Please review the following NYP updates regarding COVID19. These updates should apply to both campuses, and residents should be generally aware .
Remeber that the isolation negative pressure rooms in at Columbia are rooms RME 16, B9, C7, D15.
At Cornell, these rooms are found in Areas C and D.
Dr. Nick Gavin: Milstein to Allen Transfer
Beginning Sunday night into Monday morning, PPOC will begin identifying patients who are appropriate for admission to the Allen Hospital based on the attached clinical exclusion criteria. We are seeking to revamp this process as it will offload work from the Milstein Hospitalist team, help with Milstein ED crowding, and enhance quality of care for this cohort of patients.
When the PPOC nurses identify patients, they will be reaching out to the clinical team. During the day, when available, the care coordinators will be communicating with patients, but overnight, it will be the physicians and physician assistants caring for patients who will be responsible for approaching the patient about admission to the Allen.
The most important thing to express to patients is that the median wait for a Milstein bed has recently been 25 hours. This means that 50% of patients actually wait longer than that. When initiated, the transport to the Allen floor bed should be completed within 3 hours. Other key messaging is that Columbia Doctors follow patients at the Allen and patients typically have a better experience at the Allen Hospital.
Please see attached for the full process map, some ideas for scripting as you approach patients, and for the formal clinical exclusion criteria.
Thanks and please provide any and all feedback as this commences.
Dr. Lorna Breen: Followup Orders
We have confirmed that routine cultures and final imaging reads will automatically go into the NP follow up basket and we do not need to place follow up orders for them any longer.
While we appreciate the carefulness of those who have been doing so, the NPs have shared that it actually increases their work load as each result has two follow up orders that need to be checked.
Hopefully this new work flow will be more efficient for all. Please let us know if you have any questions, concerns or points of clarification.
From Dr. Ken Wong: Orienting off-service rotators
From Dr. Annie Katz: Joint Commission Visit
From Dr. Michael Stern: Age Adjusted D-dimer
Please do not use the age-adjusted d-dimer algorithm for determining appropriate management of PE risk in the elderly population. In the JAMA 2014 study (Righini et al), the fixed d-dimer level of 500ug/L, which is subtracted from the calculated age-adjusted cutoff (age X 10), is not the same threshold number that we use in our d-dimer assays at the Cornell campus. Therefore, extrapolation of the study’s data results to our practice is not accurate and therefore not appropriate. There has already been a case of a missed PE in an elderly patient after using this age adjusted d-dimer threshold with our assay.
From Dr. Dave Bodnar: Ortho Survey
We are constantly trying to improve our interaction with consult services. As such, we are hoping to get your feedback specifically on Orthopedic consults at Cornell. They have been attempting to improve their response to our consults, so it would be very helpful if you could please take a few minutes to answer the questions on this survey to gauge its effectiveness. The survey should take less than 5 minutes.
MCB Message of the Month
From Rachel Sullivan, LCSW: Victim Intervention Program Social Worker
Due to new NYS Laws, it is now more important than ever that all sexual assault patients are offered private, individual time with a volunteer Advocate BEFORE any part of SAFE care begins, and again throughout SAFE care.
The Advocate role is only privileged/confidential at certain times, as long as there is no third party present during a conversation.
Advocates have now been instructed to meet with SAFE patients ALONE and FIRST, in order to fully explain their role and the limits to their privileged role. They will not be obtaining a history from patients.Any time a third party is present (ex. a SAFE, a nurse, a SW, a friend, etc.) conversations are no longer confidential and Advocates can then be considered a witness, meaning they can be subpoenaed by the court system.
All sexual assault survivors will be provided with the NYS Survivors Bill of Rights in the form of a packet. This packet will be given to patients first by a Social Worker, before leaving the room for an Advocate to then meet with the patient alone. (See below for case flow).
We are asking all SAFEs and ED staff to accommodate the Advocates’ REQUIREMENT to meet with patients alone. SAFEs should wait until the Advocate has already met the patient before beginning their interview and SAFEs should leave Advocates alone with patients again BEFORE beginning exam/evidence collection.
Please let me know if you have any questions or would like to discuss this further.
Thank you all so much for your attention to this so that we can ensure that all survivors’ rights are being upheld.
SAFE Cases Guide (will be located on Algorithms Page located on nypem.net drop down menu)
Shout out to everyone for completing ITE!!
Spring is Coming.