Weekly Update – 17 January 2022 – NewYork-Presbyterian Emergency Medicine

January 17, 2022

Reminder from Residency Leadership: Continue to Wear PPE

Reminder to everyone that they should be wearing PPE (masks + N95 + eye shield) at all times in all clinical areas. During breaks and morning reports, please continue to wear a face mask at all times. This is to protect yourselves and each other and prevent us from depleting our sick call pool.

If you have not received your Covid Booster shot yet, please consider doing this as soon as possible. Please reach out to the chiefs or Manish if you are having difficulty finding an appointment.

Meals provided courtesy of the Deans from Columbia and Cornell

Cornell meals are located in the ED break room at the following times:

ED Break Room

Lunch delivery 12-1pm

Dinner delivery 7-8pm

Columbia meals are located in the EM Faculty Lounge, CHONY-116, and will be delivered at 11:30AM.

Message from leadership re: CCC Meetings:

Hello residents!

I want to make you all aware of some exciting changes to our process for the clinical competency committee. Going forward, your semi- annual meetings will be conducted by residency leadership. This is not goodbye for you and your CCC mentor; it’s just a beautiful new chapter of your mentor-mentee relationship. Your CCC advisor will continue to meet with you mid-semester to check in and support you throughout your residency journey!

With that in mind, please be on the lookout for an email from a member of the program leadership team regarding scheduling your semi-annual review meetings. If you have not yet completed your self-evaluation, now/in advance of the meeting would be an excellent time to do so. Please let me know if you have any questions and looking forward to our meetings!

Adria

From the Residency Leadership: Interview Season

Dear EM family,

Faculty and residents, if free we ask that you try and make it anytime from 9am to 11:15am (east coast interview days) on

January:

18th, 24th

Faculty and residents, if free we ask that you try and make it anytime from 11:45am to 2:00pm (non-east coast interview days) on

January:

10th, 11th

Here is the zoom link for every interview day:

Interview Day Zoom:

https://weillcornell.zoom.us/j/8641139634

Meeting ID: 864 113 9634

Passcode: 741852

One of the most positive pieces of feedback we receive from applicants is an acknowledgment of how many faculty and residents show up on interview day. So even if you can be present for 15 minutes, it would be greatly appreciated. Your shared experience, advocacy, and passion for EM truly demonstrate the essence of our remarkable NYP Columbia and Cornell residency.

Thank you for your care and commitment,

With gratitude,

The EM Residency Program Leadership

Reminder: Documenting Disposition Notes

A reminder that all patients being discharged should have a progress note documented and to use the “.resdispo” smartphrase as a template. This is important for documenting what was done in the ER and that the patient was reassessed. This should be done for all patients at both campuses.

Furthermore, all admitted patients must have a resident hanoff note.

Epic Updates:

1) Updated Sepsis Icon on Trackboard

New updated icon to hopefully catch your eye indicating the patient meets Sepsis/SIRS criteria

2) New Coag Panel on Quicklist

Now available on Common (Adult) Quicklist and Labs (Adult) quicklist
This order includes PT/PTT/INR with one click

3) PBY/ALN: Amb Referral to Interventional Radiology now available within smartset

Via Dispo tab –> smartsets –> select or
After selecting Amb Referral PBY/ALN you need to scroll down to see this list populate!

4) Coming soon: AMA discharge information to populate on AVS

When a patient is discharged AMA verbiage will now populate on their discharge stating they are leaving against medical advice.

Campus Announcements

COVID Updates 1/4 (Dr. Tedeschi)

Good morning – here are a few covid-related reminders and updates, including an updated version of the NYP ED COVID TREATMENT ALGORITHM. Thanks to Ed Suh and the EBM group for sorting through mountains of data and guidelines! As always, please send any questions my way and see you at the departmental huddle tomorrow.

Tomorrow’s huddle

Tomorrow’s EM faculty meeting (Wednesday, Jan 5; 1pm-3pm) will be replaced by a departmental COVID response huddle — you should have received a separate email with a zoom link.
All faculty, PAs, residents are welcome to attend.

What to do if you test positive (Columbia affiliates)

If you test COVID+, please email the following:
- covidtesttrace@columbia.edu to notify them of your positive test result
- leavemanagement@columbia.edu to notify them of your positive test result
- Contact NYP Workforce Health and Safety via the COVID hotline at 646-697-9470 or email the WFH&S NYP website (preferred and easier): https://covidtracker.nyp.org/
- You will need to register with your work email and password once you enter the website. Use your UNI as your employee number.
A return-to-work clearance call to WF&S or clearance letter is no longer required. However, you do have to contact WF&S at the beginning of your leave.
Contact Penny Lema or our Department HR Director, Michele Nunez, if you have any questions.

Updated NYP ED COVID evaluation tool

Thanks to the cross-campus EBM group, we have an updated ED COVID EVALUATION PATHWAY that integrates new treatments and guidelines. It’s attached here, and also available on the Teams site.

Rapid tests at home

Symptomatic staff who test positive via an antigen test performed at home DO NOT need to obtain a confirmatory PCR. Your self-attestation is sufficient.
A confirmatory PCR may be helpful for return-to-work, based on time of symptom onset and isolation period.

Returning patients to congregate settings

There have been some questions about COVID testing for patients being discharged to congregate settings from the ED. This may be changing or facility-dependent, but as we understand it, the guidance (see below) is that ED patients who have presented for non-covid related complaints can be discharged without a test.
In uncertain circumstances or when a dischargeable patient has tested positive, it’s a smart idea to discuss the case with the receiving facility.
- As per NYS DOH (12/2020): “The New York State Department of Health (DOH) has clarified that nursing home residents brought to an emergency room for non-COVID-19 related issues, can be discharged to the sending facility without a COVID test. DOH notes that these residents are not admitted patients and therefore not subject to the Executive Order that prohibits hospitalized patients who test positive for COVID-19 from being discharged to a nursing home.”

Please adhere to PPE guidelines

We’re learning that the Omicron variant is way more infectious than Delta. Please protect yourselves and your colleagues. Despite multiple staff outages and strict PPE guidelines, we’re still seeing PPE breaches in clinical areas. N95 masks and eye protection are recommended for all patient encounters. Well fitted surgical masks are required at all times. This means you! I know that you had it twice already and secretly got your fourth vaccine at CVS last week. You still have to play by the rules.

ED OB Fast Track – Update from Cornell Leadership:

Good morning —

We will pilot a new “ED OB Fast Track” workflow, which aims to expedite Obstetric patients’ transfer out of WCMC ED to Cohen Hospital, immediately after

(a) ED Triage

(b) ED Provider decision whether ED OB Activation is warranted, including Medical Screening Exam documentation

Which patients get Expedited Transfer?:

Any NYP/WCMC ED patient between 16 weeks pregnant to 6 weeks post-partum, who does not fit ED OB Activation criteria.

What’s different for ED Providers?*:

Immediate binary decision for: ED OB Activation vs. Expedited Transfer to Cohen

When ED Triage APP/Attending present, binary decision made at triage.
At all times, ED Admin Attending and appropriate Area Attending will be notified via Epic Chat from ED Triage. When no ED Provider in triage, binary decision made at bedside.
Expedited Transfers require an MSE Note, which include a brief history, brief physical, and brief assessment and plan that patient is clinically stable for transfer to Cohen Hospital
Expedited Transfers require same Epic clicks on “Dispo” Tab for Cohen Transfer
ED Provider does NOT call Transfer Center/EMS. OB PA’s will continue to own this responsibility.
Expedited Transfers will NOT require OB Team to come to ED. Patient will see OB Team at Cohen Hospital
NO changes to ED OB Activation workflow.
– ED OB Activations will continued to be roomed in A2.
– ED Providers/Nursing will activate via ED Clerk’s Telecom call (5-5555)

Given the increasing numbers of COVID-19 patients in our ED and the need for isolation rooms, special thanks to leadership from Cohen Hospital, NYP EMS, and Emergency Department leadership.

Covid Updates from Cornell Leadership:

In anticipation of rising ED arrivals for COVID-like Illness (CLI), we want to socialize the following WCMC ED Operational workflows:

SAFE exam room has moved from C10 to B3, effective immediately. As during peak pandemic times, SAFE Exams will be triaged to B Bay. This will add capacity for CLI patients in C Bay and maintain SAFE exam standards.
Patients with CLI, who fill ESI 4-5 criteria, will continue to be triaged to a patient room in D Bay. Standard isolation and cleaning processes must be taken.
- C Bay will continue to be triaged patients with CLI who require longer workups and during hours when D Bay is closed or at capacity for appropriate isolation.
Pulse Oximeters will continue to be stocked in D1 and with Social Work/Care Coordination — current inventory is sufficient; MRN’s recorded for each pulse ox given out.
Continue using Epic Orders under “Common Follow-Ups” (photo below), when appropriate:
- ED COVID Discharge, which populates options for COVID Discharge Instructions and Pulse Oximeter.