WOW 2

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) (text-style:"underline")[Summary: ] Post-op day 1 after an uneventful surgery and post operative course. Overnight events: Did well with minor pain issues, no bleeding or fever noted Subjective: Minor pain at the incision site, was ambulatory with assistance to the BR without difficulty Objective: Vitals 145/92 102 18 96% 37.2 Well appearing, in NAD Lungs clear Heart regular LE: left leg -operative dressing intact without swelling or erythema around wound. B/L LE 1+pitting edema noted, left greater than right Assessment: Post-op Day 1 s/p left hip replacement Plan: Left hip replacement initiate inpatient PT discontinue perioperative abx maintain operative dressing for 1 week HTN Continue meds DVT prophylaxis Continue lovenox Consider DOAC if needed (text-style:"underline")[Hospital Course:] Mrs. Francis is scheduled for PT. You are the med student rotating on orthopedics and you really want to impress the team so you volunteered to transport her to her therapy session via wheelchair. The PT team assists Mrs Francis onto her feet. Upon standing, Mrs Francis states that she feels like she needs to go to the bathroom, and then loses postural tone. She appears to have been briefly "out of it", and was assisted to the ground during the event. Although assisted, Mrs. Francis did strike her head on the wheelchair during the event. She landed awkwardly on her left lower extremity as well. Mrs. Francis quickly regains normal consciousness once assisted up and has no immediate complaints. You decide to... [[Call Ortho to assess the hip]] [[Call floor nurse to get more medical information]] [[Call for more PT members to help with activity today]] [[Call a Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) Orthopedics answers the phone and is in the OR. Although they can't come to the floor to see Mrs Francis now, they ask what happened. The attending appears to be busy. You decide to... [[Medical Student gives report to Ortho]] [[Medical Student gives SBAR]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) The medical student calls the floor and ask for Mrs. Francis' nurse. Floor nurse takes 2 minutes to get to the phone. She asks what happened. [[Medical Student gives report to nurse]] [[Medical Student gives SBAR]] [[Medical Student asks if Mrs. Francis has been feeling well]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) Additional PT comes to assist with Mrs Francis today due to her initial unsteadiness. During PT, Mrs Francis starts to complain of increasing left hip pain and feels a bit dizzy. You then decide to... [[Call Ortho to assess the hip]] [[Call floor nurse to get more medical information]] [[Call a Medical Emergency]] [[Continue with PT session]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) A Medical Emergency is activated by the team in physicial therapy, and the critical care management APP arrives with the respiratory tech, RN, and PCT. The APP inquires about the situation. The medical student is asked to present an SBAR. "(S)I am working Mrs. Francis. She arrived to us for a session today but I have some concerns. (B) As you may know, she recently had her left hip replaced and is POD 1. (A) Upon standing here, Mrs. Francis had an assisted fall to the ground, landing awkwardly on her left lower extremity and may have bumped her head on her wheelchair on the way down. (R) What would should our next steps be?" The APP decides... [[APP clears patient to resume PT]] [[APP uses a check-back for understanding]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) "I am working with our Mr. Francis. She arrived at PT for her session just a little bit ago. When she stood for to begin her PT, she appeared to have an episode and ended up falling-- which happens some times. Anyway, I am slightly concerned but she may be able to give therapy a go." The nurse and medical student decide to... [[Continue with PT session]] [[Call Ortho to assess the hip]] [[Call a Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) "Hello. (S)This is Medical Student working with physical therapy today. I am calling about our patient, Mrs. Francis. She arrived to us for a session today but I have some concerns. (B) As you may know, she recently had her left hip replaced and is POD 1. (A) Upon standing here, Mrs. Francis had an assisted fall to the ground, landing awkwardly on her left lower extremity and may have bumped her head on her wheelchair on the way down. (R) What would you like me to do?" The team decides to... [[Continue with PT session]] [[Call a Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) Nurse says that as far as she knows, Mrs. Francis has been feeling well. She ate breakfast fine this morning. The nurse recommends to... [[Continue with PT session]] [[Call a Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) Medical Student and physical therapy pick up Mrs. Francis and allow her to get her balances. After 45 minutes of her therapy session, Mrs. Francis collapses again and is unconscious. [[Delayed Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) "I am working with our Mr. Francis. She arrived at PT for her session just a little bit ago. When she stood for to begin her PT, she appeared to have an episode and ended up falling-- which happens some times. Anyway, I am slightly concerned but she may be able to give therapy a go." Ortho decides to [[Continue with PT session]] Ortho asks for more information [[Medical Student gives SBAR]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) The APP responds with a check-back. Ok, so Mrs. Francis is POD1 who arrived for a physicial therapy session today. Upon standing she had an assisted fall to the ground. She landed awkwardly on her leg. Then... [[APP clears patient to resume PT]] [[ APP asks if that is correct]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) A Medical Emergency is called over the hospital system with more interprofessional team members arriving. Her vital signs are checked and emergent labwork is obtained. Her troponins are elevated and serum creatinine is increased. She is sent for a stat CT scan to rule out a pulmonary embolism and intracranial hemorrhage. She is started on BiPAP for respiratory support. She is then transferred to the ICU for close monitoring. Would you like to start again? Yes, this seems like a poor outcome [[Introduction]] No, this outcome was unavoidable. [[Next steps]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) APP misheard SBAR and did not realize that Mrs. Francis hit her head. The Condition C team helps Mrs. Francis up to a chair, checks her vitals, and resumes PT. After 45 minutes of therapy, Mrs. Francis collapses again and is unconscious. [[Delayed Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) The medical student says, "No. Everything you stated is correct, except that Mrs. Francis also hit her head during her fall." Then... [[APP clears patient to resume PT]] [[APP takes over care and orders a CT scan]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) The medical student joins the APP and arrives on the floor with Mrs. Francis after her CT scan. As the medical student, you decide to... [[Medical Student rushes to noon conference]] [[Medical Student provides I-PASS to floor team]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) APP thanks medical student for staying to assist with Mrs. Francis and asks them to report back to the floor team. "(I) I believe Mrs. Francis is stable. (P) Mrs. Francis just had a Medical Emergencycalled while during her PT session. She is POD 1 from a left hip replacement. Upon arriving at PT, she had an assisted fall to the ground. She landed awkwardly on her leg and struck her head on the wheelchair. We performed a CT scan that ruled out an intracranial hemorrhage. (A)I am concerned for a concussion and the reason for her syncope. She will require a work-up to determine the cause of her syncope as well as an assessment of her operative leg. (S)The floor team should also monitor vital signs and call a Medical Emergency if she deteriorate. (S)Do you have any questions for me?" [[Yes, I do have several questions for you]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) The floor did not receive patient timeline and are beginning general patient intake. Without knowing what vital signs to monitor, Mrs. Francis becomes unresponsive. [[Delayed Medical Emergency]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) You really should start over. The patient may have avoided escalated care like ICU management, BiPAP, etc. [[Introduction]]

(enchant:?page,(text-colour:black)+(bg:white)+(font:"Tahoma")) Congratulations, you made it to the best outcome for Mrs. Francis! She was stabilized and due to some ongoing shortness of breath, she had a CTA. A minor PE was identified and treated with oral medications. Please use the following to discuss different elements of TEAMSTEPPS. * How many different professions were involved in Mrs. Francis's care today? * Which of the communication strategies used today seem the most practical? * How do communication techniques/styles compare and contrast across professions? For instance, do you expect that physician to physician communication is different than physician to nurse? Why or why not?