Lab Changes
FYI the lab is moving to new chemistry analysers at both sites.
Listed below are the most notable changes we will see with our new platform:
1. Move to High Sensitivity Troponin T
Currently, Troponin I is offered at MT and High Sensitivity Troponin I is measured at the QB laboratory. With the move to the Roche platform, both laboratories will report High Sensitivity Troponin T. This is a significant improvement with respect to standardization of troponin results between both hospitals.
While high sensitivity Troponin I and T differ in certain characteristics such as specificity, duration in the blood and reference intervals, both are considered equivalent in their ability to detect potential cardiac damage in emergency and acute care settings.
Prior to going-live, we will be engaging with our clinical colleagues through meetings and presentations. The purpose is to provide educational material to prepare for the upcoming change and decide on appropriate cut-offs and interpretative comments to accompany the change to Troponin T.
2. Move to NT-Pro BNP
Our current marker for the diagnosis and rule out of CHF is BNP. This will be replaced by NT-Pro BNP on the new analyzers. Both biomarkers have similar diagnostic accuracy with respect to the diagnosis and monitoring of CHF.
NT-Pro BNP has a longer half-life and is present in higher concentrations than BNP, thus providing a greater sensitivity. In addition, unlike BNP, NT-Pro BNP is not affected by Entresto.
Like troponin, this is another biomarker that requires engagement with clinicians to review the change in reference intervals and interpretative comment.
3. Bilirubin reporting at MT
The current platform at MT directly measures unconjugated bilirubin, which is unique to this vendor platform. The Roche platform directly measures Total Bilirubin and Conjugated Bilirubin. Unconjugated Bilirubin is a calculated result based on Total and Conjugated Bilirubin.
4. Update to calculation for LDLc
As part of the new instrument implementation, we will also be updating the equation used for calculated LDLc. The current Friedewald equation will be replaced with the NIH equation, which has been validated in the Canadian population. The NIH equation has a number of advantages compared to our current calculation, including a better estimation of LDLc and the ability to calculate LDLc at much higher triglyceride levels.
WSIB Process
We have a new communication order for WSIB paperwork. FYI — it should prompt the clerks to start the paperwork with the patient's demographics pre-completed.
eReferral Process (Referral Letter*)
We have a new electronic referral process that we are trialling live as of May 12th. This is intended to optionally replace the generic paper referrals that are used in both departments. It should be much faster than searching for a paper form and a patient label.
How to use: Create Note → Referral Letter*
There are two autotexts, ]referralMIDTOWNlong and ]referralMIDTOWNshort, that have been created (please save and modify as you see fit — I'd suggest renaming and adding your billing number at the very least).
The autotexts quickly pull in the patient demographics, the ED note, and imaging results. Then you add the reason for referral and who it is being sent off to. Once signed, it should automatically get sent to the clerks to send off to the consultant, and a copy is saved in the chart.
Vero AI Scribe
The paid memberships are available to use if you have requested this. Log in as usual and continue to use it. There is signage in the departments outlining this for patient awareness — please obtain consent to use it during your patient encounters.
If anything comes up or if there are any questions, feel free to reach out directly to support@veroscribe.com.
Form 1 / Form 42
Gentle reminder that the physician is responsible for explaining the certification under the MHA to the patient and providing the Form 42.