Welcome to Women’s College Hospital

Orientation

Malini Hu

WCH Chief Medical Resident 2024 – 2025 

Malini.Hu@wchospital.ca

Cell #: 647-938-8965

Rm #: 3452

Welcome to Women’s!

• Founded in 1883 – because medical schools in Toronto refused to admit women (Dr. Emily Stowe)
• In 1906, women were permitted to enroll, but WCH remained as a hospital run by women, for women until 1961
• Canada’s leading academic ambulatory hospital

Security (ID badge)

Cafeteria

AACU

Med Ed

Food Options

Important Places

Important Places – Clinic Spaces

Important Places

• Room numbers to note:
• If parenting or breastfeeding/chestfeeding, there is a ‘Parenting Room’ on the main floor near the big TV screen/staircase
• Computer workspace: Medical Education area 2^nd floor Computer Room, 3421, 3426

Spaces to Eat

• Cafeteria
• 2nd floor Medical Education space
• Your individual clinic rooms
• Pink Cube and surrounding area
• Take the spiral staircase from the lobby up to the second floor and make a left. Pink cube is behind the auditorium
• Room 4406
• Outside on the patio (3^rd floor)

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Spaces to unwind

• Labyrinth: Ground Floor, behind Security office
• Wellness Room: Rm 2514 (there’s a massage chair!)
• Outdoor Patio: 3^rd floor, access through 2^nd floor staircase near auditorium
• Ask security also for access with your badge when you go to security office
• My office (come chat anytime): 3452

Transportation

• Parking:
• Parking lot is on Grenville Street. You can purchase discounted parking passes from the Business Office (3^rd floor)
• Bike storage:
• Two bike racks, one in front of the main entrance by the driveway and the other in front of Grenville street.
• Bike storage area on P1

COVID - PPE

• When providing direct care to patients without suspected or confirmed COVID-19, you can wear a surgical mask.
• When providing direct care to patients with suspect or confirmed COVID‑19, immediately initiate Airborne/Droplet isolation and wear an N95 mask (fit-tested, seal-checked), Isolation gown, Gloves and face shield.
• For Airborne/droplet isolation, doors of patient rooms should be closed.  A negative pressure room is not required.

PPE

• Face shields and N95s will remain available for anyone who wishes to continue using them
• Please remember to always perform Hand Hygiene on all four moments of patient interaction (Before initial Patient/Patient Environment, Before Aseptic Procedure, After Body Fluid Exposure AND After Patient / Patient Environment Contact).
• Ask your staff, clinic secretary or hospital education coordinator if you are unsure where to find PPE in your specific clinic.

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PPE Cart Locations

• 4^th floor: PPE Cart near Rm 4434
• AACU:
• PPE code blue cart by the nursing station for face shields
• PPE carts throughout AACU for N95 masks
• There is one room that nurses have access to with scrubs, additional face shields and N95s (just ask and they can let you in)
• 3^rd floor: PPE by the clinic secretaries in Endocrine
• Ask your staff, clinic secretary or hospital education coordinator if you are unsure where to find PPE in your specific clinic.

PPE

• Staff are expected to select the appropriate respiratory protection when entering a patient or treatment room to perform a task based on:
• Their point of care risk assessment (PCRA) as outlined by Directive # 5,�and the change in PPE recommendations by PHO.
• Public Health Ontario IPAC UPDATE: here
• If on call, please review protected code blue procedures i.e., airborne precautions
• PPE Videos on Blog, PGME PPE module
• Airborne if doing an AGMP
• Your safety comes first. Please reach out to me with any concerns re: PPE or if you would like a PPE refresher on donning/doffing

Point of Care Risk Assessment

• Questions to be asked:
• What are the patient’s symptoms?
• What is the degree of contact?
• What is the degree of contamination?
• What is the patient’s level of understanding and cooperation?
• What is the degree of difficulty of the procedure being performed and the experience level of the care provider?
• What is my risk of exposure to blood, body fluids, excretions, secretions, non-intact skin and mucous membranes?

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What to do if you’re sick?�

• If you need to be absent due to illness, please do the following:
• E-mail:
• CMR (malini.hu@wchospital.ca)
• Site Director, Dr. Shoba Sujana Kumar (shoba.sujanakumar@wchospital.ca)
• Your rotation Education Coordinator
• and your clinic staff for the day.
• Complete the online Occupational Health Absence Reporting Form

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• Do not return to work without clearance from OHSW. 

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Emails with Weekly Teaching Schedules

All morning teachings will end at 8:45 AM so that you can make it to clinic by 9 AM! ☺

Lunch time teaching - usually beginning at 12:15 for Endocrine teaching, 12:15 for clerk teaching, 12:15 ECG rounds. Resp/Radiology rounds start right at noon.

Tips for Ambulatory Medicine & Virtual Care

Tips for Ambulatory Medicine & Virtual Care

www.Virtualcarehelp.com

- Checklist for Virtual Care Visit�- Virtual Care Handbook

WCH WIFI

• WC_Guest
• Password is WomensCollege

COMPUTER FAQs

• Don’t know where password is?
• Check NIRV > Hospital Details > Computer ID. �Computer password = EPIC password.
• Difficulty logging into the computer
• Make sure the domain is ‘WCHOSPITAL’ not ‘S&WCHSC’
• Still having login problems?
• Email your Education coordinator and registrations.meded@wchospital.ca (and CC me)
• Servicedesk@wchospital.ca to reach IT (or ext 4357)

Other Computer-Related FAQs

• Tips and Tricks:
• Figure out Dot Phrases on day 1 for common things (PhysEx, sign off, RoS, etc)
• In the AACU common template are .cccnew or .aacuclinicnote
• Ask your staff at the start of daily clinic if there are specific Dot Phrases they would like you to use for their clinic
• In diabetes clinic, there will be diabetic flowsheets
• Chart in EPIC as you go, don’t “double chart” on paper and on computer
• Complete most of your note and AVS (after visit summary) as you are awaiting staff review
• Update the ‘Assessment’ section with PMHx, Meds, SHx, Allergies
• Re: medications – select from the list of medications as much as possible, there is an ‘other medications’ option in EPIC as a last resort but try to pick from the list as much as possible

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Other Computer-Related FAQs

• DRAGON DICTATION: Everyone should have access – the profile will be emailed to you by EPIC team, and available on my blog under Orientations and Manuals tab “EPIC – Dragon Dictation Instructions,” password mywch.
• VIRTUAL ACCESS: Please note that there is NO expectation to be pre-charting prior to clinic. There are certain clinics (e.g. headache) that are virtual, and you will receive access to virtual access as needed. Otherwise, please contact your staff physician to request access as applicable.

Other Clinical Resources

• Language Interpretation Services
• These can be found by the nursing station in the AACU
• Can dial from any phone including cell phone or land line
• This is on wall in endocrine clinics
• Check with your clinic preceptors / admin at front desk where these are your respective clinics
• Vitals at clinic visits
• In AACU, nursing will do vitals and they will be entered into EPIC
• Check with your individual clinic supervisors what the workflow is
• In cardiology clinic, there are manual BP’s on the wall in every exam room. There is one portable BP machine in the hallway

Wellness Resources

• PGME:
• https://pgme.utoronto.ca/current-trainees/while-youre-training/access-wellness-resources/
• Connecting with someone and/or disclosing/reporting mistreatment
• https://pgme.utoronto.ca/current-trainees/while-youre-training/access-wellness-resources/urgent-advice-for-pgme-trainees/personal-health-safety/learner-mistreatment/
• Contact: pgwellness@utoronto.ca or 416-964-3074

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• Office of Learner Affairs:
• https://meded.temertymedicine.utoronto.ca/office-learner-affairs

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• IM Resident Advisor:
• Dr. Leora Branfield Day provides a nonjudgmental space for IM residents seeking confidential guidance or assistance in navigating supports for professionalism, wellness, or learning environment/learner experience concerns.
• im.residentadvisor@utoronto.ca

Harassment and Discrimination Policies

You have the right to learn and work in a safe, professional and collegial environment without mistreatment, harassment or discrimination.

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This includes verbal, physical, sexual harassment and discrimination as defined by all hospital policies, the Ontario Human Rights Code and the Ontario Occupational Health and Safety Act.

Harassment and Discrimination Policies

The University and all hospitals are committed to ensuring that you work in an environment free from mistreatment, harassment and discrimination

What should I do if I experience mistreatment from a patient or family?

• Speak to or email your staff, Chief Medical Resident and/or Site Director

What if the perpetrator is your staff or another employee?

• Speak to or email your Chief Medical Resident and/or Site Director
• You can also directly contact your program director/Dr. Goguen, Dr. Reena Pattani (Director of Learner Experience, Temerty Faculty of Medicine), Dr. Glen Bandiera (Associate Dean, PGME)

In all cases, there are clear policies, processes and supports to protect your confidentiality and help ensure your safety and well-being

Code White Policy

If a patient exhibits threatening behaviour that puts you or themselves at risk, call a Code White by dialing 5555

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When Should a Code White be Called (Extension 5555)?

• If a person is verbally and/or physically threatening towards you, themselves or others and/or
• Not responsive to verbal de-escalation, negotiating, redirection and/or
• May require restraint (chemical and/or physical) and is anticipated to be resistive and/or
• Urgent assistance is required

Code White Policy

1. Ensure your safety and remove all at risk individuals if possible
2. Dial 5555 if on-site to request a Code White
3. Brief the Response Team on arrival
4. Inform the patient’s MRP and your staff

How Can I Call a Code White?

Reporting Patient Safety Incidents

• If you have been part of or witnessed a patient safety incident, any unplanned or unintended event or circumstance which could have resulted or did result in harm to a patient, or a “near miss,” this should be reported
• mywch.ca
• Click on “IRIS – Incident Reporting” on the left hand column

EPIC and Registration

We should be here

WCH CMR Blog: www.wchcmr.org

Password for anything protected: mywch

• Orientation Slides / Day 1 Stuff
• COVID-19 Policies
• Sick Day Policies
• Teaching Schedule
• Image Challenge
• Morning Report recaps

Contact me anytime!

Malini Hu

Cell: (647) 938-8965

Email: Malini.Hu@wchospital.ca

Room number: 3452

Office Phone: (416) 323-6400 ext. 4641

Important Contacts

Internal Medicine Site Director:

Dr. Shoba Sujana Kumar

Shoba.SujanaKumar@wchospital.ca

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Education Coordinator:

Nishevitha Sarathy

nishevitha.sarathy@wchospital.ca

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AACU Director:

Dr. Tara O’Brien

tara.obrien@wchospital.ca

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Locating x4141

Academic Education Coordinators

Acute Ambulatory Care Unit (AACU):�Orientation

Acute Ambulatory Care Unit (AACU)

• Short stay medical unit that provides urgent internal medicine assessment and management for patients
• Typically, these investigations and management occur within 24h
• Access to urgent blood work/imaging, ability to administer IV medications in similar fashion to ED
• Referrals generally from ED, ambulatory clinics, family doctors
• Aim is to avoid lengthy ED visits and limit need for hospitalization
• Great medicine!
• Variety
• Undifferentiated presentations
• Emphasis on diagnostic reasoning
• Manager, Consultant role

AACU Paper Forms and Procedure Checklists

• These can be found on the blog
• Orientations and Manuals
• AACU, Procedures, Clinic Resources
• Procedure Manual
• AACU Forms (paper forms for tests and referrals that are not directly entered in through EPIC)
• Also posted in the AACU in supply room and in the resident team room

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E-Faxing Prescriptions

• For residents creating a prescription to e-fax, you will need to include your clinician supervisor's name to be able to complete the e-fax. If you attempt to e-fax a prescription without entering your clinician supervisor's name you will reach a "hard stop", informing you of what to do next to proceed.
• If you intend to print out the prescription, then the step of adding in your clinician supervisor's name is not required
• There is a handout on this under the Orientation tab on the blog

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Ordering Medications

• "Clinic administered medications (syringe icon)" are different from "Outpatient Prescription (house icon).”
• Clinic administered medications
• Should only be used for those medications that will actually be administered in the clinic at WCH. When Clinic administered medication is ordered by mistake, the pharmacists have to reject these orders, and include a comment as to why its being rejected.

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After Visit Summary

• The after visit summary (AVS) is given to patients after medical appointments to summarize their health and guide future care.
• You can fill out patient instructions and follow up plans under the “Wrap Up” section.
• Once complete, you can print the AVS by clicking on “Print AVS” located on the bottom right of the screen.

AACU Patient Check Out Process

1. Provider (resident MD) must put follow-up information in EPIC WRAP-UP tab BEFORE patient leaves the exam room 
2. Resident MDs/clinical clerks directs patient to Med Secretary before leaving unit at end of appointment
3. If no plans for follow up please select the drop down option of "discharge to family physician or other provider" - from the menu if the patient is being discharged DO NOT check "PRN"

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AACU On-Call Logistics

• Handover:
• Receive handover from day team at 5pm
• Provide handover to day team at 8am
• Call Room:
• Located in the AACU (no badge needed)
• There is a lounge next door with a fridge, sink, and microwave

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On-Call Responsibilities

Clinical Responsibilities

1. Provide assessment and management of daytime AACU patients
• Follow up results of tests that are still pending and/or discharge patients
2. Consultation for patients not yet seen from daytime
• May have 1-3 new consultations
• Review with on-call staff in real time
• Go to mywch.ca, at the top left of screen click “Department of Medicine Call Schedule” to see who the on-call staff is for you to review with
3. Provide ongoing care for patients admitted to AACU overnight (rare)
4. Provide internal medicine consultations on post-operative patients if asked (rare)
5. Respond to any RN concerns*
6. Hold SCOPE phone
7. Respond to Code Blues

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*If you get a call about abnormal lab results for patients, please defer this to/inform the AACU staff on call

SCOPE phone

It is a phone that responds to a network of family physicians who have access to the internist on call.

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As the internist on call we can do the following:

1. Provide phone advice (only after reviewing with staff on call)
2. Decide if they need to come in to be seen in AACU that night or in the next few days with a referral.
3. Advise to send to nearby ED.

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It is rare to get a call after 5 PM.

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If you do get a phone call:

1. Get all relevant information including patient information, referral question, and call back number of the person calling
2. Review with the staff on call in real time to decide next steps around disposition.

Code Blue = Medical Emergency. Call 5555.

• Can be called for either an ACLS event or a Medical Emergency.
• Note that given this is an ambulatory hospital, patients are generally well.
• It is incredibly rare to have a true ACLS code.
• Some examples of codes seen:
• Presyncope/syncope (e.g. during blood work in Lobby Lab)
• Allergic reaction/anaphylaxis (e.g. CT/MRI on 2^nd floor)
• Hypotension, hypoxia, acute pain crisis.
• Unstable arrhythmias (e.g. cardiology on 4^th floor)
• Seizures

Code Blue Logistics - During the Day

• AACU Staff holds Cold Blue pager
• Team consists of:
• AACU resident/staff
• AACU Nurses
• Security/Transport
• Anesthesia & Nurse Manager.
• Unstable patients are transferred via EMS to nearby acute care hospital.
• Generally rare to transfer to AACU for management unless they are quite stable.
• Documentation:
• Collect name, OHIP # (+/- MRN), DOB, write a Code Blue note and make a copy for EMS staff (if you have time). Print off clinic note from EPIC if available.

Code Blue Logistics - On Call

• AACU On Call MD carries the Code Blue Pager.
• “Team” consists of:
• AACU MD (you)
• +/- AACU Nurse
• Security/Transport
• Note: there is no Anesthesia overnight.
• Expectations:
• If code blue is called, immediately go to assess the patient.
• Administer BLS / stabilize the patient to the best of your ability
• For allergic reaction / anaphylaxis: Epi-pens available in the CT/MRI scanner area
• For other medications: defer to AACU nurse for assistance
• There are also AEDs available in the hospital when needed (security can help locate the nearest one).
• 911/EMS is automatically activated by security
• Give verbal handover to the EMS staff upon arrival who will transfer patient
• Write a code blue note
• Notify the AACU staff on call

Code Blue – Disposition on Call

• Guiding principle is that the code blue leader will make all decisions about what to do with the patient. If the patient is under the care of another WCH MRP (e.g. a surgeon) then those decisions should be made in consultation with the MRP
• For all overnight code blues, 911 will be automatically called. We have no ability to manage a deteriorating patient, so in terms of disposition calling 911 and transferring to an acute care hospital is almost always the right answer.

If you can’t do call

Please contact the CMR, Malini Hu, as soon as possible �(page via locating or contact my cell: 647-938-8965)

Please also email the AACU staff for the day, Malini Hu, and Nishevitha Sarathy

• Malini.Hu@wchospital.ca
• Nishevitha.Sarathy@wchospital.ca

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