Weekly Update – 5 September 2021 – NewYork-Presbyterian Emergency Medicine

September 5, 2021

From Dr. James Kenny: Admin Fellowship Opportunity

The Department of Emergency Medicine at the Hospital of the University of Pennsylvania is pleased to announce we are actively recruiting for a position in our EM Administrative Fellowship to start in the 2022 academic year. The Fellowship includes an MBA from the Wharton School at the University of Pennsylvania, and substantial financial support for that program. We encourage any interested applicants to review our website and to reach out to Dr. Keith Hemmert, Associate Fellowship Director.

From Chiefs Jamie and Chris: Holiday Scheduling

The holiday season is rapidly approaching! Please indicate your preferences for Thanksgiving, Christmas or New Year’s off by ranking them 1,2 or 3 in the form below. The deadline for submission will be September 5th:

https://forms.gle/b8Y1WVc4RxtvWCiH8

From Kaush: Opportunity for writing book chapters

Let me know if you’re willing to write a book chapter. We have a 3 month deadline. Should be fairly easy to write. Few pages and few tables. Email me with your interest and I’ll send over the sample chapter.

Approach to Trauma
Approach to Wounds
Approach to Burns

Thanks,
Kaush

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 our Columbia Critical Care Colleauges: MERINO Review

” It should be noted that in this study, extended infusion intervals of PTZ were not utilized, and there were more immunocompromised and neutropenic patients in the PTZ group. While the authors support antibiotic stewardship and judicious de-escalation of antibiotics when appropriate, in the case of ESBL producing E. coli or Klebsiella species, carbapenems should be utilized over PTZ.”

What do you think? What will we use when resistance to carbapenems develops? Do we need to be giving carbapenems in the ED to patients with a bug-drug history of ESBL bacteremia? With a bug-drug history of cefotaxime resistant e. coli?

From Dr. Betty Chang: ICU sign out process, outpatient MRI workflow

Getting hold of our Care Managers / Social Workers:
Remember that the best way to reach the Care Coordination or Social Work team in real time is via the Secure Chat group below. The earlier they can be involved in a patient’s care, the better. Even if we don’t know the final disposition, they can help coordinate resources for the patient so that their stay is more efficient.
NEW: ED Primary Team to do hand-off to Primary ICU Team (effective: September 1st):
-In order to better serve our ICU level patients and improve our communication about the care of the patient, we will be doing a verbal hand-off from ED primary team to primary ICU Team starting September 1st. This is the similar process as regular floor admission process. PPOC will connect the two teams.
-If we need to contact the team, we can either chat them via “CUIMC MICU A (Admit Team)”, “CUIMC MICU B (Admit Team)”, etc. or call the ICUs directly.
-No change: ICU triage consult resident / attending will still do the patient allocation between ICU and SD, will help with management of ICU level patients in the ED, etc. ICU patients in the ED will still be the responsibility of ED primary team.
ED Boarding & Coverage:
-As many of you know, our volume is creeping up over the past few months (see below). Every day, the ED AOC works with MAC (medical admitting clinician) to get teams for the patients. We will continue to escalate to the Hospital senior leadership, and advocate for our patients.
I know it may not mean much, but just want to say “thank you” for doing the best you can under the current circumstances. Your hard work is truly appreciated. It has not been easy. I am hopeful that it will be better with overall staffing in the fall.

To end on a positive note, ED to Outpatient MRI process:
-We just hit the 50 patients mark (since go live in April) in getting our ED patients a non-emergent MRI (in lieu of admission or doing the MRI during an ED visit). Shout out to Eugene Kim for partnering with me on this initiative!
-Please keep in mind, that this is for ED patients; and Neurology needs to be involved so the MRI results are passed on to the appropriate people and not to ED providers.
-Please make sure you consult Patient Navigators for the PCP portion (Comment: Outpatient MRI). Neurology will arrange Neurology follow up and get the key stakeholders (call center, radiology, CM/SW, etc.) in a secure chat.

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

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.