Weekly Update – July 25, 2022

Resident Room:

Conference Attendance:

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

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 

1. 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
2. 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.
3. 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.

Handoff Notes

Admin has noted deficiencies in resident handoff notes. Please document handoff notes using “.reshandoff” for all patients.

Medical Education Research Opportunity

Fam, I will be working on an education-based scoping review over the next few months and would love to have a resident be part of the team.  The workload would consist in screening/reading manuscripts, qualitative data abstraction, and work on preparing the manuscript.  I know, it’s almost too exciting.   The workload would be primarily over the next six months.  If you have an interest in Med Ed (or qualitative research in general), shoot me an email and we can discuss logistics more.  There will be no hard feelings if we talk and you decide I’m insane and want nothing to do with this.   Again, would love to have a resident participate, so keep me posted if interested!  Chris (Chr2019@med.cornell.edu, 857-919-0784)

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

Conference 7/27

Please join us at our next residency conference via Zoom. Welcome to our fourth week of the resuscitation module! We will start with a pediatrics lecture on Drowning by Cornell PEM Attending by Dr. Susan Fraymovich.  There will then by small groups for both juniors and seniors on ventilators by EM Attending Jason Hill and ICU Fellow Matt Kennedy.  There will be a break and discussion on global health elective opportunities by Dr. Jiang.  Next, our APD Dr. Trudi Cloyd will discuss Incarcerated Care as part of our Mind the Gap series on social determinants of health in the emergency department.  Lastly, Dr. Ben Abella from UPenn will deliver Grand Rounds on CPR in cardiac arrest.

SCHEDULE

To Erin for planning a fun beach day for the residency!

Chief On Call

Mary-Kate Gorlick, 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