Weekly Update – October 18 2021 – NewYork-Presbyterian Emergency Medicine

October 18, 2021

From Dr. Garg: Columbia Staffing

Dear EM family,

I wanted to provide some follow up to the email I had sent earlier today regarding our Columbia staffing. To begin, I want to reiterate that we appreciate the advocacy for our patients, our nursing colleagues, and one another. I communicated with Dr. Mills about the ways we can best make a difference and appreciate her excellent input and tireless support. For reference, new nurses have been hired and are undergoing training but it is likely that it will take some time before we return to previous ratios. We are additionally awaiting resolution of the CT tech issue.

In discussing ways with the program leadership that we, as a residency, can best advocate in this situation we have made a few important decisions in the interim.

Residency:

After discussion with the chief residents and understanding some of the general themes brought to our attention by your suggestions we propose the following:

PGY 4 will now be dedicated in C in a clinical role; and the PGY 3 will now be in B. Notifications will go to the senior resident on either side. Area D notes will be managed by the PGY 3 and handed off to the attending in D (as before) since the PGY 4 will get more nursing collateral due to geography. On Mondays and Tuesdays when we have the 2nd PGY 3, that person can function in a float role for the bays/notes.

We also recommend a length of stay combined with ESI prioritization converstation that you discuss with your attending to make sure you can see the sickest/priority patients first.

GME:

We have reached out to the DIO to express our concerns and provide background. We were reminded about the annonymous escalation pathway. I’m including that as an attachment. I would please ask that you reach out to the program leadership or GME before considering external avenues.

Hospital:
Dr. Mills has communicated with hospital leadership to set up a meeting specifically with the residents. There is a town hall meeting on Tuesday that all are welcome to attend, but we discussed how critically important it will be to have a resident voice and separate meeting. Hospital leadership has agreed and we are looking to schedule a date/time.

Thank you again for all you are doing. We are working very hard to make this better.

From Dr. Mills: Academic Job Opportunity Near New Orleans

Good morning,

I am the new Chair at Ochsner Medical Center in New Orleans, LA, recruited here to build an academic department. Things are really taking off with gusto as there was already a really fantastic group of faculty physicians in place; we are a tertiary referral site for a large network of hospitals and see ~70,000+ patient visits/year through our ED; we are already in our second year of our EM residency and the institution has ~30 residency/fellowship programs in total (robust GME presence); and we are the home of the UQ-Ochsner Clinical School (our medical students spend the first two years at University of Queensland and the final two years here with us). We have set our foundation, and now we are working on adding depth to our niches and adding an Associate/Assistant Residency Program Director. It is a really exciting time of growth here. I have a passion for education (was the Vice Chair for Education / Residency Program Director at Vanderbilt before taking on this new opportunity). So, if you have any faculty who are also passionate about resident/fellow education and looking for a really great new opportunity, please send them my way. Posting is below and attached as well for a more formal description.

Thanks,

Nicole McCoin

From Dr. Osman Sayan: Job Opportunity at Baylor

Former Columbia APD and now Baylor PD Aleksandr “Sasha” Tichter posted that “Baylor College of Medicine in sunny Houston, TX has openings for full-time faculty of all academic ranks to join our growing department.”

From Dr. Osman Sayan: Job Opportunity near Boston

Two if our grads are at a hospital north of Boston. They have an opening for whoever is interested.

Let me know and I can make the intro.

Volunteer with Adam Blumenberg at the NYC Marathon

I’d like to invite you to volunteer with me at the New York City Marathon on November 7!

The New York City Marathon is among the largest marathons with runners joining from all over the world. There are usually over 50,000 runners who cross the finish line. Many of the runners require acute medical care during or immediately after the race, and come in droves to the finish line medical tent.

I have done medical volunteering for the NYC marathon before and plan to be there this year on November 7 as a licensed attending. It is an awesome experience. This is a wonderful opportunity to see another side of medicine and I recommend it for anyone with an interest in event medicine, sports medicine, mass-casualty events (yes really), and rapid triage. I hope you will consider joining me at the race!

If you would like to volunteer go to this website, and sign up! I set up a group called “Columbia Emergency Medicine” so please make sure to request that group. Even though the organization cannot 100% guarantee that we will be together at the finish line, I emailed with them directly and they say they expect they can do it!

If you have any questions please email me!

Best,

Adam

Campus Announcements

Blinkist for Columbia Department of Emergency Medicine: Free for One Year

Colleagues,

We want to thank all of you for your hard work and contributions. We are dedicated to your continued professional growth. Some of you may find it difficult to find time to read or listen to inspirational stories. Blinkist is here to help! Blinkist would like to thank you for your work on the frontlines and your resilience over the past year and a half.

We are excited to provide you with one year access to Blinkist – for free!

Blinkist is an app that transforms key insights from the most relevant nonfiction books and podcasts into powerful explainers you can read or listen to in just 15 minutes — anytime, anywhere!

With Blinkist you can:

Save time by getting key ideas from the world’s expert thinkers in 15 minutes or less
Expand your knowledge and horizon with 4,500+ nonfiction bestsellers in 27 categories
Increase your skillset anytime, anywhere with an award-winning, audio-first, mobile-first app

Millions of people are using the knowledge from the Blinkist app to:

Improve leadership skills
Make more informed decisions
Stay updated and connected to the world
Have better personal interactions
Experiment and try out new things
Overcome challenges
The Blinkist content is the collective effort of expert authors, readers, narrators, and curators, to create genuine value for people who love to learn. Their library spans 27 categories and 150 different topics—so you can truly explore whatever excites you!

Some categories you can choose from:

To sign up, follow the instructions in this onboarding guide here or follow these steps:

1. Go to Blinkist.com
2. Tap on ‘Log in’
3. Tap on ‘You don’t have an account’
4. Create an account with your Columbia email address and your desired password. Residents, you will need to use your Columbia email for access
5. Download the Blinkist app vie the App Store or Google Play Store (after you have registered via blinkist.com)
6. Log in with your created credentials
7. Confirm email address (mail arrives within 1 hour)
8. Activate subscription (mail arrives within first 24h)
9. You’re logged in
10. Read! Be inspired! Revitalize!

Please let us know if you have any questions. Many thanks to Blinkist for this generous gift to the members of our Department. We look forward to some recommended reads from you all.

Enjoy,

Angela, Penny & the Blinkist Team

From Our Columbia Critical Colleauges: Care Colleauges:

Now live! – ED-to-VUC Referrals for Monoclonal Antibody Infusion – (attached job aid and criteria for eligability)

Ordering monoclonal antibodies for Covid positive or exposed patients is complicated. To offload the ED providers, all monoclonal antibody orders will be routed through the Virtual Urgent Care. From those I have shown how to do this, the feedback is… it is really easy!

Patients at risk: Over 65, liver, lung, kidney disease, DM, HIV, BMI>25, hard hit groups +MORE….see attached document, this doc is also up in ED bays LMH and WCM

Who qualifies for MAB? (See criteria document attached)

1) Patients who are at risk and EXPOSED to COVID

2) Patients who are at risk and COVID + within 10 days of symptom onset

What does current evidence suggest?

– 85% reduction in need for hospitalization, reduction in death

How do I connect a patient who I am discharging to MAB Therapy? (See screenshot below and PDF attached)

– Use the box in “Common Follow-Ups” under DISPO tab in Epic.

– Fill out pop-up box content.

– Patient will receive discharge instructions on how to do the VUC appointment.

– Patients who fail to make a VUC appointment will receive a telephone call to help troubleshoot.

Where is there more information?

– Our AA and AOC leaders will be able to help with this process during shifts.

– https://www.covid19treatmentguidelines.nih.gov/therapies/anti-sars-cov-2-antibody-products/anti-sars-cov-2-monoclonal-antibodies/

From Dr. Robby Tanouye: Long IVs are now stocked in IV carts

Per request from several ED Residents, who noticed a stocking gap in the two (2) WC A Bay IV carts. Thank you for your work on placing US-guided IV’s and hope this makes it a touch easier

Big thanks to our WC Nursing leadership and to David & Bill for the good idea. David & Bill, feel free to spot check this for us and let me know directly.

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

October 20- PEM Made Practical - Neonatal Fever

Time

Topic

Speaker

Conference Info

ASYNCHRONOUS LEARNING

Tintinalli’s Emergency Medicine 9th Ed – Chapters 121-124 (WCM for residents)

ALiEM: Pediatrics

CONFERENCE ATTENDANCE

Conference Evaluation and Resident Attendance Form

Columbia 2021-2022

Cornell 2021-2022

ZOOM LINK

Join Zoom Meeting

https://nyph.zoom.us/j/96872760297?pwd=WWRuRm9NRDJKSmtBOWN4TDNjcmRGZz09

Meeting ID: 968 7276 0297

Passcode: 040831

Shout out to Jon, Mary Kate, Neil and Destinee. This team, led by Mary Kate, managed an extremely diffcult case with poise and skill. Y’all made us proud!

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