It’s been reported in multiple news outlets and the NYS DOH today (a few links here and here) that Polio has been detected in NYC wastewater, indicating it is circulating in the city. This is in the context of a man in Rockland County diagnosed three weeks ago and left paralyzed. This is the first case in the US since 2013, and the assumption is that it was locally acquired and not from travel.
There’s been a rise in calls and questions primarily to outpatient clinics about Polio and vaccination.
Most adults have been fully vaccinated (99%+ protective) but may not remember or have proof. Children are more vulnerable, particularly <6 months old. In NYC, the vaccination rate for children <5 yrs old is 86% and in some city zip codes, <66% of children are vaccinated.
1 in 200 infections lead to paralytic polio, so we have to assume that there are infections out there but at the moment it isn’t clear whether it rises to the level of needing to provide boosters. There is a booster that can be recommended for those at high risk which is usually reserved for travelers.
If patients inquire about a polio booster, there’s no real reason not to do it and we can simply refer to outpatient PCP/ID.
ID and the hospital are following closely – more to come with any developments.
Please note that only the incoming resident needs to document a handoff note. This is a change from prior policy requiring both incoming and outgoing residents write a handoff note! Please do this for every patient that is signed out to you!
Please be mindful and keep the resident rooms clean. This is our shared space, please treat it with respect. Keep your personal belongings tidy and throw away your food once you are done.
Dart Room Checklist Project
We are pleased to announce a new Quality Improvement project regarding supplies in the DART room. We have developed a checklist based on YOUR survey results regarding needed items in the DART room. We are asking PGY3 residents to check the DART room using the checklist once in the morning (before/after morning report) and once in the evening (approximately midnight). This list will then be given to the charge nurse who will be the one responsible for replacing the missed items, NOT THE RESIDENT. We hope this will lead to improved quality and patient safety as well as more smoothly run (and less frustrating) notifications. If you have any questions or comments–please reach out to Mary-Kate Gorlick, Mike Defillipo and/or Shriman Balasubramanian.
See message below from Spencer Dunleavy (Equity/Justice Fellow at Columbia)
I wanted to reach out to you to see if you could help recruit EM residents to potentially mentor students.
The goal is to create a database of resident mentors of all backgrounds across all residency programs at NYP-Columbia to help guide medical students from traditionally less supported backgrounds (with respect to race/ethnicity, socioeconomic upbringing, gender, and sexuality) toward the specialties they wish to pursue. As someone who came from a background where no one in my family had gone to university, I know it has been very challenging to find people with similar experiences to help me on my path through medical school. Our hope is that we can create a sustainable system for students of varying backgrounds to help find role models and mentors.
Cases of monkeypox continue to rise across New York State and the region overall, but may be starting to slow down a bit in NYC. We had around 50 confirmed cases last week at NYP and many have been initiated on outpatient treatment. CIMA and the ED are still seeing “sporadic” cases, and are hoping we’ve plateaued.
There has been only one suspected peds case that pediatric ID is following of a 9 month-old (coinfected with VZV, unknown exposure, mom noticed spots while traveling in Morocco).
ID Clinic now has a small supply of vaccine for PEP available in the outpatient setting for high risk scenarios.
Treatment is considered for complicated for severe disease. Lesion location or type is often the important one due to scarring or stricture (i.e. eyes, mouth, rectum, urethra). See table below for details.
A couple of important ED workflow updates to be aware of that will make things a little easier (Thank you Jean for the Epic tweaks!):
1. Monkeypox Discharge Instructions are now available in Epic!
2. Ambulatory Referral to Infectious Disease is now easily orderable from the Dispo tab for adult patients at WC or LMH for stable monkeypox patients for follow up and consideration of treatment. Please mark it Urgent. Dedicated schedulers from ID will reach out to the patient and arrange for rapid (often next day) VUC visit with ID for next steps, follow up on results, and potential treatment or vaccination questions. This is already live and working nicely. This should obviate the need for most ID consults unless there are clinical management questions that need to be addressed urgently or the patient needs to be admitted.
If any of the following notes have been filed in the patient’s chart, and “Left Before Medical Screening Exam” is selected for “ED Disposition,” then an interruptive BPA will appear that asks the user to review the chart and select “Left After Medical Screening Exam” instead.