Weekly Update – 28 June 2021 – NewYork-Presbyterian Emergency Medicine

June 28, 2021

Residency Families meetings in lieu of Wednesday Conference:

Please note that there will be no EM conference Wednesday, June 30.

Residents – Please plan on meeting with your residency families on Wednesday morning. Discuss with your individual families for further details. You will be expected to report to shift at normal time if you are scheduled to work.

EM Conference will resume on Wednesday, July 7.

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. 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

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. Lauren Titone: Third Year Medical Students in the ED

Below are some class specific reminders that are relevant to the MCY (third year) clerkship students we have. This is particularly important for the rising PGY-3s who these students will be shadowing many times throughout the year.

These are “third year” Columbia Medical students that rotate with us for two weeks, they are not Sub-Is. Many of these students have never rotated or shadowed in the ED (or ANY clinical area) before.
PGY4s: These students may be presenting to you, as any junior resident would, in Area Green. At the end of every shift, the student will hand you a feedback card with a QR code. Scan the QR code with your smartphone and it will take you to a 4 question Qualtrics survey. Please, please, please fill these out in real time. Then sign the card and hand back to the student. Please also provide as much verbal and direct feedback as possible throughout their shift.
PGY3s: The students will be shadowing you during some of your shifts from 3p-8p (if you are singing out at 4p please also have them shadow your relief form 4p-8p, do not dismiss them early). They will not be seeing these patients primarily on this shift so should not be writing notes. Please encourage and involve them in the resuscitation process for patients that you see and try to share your thought process with them. This will be the most exciting part for them! At the end of their shift, the student will hand you a feedback card with a QR code. Scan the QR code with your smartphone and it will take you to a 2 question Qualtrics survey mostly asking if they were on time and professional. Please, please, please fill these out in real time. Then sign the card and hand back to the student.

PGY1s/PGY2s: The students should not be presenting to you directly on any patients. However, please feel free to involve them in any case, imaging study, procedure, etc. that you think may be interesting. Remember, a lot of these students have never been in the clinical arena, so everything is new and exciting for them!

The students are expected to work directly with the attending (or PGY4 if working in Area Green) and see patients independently (about 2-3 per shift). This is not a shadowing experience (except for the PGY-3 shift). Please do not have them move to a different clinical area. There may be two students on shift at a given time but never two students per attending. If any issues arise regarding staffing of the MCY students, please reach out to us directly.

We wanted to thank each and every one of you for the incredible work that you do for our medical students. They look to you for guidance both medically and career wise so please share your experiences and knowledge with them as much as possible. Here is a link to a great resource that your colleagues have put together with class specific tips for teaching medical students. These students will see and listen to everything you do and say, so please show them how great it is to be an EM physician!

From Dr. Marc Probst: New NIH-funded Syncope study – PACES.

Dear EM Residents,

We are very excited for the upcoming launch of a new ED clinical research study called PACES.

Here is a brief summary of the study:

Study Design: Prospective, observational study.
Inclusion Criteria: ED patient with syncope OR pre-syncope. Adults aged 40 and over.
Exclusion Criteria: AMS, unstable, lacking capacity, NEW serious ED diagnosis (e.g MI, PE, GI bleed.)

The research coordinators will first approach you to check whether the patient is stable, has capacity, and truly had syncope/presyncope. If yes, they will do all the screening and consent. Then they will ask you a couple of clinical questions (e.g. vasovagal vs cardiac syncope vs unclear). Later they will ask you to interpret the EKG and about any serious ED diagnoses (e.g. MI, PE, GI bleed).

Please do NOT hesitate to contact me if you have any questions or comments:

My contact information:

Cell: 310-666-3834 (Any day, any time.)

Email: mprobst@gmail.com.

Thank you in advance!!

-Marc

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).

From Dr. Garg: New ED/IM/Endoscopy workflow

GI confirms that an ED patient needs to go to the endoscopy suite
ED Team clearly states in their Transfer of Care note “Working ED Diagnosis / Reason for Admission” that the patient is being admitted for food impaction/endoscopy
ED places Bed Request to Medicine
PPOC prioritizes these endoscopy patients for a Medicine team
PPOC initiates the admission secure chat with Internal Medicine + ED + GI consult “WC GI Consult”
–>> Allows for all parties to discuss case details & anticipated discharge timeline