Emergency Department
Emergency Care
The QGH ED sees an average of 50-80 patients per day, though this can vary widely. We service the community of Iqaluit and act as the referral center for 11 other communities in the Qikiqtaaluq region, and sometimes from the Kivalliq region.
Emergency Department Shifts:
Day shift (D): 7:30 – 16 :30 (9 hours)
Middle shift (M): 12:30 – 21:30 (9 hours)
Night shift (N): 19:30 – 7:30 (12 hours)
Community Pager shift (CP) 10:30-19:30 (9 hours)
Shift Responsibilities
You will provide care to all the patients presenting to the ED. This includes patients from Iqaluit, and patients from the communities. Community patients travel to Iqaluit through medical travel, either by a scheduled commercial flight (“schedevac”) or a medevac (please see section on patient transport)
Hospital Cardio-respiratory Arrests: Resuscitations outside of the emergency department are the responsibility of the emergency physician unless the primary physician for the patient is available and would prefer taking over care.
Neonatal Resuscitation & Deliveries: There are rare situations where the ED physician is called for support with neonate or in a delivery. This can occur at times when multiple deliveries are occurring at the same time, or if the OBS physician or pediatrics cannot make it to the hospital in time for a precipitous delivery.
Admissions
Admissions occurring between 7:30 and 16:30 will be completed by the hospitalist. Once you have decided to admit a patient, please call the hospitalist to discuss the case and they will write an admission order. After 16:30 it is your responsibility to complete a typed admission history and physical examination, as well as to write the admission orders.
The hospitalist is on call until 23:00 to deal with ward issues and is expected to return to the hospital for ward emergencies. Between 23:00 and 8:00, the ED physician is responsible for ward emergencies.
The hospitalist should be notified of patients admitted overnight and any ward issues at 7:30 during handover. There is a handover tool that must be completed for all admissions that occur after the hospitalist has left (this is located at the ED MD desk)
How to admit a patient:
Every patient that is admitted through the ED requires an electronic admission note on Meditech. This can be written by selecting the “GP Admission Note” note type. After hospitalist hours (16:30) you are responsible for writing this note so that the hospitalist has a clear story of the impression and admission plan for this patient.
Other things that are required for every admitted patient include:
Medication reconciliation form (printed off by the nurse and signed by you)
Adult or Pediatric Admission Order Set
Additional appropriate order sets (ex. bronchiolitis, NAC protocol)
Mental health admission under the Mental Health Act requires a MHA Form 1, MH order set and MH Form 25 (see Mental Health Guidelines section).
Community Pager
The Community Pager (CP) is carried by a dedicated physician from 10:30 to 19:30, and by the ED physician overnight. You will be responsible for managing phone calls from nurses in the community health centers, determining their disposition and completing the community call form.
The community pager receives urgent and semi-urgent pages from community health nurses (CHNs) across the region. Each call or page should be accompanied by a completed .pdf Community Call Form in the Community Pager mailbox. You can read the case and then discuss further history, physical or investigations and management with the CHN.
The management plan should be documented on the bottom of the form. Then “Save as” in your Y: drive and reattach the completed call form in an email back to the CHN.
All call forms requiring Schedevac or Medevac must be printed off and go on the appropriate shelf in ED (ask ED RN’s where) so that the ED physician can access them when the patient arrives.
Once completed, the community call form is emailed back to the CHN. A copy must be printed off if medical travel is necessary for the community patient (for either a schedevac or medevac). Please cc the SHP email on all correspondence.
Where to find the community pager folder in Outlook? Click on the small file folder icon on the bottom right of the photo to show the Public Folders, then enter HSS, and then Community Pager (this can then be favourited).
On-Call
The night before the Community Pager shift the CP Staff is “on call” from 19:30 to 10:30. It is expected to always keep your pager on you during this shift.
The purpose of this on call coverage is to provide back up in the ED when it is too busy for one physician to handle, to be available for high-risk medevacs, and to provide surgical assist for emergency cases.
If the staff is called, you might be called in to assist. If you were up well past midnight on a call back and decide to take the following day off, ensure the staff or ED physician is aware that you will not be coming in.
Handover
There are three handovers daily:
1) 7:30
Night ED physician to hospitalist: handover the admissions from the previous evening/overnight and any overnight inpatient issues.
Night ED physician to day ED physician: hand over any patients remaining in the ED and any medevacs and pending community calls.
2)16:30 (or when the hospitalist leaves)
Hospitalist to mid ER physician: any active inpatient cases or expected issues
3) 21:30
Midday ED physician to Night ED physician: hand over all ED patients, community pager cases and medevacs, expected inpatient issues and handover tool with patients admitted after hospitalist left.
Resources
There is 24/7 back-up in Iqaluit for general surgery, obstetrics, anesthesia, pediatrics, and respiratory therapy.
There is also a “second on call” family physician that is available for high-risk medevacs, surgical assist after hours and assistance in the ED (Community pager).
There is a QGH mental health nurse available 24 hours. Please only call them if you believe it will change management in the moment (between 9:00 and 22:00).
Specialist at the Ottawa hospital are always available to discuss cases.
If you are not sure of what to do or need to discuss a case, you can talk to a fulltime physician or the chief of staff.
Specific Patient Populations
Pediatric Patient
A pediatrician is always on call. Do not hesitate to speak with the pediatrician about complex cases both in the ED and in the communities. If you are considering a transfer of a pediatric patient the pediatrician on call could be consulted. All pediatric admissions (less than 18 yo) are under the pediatrician.
Obstetrical Patients
Obstetric patients presenting past 22 weeks with OB-related complaints are referred to the OBS nurses and MD on call. Those at any gestation with non-OB complaints, or those 22 weeks or less remain in the ED for care.
