Weekly Update – November 29 2021 – NewYork-Presbyterian Emergency Medicine

November 29, 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:

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

Reminder: Hospital Training Due December 31

Remember to complete the SabaCloud training by December 31.

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?

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.
We no longer need to order a flu test for all patients who receive a COVID test. This NYS DOH mandate has ended.
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)

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).
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

Please reach out with any questions!

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.

`

Epic Updates From Laurie Malia,

1)You can now document First Provider Contact time

The ideal time to use this is when going off shift and you are not formally picking up a patient but are getting things started. Use this to document the first provider contact, enter orders and handoff to the oncoming provider
Assigning yourself to the patient, writing a MSE or Provider Note (whichever comes first) will also file this time automatically

There are 2 ways to document first provider contact time

1A:Select the patient from the trackboard and click on provider contact time

1B:Next Select file and Accept. You can also adjust the time you first saw the patient here (see below)

2. Second option to file the time: Usethe MSE Intake tab and select ‘File’

2) Patient Belongings now visible on trackboard

A suitcase icon will appear within the patient belongings column if items are documented
Double click on the row to see the details or edit the belongings

3)ALN Only: Raven Clinic Discharge Instructions

Raven Follow up Clinic for TIA & Stroke information now available as discharge attachment
Search “Raven” in the discharge instructions on the dispo tab to populate these instructions.

Reminder to Clean Ultrasound Probes!

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:

Close/end exam out (no HIPPA on screens)
Clean off probes/machines with red or purple wipes
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.

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

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