Clinical Quality Review topics for September 2014

  • -After ruling out ectopic, involve OB in patients with 2nd trimester miscarriage (these patient are more likely to need an intervention/procedure), or in unwell patients with 1st trimester miscarriage
  • -Discuss with the patient how they will get the prescription, and what the backup plan is if they can’t get the prescription
  • -Specifically consider vascular lesion with isolated hand or foot neurological complaints, such as a numb hand.
  • -Be mindful when ordering non-routine radiology. Have a low threshold to use free text to communicate with radiologist/radiology tech.
  • -Most head-injured patients with loss of consciousness do not need a head CT. Use a decision rule such as the Canadian CT Head rule.
  • -It can be easy to overlook neutropenia on lab results. As a rule-of-thumb, any patient with ANC < 1500 cells/mm^3 is neutopenic. All of these patients with fever should at minimum be admitted and most should have empiric antibiotics dosed.  Even without fever, all of these patients should be referred for urgent follow-up. Consider admission for patients with severe neutropenia (ANC < 500 cells/mm^3) even without fever.
  • -An important, often slowly progressing, infection in which the ED can make an important diagnosis is disseminated gonorrhea. This can be easy to miss. Consider disseminated gonorrhea for patients with polyarthritis and any signs of tenosynovitis.