Weekly Update

January 3, 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.

 
Please join us in congratulating Dr. Christie Lech on her appointment as Assistant Program Director of the NewYork-Presbyterian Emergency Medicine Program. The bi-campus Weill Cornell and Columbia Emergency Medicine residency program is led by Dr. Manish Garg, Program Director, and the Associate/Assistant Program Directors, Osman Sayan (Columbia), Anne Katz (Cornell), Trudi Cloyd (Columbia), and Adria Simon (Columbia).
 
As assistant program director, Dr. Lech will oversee didactic and clinical education, resident scholarly and professional development, resident evaluation and selection, resident advocacy, and patient management. Dr. Lech will be assuming the role from Dr. Mark Curato, who will be taking on a new role on the Weill Cornell Medicine Emergency Medicine Undergraduate Medical Education (UME) leadership team. We would like to extend a sincere thank you to Dr. Mark Curato for his wonderful service as Assistant Program Director. and congratulate him on his new role.
 
Dr. Christie Lech received her undergraduate degree from CUNY Honors College at Queens College, and earned her medical degree from New York Medical College. Dr. Lech completed her residency at Mount Sinai Hospital, where she was Chief Resident. During her time there, she continued her medical school research into looking at barriers into HIV testing in emergency departments both locally and abroad.
 
After her residency, Dr. Lech joined the NYU Langone Department of Emergency Medicine at Bellevue Hospital. For three years, she served as the assistant residency director and then as the interim residency program director. While there, she completed her master’s in health professions education (MHPE). Her thesis focused on the design, implementation and evaluation of a novel debriefing program in the emergency department. 

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
 
December: 
20th, 21st
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. 

Campus Announcements

Hello all: 
 
As you’ve noticed, the COVID surge situation in NYC and at NYP has been escalating rapidly — and some of the changes have been difficult to keep up with. I’ve included a few brief updates below regarding some of the most important issues. Please note that guidelines and procedures tend to change quickly – please check the infonet and most up-to-date email updates from Columbia and NYP for current guidance. Feel free to email me with questions or clarifications and I’ll attempt to obtain information from the most accurate sources.
 
 
Eligibility and Distribution of Oral Antiviral Medication – now available
  • The FDA has authorized two oral antivirals for emergency use:
    PAXLOVID is produced by Pfizer.  MOLNUPIRAVIR is produced by Merck. 
    PAXLOVID – reduces risk of hospitalization and death by 80%. This is the preferred product and is available for patients 12y and older. MOLNUPIRAVIR – reduces risk of hospitalization and death by 30%. Consider for patients 18y and older for whom other product is not available. 
  • NYP distributed guidance earlier today regarding the use of oral antivirals. That document is attached to this email and linked here on our Teams site. PLEASE USE THIS GUIDANCE DOCUMENT TO IDENTIFY ELIGIBLE PATIENTS AND INITIATE TREATMENT.
  • Who should get these drugs and how can I prescribe them?
    This is complicated. The cross-campus ED evidence-based medicine group is working to develop ED-focused guidelines for clinicians asap. These guidelines will mirror state and city eligibility and prioritization guidelines. In New York City, ALTO PHARMACY is the sole distributor of these medications. Prescribers will need to send a prescription to ALTO pharmacy. Once the prescription is delivered, patients will contact the pharmacy via phone, text, or mobile app to schedule a same-day delivery. Outside of New York City, a small number of pharmacies in each region have allocations of the medication. In Westchester, this is initially CVS in Portchester, Peekskill, and Yonkers.
  • The most recent guidance from NYS is here.
  • And the most recent guidance from NYC is here (external link).
  • More detailed information for ED providers is forthcoming – including smartphrases for specific discharge instructions.
  • Currently, availability of these medications is severely constrained and NYP endeavors to follow FDA and state eligibility guidelines to ensure that our most at-risk patients receive these potentially lifesaving medications. Please carefully consider the guidelines prior to prescribing. 
  • Pro tip – the information for these medications is available in Lexicomp – including contraindications and drug-drug interactions.
 
 
Return to work guidelines for employees:
  • Confusing? You bet! Here’s the upshot:
  • COVID-positive health care workers may return to work after FIVE DAYS HAVE PASSED following symptom onset, or following a positive test if asymptomatic. NYP and CU guidance now align on this matter. That means the day of the test or the first symptoms is day 0, and you return to work on day 6.
  • Return to work criteria include symptom improvement, afebrile for 72 hours, and able to safely and comfortably wear an N95 mask. 
  • You are NO LONGER REQUIRED TO CALL THE WHS HOTLINE TO OBTAIN CLEARANCE TO RETURN TO WORK. Please do continue to email the AOC and Jimmy+Zysa.
  • Per yesterday’s guidance, personnel may return to work if qualified as above, without the CU test trace team. 
  • Dec 29 NYP guidance is linked here (infonet link).
  • Use https://covidtracker.nyp.org to report illness and get further information.
 
 
One last word about returning to work:
  • You’ll notice that the isolation period for covid-positive workers has been significantly reduced, in light of available evidence regarding transmissibility of the delta and omicron variants. And clearly staffing is very tight.
  • This doesn’t mean that you’re expected to work while sick, or that you should feel pressured to return before you are healthy and ready to work. No one wants to leave their colleagues high and dry — but dragging your sniffly cough cough foggy-headed self to work before you’re ready doesn’t help your patients or your co-workers. 
 
 
Testing for Employees – expanded availability
  • Alternative testing locations are available for CUIMC personnel. Employees should not be referred to the ED for testing.
  • The CU testing center in the Black Building is available for employees, but will be closed from Thursday, Dec 30 through Monday, Jan 3. Normal hours will resume on Jan 4th. 
  • As of yesterday, the Black Building site was accepting walk-ins. This may change. 
  • The Heart Center NYP testing center has expanded capacity and will now be open 7am-7pm Monday through Friday. The Heart Center site will be open for symptomatic testing only on Friday 12/31, Sat 1/1, and Sun 1/2 (830am-5pm each day). Use the Connect app to schedule.
  • We are able to expedite testing for symptomatic employees who need to work clinically. If you find yourself in this situation, contact the ED AOC (residents, contact program leadership) for help.
 
 
Community-based testing remains scarce
  • Testing capacity is very limited. The NYC DOH has begun to operationalize community based testing sites at a variety of locations, hopefully there are more to come. 
  • Here is a list of NYC DOH testing sites, including mobile sites and availability over the coming holiday weekend. 
  • A searchable map of testing sites is here.
  • For tests done at NYP, the capacity to follow up pending tests and notify patients of positive results is constrained. When possible, please encourage patients to enroll in Connect to track their test results. 
  • See Laurie’s Tuesday email describing how to enroll a patient in connect. Here’s the quick reference sheet that she attached. 
 
 
“Cough and Cold” clinics are back!
  • A ‘cough and cold’ clinic operated by the faculty practice and ACN has been opened in the VC lobby at CUIMC. The purpose is to provide evaluation and care for low acuity patients as an alternative to an ED visit. Screeners should be stationed at the Broadway ED lobby to help direct appropriate patients to the clinic. As of now, likely hours are 10a – 8p, hopefully 7d/week.
  • Plans are in the works for similar clinics at other clinical sites — stay tuned. See Angela’s email from earlier today for more detail.
 
 
Bonus Situational Awareness Info – New Year’s Eve
  • If you’re looking to scroll some helpful info while waiting for the ball to drop, here you go (also if you’re traveling or working on NYE):
    Estimated Attendance: 15,000 attendees 
    Participant requirements: 
    Attendees must show proof of full vaccination and valid photo identification Unvaccinated minors under the age of 5 must be accompanied by a vaccinated adult to enter the event. Attendees will be required to wear masks and the event is fully outdoors. Viewing areas will be filled with fewer people to allow for social distancing. Visitors won’t be allowed entry until 3:00 pm.
    Street closures: 
    Vehicle traffic from 45th through 48th Streets in Times Square is generally closed by the early morning 12/31 By 3:00 pm, the streets are closed from 42nd to 49th Streets between 6th and 8th Avenues 
    Subway impacts: 
    Certain subway access will be altered in the Times Square area (the actual time of the system changes could change) TIMES SQUARE-42 ST STATION: The 42nd Street entrances close at approximately 11:00 am 49 ST STATION <N/R/W>: This station will be bypassed beginning at about noon 12/31 until approximately 12:15 am, 1/1 50 ST STATION <1>: This station will be bypassed beginning at noon, 12/31 until approximately 12:15 am, 1/1 
  • Updated information is here.
 
One last reminder — please be vigilant with PPE. Current recommendations are for N95 + eye protection for all patient care. We’re at that point now where even patients with broken ankles are covid positive. This also means exercising care in team rooms, break rooms, etc. 
 
That’s plenty for now. I’ll continue to send out periodic updates as the situation evolves. Remember, the next couple of weeks are going to be a bit sporty, but we’ve got this. Take some time to exercise, enjoy the outdoors and New Year’s holiday.


12/31 Update: Oral antivirals – guide for providers
  • Here’s the NYP ED guide for provision of oral antivirals. This document summarizes the guidelines I mentioned yesterday. Please note that we’re still in category 1A, which means only patients who are moderately to severely immunocompromised or age 65+ AND not fully vaccinated AND one or more risk factors for severe disease.
  • The document is attached here as well.

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.

1/5/22: Orthopedics Week One

Time

Topic

Speaker

  • 08:00 - 08:30
  • Case Follow Up
Dr. David Chu

NYPEM PGY-3

  • 08:30 - 09:15
  • The Americans with Disabilities Act: An EM Perspective
Dr. Tomas Diaz

CUIMC EM Attending

  • 09:15-10:30
  • Journal Club
NYPEM Faculty
  • 10:30 - 11:00
  • PGY 4 Grand Rounds
Dr. Alex Wang

NYPEM PGY-4

  • 11:00 - 12:00
  • Columbia Morbidity and Mortality
Dr. Blake Lopez

NYPEM PGY4

ASYNCHRONOUS LEARNING AND MATERIALS

ALiEMU Ortho Lower Extremity Module

ALiEMU Ortho Upper Extremity Module

Tintinalli’s Emergency Medicine 9th Ed – Chapters 267-284 (WCM Library for residents)

Journal Club Attachments

(Note that reading time will be incorporated into Journal Club)

Journal Club Schedule and Instructions

Measuring Patients’ Experiences 

Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial

Clinical Appraisal Checklist

CONFERENCE ATTENDANCE AND EVALUATION

Conference Evaluation and Resident Attendance Form

Columbia 2021-2022

Cornell 2021-2022

 

ZOOM

Topic: NYPEM Conference 1/5/21
Time: Jan 5, 2022 08:00 AM Eastern Time (US and Canada)

Join Zoom Meeting
https://nyph.zoom.us/j/99562008686?pwd=TlRMQThUTzhOQWhGL0o3SFRrSXovQT09

Meeting ID: 995 6200 8686
Passcode: 924398

Shout out to the many residents who have stepped up to cover sick call with a positive, team-first attitude! 

Chief on Call

Ryan Latulipe, M.D.  
EM Chiefs’ Cell:  917-410-1056
  • Please call and do not text/ email so we can address issues promptly.
  • If you do not hear back within 10 minutes, then call any of the other chiefs