Weekly Update – 26 July 2021 – NewYork-Presbyterian Emergency Medicine

July 26, 2021

NEW from Dr. Cloyd: CPC Competition is coming to conference October 27th!

We are soliciting 5 resident volunteers to present the details of mystery case (5 minutes) and then culminate the case with teaching points (10 minutes) on the topic or diagnosis at play. In between, the faculty will work through their differential and reasoning for the audience, having reviewed the case beforehand. Nothing like day full of mystery cases and watching your attendings sweat trying to figure out the diagnosis!

Having your own case is not a prerequisite, I have a few saved goodies to share. It’s really a lot of fun and minimal work on the part of the resident. Trust me. It’s hell for the faculty! We then vote on the best faculty and resident presenter to represent NYP at CORD Academic Assembly in March 2022.

I have examples of previous presentations and am happy to help coach you through the process.

CORD Clinical Pathologic Case Conference (CPC)

Please let the Chiefs know if you are interested! Happy to answer any questions you might have.

I did it 3 times in residency, so it’s definite a fave of mine.

Trudi

NEW from Dr. Avitabile: Flipped Classroom Assingnments for 8/4 Sono Conference

Hi everyone! Please review these videos prior to 8/4 Ultrasound Conference.

Basic:

Aortic dissection: https://www.coreultrasound.com/ad/

Aortic aneurysm: https://www.coreultrasound.com/aaa/

RUSH/IVC: https://www.coreultrasound.com/rush-exam/

Basic cardiac function: https://www.coreultrasound.com/basic-cardiac-function/

Cardiac windows: https://www.coreultrasound.com/how-to-obtain-cardiac-windows/

US leadership academy lecture: https://www.coreultrasound.com/ula_claire/

Advanced:

Right heart strain: https://www.coreultrasound.com/right-heart-strain/

Valves: https://www.coreultrasound.com/valves-2/

NEW From Dr. Shah: CORD Resident Conference Facilitators Needed: High-Performance Resuscitation Teams Summit: Chicago, IL. 10/14-10/16/21

Stanford EM, Mayo Clinic EM, and the Mission Critical Teams Insitute are hosting the inaugural High-Performance Resuscitation Teams Summit in Chicago on October 14^th – 16^th, 2021.

We are looking for 10 residents interested in Critical Care, Tactical, EMS, or High-Performance Teams to serve as facilitators. The conference fee will be waived for the selected residents selected. Here’s the application. Deadline: August 5, 2021. A letter of support from the PD is needed to apply.

This summit will review critical concepts and operationalize implementation practices for High-Performance Resuscitation Teams. Attendees will explore how team members acquire, process, and make information actionable, including strategies for effective communication, collaboration, and cooperation. Experts in the field will focus on situations of high risk and high consequences, as well as, constructive communication in intense and highly emotional scenarios.

This summit will be led by a series of dynamic speakers from medicine to military to sports teams and NASA presenting on topics related to team performance and medicine. Each participant will then engage in a process of small-group collective inquiry. Participants include medical resuscitation teams (Trauma, Critical Care, Emergency Medicine, Cardiology, Obstetrics, Flight Medicine) and other professions such as competitive sports, law enforcement, structural and wildland firefighting, and Tier 1 military teams.

We are also looking for curious, engaged individuals from a wide range of teams to participate in the course.

Please have your residents reach out to me directly at alai.alvarez@stanford.edu for interests and/or inquiries.
For more information about the course, please check out: High-Performance Resuscitation Teams Summit

Reminder: All NYP employees must have COVID vaccine by August 1

Dear Colleagues:

Thanks to all of you, NewYork-Presbyterian is one of the leading health care providers in the nation in the fight against COVID-19.

We continue to have a responsibility to protect the health and safety of our patients, their families, and each other. Having witnessed the devastation of the pandemic, we know how important it is for all of us to be protected against this deadly virus and its unpredictable and alarming variants. Our commitment to the well-being of every NYP patient and employee is unwavering, and all employees, physicians, students, clinical rotators, volunteers, and vendors are required to participate in the NYP COVID-19 vaccination program. This means that everyone must have received their first dose of the vaccine, or have an approved exemption, no later than September 1, 2021

Reminder: Complete the monthly ChIP forms by the end of the month - see e-mail from Dr. Mark Curato

Dr. Curato sent an email on 7/1/21 describing the ChIP program and assignments (due 7/31, assignment attached to the email). Here is an excerpt.

Beginning now, and around the 5th of each month hereafter, you’ll receive an assignment of 2 charts to review (see the attached spreadsheet).
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.

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.

Campus Announcements

From Dr. Betty Chang: Columbia Ops Updates

1) REMINDER: Transfer of patients to Area D

-Recently, we are seeing a communication gap within members of clinical team when there is a patient being transferred to Area D.

-For safety reasons, before a patient is transferred to Area D, both the transferring attending and the receiving attending must be made aware. This is the responsibility of everyone in the care team.

-Please make sure proper documentation is done. Including Observation orders when indicated.

2) LAB REFERENCE

The new aPTT heparin therapeutic range will be 51-83 seconds.
D-dimer results will be reported in ng/mL in D-dimer Units (DDU), as opposed to the current assay that reports results in µg/mL in fibrinogen equivalent units (FEU). Reference range will cut off at < 230ng/mL.
HIT (Heparin induced thrombocytopenia) assay results will be reported in U/mL and are interpreted as either negative or positive based upon the assay cut-off of 1.0 U/mL.

3) WANTED: PROVIDER CHAMPION — Visitation in the ED – Patient Experience

-We are looking for someone to work in this interdisciplinary group to enhance patient experience as related to visitations in the ED.

-During DBD (Direct Bed Deferral), visitation by family is suspended leading to poor patient satisfaction/experience. However, we also need to consider space constraint and distancing. Looking for a solution that is conducive to both issues.

–If you are interested in joining nursing, patient services and security officers, to lead in this initiative, please email me.

4) COMING SOON – mid JULY (anticipated date July 18): Navigator to Return to Milstein ED in a hybrid form

– 2 Patient Navigators on site on weekdays

– 1 Patient Navigator (either morning or evening shift) on site on weekend.

On site: a morning navigator (7a-3pm or 8am-4pm) and an evening navigator (11am-7pm or 12pm to 8pm) will be available

Off site: we have the rest of the navigators working from home working morning and evening shifts so all orders placed will be taken care of

For in-person navigators: just place an AMB referral to Patient Navigation as usual. The team knows that when they are on site they will be assisting a minimal of 5 patients each who are only at bedside. In-person navigators will not select discharged patients as those patients will be assisted by the navigators that are working from home.

If a provider needs an in-person navigator immediately they can send a secure chat to our group: CUIMC ED Patient Navigator Team.

**Please use the Patient Navigator services for patients who you think will have difficulties making appointments on their own.

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. Sara Zaidi: Oral Histories from the Front Line during COVID

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).