Weekly Update – 21 August 2021 – NewYork-Presbyterian Emergency Medicine

August 23, 2021

From Dr. Adria Simon: Recruitment Goals 2021-2022

Hi everyone,

I want to invite all of you to join the program leadership for a meeting about our goals for our 2021-22 residency recruitment season! In this session, we’d like to work to define our collective vision for the residency and shared values for the program. As the group that defines the culture of our program, you are our most important stakeholders in identifying who thrives here and what ways we can continue to grow into a more inclusive, cohesive and supportive residency family. The leadership’s goals are to pull in the themes that arise from this meeting to build guiding principles as we screen and interview our potential future residents in the very near future. To that end, please let me know if you’re interested in attending and consider preparing 2-3 ideas about core values or areas for growth for 8/25. If you’re not able to make it, I’m always available over email or to chat on the phone to get your input.

Cheers!

Adria

Mind the Gap: Social Disparities of Health Curriculum

Dear EM Family,

We are working on a new social disparities of health curriculum called “Mind the Gap” for our weekly departmental didactics. Please take a moment to let us know which topics you are interested in learning more about as well as your comfort and knowledge in some key areas.

Qualtrics Anonymous Survey

We are most grateful for your time completing the survey.

It should be short and sweet!

With gratitude,

Denise Marte

Adria Simon

Trudi Cloyd

Campus Announcements

From Dr. Oz Sayan regarding Columbia Morning Report:

“We need the clinical faculty to ensure that all trainees are released with enough time to get to Morning Report at 9:15am. Late arrival disrupts the learning for all.” This will be messaged to the faculty as well.

NEW From our Columbia ICU Colleauges: Critical Care Trial Infographic of the Week – The “65 Trial”

What do you think? How does this apply in an ED vs. ICU setting?

Here’s a link to a Powerpoint with Prior Infographics: EBM PPT

From Dr. Adria Simon: Columbia Moonlighting

If you are a senior resident who received an email from Adria noting eligibility (explained in another email) you may moonlight! You would be working as a junior and the pay would be $100/hr.

Note that the exact side (B/C) may be subject to change prior to the shift.

Tuesday 8/31 Green 12p-12a
Thursday 9/2 Blue 8p-8:30a
Friday 9/3 Green 12p-12a
Saturday 9/4 Green 12p-12a
Sunday 9/5 Green 12p-12a
Friday 9/10 Green 12p-12a
Saturday 9/11 Green 12p-12a
Sunday 9/12 Green 12p-12a
Friday 9/17 Blue 8p-8:30a

To pick up one of these shifts, please email Adria your desired date (s) with a completed copy of the GME moonlighting form (see Adria’s 8/20 email).

Please fill out as follows:
Check the box that states: “Coverage within the scope of my residency program.”
Name of Institution: NYP
Professional Liability coverage is: NYP-MCIC
As a reminder, moonlighting counts towards your duty hours requirements so please reference your schedule to ensure that any dates requested don’t violate the duty hours policy (no more than 60 clinical hours a week, equivalent # of hours off as the length of shift worked, 24h off per 7 day period).

Reminders from the Cornell Opertions Leadership:

Escalation Rolodex:

Any clinically important delays can be escalated using the escalation rolodex
Search in nexus on top right “Escalation”
Use judiciously– involve your attending or admin attending if needed

LABS vs LWBS:

Only select Walked Out Before MSE if no providers have evaluated the patient, meaning there is no MSE Note, ED Provider Note, or ED Progress Note indicating evaluation.
If the patient has an MSE Note or other evaluation documented by any provider (it doesn’t have to be you!), choose Walked Out After MSE instead.
See Nexus > Dispo & Transfer > Elopement.

Reaching the Unit Coordinator (formerly PM):

For any equipment needs in the ED for which you need help, please utilize the epic role “WC GBG ED Unit Coordinator“ to reach the available UC, not the individual

Social Work/CC:

Please inform the patients that they often will need to wait substantial amounts of time for ambulette/lance and may need to pay for the ride
Refrain from offering ambulette/lance if the patient has the means to get home safely on their own

Patient navigators:

Reserve for patients who actually require services (who will fall through cracks if not given appointment)

Activations:

4 Activations: OB (include out of hospital deliveries), Trauma, Stroke, Acute MI/STEMI
Inform the unit clerk

Key Epic Updates from Dr. Jean Scofi

CRITICAL EPIC UPDATES

1. A new “ED Adult Spinal Cord Compression Emergency Order Panel” is now available on our Quick List!

The goal of this new order panel is to limit delays in the diagnosis of non-traumatic spinal cord emergencies using a unified and standardized approach.
If you identify a patient at risk for a spinal cord emergency, please use this order panel to place your lab and imaging orders.
This will expedite MRI imaging for your patient by marking it as “life-threatening.” It will also ensure that the appropriate labs and nursing communication orders are included.
For questions, please contact Dr. Brenna Farmer or Dr. Matt McCarty.

2. Starting this week, you can select the status “DC Awaiting Transport” for your patients who are discharged but awaiting transportation in the ED.

This is a handy way to keep track of these patients while they are still physically in the ED (and prevent ED staff from prematurely remove them from the trackboard).
We hope this is particularly useful to our ED nurses who are tracking patient flow!

From the ED trackboard, right click on the colored “Status” column on the far left.
Then select “Patient Status.”
Then select “DC Awaiting Transport.”

3. We have 2 new ED trackboard views called “My + Attending Unassigned” and “My + Provider Unassigned” to help you pick up patients.

You may need to click on the “Wrench” icon on the ED trackboard to add these views.
The “My + Attending Unassigned” view shows your patients (the ones that you’ve assigned yourself to) plus patients who have no attending assigned (even if a resident/APP is assigned). This replaces the old “My + Unassigned” view.
The “My + Provider Unassigned” view shows your patients plus patients who do not have ANY provider assigned (attending or resident/APP).

4. You can now review Pulse Checks in the ED Narrator Event Log (for nursing) and the ED Patient Care Timeline.

Wondering how to find out when pulse checks happened during a code?
The Pulse Checks documented by ED nursing are now visible in the ED Narrator Event Log and the ED Patient Care Timeline. It looks like this:

EPIC USER TIPS

See the full list here! A big thanks to Dr. Anthony Yuen for compiling these based on Epic Power User training material.

1. Did you accidentally upload an image to the wrong patient’s chart?

You can remove the image using these steps:

Within Hyperspace search for Media Manager.
Type in the Patients MRN
Find the images referenced below and single click to select one of them
Click Delete in the tool bar.

2. Need help with Epic? Come to Epic Office Hours at noon every Friday!

This is a friendly reminder that Jane Torres-Lavoro and I hold Epic Office Hours every week. Here’s some things I can help with:
- Clear your In-Basket
- Help complete notes when you get emails from coders
- Customize your SmartPhrases and macros
- Help fix any Epic/DUO/Haiku/Jabber access issues
- Hear your ideas about how to make the EMR better and formally enter an optimization request for you
- Hear your data needs and formally enter a reporting request for you
- Give you updates about your existing requests
Come check it out on Zoom every Friday from 12pm-1pm!
Zoom Link: https://weillcornell.zoom.us/j/92851800762

Message from Dr. Peter Steele on ED Walk-Outs:

Our LWBS (left without being seen) rate has sky rocketed. This is a highly-scrutinized QPS metric by executive leadership; our individual chart reviews reveal many of these cases are due to inaccurate disposition documentation.

It is critical the ED team accurately documents left after being seen vs left without being seen. Please can you ensure the attached document is reviewed in detail by residents, specifically that LWBS should not be the selected disposition if there is any initiation of care prior to the event, including an APP triage RME.

If the patient walks out while an ED team member is performing an initial evaluation, please document that evaluation as a brief note and identify as pt as left after being seen.