Weekly Update – June 26, 2022

Cornell Ops Updates

Adult ED Scheduling Update: There are several changes to the shift map and times starting in July:

• WC will again have 2 swing attendings Mon-Fri starting July 5th
• The WC Wednesdayswing #1 shift time is now 10a-8pm
• The WC Mon-Fri swing #2 shift time is now 2pm-12am
• Swing 1 will sign out to Swing 2; and Swing 2 will night out to the overnight team. This will help decompress the evening shifts.

Paxlovid ED Rx Order now LIVE!: nirmatrelvir-ritonovir (PAXLOVID) pack EUA – ED Discharge Dispense

• Available for take-home on discharge starting June 15th​. 
• No change to criteria, and job aid is available (see Nexus!)​. 
• Job aid: https://epictogetherny.org/Training/TipSheets/EpicTipSheets/COVID-19%20-%20Ordering%20Paxlovid.pdf
• Verified by our pharmacy with dosing and interaction check​, and patient fact sheet with meds delivered to patient/nurse​.

Interdisciplinary Rounds (IDR’s) @ 10am, 4pm, 10pm: 

• Will start to include D Bay patients under evaluation for 4 hours or longer.  
• Adult Main Bays will continue to maintain the threshold of 8-hour or longer.  
• This is an opportunity to evaluate barriers to disposition, which are being tracked by Patient Services. 

Area A Refresh is planned for Mon, June 27:  

• Similar to Area B Refresh, it will last for one week and require a complete closure of the area, in this case diverting Trauma and Obstetrics Activations to alternate bays.  
• Staffing & workflow details to come.

Major ED Events: Please escalate all of the following major events to the AA in real time:

• Shootings, stabbings presenting to ED
• All physical violence to staff in ED
• ED patients who attempt or achieve deliberate self harm while in the ED(e.g.: cut wrists; try to hang themselves while in ED)
• ED patients with accidental harm event in the ED(fall with head injury, anaphylaxis to med with known allergy)
• Delayed diagnoses in the ED that may have translated to patient harm (e.g.: a aortic dissection that crashes while waiting for CT)
• Patients who expire in the ED(except patients who arrive in the ED peri-arrest)

Transfer of patients from ED to 4N / CCU: 

• Transfer of patients from the ED to 4 North / CCU is the primary responsibility of the accepting service. A provider from the admitting service will accompany the patient upstairs within 1 hour of bed assignment. 
• The decision for transport without a provider is at the discretion of admitting team. 
• 4N team members may cover for the CCU team.
• This process has been reviewed and approved by ED and Cardiology leadership as of June 2022.

Avoid Unnecessary Exposures: Empirically use isolation precautions:

• Contact precautions are for your C.diff, MRSA, VRE, spread by direct or indirect contact, remember to wash your hands with soap. ​
• Droplet isolation is for relatively larger particles and how respiratory viruses are typically spread via talking, coughing and sneezing. ​
• Airborneisolation is for your TB rule outs, and Varicella Zoster virus. Needs an N95.  
• Monkeypox needs all 3!
• Any suspected disseminated zoster infection or immunocompromised patient with localized zoster should empirically be cared for in NEGATIVE PRESSURE
• Remember to Inform nursing once identified

Neuro QPS & Risk Documentation: Remember to document appropriate near exam for all patients with the following complaints.

• Dizziness – including cerebella
• Headache
• Lower back pain
• Chest pain with dissection concerns

Food Insecurity Resources Available:

• Screening Questions for Food insecurity (either positive)
  • Within the past 12 months, you worried that your food would run out before you got money to buy more. 
  • Within the past 12 months, the food you bought just didn’t last and you didn’t have money to get more
• How to Refer: Epic: Refer using the referral order “AMB REFERRAL TO FOOD INSECURITY”Dx Association – food insecurity