty. 3. Students will be assigned a grade [Pass/Fail] based n attendance, participatin, case presentatins and interactins with ED bservatin prviders, residents, faculty, staff, and patients. Specific criteria such as engagement f student, verall student attitude, and cntributin t the learning milieu, imprvement, timeliness and reliability will be used as factrs in grade assignment. 4. Real time daily feedback and weekly written evaluatins will be discussed with each student. Required reading: Emry Clinical Decisin Unit Manual Emry University Schl f Medicine, Department f Emergency Medicine: CDU Manual Rss MA, Wheatley M, Leach G, O Malley R, Osbrne A. electrnic media, Macintsh i-bk Emergency Medicine Clinics f Nrth America: Emergency Observatin Medicine Rss MA, Graff LG, Editrs, WB Saunders, Philadelphia PA, Vlume 19; Number 1; Feb 2001 (258 pages). Graff LG. Observatin Medicine: The Healthcare System's Tincture f Time. (nline textbk) Rss MA, LG Graff "Principles f bservatin medicine." Emerg Med Clin Nrth Am 19(1): Observatin Units: Implementatin and Management Strategies Graff, LG ed. American Cllege f Emergency Physicians, Texas, 1998.