Weekly Update

December 13, 2021

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

December:

6th, 7th, 13th, 14th

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

November:

22nd, 23rd

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: Hospital Training Due December 31

Remember to complete the SabaCloud training by December 31. All residents must also complete the required stroke modules, also due December 31.

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

From Laurie Malia:

Ambulatory Referrals now available via Dispo Tab

See the Tip Sheet (attached) on when and how to use the ambulatory referral order vs patient navigator order
Patient Navigator Order: If the patient is a complex patient that requires support of patient navigator
Ambulatory Referral Order: Select appropriate referral. If subspeciality not listed, use ED Discharge Follow-ups smart set (no change from prior)
View the tip sheet attached for further details on ordering.

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Updates to become Involved with Columbia Ops Projects

Dear Aspiring Physician Leaders,

I want to share with you some exciting opportunities to get involved in administration and operations on West Campus. Please reach out to me if any of these strikes your fancy.

CT Utilization Study – This just received IRB approval and is ready for data collection. The purpose of this study is to review the current state of CT utilization in the Emergency Department (ED) and to see if there are a significant number of acquired images ED that are not urgent/emergent or necessary for patient disposition. The goal is to identify recurring themes related to commonly acquired CT scans that may not be required in the ED. By doing so, we hope to reduce burden on the ED CT suite. This will be a retrospective study with presentable and publishable output.

Transitions of Care – This is a quality initiative at Allen Hospital to improve transition of patient care to and from the ED and facilities like Skilled Nursing Homes and Subacute Rehabilitation Centers in our catchment area. It will be a collaborative effort between the ED, Internal Medicine and Care Management (Social Work/Care Coordination). Output will be presentable, and hopefully publishable.

PENUMBRA – An Allen ED centric stroke subcommittee that is about to launch. Inaugural initiatives will include the creation of a real time stroke activation dashboard and improving Door-to-Stroke Activation time.

EKG Turnaround-Time – Ever order an EKG then wait with baited breath for it to get done? Then this is the perfect project to get involved in! Another Allen ED Centric subcommittee will be looking at the process of EKG order to acquisition, with the goal of creating a standardized process that improves turnaround times.

My Best,

Mahesh

Several Updates from Cornell Ops team:

Long IVs continue to be located in A Bay IV Carts on bottom drawers. We’ll work toward getting them in C Bay.
Continue documentation hygiene: .resdispo for discharges and ED-PASS handoff notes for admissions.
Transvenous Pacer (TVP) are now bundled together in blue cart in front of Trauma Bay/A1

Unit Coordinator should be contacted to unlock cart with: Pacer box, 6 Fr. Cordis, Pacing Electrode Catheter. Prior to Faculty Simulation, these were formerly stored in separate spaces around the ED. Thanks to Drs. Senturia, Owyang, Naik, and others for that informative session.
Please click off the endorsement in the dispo section for all patients being admitted (not just change it over on the status board). It’s good practice but also needed for patients to physically leave the ED for their inpatient bed when it is ready. Avoids PPOC having to hunt down another provider to do it much later who was not involved in the care.

On Wed Dec 1st 7:30am, Adult ED will begin using EMS Notification phone (pictured below). This red phone is located by Area A nursing team leader workstation and intentionally has a loud ringer so it cannot be ignored. This direct line aims to eliminate the current two-step process of Clerks answering phone & overhead announcing, “pick up EMS notification on 65”. A few details to note:

1. – Nursing will continue to own primary answering responsibility of EMS Notifications and the associated reporting out to the Charge RN and relevant Area’s clinical team
2. – After answering calls, it requires ED team to use the paging service for Activations (Clerks call 55555 to activate STEMI, Stroke, OB, Trauma Activations)
3. – Pediatric notification will remain on a separate 746-3300 number

Reminder about McGraths - PLEASE return after use

I believe the Intubating Providers know, but our McGraths are not disposable. The blades are single use and disposable, but the handles and screens are not (photo below) and can be placed on Mayo stand or given directly to Unit Coordinators for sterilization.

We’ve had three go missing in the past week, hence the urgent email. We’re also messaging Environmental, Nursing and all others who may touch them.

From Cornell leadership: Reminder about Community Para-Telemedicine program

Cornell ops/leadership has implemented CTP (Community Tele-Paramedicine) to improve post-ED care for our community and to minimize avoidable admissions. As senior residents managing the bay and thinking of all your patients’ disposition, please keep an eye out for patients that meet the criteria and refer them appropriately. It’s a few extra steps but it can really help minimize boarding and overcrowding in the ED.

Who: Cornell ED patients with cellulitis, heart failure exacerbation, pneumonia, sub-segmental PE, syncope, COPD/asthma, dehydration/AKI + must meet other enrollment criteria (please see attached pdf for details)

When: Patient can be discharged from ED and be seen in the next 1-2 days (M-F for now)

What: After discharge, patients will be scheduled for a paramedic visit at home + ED provider televisit. During their visit they will have their vitals/weight/POS FS checked, receive med rec, and in some cases receive medications.

How:

Please use the CTP referral tab in Epic’s Dispo tab AND email Jeanette and Rachel, the CTP care managers: Jeanette Melchor <ejm9017@nyp.org>, Rachel Bestritsky <rab4011@med.cornell.edu>
Jeanette (Elizabeth) and Rachel are also available during business hours on Epic Haiku Chat to discuss potential cases. Please feel free to reach out to the AOC or AA if you are unsure if a case is appropriate for CTP referral

December 15, 2021 -
Ultrasound Olympics!

Reena, for smoothly placing in two crash lines in a critically ill patient. “Reena was very calm and collected, performed wonderfully under pressure, and had great questions to ask at our debrief.”

Sean, for keeping a man who ended up having a critical diagnosis from walking out. “I thought Sean’s care was above and beyond.”

Chief on Call

Emerson Floyd, 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

December 13, 2021

Campus Announcements

December 15, 2021 - Ultrasound Olympics!

Chief on Call

December 15, 2021 -
Ultrasound Olympics!