Hospitalist Care
Inpatient Ward
The inpatient ward is found on the second floor of the hospital above the ER (new hospital) and has 20 beds.
Hours
Hospitalists are on an 8-day rotation from Monday to Monday with a day off on Tuesday.
The hospitalist is on-duty 7:30. – 16:30 with evening phone coverage until 23:00
After 23:00, ward calls go to the ED physician
Handover to the next hospitalist occurs at 7:30 on Monday mornings (plan to stay until the early afternoon
Responsibilities
In-patient rounds
Discharges
Admissions through the ED (during daytime hours)
Phone coverage for ward issues until 23:00
On Day 8 (Monday), the out-going hospitalist is responsible for organizing follow-up-, completing handover and assisting the in-coming hospitalist by completing any discharges and needed paperwork.
There is no dedicated admin staff or unit clerk for the ward. This means that you need to enter your diagnostic imaging and lab orders into Meditech yourself, as well as make sure that faxes (such as discharge medications list) are faxed.
Medication and medical orders have to be written in the patient's chart, otherwise everything else is on Meditech
The hospitalist has a dedicated office for the week located on the inpatient ward which has a computer, telephone and printer.
Daily Handover
Good collaboration, a team-approach, and clear communication regarding important patient care issues ensure that potential problems are addressed early, Ottawa transfers are initiated prior to ICU interventions (as much as possible), and everyone gets the care they need when they need it.
It is very important that daily AM/PM handovers occur. This reduces communication gaps and translates into better and safer patient care.
Each morning at 7:30 a.m., the hospitalist performs handover with the out-going ED physician in the emergency department to review any new admissions. It is crucial that the night ED physician be aware of any previous evening admissions (from the evening handover).
The hospitalist will then meet the nurse in charge and the discharge coordinator in the hospitalist office to get a report.
Patient Turnover
Patient turnover is high at QGH, with several admissions and discharges occurring daily.
The key here is for the hospitalist to see themself as part of a team that manages in- patient flow. Avoid hanging on to patients unnecessarily as the in-patient census can rapidly climb.
If you are not sure about the logistics regarding discharging a patient, please do not hesitate to consult your colleagues to make the best discharge plan (ex: discharging a non-contagious active TB patient back to community - you should make sure public health and TB MD are consulted before discharge)
Admissions
Most admissions are admitted through the ER. They are first seen and assessed by the ED physician.
All admitted patients require:
A typed electronic admission note in Meditech
A signed medical reconciliation form (you must choose to continue or hold/discontinue their regular medications in hospital)
Adult or Pediatric Admission Order Set (including additional medications)
Other appropriate orders – ie Mental Health patient admitted under the Mental Health Act (see Mental Health Guidelines section)
Any required electronic referrals, blood work and investigations
Direct Admissions
Rarely, patients will be admitted directly to the ward. This most often occurs when a patient is repatriated to Nunavut from a tertiary care centre (usually Ottawa). In these instances, you can hear about the patient and receive a physician handover to determine if the patient is medically appropriate from a physician perspective for QGH Inpatient ward.
Please discuss all cases with the inpatient nursing manager prior to accepting. If there are several cases awaiting repatriation, then a meeting may be required to prioritize them.
Any patient that is directly admitted to the inpatient ward will need to have a medication reconciliation form completed by the admitting physician (because they have not been assessed by a nurse as they would have been had they been admitted through the ER) and this needs to be done prior to their arrival to the floor (i.e., it should not be delayed until the next day).
Documentation
Electronic notes: You are the MRP for patients admitted under you. Therefore, you need to complete a
daily electronic note on admitted patients. There are exceptions to this based on your discretion including having an exceptionally busy ward or acutely ill patient in which case you may choose not to write a note on a stable patient admitted with TB, etc. Patients awaiting long term placement are another example.
Discharge:
Discharge summaries need to be completed on every patient that you discharge. They can either be dictated or can be typed and entered under “QI MD Discharge Summary”. The latter option is only available on Meditech for 48 hours after the patient is discharged.
Please document regular medications, medication changes and discharge medications to avoid confusion with patients’ medications.
Please outline a clear discharge and follow up plan including investigations and specialty referrals in Meditech. If follow up is required in the community please email the generic SHP email for that community to inform them of the plan.
Every discharged patient requires a discharge prescription. Patients with no previous medications who are discharged with none do not require a prescription.
All patients who are cleared to return to their home community require Medical Travel Clearance form filled on Meditech (found in Orders)
If you would like the patient to be reassessed by a MD, you can either book the patient in a regular clinic spot or take one of the daily reserved spot in RAC (rapid assessment clinic) for the patient to be followed up.