Weekly Update

April 12, 2021

Academic Practice Tracks!

The link for the new APT website is here! The page is also accessible from the "Education" dropdown on the main page.

From Dr. Garg:

Please make sure you are maximizing your engagement with your APTs! The faculty are very excited to share their expertise and opportunities.

Haiku chats become a permanent part of the patient’s medical record. While it’s a tool meant for free form communication (so punctuation and usage are unimportant, and colloquialism is OK), we must always remain professional.

Campus Announcements

From Columbia Anesthesia Chiefs: Subway Coordination

Columbia Anesthesia Chiefs have started a Google Spreadsheet to faciliate residents getting to and from work together. Read about the details here. The spreadsheet (editable link here) contains “contact info, home subway station, subway line, and usual times on the subway to and from work. If enough people post their same information, we could reach out to each other to coordinate beyond a first/last car situation.”

From Columbia Operations and Education Leadership: PGY 3's at Notifications

Whenever possible,

PGY 3’s should respond to all Area D notifications. They should write an MSE note.
While they can assist with stabilization and procedures if they choose, a clear handoff from the PGY 3 resident to the Area D Attending + Resident/PA is necessary because PGY 3s will not be responsible for the continued coverage of patients in Area D, even if they participated in the initial resuscitation.

From Dr. Bernard Chang: ED Buprenorphine Study

We’re excited to announce that starting Monday March 22, our Emergency Department will be launching a new clinical trial funded by the NIH on treating opioid use disorder patients. This study will be comparing the effectiveness of two different formulations of buprenorphine, a medication that can help treat patients suffering from substance use disorder. If interested, click here to learn more.

From Dr. Betty Chang: Patient Navigators, Mint, Dexcom Glucos Monitoring, Bupe Initiation

1) Patient Navigations – SOS!!

-I was informed today that our navigators have a backlog of about 400 patients at this time to do follow ups. They are doing their best but there will be delays.

-PLEASE consider using this service for the most vulnerable group of people. If patients can make appointments themselves, please have them do so.

2) MINT process – Where did PURPLE go?

-After our experience with the last COVID surge, we decided to keep PURPLE and MINT together as one team (MINT) – for better patient flow and patient care. Please make sure that we see them based on LOS (length of stay), regardless of ESI V3, 4, 5.

-Our NPs and “purple” PAs are still available – NPs will continue to see ESI 4,5 (Intake RN will note “FT” or ” ESI 4,5″ on the comment section). This is just a flag for our NPs. Again, all MINT team members should see all patients assigned to MINT.

-Some ESI 4, 5 (FT) level patients will be kept outside in WR A due to space constraints in Area A. Providers should be proactively seeing them and not wait for patients to be brought inside. One suggestion is to work out of RME 1-5, if available.

–Patients can be seen before triage. ALL patients will have vitals done at intake.

3) Continue using Dexcom Glucose Monitoring for stable DKA patients

Contact Dr. Magdalena Bogun at 347-831-2841 to discuss the case.
If Dr. Bogun agrees that the patient is appropriate for this pilot, consult ICU triage as you normally would give they still manage SDU beds. Discuss that you think this patient is stable for stepdown and you spoke with Dr. Bogun from Endocrinology to who approved using the CGMs. The ICU triage residents are aware of this pilot.
If accepted to the SDU, a CGM superuser will coordinate with the patient, nurse, and primary provider (can be an attending, resident or PA) to give each person a phone to track the patient’s glucose. Only the RN will be recording these results (q2 hours in the ED). You as the provider DO NOT have to record anything.
Place a “Nursing communication” order that writes, “Use inserted CGM for continuous glucose monitoring instead of q1h POC glucose/finger sticks.”
Continue DKA management as you normally would until the patient is admitted.
When the patient has a bed, hand off the phone to the ED RN who will give to the SDU team (to give to the SDU provider) when the patient is transported upstairs. If the patient has not been admitted by the end of your shift, hand off your phone to the person you sign out to.

4) Buprenorphine Initiation in the ED for OUD patients – identify, assess, consult/refer, & treat!

-Identify OUD patients. Assess them for ED Induction or Home Induction. Follow the algorithm for treatment (on CGAP).

-Consult CM/SW to have referral set up: “CUIMC ED SW & Care Mgr Consult (Contact & List)” secure chat.

-Secure chat “CUIMC ED-Buprenorphine Assistance (Contact) Group)” for any assistance, including getting prescription for buprenorphine if you do not have a X-waiver status.

-We have Smart Phrases in EPIC (shared) for your use:

BUPINDUCTION – standard note for buprenorphine induction
HOMEBUPDC – discharge instructions for home induction
HOMEBUPDCSPANISH – discharge instructions for home induction (Spanish)
EDBUPDC – discharge instructions for patients initiated on bupe in ED
EDBUPDCSPANISH – discharge instructions for patients initiated on bupe in ED (Spanish)

-At discharge, please make sure patients have buprenorphine prescribed AND order for naloxone kit to be given (now we have an order in EPIC).

From Drs. Emmagene Worley and Peter Wyer: EBM Survey

Hi everyone! We are hoping to gauge your exposure to critical appraisal and all-around research literacy before an upcoming conference session. Would you click on the link below for a short qualtrics survey? Should take approximately two minutes – in fact, you could do it right this moment! Thank you in advance! -emmagene

https://cumc.co1.qualtrics.com/jfe/form/SV_095ZG5xVCVhlQsl

From Dr. Shah: Free Education featuring Scott Weingart (Tuesday April 13 @ 8PM EST)

EB Medicine Live Virtual Learning Session

Tuesday April 13 @ 8PM EST

“Traumatic Hemorrhagic Shock in the ED”

Link to Register

Course Description:

Hemorrhagic shock is the major preventable cause of morbidity and mortality in patients who suffer trauma. The management of traumatic hemorrhagic shock has evolved, with increasing emphasis on damage control resuscitation principles, and it requires swift coordination of ED resources and protocols.

This 1-hour didactic, by leading critical care expert Dr. Scott Weingart, will present evidence-based recommendations for:

Logistics of massive transfusion
Lethal tetrad (rather than lethal triad)
Factor replacement
Crystalloid’s role (none)
Monitoring
When and how to intubate a bleeding patient
The hemorrhagic cardiac arrest

From Dr. Shah on behalf of Dr. Eric Steinberg: Resident Learning Survey

“One of my residents is researching the learning preferences of emergency medicine residents. She has developed a super-short survey that can be completed in approximately 2 minutes. If you could please distribute this to your residents, I would be forever grateful!”

Link