Weekly Update

November 15, 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 
 
November:
8th, 9th, 15th, 16th, 29th and 30th
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
New COVID/RPP panel will be replacing the old one on Monday, November 15.
 

THE NEW RESPIRATORY PATHOGEN TESTING PANEL

 
 

1. What Tests are Available in this New Order Panel?

  • The Respiratory Pathogen Testing Panel contains everything you need for COVID, influenza, RSV and RPP testing:
    • LIAT POC (PBY & LAW ONLY): Tests COVID-19, Flu A & B in 20 minutes (reserved for critical patients)
    • SARS-CoV2 NAAT: Tests COVID-19 in 2 hours (rapid) or 24 hours (non-rapid)
    •  
    • 3-PLEX: Tests COVID-19, Flu A & B in 2 hours (rapid) or 24 hours (non-rapid) 
    • 4-PLEX: Tests COVID-19, Flu A & B, RSV in 2 hours
    • RPP: Tests COVID-19, Flu A & B, RSV, 20+ Pathogens in 2 hours
  • You should ALWAYS use the order panel. You will not be able to place orders for COVID, flu, RSV or RPP outside this panel.

2. Which Patients Should Receive Which Orders?

  1. Starting 11/15, full RPP testing is required for admitted patients with symptoms of COVID/respiratory infection. RPP testing is also appropriate for immunocompromised patients or those with high suspicion for atypical pneumonia or pertussis.
  2. We no longer need to order a flu test for all patients who receive a COVID test. This NYS DOH mandate has ended.  
  3. Starting 11/15, patients with suspected or confirmed COVID-19 now require an Enhanced Droplet Isolation Order. This will replace the previous requirement for Contact Isolation + Droplet Isolation.

3. For Sites with LIAT POC Testing (Milstein and LAW)

  1. The LIAT POC should be reserved for time-sensitive or emergent situations ONLY, where you need to know the patient’s COVID status in the next 20 minutes. This includes patients who need emergent procedures or expedited patient movement (e.g., the symptomatic admitted patients mentioned above, or those being sent to a facility or the OR). 
  2. BOTH the LIAT POC and RPP should be ordered for admitted patients with symptoms. 
 

4. Where Do I Find the Order Panel? 

  • The “Respiratory Pathogen Testing Panel” will replace the “COVID-19 and Influenza Panel” on the Quick List.
  • Once you answer a few quick questions, the correct orders (per IP&C guidance) will appear for you to sign.

 
5. Key Resources
Introducing the Interdisciplinary Critical Care Interest Group!
Let’s kick off with a happy hour.
 
Please join us for a happy hour on November 18th, starting at 6:30pm.
Where: Harlem Tavern — 2153 Frederick Douglass Blvd, NY, NY 10026
When: Thursday, November 18th, 6:30 – 8:30 pm 
 
Are you interested in a career in critical care? Interested in mingling and advancing your critical care knowledge and skills? We are starting a critical care interest group, and we want you! Our goal is to bring together a multidisciplinary group of providers (residents, fellows, attendings, PAs, pharmacists, students — open to all who are interested!) to create a community of those interested in critical care, and provide opportunities to learn about critical care-relevant topics together. We will be starting with a happy hour to gauge interest, and going from there. Please RSVP at this form to give us a sense of a headcount, and so we may reach out to confirm final details closer to the date.
 
If you have any questions, please reach out to Laura McClung (lmm9036@nyp.org) and Caroline Jensen (chj9092@nyp.org). Looking forward to seeing you there! 
 
Best,
Laura McClung, CA2
Caroline Jensen, CA2 

Campus Announcements

Hi everyone,

 

This is your friendly PSA to PLEASE clean the ultrasound probes and machines after every use! 

 

This reduces the wear and tear of these $15,000 probes, and keeps our patients safe from the spread of iatrogenic infectious diseases. The machines also cost $70,000 each… which costs more than the Tesla I don’t own. So please wipe the machine down if there is any concern for soil by bodily fluids/gel etc!

 

When finished using the ultrasound, please remember to: 

  1. Close/end exam out (no HIPPA on screens)
  2. Clean off probes/machines with red or purple wipes 
  3. Plug in the machines 

 

For endocavitary probes, please follow Departmental protocol and place them in the marked ‘Dirty Probe’ bucket with a biomed bag and patient sticker on it. 

 

If you have any issues with the machines, please let me know and I will contact Biomed. 

 

Thank you for your help in taking care of our ED equipment! 

 

Best,

Lorraine Ng

Regarding staffing shortages at Columbia:

  • Escalation: Please continue to escalate any events that are out of the ordinary. We continue to have cases that lead to need for ethics, legal, patient services, etc. on off hours. While nursing will ensure the nursing administrator is aware, physician leadership also needs to be aware.
  • Keepsafe: Please Keepsafe any unexpected events, errors, or safety concerns. Please keep language professional 
  • Worksafe: Please Worksafe any staff safety related events. And reach out to security for any situation that you feel needs to be reported to the police. The report can be made using the Hospital address and phone number, but it needs to come from an individual.

If you have any issues you would like to escalate, feel free to reach out to the chiefs (on shift or post shift) so we can help escalate appropriately.

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.
 
  1. 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.
 
  1. 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.
 
  1. 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.
 
  1. 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
1. Given the below event, there may be an uptick in patients presenting to the ED in opiate withdrawal, requesting opiate rx or further opitate related complaints.
 
Please be sure to consult Social Work in drug abuse cases, discharge high risk patients with Naloxone kits and consult Toxicology when appropriate for toxicity related questions.   
 
 
2. Peer Supporter Training Session:
 
On Tuesday, November 23rd @ 9am (2-3 hours), Christie Lech and Lucy Willis will be leading a peer supporter training session via Zoom, and all are invited! 
  • Peer support is a great way to help each other through the inevitable challenging cases, bad outcomes, and lawsuits. 
 
 
 
3. Updates and Reminders on Renal Transplant patients: 
 
We are encouraged by transplant leadership to consult early and often, including when there are concerns in a patient transplanted at an OSH or >1year since transplant. 
  • In general, avoid IV contrast
  • Renal transplant US is not always necessary in unrelated ED presentations
  • Always involve transplant surgery within 1 year of transplant, prior to imaging
 
 
4. Smart Phrase .NYCEDEXIT:
 
Re: patients in custody presenting to ED with officers for “medical clearance” evaluation.
  • Please do not use the commonly requested “fit for confinement” terminology. 
  • We have carefully vetted (legal) language in the Epic smart phrase:  .NYCEDEXIT
 
 
5. Informatics Update:
 
Starting next week, you will no longer be able to discharge a patient who has unreviewed results. This will be a hard stop in Epic.
  • This is an important patient safety initiative to prevent test results from being missed before the patient leaves the ED.
  •  
    You must review all results and mark them as “Reviewed” to successfully place the “Discharge Patient” order.
     
  • If you have not marked all results as “Reviewed” in Epic and attempt to place a “Discharge Patient” order, a hard stop will appear.
  • This is similar to the existing hard stop for “No Clinical Impression Entered” when you attempt to place a “Discharge Patient” order. 
 
 
6. Prenotification STEMI EKGs
 
Pre-hospital EKGS, from FDNY, showing STEMIs should be emailed to the AA phone.
  • The AAs should receive these EKGs via the AA phones and be activating STEMI before arrival.
  • For STEMI arrivals, please reach out to the AA for potential first EKG.

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

 

November 15th - Endocrine Part 2

Time

Topic

Speaker

  • 08:00 - 08:30
  • Adrenal Crisis
Dr. Cam Callipari

NYPEM PGY 2

  • 8:30 - 9:30
  • Foundations
WCMC and CUIMC EM Faculty
  • 9:30 - 11:00
  • T-RECS
CUIMC EM Faculty
  • 11:00 - 12:00
  • Town Hall

ASYNCHRONOUS LEARNING AND MATERIALS
-Tintinalli’s Emergency Medicine 9th Ed –  Chapters 223-224 (WCM Library for residents) 

–ALiEMU Endocrine Module

– Please see attached asynchronous resources and the T-RECS “Breakout Rooms and Reading Assignments” document. 

CONFERENCE ATTENDANCE AND EVALUATION

 

 Conference Evaluation and Resident Attendance Form

Columbia 2021-2022

Cornell 2021-2022

 

ZOOM

 

Topic: NYPEM Conference 11/17/21
Time: Nov 17, 2021 08:00 AM Eastern Time (US and Canada)

Join Zoom Meeting
https://nyph.zoom.us/j/98189940507?pwd=eVQ4TTZYRklCR0dGQXhHZGxmVElaUT09

Meeting ID: 981 8994 0507
Passcode: 967536

Shout out to Mike and Matt for being active participants on interview days and in socials!   

 

Interview Day Zoom: 

https://weillcornell.zoom.us/j/8641139634

Meeting ID: 864 113 9634

Passcode: 741852

Chief on Call

Jamie Lee, 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