Provider Letter
Reminder on how to follow the eReferral process — job aid attached.
Summer Games in Waterloo Region
FYI — the Ontario Summer Games are being held in Waterloo Region this weekend. You may see some patients transferred to the ED if needed. They'll likely have a referral form (attached below).
Neurosurgery — mBIG Follow-up
OH received our feedback that this process change felt rushed, and leadership at WRHN indicated we would not be ready to implement the entire process last week. Their response:
Last week the attached memo and updated modified Brain Injury Guidelines (mBIG) were shared to create awareness of a change in the practice for eligible lowest-acuity cases. For these cases, if ED physicians contact CritiCall they will now be connected with ED Peers for guidance rather than routine connection to neurosurgery. Neurosurgical consultation remains available when clinically indicated, but for patients at lowest risk (mBIG 1) is not routinely required unless there are features that otherwise cause concern.
mBIG are evidence-based and well-established in multiple jurisdictions. Ontario's implementation adapts these guidelines to support consistent application within the provincial health care system, beginning with the lowest-risk patient populations. Importantly, mBIG supports decision-making but does not replace clinical judgement. Radiology reporting plays an important role in the assessment and management of patients with traumatic brain injury. Emergency physicians integrate imaging findings with their clinical assessment, alongside other relevant factors, to determine patient management, disposition and consultation needs.
Our aim in the communication and distribution of the updated guidelines was to provide awareness and visibility into how specific imaging measurements inform clinical decision making, contribute to final mBIG classification, and to encourage inclusion of those measurements as relevant to the case. Assigning a radiologic mBIG category is not required at this time.
As noted, we are convening a working group with imaging experts — representing both subspecialty and general radiology — to help guide this work and identify areas where additional resources would be helpful. A Community of Practice webinar on August 26, 1 to 2 PM will also bring together multidisciplinary care teams for education, discussion, and shared learning.
Let me know if anyone has questions. For neurosurgery cases, please familiarize yourself with the mBIG calculator — this is the direction OH is moving. In the interim, continue to call CritiCall as required.