What the EFF is LAMA?

What is LAMA

LAMA is a way to have clinical eyes on patients while checking in. The first goal of this is to notice patients in acute distress and get them the help they need. The second point of LAMA is to facilitate a quicker way for low and mid acuity patients to get seen.

After getting the sick people out of the way, the next step is to identify people who can benefit from a quick visit for easy to solve / fix problems. This is a 1-2 min interaction with the patients to screen for inclusion / exclusion criteria. The idea behind this being to take some stress off portal staff, and to increase patient satisfaction levels by having them seen by a provider quickly and discharged even quicker! We have established some inclusion and exclusion criteria for the pivot nurse to use in order to help us sort these patients out.

LAMA Exclusion

Any Acute Distress -> Contact portal lead for hand off and they will direct bed

Anyone on thinners with neuro changes 

CP over 60 or hx of MI/CHF 

SOB over 60 or with complex pulm hx

New o2 needs

No lasix 

Difficult foleys in the past / requiring CBI

Any WC unless pt is ambulatory at triage and gets in a WC d/t isolated injury. 

No obvious deformities

Diabetic foot ulcers

Current cancer pts / immunocompromised

Social support requirements (housing transport etc)

Substance abuse issues (?)

SI/HI

New onset seizures

Cyclic vomiting

Hyperglycemia 

Vaginal bleeding/discharge

LAMA Inclusion

Thinners with head injury, no neuro deficits

CP under 60 no cardiac hx

SOB under 60 with no pulm hx

Pt normally on o2 without SOB complaints.

Concussions

Flu like

Isolated ortho no deformities requiring reduction

Rx needs

UTI without sepsis concerns

Ab pain without pregnancy  

N/V ok, no cyclic vomiting

Skin rash

Abscess

 simple lacerations

Eye pain

Ear pain

Dental Pain

MVA ambulatory

Palpitations under 120HR

TENETS of LAMA:

Minimize IV’s

PO meds

Quick assessment by provider

Instant completion of orders

Streamlined Phleb, Xray, CT, and US

Prioritize discharge

What about EKG’s?

The pivot nurse will enter EKG’s for any patient who needs them that is not directly bedded. They will cross them over and call for a Tech/RN to complete the EKG regardless of the patient's final destination.

But what about Triage Alerts?

For those that work in portal, sadly LAMA will get rid of triage alerts as a clinical person has eyes on patients first. I know this will be greatly missed but with great changes come with great cost.

Offramping:

If a patient is noted to be in acute distress, Pivot nurse will call the portal lead, (We have a portal lead vocera group now!) and the lead will take pt and either direct bed or place in portal room for appropriate care.

What about the video?

Presumably if you’re here you’ve already seen the video, but if you cant get enough, here it is again: