March 8, 2020

General Announcements

  1. Please ensure that you’re doing walk rounds of the active patients after computer handoff.  This allows the new provider to associate a face to the patient’s name/ HPI, to pick up changes in clinical status, and for the patient/ family to see that a handoff is occuring.
  2. Sign DOP Forms – As part of your reappointment package you must complete a Delineation of Privileges From.  Attached is the DOP form for your convenience. It simply requires your printed name on the front page and your signature on the back page. You are welcome to return the completed form via email as a PDF (no photos please).
  3. Prioritize completing the QA sheets in QPath for FAST exams so that they can be QA’d
  4. 2020 NYPEM residency graduation at the Central Park Boathouse on June 3, 2020! 

Coronavirus Updates

Given the rapidly evolving response to COVID19, it can be challenging to stay current.   Below are the most critical updates from NYP and GME. 

For future updates, please see the COVID19 Updates page 

Please review the following NYP updates regarding COVID19.  These updates should apply to both campuses, and residents should be generally aware.

Remember that the isolation negative pressure rooms in at Columbia are rooms RME 16, B9, C7, D15. 

At Cornell, these rooms are found in Areas C and D. 

NYP ED MANAGEMENT ALGORITHM

NYP COVID19 TRAVEL GUIDANCE AND FAQs

NYP COVID19 CLINICAL BULLETIN #5

NP COVID19 FAQs 2.28.2020

Campus Announcements

Dr. Nick Gavin: Milstein to Allen Transfer

Beginning Sunday night into Monday morning, PPOC will begin identifying patients who are appropriate for admission to the Allen Hospital based on the attached clinical exclusion criteria. We are seeking to revamp this process as it will offload work from the Milstein Hospitalist team, help with Milstein ED crowding, and enhance quality of care for this cohort of patients.

When the PPOC nurses identify patients, they will be reaching out to the clinical team. During the day, when available, the care coordinators will be communicating with patients, but overnight, it will be the physicians and physician assistants caring for patients who will be responsible for approaching the patient about admission to the Allen.

The most important thing to express to patients is that the median wait for a Milstein bed has recently been 25 hours. This means that 50% of patients actually wait longer than that. When initiated, the transport to the Allen floor bed should be completed within 3 hours. Other key messaging is that Columbia Doctors follow patients at the Allen and patients typically have a better experience at the Allen Hospital.

Please see attached for the full process map, some ideas for scripting as you approach patients, and for the formal clinical exclusion criteria.

Thanks and please provide any and all feedback as this commences.

Dr. Lorna Breen: Followup Orders

We have confirmed that routine cultures and final imaging reads will automatically go into the NP follow up basket and we do not need to place follow up orders for them any longer.

While we appreciate the carefulness of those who have been doing so, the NPs have shared that it actually increases their work load as each result has two follow up orders that need to be checked.

Hopefully this new work flow will be more efficient for all. Please let us know if you have any questions, concerns or points of clarification.

From Dr. Ken Wong:  Orienting off-service rotators

Senior residents: please ask the rotator if it’s his or her first or second shift, and (if so) give a brief orientation at perhaps 7:45.  This is a shared responsibility with the attending. 
 
Rotators have gotten a welcome email and a handbook; chiefs also gave June in-person orientations.  However, a rotator’s first shift can be any one of ~12 times during a month, and nothing’s as good as on-shift instruction.  Focus your brief pointers on where to find things, the dispo note template, how to bed request after the dispo, and how to PFD and discharge a patient.  It will pay off with a more effective member of your team for the following dozen hours.
 
 

From Dr. Annie Katz:  Joint Commission Visit

It is very important that the residents are prepared and should refer to the attached provider guide above regarding their roles and expectations. The info will also be uploaded to nexus.
 

From Dr. Michael Stern: Age Adjusted D-dimer

Please do not use the age-adjusted d-dimer algorithm for determining appropriate management of PE risk in the elderly population. In the JAMA 2014 study (Righini et al), the fixed d-dimer level of 500ug/L, which is subtracted from the calculated age-adjusted cutoff (age X 10), is not the same threshold number that we use in our d-dimer assays at the Cornell campus. Therefore, extrapolation of the study’s data results to our practice is not accurate and therefore not appropriate. There has already been a case of a missed PE in an elderly patient after using this age adjusted d-dimer threshold with our assay.

From Dr. Dave Bodnar: Ortho Survey

We are constantly trying to improve our interaction with consult services. As such, we are hoping to get your feedback specifically on Orthopedic consults at Cornell. They have been attempting to improve their response to our consults, so it would be very helpful if you could please take a few minutes to answer the questions on this survey to gauge its effectiveness.  The survey should take less than 5 minutes.

https://www.surveymonkey.com/r/T5W3HB3

From Dr. Sara Murphy:  ICU/CCU consults 

Here is the ppt and details of the QI project with ED/ICU/CCU project. The documents are pretty self-explanatory but I’m happy to clarify if needed. 
  1. Formalized Qualifications of Consult Levels
  2. Revised MICU CCU ED Consult Guidelines

MCB Message of the Month

From Rachel Sullivan, LCSW: Victim Intervention Program Social Worker

Hi all,

Due to new NYS Laws, it is now more important than ever that all sexual assault patients are offered private, individual time with a volunteer Advocate BEFORE any part of SAFE care begins, and again throughout SAFE care.

The Advocate role is only privileged/confidential at certain times, as long as there is no third party present during a conversation.

Advocates have now been instructed to meet with SAFE patients ALONE and FIRST, in order to fully explain their role and the limits to their privileged role. They will not be obtaining a history from patients.Any time a third party is present (ex. a SAFE, a nurse, a SW, a friend, etc.) conversations are no longer confidential and Advocates can then be considered a witness, meaning they can be subpoenaed by the court system.

All sexual assault survivors will be provided with the NYS Survivors Bill of Rights in the form of a packet. This packet will be given to patients first by a Social Worker, before leaving the room for an Advocate to then meet with the patient alone. (See below for case flow).

We are asking all SAFEs and ED staff to accommodate the Advocates’ REQUIREMENT to meet with patients alone. SAFEs should wait until the Advocate has already met the patient before beginning their interview and SAFEs should leave Advocates alone with patients again BEFORE beginning exam/evidence collection.

Please let me know if you have any questions or would like to discuss this further.

Thank you all so much for your attention to this so that we can ensure that all survivors’ rights are being upheld.

SAFE Cases Guide (will be located on Algorithms Page located on nypem.net drop down menu)

Conference This Week

Shout out to Drs. Marc Tarsillo and Dino Munoz for covering multiple sick callouts this month. The dedication is appreciated!

Upcoming Residency Events

  • March 18th – Intern Bowling Retreat
  • April 1st – PGY2 Retreat 
  • May 27th – 8 hr Theme and PGY4 Research Day
  • May 28th – Residency Retreat 
  • June 3rd – Graduation at the Central Park Boathouse 

To Dos

ALL

  • MedHub hours must be logged! 
  • Please fill-in your resident profile on nypem.net. It’s a great way to highlight your interests and things you’ve done during residency. https://nypem.net/meet-our-residents/
  • Remember– Away Electives require an application submitted 112 days in advance, while NYP electives are a minimum of 56 days. Instructions located here
  • Check out this career guide from the Academy for Women in Academic Emergency Medicine  https://issuu.com/saemonline/docs/saem_awaem_toolkit
  • Please be wise on social media use and don’t risk patients’ trust in the medical profession.  
  • Give time and action-specific instructions in the discharge papers.  “See your primary doctor soon” is much less informative than “See your primary doctor in the next four days, but return to the E.R. if your abdominal pain worsens or persists.”  

PGY4s

  • Get disability insurance before graduating residency.  Here’s one resource to start.
  • Educate yourself on potential job contract issues.  Here’s one article and another EM specific book.   
  • If a job requires your residency malpractice insurance history, email nog9010@nyp.org & mam9160@nyp.org to obtain the relevant documents.  
  • Remember to complete your EMS ride-alongs! You need 10 4-hour sessions to graduate!

PGY3s

PGY2s

  • < 4 months to leading notifications!  Start thinking big picture, and what you’d decide from the foot of the bed.  Create a mini-curriculum for yourself of resuscitation-related podcasts, EM:RAP episodes, etc.
  • If you have money to save after NYC costs and student loan repayment, consider putting it into NYP’s 403(b) or an IRA.  The “Roth” option is likely better when you’re a resident.  

PGY1s

  • Scroll down to 3. Publications and Educational Initiatives for some good EM resources!  Or check out this centralization of other EM resources including podcasts, books, apps and Qbanks.
  • Do you take public transportation sometimes to work?  Do you want to save 30% of that amount in tax savings over the next three years?  Take 15min to enroll in NYP’s Commuter Transit program.  
Opportunities

Chief on Call

Ahmed Shaikh, M.D. – first call
Cleavon Gilman, M.D. – second call
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.