Interprofessional Education During Residency:

The Highland Allied Health Rotation Program (H-AHRP)

Emergency Medicine is a team-based specialty requiring daily collaboration with many  professions within the hospital. During residency, trainees have the opportunity to rotate on different medical and surgical services, but have  minimal education from emergency nurses, respiratory therapists, social workers, pharmacists or laboratory staff.

In 2016, Highland graduate Dr. Tiffany Chioma Anaebere started the Highland Allied Health Rotation Program (H-AHRP) to facilitate an introduction to the ED team and help residents better understand the roles of interdisciplinary providers. H-AHRP aims for residents to:  

(1) better understand the roles of their fellow health professionals

(2) learn to perform a number of procedures common to that role

(3) develop skills of interprofessional communication and teamwork

     while getting to know team members

 

The desired outcome is a resident-physician who is educated on the contributions of other healthcare professionals, understands how to effectively integrate their skill sets, and champions interdisciplinary approach to patient care.

 

The H-AHRP is integrated into the EM intern orientation month. In addition to didactics, training sessions, and ten ED shifts, interns participate in five H-AHRP sessions with the following health professionals:

  • ED Nursing

  • ED Respiratory Therapy

  • ED Pharmacy

  • ED Social Work

  • Laboratory


 

The nursing, respiratory therapy, and pharmacy sessions are scheduled as individual four-hour sessions with a preceptor in the ED. During the session, the intern shadows the preceptor, learns procedures and tasks specific to his or her role on the healthcare team, and meets colleagues with whom they will work over the next four years. The social work and laboratory sessions are one hour group sessions with a social worker and laboratory administrator (which includes a guided tour of the lab!)

Sample Schedule during a week of intern orientation month

RT: Respiratory Therapy, RN: Nursing, PH: Pharmacy
D: Day Shift, S: Swing Shift

25

RT: Intern1
RN: Intern2
PH: Intern 3

D: 2 interns
S: 2 interns

3-6pm lectures

26

RT: Intern 4

RN: Intern 5

PH: Intern 6

D: 2 interns

S: 2 interns

3-6pm lectures

27

Conference

RT: Intern 7

RN: Intern 8

PH: Intern 9

S: 2 Interns

28

RT: Intern 10

RN: Intern 11

PH: Intern 12
D: 2 interns

S: 2 interns

3-6pm lecture

29

RT: Intern2
RN: Intern3
PH: Intern 1

D: 2 interns
S: 2 interns

3-6pm lectures

30

D: 2 interns

S: 2 interns

N: 2 interns

Sample procedures performed/tasks learned during each session

LAB

  • Proper labeling of tubes

  • Blood bank safety

  • Type of additives in each tube

  • Special handling (ie. Lactate on ice)

  • Time frame of processing lab studies

  • Common provider/lab errors

  • Microscopy techniques

  • Cultures – what it takes to be positive

  • Ordering special analyses: CSF, paracentesis, joint aspiration, parasites

  • When to contact the lab for heme/onc cases

RN

  • Art line set up

  • IV placement

  • Foley catheter/straight cath

  • Medication administration (PO, IM, IV, drips)

  • Obtain EKGs

  • OG tube placement/wall suction management

  • Medication protocols (DKA, heparin, electrolyte replacement)

  • Wound assessment and care

  • Location of supplies in code room (including peds!)

  • Set up/ work IV Pump, titration of drips

RT

  • BIPAP set up and management

  • Bag valve mask

  • Endotracheal intubation and aftercare

  • Oxygen delivery devices (NRB, NC, Hi flow NC, regular facemask)

  • Asthma treatment

  • Peak flow measurements

  • Equipment ordering (vapotherm, bipap)

  • Tracheostomy care

  • Arterial blood gas and interpretation – including co-oximetry

  • Ventilator modes and management

SW

  • Shelter Referral

  • Placement

  • Sexual assault/DV (including DV reporting form)

  • Decedent care/death notification

  • Family Collateral

  • Mental Health Service Referral

  • Substance Abuse Referral

  • Minors in the ED

  • CPS/APS referral

  • Resources for trauma patients

Pharm

  • Medication availability: ED Pyxis vs. brought from pharmacy

  • Review a patient's allergies, identify cross-reactivity

  • Calculate weight-based dosing, conversion to volume

  • Run drug-drug interaction checker for polypharmacy

  • Medication delivery route: IV, IM, intranasal, nebs, PO, PR, topical

  • Review the contraindications for pressors or anti-arrhythmic

  • Management of IV infiltration

  • Assist with a conscious sedation or intubation medications

  • Risk classes of medications in pregnancy

  • Review antidote dosing for acute poisoning

  • Participate in the pharmacy side of a medical code or trauma activation

This program was presented at the CORD Academic Assembly in 2019. For more information or to request a syllabus, please email ashley.christine.rider@gmail.com or mari.nomura@gmail.com.

 

Your H-AHRP coordinators,

 

Ash, Mari, and Chioma


 

References:

Beeson MS, Carter WA, Christopher TA, et al. The development of the emergency medicine milestones. Acad Emerg Med 2013;20(7):724–9.

 

Rider A, Nomura M, Anaebere TC, et al. Structured Curriculum for Interprofessional Training of Emergency Medicine Interns. Council of Emergency Medicine Residency Directors (CORD EM) Educational Soundbites. Oral Presentation. March 2019.  

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