Weekly Update – November 14th, 2022

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SAFE Training Available 

– Registration for CVTC’s November SAFE training course for advanced practitioners is now live!

Kindly find our flyer attached, embedded with the registration link. I have included the link below as well. Please feel free to share with your network of eligible registrants. 

As a reminder this course is an online only, self-paced training for MDs, DOs, PAs, NPs, and CNMs. The cost is $100 per registrant. The course itself will open on Monday Nov 14th, 2022. The course will remain open for one full week and close on Monday 21st, 2022. Registrants will have until then to complete all materials. 

If you have any questions, concerns or trouble signing up, please do not hesitate to contact me. 

Thank you all for your dedication in providing comprehensive, quality care to survivors of sexual violence. 

CVTC’s Advanced Practitioners SAFE course NOV 2022

 

 

Campus Announcements

 Cord Compression Protocol

Please review the cord compression protocol at Columbia:

Cornell Ops Update 

 

We would like to remind you of the appropriate workflow when up-triaging a patient from D bay to a main bay for their evaluation:

  • Ensure we are not in surge protocol, when Area D takes stable ESI 3’s
  • D bay attending should give verbal sign out to the receiving bay attending 
  • D bay provider team should complete an MSE note and place pertinent orders prior to transfer
  • Please let AA and triage nurse know of your plan to up-triage a patient

 

Busy surge days typically means D bay takes stable patients requiring more complex, main bay work ups. The AA should be communicating this is real time to the D bay team.

 
 

Regarding airway equipment at Cornell, the following items are reusable:

Glidescope blades should be sanitized with the purple wipes along with wiping down the rest of the glidescope machine by the provider who uses them. 
 
Rigid stylets should be placed in a specimen/biohazard bag, and given to the unit coordinator. If the unit coordinator is not available, the stylet can be left by the IV pumps by the refrigerator in A bay, and the unit coordinator will take to be cleaned.
D-OB Workflow:
  • Due to OB staffing challenges surrounding the completion of NSTs in the ED all stable pregnant patients over 24 weeks gestation who do not meet “OB Activation” criteria should be transferred to Cohen via the “OB Fast Track” workflow.
  • The “Expedited ED/OB Consult” pathway has been updated in triage and in Nexus to reflect this change
    • This pathway will now only apply to patients between 16-24 weeks gestation and those > 2 weeks post-partum.
Ebola:
  • On October 6, 2022, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Advisory about the recently confirmed outbreak of the Sudan strain of Ebola Virus Disease (EVD) in Uganda. 
  • There are currently no suspected, probable, or confirmed cases of EVD in the United States, and the geographic scope of the outbreak is limited to Central Uganda. 
  • While there are no direct flights from Uganda to the United States, travelers from, or passing through, affected areas in Uganda can enter the United States on flights from other countries.
  • Please familiarize yourself with the Ebola protocol for each campus (attached)
 

EMS Run Sheets:

Bed Requested/Prolonged ED Stay Patient Management:
  • To ensure our patients with prolonged bed requests/ED stays are receiving their priority home meds, an added layer of support is now being added via our AA and Patient Services at IDRs.
  • Please review the attached document
Respiratory Samples via Pneumatic Tube:
  • Respiratory samples can now be sent via the pneumatic tube, this will liberate the ER techs from having to walk the samples to the micro lab
  • Samples must be double bagged, and absorbent pad in the outer bag. 
 
Panic Buttons:
  • Phone panic buttons are located on the different phones scattered throughout the ED.   On the older phones, it is a yellow button, and on the digital phones, it is on the top left of the panel.  To use them, take the phone off the hook, and push the button and leave the phone off the hook.  Hospital Security command can track the calls to the specific location.
  • (Actual) Panic buttons can be found throughout the ED, they are now identified with a small sticker.  Please take a look around the unit for them.  To use them, you have to pull the button forward from underneath the counter.
Emergency Ultrasound:
  • Our new Mindray ME-8 ultrasound machine has arrived!!! 
     
  • The machine will live in A6. Please remember to clean the probes and touchpad/keyboard as well as put the machine back in A6 and plug it in after each use.
     
    • The machine’s screen cannot be cleaned with the grey, purple or red wipes.
    • The barcode scanner is not yet operational. 
Official Echos:
  •   Echo techs are available: 
    • Mon-Fri 6am-6pm (last patient taken around 5pm). Cardiology fellows begin covering requests for stat echos around 5:30pm.
    • Sat/Sun: 2 techs are available 7am-3pm but their priority is discharges or pre-op exams. Cardiology fellows are still expected to perform stat echos. Techs may be able to perform exam if they have availability.
       
  • Echos performed overnight by cardiology fellows are typically read first the next morning. 
    Echos performed by techs over the weekend will be read that day by an Echo attending. 
     
  • If you wish to obtain an official echo during the above tech hours:
    • Place order for “Transthoracic echo (TTE)” in epic and label as ‘STAT’
    • Send message with patient’s name via secure chat to “WC Echo Lab (Contact)”
       
  • Techs cannot perform hallway echos. Please make sure the patient is in a room if you want 
    the exam to be performed at the bedside.
 
  • Flu Shot and Fit Testing.  If you get your Flu vaccine outside of NYP, please follow the steps from ‘Outside Influenza Vaccine Documentation’ (available on the Infonet) so that your information can be successfully recorded by WHS.
  • Annual Hospital Training is available in Workday (login through the infonet if you search ‘Workday’).  For whatever reason and surprising no one, it is not always readily available in your ‘My Learning’ section.   Select ‘Discover’ –> ‘Browse Learning’ –> search for ‘Annual Hospital Training’ and select ‘AHT22 – Provider Program’ in order to enroll and complete. Be sure to take a screenshot of your completion.
COMING SOON: New IP&C Column on the ED Trackboard
  • A new Infection Prevention & Control (IP&C) column will appear on the ED trackboard next week. This column will contain up to 5 icons to capture the patient’s IP&C status. It will replace the existing COVID virus icon.
  • Infection status (biohazard icon) will display the patient’s notable infection history. Hover on this icon to see a full list of the patient’s current and past infections, including MRSA, COVID, etc.
  • Isolation Status (hand icon) will display all the active isolation orders for the patient’s current ED visit. If the patient has no active isolation orders, no icon will appear. Hover on this icon to see a full list of the patient’s active isolation orders.
  • COVID/Flu/Monkeypox Test Status (C/F/M letter icons) will display the status of any COVID flu, or monkeypox orders placed during the patient’s current ED visit. The icon will be yellow if the test result is pending, green if negative, and red if positive. 
  • This new IP&C column will be permanently fixed to the ED trackboard and cannot be removed. In addition, the Patient Status, Patient Name, and Bed Location columns will also be permanently fixed.
 

GC/CT testing

  • Collection media has changed for gonorrhea and chlamydia and currently only stocked in the lab
  • Urine can be sent in a sterile cup and the lab will place in the appropriate medium. YELLOW.
    • The other two collection media need to be requested from the lab. PURPLE/ORANGE (urethral, endocervical, rectal, oropharyngeal, vaginal)
    • Lab is working with supply chain to have stocked in the EDs
    • On Nexus under “Infectious Disease”

Heart Transplant Workflow

  • New WC Heart Transplant Program set to go live this fall

  • Advanced Heart Failure/Transplant team wants to know about all heart transplant patients that present to the ED regardless of their complaint or when/where their transplant occurred

  • Place “Inpatient Consult to Cardiology (Advanced HF/Pulm HTN)” order when these patients present to the ED

    • If patient in shock use consult order “Inpatient Consult to Cardiology (ECMO)” instead

  • A member of advanced HF team or CCU fellow (overnight) will evaluate patient in the ED

  • Admit these patients to 4N (under Advanced Heart Failure PA team) or CCU depending on their necessary level of care

 Conference

 
Welcome to the third week of our Pulmonary module. Please join us for our next residency conference via zoom. We will begin with breakout rooms for our advanced practice track meetings with the respective faculty mentors. Next, Dr. Clark Owyang, EM-Critical care Cornell faculty, will present a lecture on massive pulmonary embolism. Next, EM-Critical care Columbia faculty, Dr. Angela Barksaya will lead an EKG workshop. Our PGY-4 Dr. Zachary Freedman will present his grand rounds talk on low-risk syncope. Finally, Dr. Shira Steinberger, assistant professor of clinical radiology at Weill Cornell Medicine specializing in cardiothoracic imaging, will be presenting her Grand Rounds lecture on imaging cardiothoracic emergencies. 
 

8:00 AM

Advanced Practice Track Meetings 

9:00 AM

Massive Pulmonary Embolism: Evidence, Physiology, and Bedside Pearls (Clark Owyang)

9:30 AM

EKG Series (Angela Barskaya) 

10:30 AM

PGY4 Grand Rounds: Low Risk Syncope (Zachary Freedman)

11:00 AM

Grand Rounds: Imaging of Cardiothoracic Emergencies (Shira Steinberger, Cornell Radiology)

 

Shout out to Emily for being an awesome teacher on shift and supportive senior!

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.

 

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