Weekly Update – August 7, 2022 – NewYork-Presbyterian Emergency Medicine

Handoff Notes:

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!

Resident Room:

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.

HIV PEP Kits

Our ED pharmacists recently brought up some confusion about the HIV PEP Kits we dispense to ED patients. It seems like “Occupational PEP” which is a 3-day kit, is frequently being selected for patients who have “occupational exposure” from an event occurring in their line of work. However, this oPEP 3-day kit is actually meant for NYP employees (to provide enough supply over a weekend) because they would be able to follow up with WHS. Non-NYP patients should receive a 7-day kit because they need adequate time to follow up outpatient elsewhere.

Because of this confusion, it seems pharmacy has sometimes recommended one-time doses of PEP in the ED for non NYP employees with a 28-day Rx which is not ideal. I’ve clarified with our ID team the following information which I’ve sent to our pharmacists and was hoping you could also communicate with ED providers?:

· NYP employee occupational exposure = Occupational PEP

o 3 days since can follow up with WHD

· Non-NYP employee occupational exposure or non-occupational exposure (needle sharing, exposure to fluids etc) = Non-Occupational PEP

o 7 days since needs time to follow up with outpatient

· SAFE patients = Sexual assault adult/peds

o 7 days since needs time to follow up with outpatient/required by NYS

Campus Announcements

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.

Check out the checklist here!

Medical Student Mentorship Opportunity

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.

Would you be able to help us recruit residents in your program? A sign up form for residents can be accessed here. I would be happy to discuss further with you if you have any questions, concerns, or suggestions.

Stroke Reminders at Columbia

There has been some confusion regarding activation stroke for TIA (stroke like symptoms that resolved) within 6 hours of onset. These patients need an activation since we still need to report our time metrics for TIAs< 6 hours to New York State. Furthermore, sometimes there are subtle findings on their neuro exam or have stuttering symptoms which would make them a stroke patient rather than TIA. Activate Stroke Code for these patients and neurology is aware of this as it is part of our hospital stroke policy
Activate Stroke Code for patients who presents with symptoms concerning for SAH or ICH within 6 hours. This is also per our stroke policy and we are required to report out those metrics. It will expedite getting the head ct on time and utilize the appropriate resources to take care of these patients.
Use ED Adult Stroke Order set for patients that a code stroke is activated for. This order set have key elements that trigger multiple departments to expedite results for stroke patients as all these results are time sensitive. In addition, the [Head CT Acute Stroke Team Activation] order triggers the radiologist to be on standby to read this CT scan and expects someone in the CT scanner to communicate the results to. In addition, the CT scanner is usually placed on standby till the patient arrives. As one can imagine, if it is used for a 6/24 that does not meet criteria for LVO, it can lead to delays in other patients’ care when it is not warranted and may hold up valuable resources such as CT scan room as well as radiologist.

PGY1 EMS Rotation

Before the start of your EMS rotation, please review workflow which is available here- info here: https://sites.google.com/view/nyp-ems-practice-track/pgy-1-nypems-rotation

Reach out to Dr Lech with any issues!

Walk-out Notes

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.

o MSE Note

o ED Provider Note

o Psych Brief Eval Note

o Psych Initial Evaluation Note

Lung Nodule Follow-up

Please review the Lung Nodule Follow-up work follow on Nexus when discharging patients from Cornell. https://nexus.weill.cornell.edu/display/ED/WCMC+ED+Nexus+Site

Online Resuscitation Course At Upenn

Please see below for information to register for a resuscitation course taught by grand rounds speaker Dr Abella from UPenn

https://pennmedonline.upenn.edu/virtualfall/

Conference 8/10

Please join us at our next residency conference via Zoom. W

Welcome to the second week of the cardiology module! We will start with a core content lecture on Pericarditis by Dr. Barbara Magid. Next, Cornell Ultrasound faculty and TEE expert, Dr. Felipe Teran will discuss Updates in ACLS. There will be small group case discussion of Foundations of EM cases led by Drs. Matt Nguyen, Chris Hennessy, Chris Tedeschi, Diksha Mishra, and Jeff Mayer. Columbia attending and rapper extraordinaire, Jason Hill will then deliver a talk on Bradys and Blocks.

Please note that at 11AM we will have a resident-only Town Hall.

Hope to see you there!

SCHEDULE

8:00 AM	Pericarditis (Barbara Magid, PGY-2)
8:30 AM	Updates: ACLS (Dr. Felipe Teran)
9:00 AM	Foundations (Small Groups)
10:15 AM	Bradys and Blocks (Dr. Jason Hill)
11:00 AM	Town Hall