Memo

To:Surgeons, Physician Assistants, Fellows and Residents
From: Dr. David Dries, Assistant Medical Director, Regions Hospital

Dana Langness, Senior Director of Surgical Services
Dr. Matthew Layman, Director of Perioperative Services


Date: October 11, 2010


Topic: History and Physical Documentation & the Importance of Communicating Accurate Expectations
History and Physical Documentation

The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) require that a physician must complete a medical history and physical examination no more than 30 days before admission for elective surgery. Even though the medical history and physical may have been completed within 30 days before admission, due to changes in current regulatory guidelines, an update to the patient’s condition since the assessment (H & P) must be recorded at the time of admission.

CMS and TJC require each patient to be reassessed on the day of surgery, inpatient or outpatient, prior to surgery. The anesthesiologist will reassess each patient for any changes in the patient’s condition for those patients with an H & P completed within 30 days before the patient was admitted. This reassessment will serve as the update to the medical history and physical and will be documented in the patient’s medical record.
However, when the patient has a medical history and physical examination that was completed more than 30 days before the admission for surgery or is not signed and dated by the provider, the surgeon will need to do a new, complete medical history and physical before the patient can have surgery.

Note: Except in emergencies, a dictated medical history and physical examination that has not yet been transcribed and attached to the medical record, will not meet regulatory standards. In an emergency, when there is no time to record the complete history and physical examination, a progress or admission note describing a brief history and appropriate physical findings and the preoperative diagnosis must be recorded in the medical record before surgery.

We can no longer accept the practice of performing the medical history and physical examination the morning of surgery. Unless there are unusual extenuating circumstances (e.g. patient traveling great distances), the patient’s medical history and physical examination may only be done the morning of surgery in emergency situations.
Surgery will be delayed until the issue with the patient’s medical history and physical has been reconciled unless the surgery to be performed is due to an emergency.

The Importance of Communicating Accurate Expectations

It is important that we communicate accurate expectations to family members regarding a patient’s stay in PACU.
We continue to have families experience frustration due to several issues:
1. They were told by the surgeon an estimated PACU timeframe that was too short;
2. They were told the patient had been moved to PACU when they were really still in the OR;
3. Lengthy close times are not being considered when communicating wait times to families (e.g. the surgeon tells the family that the surgery is over and the patient will be in PACU for about one hour when in actuality they are still closing and, in some instances, the closing is lengthy)

Therefore, we ask that when communicating PACU times, you use our average of 60-90 minutes from entry into PACU. Also, when you give a time estimate, please take into consideration the time the patient will remain in the OR for closing before moving to PACU.

We appreciate your help with setting clear expectations for our families.

cc: Gretchen Leiterman
Ken Holmen, MD

Join the 2011 Core Competencies Conference Planning Committe

Last year, we generated many wonderful ideas we would love to explore further and get input from program directors and residents. Based on the information we gathered last year, we would like to propose the theme " Connecting with the community we serve." The conference will be held, Thursday, May 19, 2011.

We typically meet a couple of evenings and dinner is provided. The planning meetings were well attended the last couple of years and we would like to continue to benefit from your contributions.


The planning sessions will be held on the following dates:
Thursday, September 30th, 5:30 p.m. to 7:30 p.m., location TBD
Thursday, October 28th, 5:30 p.m. to 7:30 p.m., location TBD

Please contact: Marcella.X.delaTorre@HealthPartners.com directly if you are able to join the planning committee.

Kudos!

Congratulations to Dr. Kara Kim, one of two recipients of the first annual ACEP Quality Improvement and Patient Safety Section Resident Quality Award! We look forward to Dr. Kim's continued involvement in quality and patient safety in the future. She is a budding young star in medical quality management. Dr. Kim is one of Regions Hosptial's Emergency Medicine Chief residents this year.

SAVE THE DATE: Wednesday, August 18, 2010

Residents, Fellows, Medical Students, Program Directors and Coordinators - YOU ARE INVITED! 

ATTENTION ALL RESIDENT ALUMNI

Important Information Re:
Medical Resident FICA Refund Claims

If you were a Regions Hospital/IME resident during the years 1997-2005, you may be eligible for a refund of the FICA you paid during that period of time. For more information and to receive an important letter and accompanying employee consent claim form, call 651-254-1496 and leave your name, home address, telephone number and email address and a letter and form will be sent to you. Be sure to return the employee consent claim form no later than the date specified in the letter.

Transfusion Best Practice Alert Announcement, Effective 7.28.10

On July 28, 2010 a new best practice alert will be implemented to ensure appropriate use of donated red blood cells. Regions Hospital transfusion guidelines were developed by the hospital Transfusion Committee and approved by the Patient Care Committee. When a red blood cell transfusion is being ordered, Epic will examine the prior hemoglobin result. If the hemoglobin value does not meet best practice guidelines, the following message will appear.

This change is in accordance with best practice as exemplified by this seminal article: N Engl J Med. 1999 Feb 11;340(6):409-17. This alert will be presented to all persons placing the order, regardless of location, role, or admission status. It will appear once per 24 hours on any patient. This BPA has been approved by the Patient Care Committee of Regions Hospital. Please direct questions to Dr. Subramanian, Director of Pathology Informatics 651-254-9628 amar.t.subramanian@healthpartners.com

2010 New Resident Orientation

REGIONS HOSPITAL NEW RESIDENT ORIENTATION

Thursday, June 24, 2010,

North Woods Conference Rooms - 2018 A&B North

Breakfast & Lunch will be provided by:

Scrubs Reminder

SCRUB POLICY # RH-SP-RM 01:11


Surgical attire is worn to promote high level cleanliness and hygiene within the surgical environment and to provide a barrier to contamination that may pass from personnel to patients, patients to personnel, as well as from personnel to sterile instruments. Additional protective barriers are worn in order to prevent exposure to blood or body fluid contamination during the reprocessing of instruments and equipment. Scrub suits are appropriate for designated areas (e.g. OR and L&D). In all other areas, a long white coat must be worn over the scrub suit.

• Hospital provided scrubs are to be worn inside the hospital only.

• Scrubs are not to be worn outside for breaks or smoking

• Scrubs are not to be worn while traveling between hospitals

• Scrubs are not to be worn home; or to and from work

• Before leaving the hospital, staff should change into street clothes and deposit used scrubs in the laundry hamper



(This information can also be found in the 2009-2010 Graduate Medical Education Resident Handbook)