Brian Wong Profile picture
Sep 23, 2020 6 tweets 4 min read Read on X
I have set my clock to 10:30 AM to get @jkwan_md's amazingly informative updates on Ontario's #COVID19 situation.

Want to take this opportunity to thank her immensely, but also reflect on 4 #COVID19 curves that really worry me.
The first is the fact that we have no known Epi-link for 50% of our new cases -- @IrfanDhalla points this out repeatedly as a major barrier to properly #TestTraceIsolate Image
The 2nd is the fact that our testing turnaround time is getting longer -- for the first time since early April, we have more pending test results than reported test results (a whopping 48,000 tests pending) -- which means a delay to identifying cases and proper #TestTraceIsolate Image
And so now we are seeing the impact on our hospitals -- with a clear increase in admitted cases to hospital over the past 10 days Image
And also in our #LTC homes -- as seen in the data posted by @NathanStall today Image
Please @fordnation @celliottability @Sflecce and David Williams we need action now. I provide this perspective as an MD working the front-lines and a parent of 2 boys in schools at @tdsb. But also from the perspective of an Ontarian that knows we can do better.

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More from @Brian_M_Wong

Sep 24, 2020
I often hear people say that we should apply what we know from #QI to the #COVID19 response -- the concerns around COVID testing and trying to increase our testing capacity serve as a good example where knowledge of systems can be helpful. A thread.
I often teach #QI with @kgshojania.

He uses this analogy of a Rube Goldberg machine to describe complex systems in healthcare.

Rube Goldberg machines are intentionally designed to perform a simple task in an indirect and overly complicated way

E.g., a pencil sharpener
A: Open window
B: Fly kite
C: Pull pulley
D: Lift cage door
E: Release Moths
F: Eat coat
G: Raise boot
H: Flip switch
I: Turn on iron
J: Burn shirt
K/L: Smoke out opossum
M: Jump out of tree
N: Land in basket
O/P: Lift cage
Q: Reveal woodpecker
R: Sharpen pencil
Read 9 tweets
May 25, 2020
The inaugural @NEJMres360 resident #QI challenge was launched this year. Received 90 submissions.

Of these, 59 invited to prepare and post a poster -- can view them here: resident360.nejm.org/groups/qi-chal…

I'm thrilled that FOURTEEN posters are from @uoftmedicine cc @UofTMedDean @UofTPGME
Would like to highlight these amazing #QI posters from resident programs in medicine (@UofT_DoM), pediatrics (@SickKidsNews) and family medicine (@UofTFamilyMed)

cc @UofTPGME @SalSpadafora1 @UofTDoMChair @LennoxHuang @ronald_cohn @CQuIPS @tara_kiran @kgshojania
1) Let 'em breathe -- submitted by @Aditijain8243 @leechristiem et al from @ccmtoronto @SinaiHealth (critical care) -- increased rates of spontaneous breathing trials in the ICU from 53% to 71% resident360.nejm.org/posts/21339
Read 17 tweets
Mar 13, 2020
Today, as the Director of the Centre for Quality Improvement & Patient Safety (@CQuIPS) at the University of Toronto (@uoftmedicine) sent a message to all of our members -- a call to action to mobilize now to support health system efforts to respond to #COVID19
"Our focus at @CQuIPS will be to mobilize as many of our members, graduates and current students and direct them towards their local QI efforts to respond to the #COVID19 pandemic."
I urged each and every one of them to strongly consider whether any non-COVID related initiatives can be put on hold for now, and direct their time and energy to help our health system respond to the #COVID19 pandemic
Read 6 tweets
Feb 11, 2020
Are you an academic clinician or trainee with a career focus in #QI?

Are you interested in implementing QI initiatives in an academic teaching hospital/clinic settings?

Apply for EQUIP - QI certificate program offered by @CQuIPS
(Deadline Mar 27, ‘20)

cpd.utoronto.ca/equip
Program format:

1) Two 3-day in-person sessions in Toronto, Canada
2) Longitudinal #QI project
3) Webinars for participants to receive feedback on their projects
4) Personalized coaching from expert program faculty Image
Learn from the best — here are just a few of the expert @CQuIPS faculty you will interact with if you enroll in EQUIP

cpd.utoronto.ca/equip/faculty/…
Read 14 tweets
Dec 6, 2019
We are now accepting applications for EQUIP for 2020-21, our #QI certificate course at @CQuIPS that prepares faculty & senior trainees to lead QI in academic environments. Pls retweet & encourage others to apply. Deadline for applications is March 27, 2020 cpd.utoronto.ca/equip ImageImage
Read 4 tweets
Nov 28, 2019
An important thread for how we as GIM/hospitalists can communicate more effectively with our primary care colleagues at the time of discharge — @AM_Cressman we should send to our trainees on CTU right now. #MedEd
My 2 major takeaways:

1) I need to spend as much or more effort confirming the patient’s primary care provider (who likely sees patient regularly) as I do figuring out who their specialists are (who might only see patient 1-2 times per year)...
2) In a discharge summary, when listing follow up instructions that involve the patient’s primary care provider, address them by name — I’m definitely guilty of typing “Family doctor to check patients BP in a week...”
Read 4 tweets

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