Clinical Highlights in General Internal Medicine

General Internal Medicine Longitudinal Clinic Rotation

The Division of General Internal Medicine (GIM) has created a weekly year-long outpatient clinic (GIM Longitudinal clinic) for the fellows in General Internal Medicine to enable the fellow to acquire the skills required to be a competent specialist in ambulatory care. The clinic has now been in operation since October 2010. Each fellow is assigned a weekly mandatory clinic for the duration of their fellowship. The fellow will be assigned a preceptor for each clinic. Over the course of the fellowship the fellow will achieve competency in diagnosis, investigation and treatment of the specific subset of patients seen by General Internists including patients with:

  1. Chronic multi-system failure in the ambulatory care setting.
  2. Undifferentiated symptoms in the ambulatory care setting.
  3. Common medical problems in both the acute and ambulatory care setting.
  4. High acuity illness with disease in any one system complicated by other co-morbidities.
  5. An illness that spans multiple organ systems but that may not necessarily fall into one subspecialty area.

Referrals for the clinic have mainly come from 3 sources: urgent assessments from the ER, post-hospital discharge assessments, and urgent referrals from community family physicians. Each week a fellow will see and review either 3 consults or 2 consults and patients that they have identified from previous clinics that require follow-up.

The Internal Medicine Perioperative Assessment Clinic (IMPAC)

IMPAC (Internal Medicine Perioperative Assessment Clinic) aims to provide comprehensive, timely, patient centered, preoperative internal medicine evaluations that are linked to postoperative care. These consults are based on a standardized digital assessment form that has been developed which allows recommendations to be forwarded to surgeons and anesthetists on the day of assessment. Since it’s inception the clinic has increased from two physicians to seven, and sees approximately 800 patients a year. We enjoy positive partnerships with the Bariatrics program, the Cancer Assessment Centre, various diagnostic services, and a multitude of surgical specialties.

The goal of the clinic is to provide rapid medical assessments (less than 2 weeks from referral to assessment) for complex medical patients requiring surgery. Uniquely, we identify high risk patients and make provisions to see them postoperatively, with the goal of pre-empting problems before they start in the perioperative period.

In the near future we look forward to full vOASIS integration, and closer collaboration with Anaesthesia and the PAU service.

Short Stay Unit (SSU)

The Short Stay Unit at the Civic Campus opened in October 2011. When patients are admitted to General Internal Medicine they are assigned an EDD (expected day of discharge) by the attending physician. If the EDD is less than 72 hours the patient is admitted to the new SSU on A3. Expedited resources such as physiotherapy, social work and diagnostic tests (to name a few) are deployed. The goal is to reach that target EDD of 72 hours. Although it is in it’s infancy, the unit has so far been quite successful. Staff have noticed much improved patient flow and fewer patients waiting in the emergency room for empty ward beds. The plan is to expand the service to the General campus in the near future.

Rapid Referral Clinic

Within the next six months the division of General Internal Medicine is planning on developing and initiating a Rapid Referral Clinic (RRC). The clinic will be a novel ambulatory care model for the division. It will take place 4 or 5 half days per week at the Riverside Campus. It will be staffed by clinical fellows in GIM as well as most GIM staff physicians. The RRC will be a shared group clinic that runs almost every week of the year. The priority of the RRC will be to see patients discharged from the medical CTUs, patients discharged from the ER by the medicine Consult/Triage team and patients referred directly to the existing “fellows” clinic. The focus of the clinic will be acute, urgent and post discharge care and not long term longitudinal ambulatory care. The division will liaise with Family Medicine to try to address some of these issues. The goal and hope is that such a clinic will help with patient flow and care by allowing an avenue whereby patients can be seen quickly by a multi-disciplinary team thus avoiding certain admissions to hospital and by shortening length of stay for some patients requiring quick and reliable follow-up upon discharge. Metrics will be calculated in order to gauge the success of the clinic.