[Logbook v2] Adding support for Emergency Medicine

[anaestheticsapp]

Form

• [x] Add new form fields location, problem, disposition
• [ ] Problems list
• [ ] Critical events move to top
• [ ] Ultrasound form items
• [ ] Update procedure list with items from RCEM curriculum

Other pages

• [x] Cases tab
• [ ] Graph tab
• [ ] Report tab

First draft for layout

Date - radio datetime

Session - radio - Morning, Afternoon, Evening, Night

Location - radio

• Resus / Majors / Minors / paeds / RAT

Age - radio age

Problem ?radio ?select ?new filter button (select medical or surgical then next set of options open, only able to select one)

• Medical (cardio / resp / renal / neuro / endo / GI / Rheum / haem / oncology)
• Surgical (General / Ortho / ENT / Max Fax / Neurosurg / Vascular / Gynae)

Diagnosis - text - depending on specialty chosen there will be a number of prepopulated options (TBC) e.g, cardio - STEMI, NSTEMI, Unstable angina, cardiac failure etc.

Critical events - check / multiselect list (select any number) - Cardiac arrest / respiratory arrest / sepsis / major trauma / major haemorrhage / low GCS / emergency airway management / arrhythmia

Procedures check, allow custom items

• ultrasound (further sub section opens up)
• arterial line
• central line
• chest drain (seldinger / open)
• sedation
• reduction of fracture/dislocation
• airway management
• suturing
• cardioversion

Ultrasound sub section - ??? Scan - FAST / focused ECHO / vascular access / AAA / Lung / Other (free text) Reason for scan (free text) Pre scan (free text) Findings (free text) Post scan (free text)

Supervisor - radio

• Same options as theatre/icm/theatre

Outcome - radio

• Inpatient ward
• Critical care/ HDU
• Transfer (major trauma/stroke/cardiac)
• Discharge
• Ambulatory follow up
• Observation/short stay unit

Notes - text area

Internal note

• no plans for I18N
• link to alpha is private, do not post

[sb337]

Location

• What does RAT stand for?

Problem requires some thought.

• Option 1 use as is, but form might be more complex with large number of items to select from
• Option 2 use of categories ie Head & Neck (would include neurology, neurosurgery, ENT, MaxFax, ...), Respiratory, Cardiovascular (would include cardiology, cardiacsurgery), Renal, Urology, Metabolic, Abdominal, Haematological, Limbs, Oncology but reports will be limited and won't be able to generate reports per speciality
• Option 3 ???
• We won't be able to change this form item once final decision has been made, so this needs to be thoroughly tested

Ultrasound subsection

• Not sure how to design this yet, ?sub-item form ?new form item ?dialog box
• Scan must be radio buttons, won't be able to add free text (but can leave Other to select from)
• What are the pre and post scan form items for?

[jamesevee]

RAT is 'rapid assessment and treatment' - basically triage with some initial tests requested and treatment started.

For the 'problem' I think it would be particularly nice if able to focus down into individual specialties, so people can get an idea of the specific casemix they are seeing. If having subsections is too messy or tricky to do, then would it be better/easier to just have one list of categories as radio buttons (but potentially quite a lot)? Other option would be scroll wheel style (as on the 'reason for referral' section in ICM) - ordered alphabetically seems easiest to me.

Ultrasound - how you have it now on the draft you sent me looks great, how it just opens up beneath the procedures section. Most importantly, will it be possible to have some sort of discrete ultrasound logbook output where you can see all your scans and all your written text arranged in some sort of table (this would just mean it could be directly used as your formal logbook for sign off, rather than having to transpose into something else first). In the standard curriculum logbook format it is structured as 'pre scan' (space for comments about setup/positioning - e.g. ideal ultrasound probe might not be available, patient may not be able to lie flat etc.), 'findings' (probe used, what images were obtained, could you get all required views, any limitations, key findings etc.), 'post scan' (findings explained to patient, how were findings documented, how were findings used - e.g. decision for CT).

Is it possible for 'critical events' to appear under diagnosis so it comes up early on? Also can the items in these be made into radio buttons or are there too many options to fit this in?

[anaestheticsapp]

I think you are right, better to have specialities for the problem form field. I quite like the categories from the RCEM curriculum. We could have those as either radio buttons (hiding infrequent ones) or a select dropdown list (like the ICM one). Maybe we can merge some of them to make the list shorter. Conditions/Issues/Presentations can go into the diagnosis list. I updated the problem field with the new categories from the curriculum.

Yep planning a section in the reports tab just for ultrasound. This might also be useful for ICM trainees as well.

Do you have a link for the curriculum logbook format? Text areas are quite difficult to use on mobile, not sure if many people will use them. Added the FICE logbook form items to the website (click on Ultrasound then ECHO), maybe we can implement similar style for the other scans?

Also see FUSIC logbook paper forms for reference

Will move critical events to the top. I tried radio buttons in the past and didn't really work. Been working on a dialog box with categories so people can select several items. It's somewhere in my code just need to find it and then we can test it.

One of those blue notification messages has an "Update" button, you have to click on it to see new changes.

[jamesevee]

I think how you have the problem categories is great now - as long as you don't think the section as a whole is too big/unwieldy, in which case we could try the scroll wheel style selector?

For ultrasound, I have attached a copy of the logbook I am using - annoyingly RCEM don't seem to actually specify what they will accept or not, and don't have their own example - I'm going to check in with the regional ultrasound lead for clarity. For EM, the echo is far more basic than FICE or FEEL and is mainly limited to cardiac arrest and looking for tamponade/presence of cardiac activity/massive right heart strain, so I'm sure using FICE or FEEL logbook criteria should be more than adequate. This link https://www.rcem.ac.uk/docs/Training/1.14.5%20RCEM-EMUS-booklet%20(3).pdf on page 66 - 69 has examples of the structure for the final sign off for each category, so I think most logbooks are based on this.

Thanks for all your work so far!

James Everson Ultrasound Logbook.docx

[anaestheticsapp]

Form has been added to the app. Rest will be implemented based on feedback and usage

[anaestheticsapp]

Form will be finalised in the next few weeks and option to generate reports added. Feedback so far:

• [x] Change ECHO to Echo - this broke the Ultrasound form, fixed with the next update in a couple of days (after 23/5/22)...
• [x] Hide Lumbar Puncture