Weekly Update – 12 July 2021 – NewYork-Presbyterian Emergency Medicine

July 12, 2021

From Dr. Mark Curato:

Dear Residents,

We are ready to roll out the bi-campus Charting Improvement Program (ChIP, for short)!

Beginning now, and around the 5th of each month hereafter, you’ll receive an assignment of 2 charts to review (see the spreadsheet sent out from July 1).
Your job is to access the charts in EPIC and review them for quality. You must submit this form for each chart. The due date is the last day of the month. Feel free to include PHI in your comments because the software is HIPAA compliant.
When you receive the next month’s assignments, we’ll also include some pearls and learning points from the prior months reviews.

This is not optional (but it’s also not difficult). First assignment is attached, due 7/31.

Thanks!

The ChIP Team (Mark Curato, Marissa Cohen, Trudi Cloyd, Lily Abrukin, Dan Golden, Chris Hennessey)

From Dr. Mark Curato

Residents,

As you know, we are part of a group studying factors influencing EM resident career choices. We’re working with some other big programs (UCLA, Davis, UW, Iowa, Rush, Michigan, and Pitt). Participation is voluntary, but the other programs get 100%, so we want to keep pace! Your answers are confidential.

It should only take a few minutes.

Intern survey is here.

PGY2-4 survey is here.

THANK YOU!!!

From Dr. Trudi Cloyd: Critical Care Cuts

Our critical care team at Columbia (led by a former EM attending) is leading an exciting new project designed to push you bite-sized tidbits of critical care knowledge on weekdays this academic year. The plan is to push these messages to your phone, likely in WhatsApp messages, to review at your leisure (read: shuttle/Lyft ride home after shift). Who doesn’t need a little more knowledge on vent management, blood gas analysis and CVL tips & tricks? Best of all this is being led by some great educational faculty who already have an EM background!

If you are interested, please fill out this short survey on your comfort level with critical care skills.

From Dr. Tiffany Murano: EM Reports Publication Opportunities

EM Reports is a peer-reviewed periodical for which I have previously written review articles. The pay an honorarium of about $1000. I have written these articles with junior faculty or residents and think it’s a great opportunity to have a scholarly product and work together.

Dr. Adria Simon noted that “she’d be happy to co-write some of these with a plan to split the honorarium,” putting her half towards fun residency activities!

Below are some topics that are needed but the editors “are open to other topics as well so don’t hesitate to suggest something that you don’t see on the list”

Emergency Medicine Reports Topics

Carbon monoxide exposure

Improving management of acute severe asthma and COPD

MRI in patients with cardiac devices

Eclampsia and postpartum eclampsia

Thrombectomy for stroke, especially the value of screening tools to identify potential candidates

ACEP new guidelines on procedural sedation and sepsis

STEMI in the era of COVID

Trauma Reports Topics

COVID-19 and impact on trauma care

Update on burn care

Trauma transport

Pain control in the elderly

Geriatric trauma

Update on pediatric concussions

Pediatric pain control

Author guidelines are attached here.

Residnents, if you identify a topic and a faculty mentor, please have the mentor email editor Shelly Mark directly and she will walk you through the process.

Thanks!

Campus Announcements

Reminder from Dr. Foster: 1-833-ED-RELAY

1-833-ED-RELAY

Please remember, for any patient who presents with an overdose where opioids played a role and especially whenever Narcan was given appropriately,

CALL 1 833 ED RELAY.

RELAY workers are able to come in and help patients overcome the many obstacles to REHAB as well as train patients (and family or friends) in the use of Narcan Kits

Even if patients are unresponsive in ED,the RELAY team wants to be called as soon as possible and they will wait near ED until patient is awake to make a connection.

If on rare occasions the patient is COVID positive there is still an option for a telephone connection.If there are any problems or concerns, please do not hesitate to call me.

Thank you

Jordan

From Dr. Angela Mills: New clinical leadership fellowship launched by NYC H+H

LEADERSHIP FELLOWSHIP: New York City Health + Hospitals has opened applications for a one-year clinical leadership fellowship geared toward post- residency graduates interested in administrative roles, the system announced Monday. Fellows will be assigned to the offices of quality, population health, ambulatory care, managed care and patient growth or medical and professional affairs. The application deadline is Oct. 29.

From Dr. Betty Chang: Columbia Ops updates

1) Area A (MINT) Sign Outs

-To ensure that there is a balance of workload during sign out in Area A — when a provider is leaving the shift, please distribute the sign outs / hand offs among the remaining providers (regardless of PA or Attending). This will give some pressure off the overnight PA.

2) Provider column in EPICs: safety issue!

-The attending and resident/NP/PA columns in EPIC need to reflect the current ED provider (NOT the previous shift provider) on ALL active patients who are not endorsed to other services. Nurses, consultants, labs, etc. are trying to reach the primary ED provider regarding patient care.

3) Please enter Observation Order in Area D (L140 Policy)

1:1 clinical observation (Safety Watch), plus Security Watch add-on – active suicidal patients
1:4 cohort observation (Safety Watch), plus Security Watch add-on – patients with acute psychiatric issues; anyone with dementia/delirium/AMS + elopement risks/wandering risks; patients with violent behavior
Consider 1:1 clinical observation (Safety Watch) on patients with severe dementia / delirium / AMS, etc, if patients impose danger to themselves and requires more than 1:4 cohort obs
For our purposes, there are currently no patients that we place on security watch only

4) Safe Discharge back to SNIF

-When NH patients are being discharged from the ED, especially if there is a change in the patients’ NH management (such as discontinuing a medication, adding other medications, etc.) or if NH patients are not able to reliably understand the instructions, please contact the NH and speak with the provider or the Charge RN there (and document).

-We can always involve SW/CM to assess for safe discharges. They can help with the communication between us and the SNIF.

5) CHONY ED Young Adults Transfer Hold

-Due to weekend staffing challenges, the Milstein to MSCH transfer of 20–25-year-old patients, will be put on hold from midnight Friday to midnight Sunday for the rest of June.

-This should have little impact as only 10-12 patients are transferred over in a 24hr period.

From Dr. Mark Curato: ED OB activation Criteria

Please note that when you are in need of an “OB Activation” at Cornell, the process is:

Tell the clerk to activate ED OB Activation or dial 5-5555 from any hospital phone

If Activation Fails Call L&D Directly at 646-697-1414

It’s VERY important that you use the correct terminology. Say: “ED OB Activation“ (not “code OB” or “STAT OB” or anything like that).

As a reminder, here are the ED OB activation criteria

Fetal

Fetal bradycardia
Category 3 FHRT
Cord prolapse
Suspected uterine rupture
Advanced labor with fetal malpresentation

Maternal

Seizures
Level 1 &2 Trauma
Cardiorespiratory arrest or imminent arrest
Maternal hemorrhage
Hemorrhagic shock
Septic shock
Altered mental status
Advanced labor

Discretion of the ED or OB physician, nurse or EMS personnel

From Dr. Sara Zaidi:

To whom it may concern,

Researchers from the Departments of Psychiatry and Emergency Medicine are carrying out a study that will explore oral history accounts of experiences sustained during the COVID-19 pandemic by front-line medical providers (March 2020- January 2021). This is being done with the larger goal of identifying professional and emotional needs, and therefore informing ways to reduce burnout in this population.

Moral injury arises from an act of transgression that creates dissonance and conflict by its violation of assumptions and beliefs about right and wrong and personal goodness. Within the healthcare field, it refers to “the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond a provider’s control”. When left unaddressed, these experiences can lead to burnout in the professional setting, therefore supporting the rationale to explore it in our providers.

Title: Exploring the effects of morally injurious experiences on medical provider identity during COVID-19.

Co-Principal Investigators:

JoAnn Difede PhD (Director of Post-Traumatic Stress Disorder Studies, Department of Psychiatry, Weill Cornell Medical College)
Sara Zaidi MD (Assistant Attending of Emergency Medicine, New York Presbyterian-Weill Cornell)

If you are interested in learning more about the study and participating in an anonymous, single 45-minute interview and brief questionnaire, please contact Giselle Appel MS (gia9026@med.cornell.edu).