1, code system,
if you are in the hospital, you will hear lots of code annoucement, what does that mean?
Code red: means fire, most of the time is fire drill, usually once a month, normal practice, the security guards will clear the visitors in the building, nurses will close the ward door, and clear the hallways, usually the fire drill lasts 5-10 minutes.
Code Blue (Pink): both means heart arrest, code blue is for adults, code pink is for infants. a team consisted of emergency physician, ICU nurses, respiratory therapist, anesthesologist and security guards will run into the scene within 5 minutes, take over the CPR from the floor nurse, until the patient is stable then to ICU.
Code white: violence. a team consisted of 4 security guards, psychatrist and psychatry nurse will run to the scene, talk to the patient or families, sometimes, they have to restrain the patient, if the patient is violent to self or to staff, the psychatrist will fill a form, then a security guard will stay with the patient until reassess depend on patient's condition. if the patient is dementia, or wonder around, a private sitting will be assisged (hospital pay for it) to accompany to patient.
there are also code grey, code black, code purple.......
2, Acute care facility
unlike hospitals in China, the unit is relatively small, and there is no doctors staying on the floor. so the patient care is managed by nurses, interdiciplinary teams and house keepers. for example, an acute stroke unit with 25 beds, there are 1 nurse manager, 1 clinical leader (RN), 6 nurses at days, 4 nurses at night; 2 unit clerk (do orders), 1 occupational therapist, 2.5 physiological therapist, 1 speech pathphysiologist, 1 dietition, 1 social worker and 1 pharmacist. The doctors will come to see their patient once a day, oncall doctor is always available at night and weekends. As nurses are doing whole systmic assessment and know the patient well, once patient condition changes, they know what is happening and know what they want from the doctors. beside, there is a Medical emergency team available 24/7 for non code issues, RT is also available 24/7.
there is also paster available for you if you need one; if patient needs to be discharged home with community care (such as long term antibiotics treatment, or home care), the nurse from community care centra (CCAC) will come and assess patient and assign nurse for you.
3, Canada has free medical care, in Ontario, it is covered by OHIP. doctors either as physician or at emergency, never, ever ignore life threatening diseases. So if you called ambulance, the paramedics have already had a basic impression of what happened, the nurse in triage also rank patient's urgent condition by their judgement. Flu, fever, limb fracture .... they are not life threatening, so you wait. but if you have heart attack, stroke, massive bleeding, extremely high fever, sepsis, shock, you are definitely on the top list.
Acutally, the ontario stroke strategy is the best in north america. once you call and report stroke, the 911 will automatically initiate the system, they will pick you in short time, sent to emergeney, if you are within time frame and be a candidate for TPA, they will do it right away. the stroke patient is followed as ER-stroke unit-rehab-community care, the whole process is monitored and followed until your activity of daily care is back to standard.
4, Treatment
back home, we judge the doctors give good care or not by giving IV treatment or not most of the time, so you go to see a doctor, you expect IV fluid. what is why everybody get IV even there is no need to.
It is different here, doctors encourage patient to eat, so the IV is just for hydration, usually Normal saline. once the patient starts eating, IV will be locked, leave it for IV meds such as pain, vomiting, antibiotics...; for patients who can not eat, a feeding tube is always inserted, all kinds of Ensure will be ordered by diatition; if patient starts showing signs of swallowing, gag reflex, the speech pathapsyologist will assess the patient and decide to remove the tube or not. So do not be surprised if you get the "worst " treatment in Canada.
I think it is a great idea not adding all kinds of unnecessary meds into sterile fluid. I never see one fluid or blood reation here in so many years. one of my professor who suffered an infarct stroke, admitted into her own hospital, treated by the best doctors, she told me her worst nightmare was the fluid reation, twice, shivering, high fever, she said she almost lost her life, she also consider her loss of remembering names was cost by the fluid reaction too.
5, pain control
I do not have the concept of pain control before I came here, you tolerate pain, you were told all your life, by textbooks, by teachers, by parents, by doctors.... It is so amazing to here that doctors and pain team staff tell patients zero tolerance of pain. so you see self control pain pump, morphine, oxycontine, codein...... I think it is good idea, because they want to mobilize after big surgery, they want you out of bed, even sitting in the wheelchair with feeding tube and trachectomy on; they want you to get better fast. besides, short term of narcotics will not make you addict.
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