Training in Emergency Room Medicine

Retrieved File (circa 1991)

THE MANILA DOCTORS HOSPITAL EMERGENCY ROOM (MDH-ER)

THE MDH-ER TRAINING PROGRAM FOR PHYSICIANS


COURSE DESCRIPTION

GENERAL OBJECTIVE

SPECIFIC OBJECTIVES

TEACHING AND LEARNING ACTIVITIES AND MATERIALS

TRAINEES

TRAINORS

EVALUATION

LIST OF CONFERENCES AND MEETINGS

TOPICS FOR LECTURES AND DISCUSSIONS

TOPICS FOR PRACTICUM SESSIONS


COURSE DESCRIPTION

The course consists of a formal training in emergency room medicine. It includes management of a present day emergency room; evaluation and treatment of patients seen in the emergency room; decision-making of all problems involving the emergency room and the patients; and disaster control.

 

GENERAL OBJECTIVE

To acquire the requisite knowledge, attitude, and skills relevant to the management of the emergency room and its patients.

 

SPECIFIC OBJECTIVES

At the end of the course, the trainee should be able:

1. To describe the types of patients consulting at a present day emergency room.

2. To enumerate the different patterns of medical staffing of the emergency room and indicate which one would be best for a particular situation.

3. To discuss the general functions of an emergency room officer.

4. To provide proper immediate resuscitative measures to patients with life-threatening conditions.

5. To make a logical and accurate diagnosis of medical problems of patients seeking help at the emergency room.

6. To identify which patients need to be hospitalized and who can be treated on an outpatient basis.

7. To identify which patients need the care of a subspecialist.

8. To provide proper definitive management to patients who do not need hospitalization nor care of a subspecialist.

9. To provide proper initial management to patients who need hospitalization and the care of a subspecialist.

10. To make proper decisions on any problems involving the emergency room and the patients.

11. To discuss the general principles and methods of disaster control.

12. To serve as an effective disaster medical officer or coordinator.

 

TEACHING AND LEARNING ACTIVITIES AND MATERIALS

1. Duties at the MDH-ER (hands-on training and preceptorship)

2. Lectures

3. Case discussions

4. Journal reports

5. Practicum sessions

6. Teaching and learning manual on emergency room medicine

 

TRAINEES

1. Interns – Rotation of 1 1/2 months

2. Residents – Rotation of 3 months

 

TRAINORS

1. The MDH-ER Director – Course Coordinator

2. The MDH Emergency Room Officers

3. The MDH Consultant Staff

 

EVALUATION

1. MDH-ER duty requirement

2. Attendance during conferences

3. Case presentations, lectures, and journal reports

4. Typewritten reports

5. Preceptorship grade

6. Practical examination

7. Written examination


LIST OF CONFERENCES AND MEETINGS

1. ENDORSEMENT CONFERENCE

– Every day except Sundays and holidays, 0730 – 0800

– Outgoing EROs endorse to incoming EROs

2. MEDICAL CONFERENCE

– Every day except Sundays and holidays, 0800 – 0900

– Lectures, case discussions, and journal reports

– Consultant ERO : every Mondays (Lectures)

– Intern ERO : every Tuesdays, Thursdays, Saturdays

– Resident ERO : every Wednesdays and Fridays

– Assignment by rotation and those who are not on duty

3. PRACTICUM SESSIONS

– Every day except Sundays and holidays, 0900 – 1000

– Instructor : Consultant ERO on duty

– Students : All residents and interns on duty

4. AUDIT CONFERENCE

– Every third Friday of each month, 1500 – 1700


TOPICS FOR LECTURES AND DISCUSSIONS

1. Management of an emergency room

2. The diagnostic and treatment processes in the ER

3. Basic and advanced life support

4. Common life-saving surgical procedures

5. Plain X-rays

6. Electrocardiogram

7. Arterial blood gases

8. Acute head

9. Acute eye

10. Acute ear, nose, and throat

11. Acute neck

12. Acute chest

13. Acute abdomen

14. Acute extremity (bone, nerve, blood vessel, and skin)

15. Acute male genitourinary system

16. Acute female urinary and reproductive system

17. Acute endocrine system

18. ER management of newborn and pediatric emergencies

19. ER management of shock

20. ER management of trauma

21. ER management of poisoning

22. ER management of seizures

23. ER management of coma

24. ER management of dyspnea

25. ER management of myocardial infarction

26. ER management of abdominal pain

27. ER management of gastrointestinal bleeding

28. Medicolegal issues in the ER

29. ER management of hypertension

30. ER management of gastroenteritis

31. ER management of bronchial asthma

32. ER management of sexually transmitted diseases

33. ER management of urinary tract infection

34. ER management of respiratory tract infection

35. ER management of burns and wounds

36. Disaster control


TOPICS FOR PRACTICUM SESSIONS

1. Basic and advanced life support

2. Plain X-ray interpretation (Skull, chest, abdomen, extremities, and spines)

3. Electrocardiogram interpretation

4. Arterial blood gases interpretation

5. Establishment of venous lines (Percutaneous and cut-down)

6. Nasogastric intubation

7. Urinary catheterization

8. Endotracheal intubation

9. Tracheostomy

10. Thoracentesis and tube thoracostomy

11. Pericardiocentesis

12. Peritoneal tap

13. Diagnostic process in the ER

14. Decision-making in the ER (diagnosis, treatment, disposition, referral, medical ethics, medicolegal issues, etc.)

 


ROJ@17nov24

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Throwback Thursday – MDH ER – Circa 1991

I was the MDH-ER Director in 1991.  I was forgot all about it.  Up to when, I cannot remember. Will look.

Will put this in my CV.

mdh_er_org_chart1


ROJ@17nov24

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ROJoson’s Files – Emergency Room Manual – Circa 1991 – Clutter Management – Digitalized – Ready for Discard


mdh_er_manual


ROJ@17nov24

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Project Study for My Master in Hospital Administration in 1991 – Improving Medical Staffing in Emergency Room – Excerpts

History: After this project study in 1991, there was a change in medical staffing in the emergency room of MDH.  Graduates of residency programs of different specialties (such as surgeons, pediatricians, internists, and family medicine specialists) served as Emergency Room Officers (EROs).  Then came the graduates of Emergency Room Medicine Residency program, mostly from Philippine General Hospital, serving as EROs.  The EROs currently is a mixture of graduates of the Emergency Room Medicine Residency Program and graduates of residency programs of other specialties.  There is now an accredited training program in emergency medicine in Manila Doctors Hospital.

Happy to be part of these developmental milestones in MDH Department of Emergency Medicine.

ROJ@17nov23

cph_mha_er_1991_1

ABSTRACT

cph_mha_er_1991_7

cph_mha_er_1991_8

REVIEW OF PERTINENT LITERATURE

cph_mha_er_1991_16

 

cph_mha_er_1991_17

cph_mha_er_1991_18

cph_mha_er_1991_19

 

cph_mha_er_1991_20

cph_mha_er_1991_21

cph_mha_er_1991_22

CONCLUSIONS AND RECOMMENDATIONS

cph_mha_er_1991_38


ROJ@17nov23

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Project Study for My Master in Hospital Administration in 1991 – Ready to Throw Away after Digitalizing

My second master degree after MD –  1974 then 1991.  MD is considered a master degree course.

MD – Doctor of Medicine

MHA – Master in Hospital Administration

Will upload in scribd.

Will publish excerpts in the near future – reminiscing and cherishing the golden days!

IMG_6238

 


ROJ@17nov23

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Promoting Excellent Patient Experience – NICE Pathway

I like this NICE Pathway on Patient Experience – simple to remember!

NICE – National Institute for Health and Care Excellence

https://pathways.nice.org.uk/pathways/patient-experience-in-adult-nhs-services/patient-experience-in-adult-nhs-services-overview

Promoting Excellent Patient Experience

 


ROJ@17nov22

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Control of Documents and Records – Variable Interpretations

Control of documents and records is a phrase that was popularized by ISO.

Document control is core to ISO 9001, and is common to the other management standards.

ISO 9001:2015 –

“Documented information required by the quality management system and by this International Standard shall be controlled”

ISO 9001:2008

Control of documents and records is one of the six procedures that one must document in ISO 9001:2008.

The phrase has been interpreted and misinterpreted by a lot of people who are into ISO 9001 certification.  Even ISO realizes this situation that it tries to remedy and come out with new terms: documented information instead of documents and records and control of documented information instead of documents and records is now seen in the 2015 edition.  It also tries to explain what control activities consist of.

A lot of people, hospital staff and hospital directors included, interpreted “control” to mean a staff cannot show any documents to the public or share them to the public or outsider whatsoever.  They think all hospital documents and records are restricted or confidential, even operation forms and manual of procedures, etc.  This is an example of misinterpretation.

Control in laymen’s meaning is the mechanism (policies and procedures) installed and instituted to guide or regulate the operation of a management system, here, the information management system.

Controlling the documentation materials or documents and records means there are measures to:
  • Ensure adequacy and suitability for use.
  • Protect from loss and destruction.
  • Secure from unauthorized usage.
  • Maintain confidentiality when prescribed as confidential documented information.
  • Actively use the documented information for their established purposes.
  • Ensure easy access and easy retrieval when documented information are needed.
  • Ensure legibility of documented information.
  • Ensure up-to-dateness of documented information.
  • Dispose documented information not to be used anymore.
  • Archive documented information as indicated.

Below are statements from ISO 9001: 2015 on Control of Documented Information:

7.5.3 Control of documented information

7.5.3.1 Documented information required by the quality management system and by this International Standard shall be controlled to ensure:
a) it is available and suitable for use, where and when it is needed;
b) it is adequately protected (e.g. from loss of confidentiality, improper use, or loss of integrity).

7.5.3.2 For the control of documented information, the organization shall address the following activities, as applicable:
a) distribution, access, retrieval and use;
b) storage and preservation, including preservation of legibility;
c) control of changes (e.g. version control);
d) retention and disposition.

With regards to the misinterpretation mentioned above, “staff cannot show any documents to the public or share them to the public or outsider whatsoever” and “all hospital documents and records are restricted or confidential, even operation forms and manual of procedures, etc.” – it is true that there are certain documents and records in the hospital that are considered restricted or confidential.   These restricted documents and records usually consist of financial documents and records, strategic plan documents and records, minutes of meetings, and patient medical records.  The hospital should declare to its staff which documents and records are to be considered restricted.  These restricted documents and records should be “adequately protected” (7.5.3.1b) and secured from unauthorized usage.

Manuals of governance and operations and forms used for operations (not records yet) which are usually included in the manuals of governance and operations should not be considered restricted documents.  First, they are supposed to be publicized not only to the internal staff or stakeholders (to guide them on what has to be done as well as to facilitate knowledge management system) but also to the pubic (to guide them what are supposed to be done by staff of the hospital and to promote transparency and patient experience).  Second, the ISO 9001:2015 stipulates that they should be always available for use, where and when they are needed (7.5.3.1a).  These manuals of governance and operations should not be stored as restricted information. In fact, they are openly publicized even on the Internet particularly to promote transparency and patient experience.  It is important to note though that these publicized manuals of governance and operations should be suitable for use (7.5.3.1a), particularly on up-to-dateness.


Below are more notes from me in the setting of a medical center:

ROJoson’s Notes on Documented Information and Control of Documented Information in a Medical Center Setting:

The term “documented Information” of ISO 9001:2015 refers to all data and information used by the medical center in or for planning, deployment, implementation, evaluation, review and improvement purposes and which should be “documented” or “recorded” in whatever media and which will be used as references or guides for actions as well as evidences of accomplishment.

Document information requirements refers to all documentation requirements in the medical center.The safest approach to comply with the documented information requirements is to document everything being done in planning, implementation, review and improvement and then control the documentation materials.

Controlling the documentation materials means there are measures to:

  • Ensure adequacy and suitability for use.
  • Protect from loss and destruction.
  • Secure from unauthorized usage.
  • Maintain confidentiality when prescribed as confidential documented information.
  • Actively use the documented information for their established purposes.
  • Ensure easy access and easy retrieval when documented information are needed.
  • Ensure legibility of documented information.
  • Ensure up-to-dateness of documented information.
  • Dispose documented information not to be used anymore.
  • Archive documented information as indicated.

Documentation, quality manual, documented procedures, records  (2008) = Documented information (2015) – ROJoson’s Notes



Below are lifted from ISO 9001:2015:

9001:2015 Edition on Documented Information

7.5 Documented information

7.5.1 General

The organization’s quality management system shall include:
a) documented information required by this International Standard;
b) documented information determined by the organization as being necessary for the effectiveness of the quality management system.

NOTE The extent of documented information for a quality management system can differ from one organization to another due to:
— the size of organization and its type of activities, processes, products and services;
— the complexity of processes and their interactions;
— the competence of persons.

7.5.2 Creating and updating
When creating and updating documented information, the organization shall ensure appropriate:
a) identification and description (e.g. a title, date, author, or reference number);
b) format (e.g. language, software version, graphics) and media (e.g. paper, electronic);
c) review and approval for suitability and adequacy.

7.5.3 Control of documented information

7.5.3.1 Documented information required by the quality management system and by this International Standard shall be controlled to ensure:
a) it is available and suitable for use, where and when it is needed;
b) it is adequately protected (e.g. from loss of confidentiality, improper use, or loss of integrity).

7.5.3.2 For the control of documented information, the organization shall address the following activities, as applicable:
a) distribution, access, retrieval and use;
b) storage and preservation, including preservation of legibility;
c) control of changes (e.g. version control);
d) retention and disposition.

Documented information of external origin determined by the organization to be necessary for the planning and operation of the quality management system shall be identified as appropriate, and be controlled.

Documented information retained as evidence of conformity shall be protected from unintended alterations.

NOTE Access can imply a decision regarding the permission to view the documented information only, or the permission and authority to view and change the documented information.




Clarification of new structure, terminology and concepts (ISO 2008 – ISO 2015)

There is no requirement in this International Standard for its structure and terminology to be applied to the documented information of an organization’s quality management system.

The structure of clauses is intended to provide a coherent presentation of requirements, rather than a model for documenting an organization’s policies, objectives and processes. The structure and content of documented information related to a quality management system can often be more relevant to its users if it relates to both the processes operated by the organization and information maintained for other purposes.

There is no requirement for the terms used by an organization to be replaced by the terms used in this International Standard to specify quality management system requirements. Organizations can choose to use terms which suit their operations (e.g. using “records”, “documentation” or “protocols” rather than “documented information”; or “supplier”, “partner” or “vendor” rather than “external provider”).

Documentation, quality manual, documented procedures, records  (2008) = Documented information (2015) – ROJoson’s Notes

A.6 Documented information

As part of the alignment with other management system standards, a common clause on “documented information” has been adopted without significant change or addition (see 7.5). Where appropriate, text elsewhere in this International Standard has been aligned with its requirements. Consequently, “documented information” is used for all document requirements.

Where ISO 9001:2008 used specific terminology such as “document” or “documented procedures”, “quality manual” or “quality plan”, this edition of this International Standard defines requirements to “maintain documented information”.

Where ISO 9001:2008 used the term “records” to denote documents needed to provide evidence of conformity with requirements, this is now expressed as a requirement to “retain documented information”. The organization is responsible for determining what documented information needs to be retained, the period of time for which it is to be retained and the media to be used for its retention.

A requirement to “maintain” documented information does not exclude the possibility that the organization might also need to “retain” that same documented information for a particular purpose, e.g. to retain previous versions of it.

Where this International Standard refers to “information” rather than “documented information” (e.g. in 4.1: “The organization shall monitor and review the information about these external and internal issues”), there is no requirement that this information is to be documented. In such situations, the organization can decide whether or not it is necessary or appropriate to maintain documented information.


 ROJ@17nov5

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