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MabelA brief response about the T-System for pediatrics:    I appreciate Kathleen's comments- we found them useful.  (sorry- I don't know your last name)  Although the upper extremity injury template includes a prompt for reduction of nursemaid's elbow in the progress notes section, somehow it is indeed misssing from the clinical impression section.  I think it may have been accidentally removed at some point from our prototype.  We will correct that error.  One clarification is in order-we do indeed have templates for sickle cell crises and for chest pain, but they are not part of the core set of templates.  We are happy to provide these at no additional charge upon request.  We probably should do a better job of publicizing the existence of the additional templates that are available.  We also have a small supplementary shelving unit to hold them!
 
I would like to point out that we commonly customize the T-System for various clients and can revise the relative mix of open areas vs. formatted areas.  We are happy to change or add to the formatted content, including the clinical impression section.   Our clients have widely varying template sets depending on their local needs.  For example, many groups do not want to record the age or vital signs on the templates, so our prototype doesn't have areas for these issues.  We can easily add them.  Many teaching sites have requested a rather small area for the faculty note, but other groups prefer a configuration that gives a much larger area.  We have a wide range of options in this regard.  It's true that the system is not designed to record orders to the nurses or discharge instructions.  However, on a number of occasions we have modified the templates to provide a place for a summary of discharge instructions.   Many groups do not ask for this because they are using a separate tool for that purpose.
 
Kathleen- if you will contact me at [log in to unmask] I would be happy to discuss modifications to make the system a better fit for your site.  We are willing to make very extensive customizations at no additional charge.
 
-Woodrow Gandy, MD, FACEP
President, T-System, Inc.
 
 
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  Original message:

  We use the "T" system and I find it to be lacking in certain pediatric areas. For those who are not familiar with these: a set of ready to complete checklist/write in sheets based on presenting symptom. There are the general illness, injuries, cough, V/D, etc. Yet, there is no sheet for sickle cell disease or chest pain. The list of discharge diagnosis is not always complete. For instance the "Upper Extremity Injury Template" does not list radial head subluxation as a possible diagnosis,  the "Wheezing Template" does not offer fever as a diagnosis, and the "Facial/Head Injury" offers contusion/hematoma/concussion but not just plain old head trauma. These sheets do not have an area to list an age or the vitals signs - things that we commonly write in on the sheet. Some of the areas that you are supposed to write in for either the hx or progress in the ED are very limited. The hx area for head trauma allows you to write maybe a sentence. It is difficult to document if meds were given or the course of ORT or asthma tx. There is a very small area for the attending progress note so most of us (attendings/PNP) use the template and the residents write progress notes. Also, there is no area to document discharge instructions or medications. 
   Some nice aspects of them are the laceration repair procedure note, LP procedure, and documentation area that the PMD was notified. They can be quick but sometimes finding the right word to backslash or circle is not. I find that the concept is a good one but I think that the flow of the hx can be awkward and there needs to be improved documentation areas. (I think that I tend to lean heavily on the problem with documentation b/c there are so many times that I am called by a PMD wanting to know what happened in the ED and I pick up the T sheet and I am not seeing a lot on it.)

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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html