Weekly Update

September 20, 2021

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

I hope this email finds you all very well! As you may be aware the VP&S Office of Student Affairs and CUIMC Center for Student Wellness have run an annual Mock Interview Program for our 4th year medical students. This program has been invaluable in preparing students for the residency interview process.

 

With the 2023 application cycle continuing to be in a virtual format, the component that is still essential to the success of this mock interview experience is engaging residents and fellows in each specialty to serve as our “interviewers.” There are ~ 6 4th year students applying into Emergency Medicine and we are hoping you will be able to help us secure at least 2 residents / fellows volunteers from internal medicine to serve as this year’s mock interviewers. For the residents, they would just need to not be currently involved in the Match / and or residency selection process (otherwise it is a violation of the Match).

 

The format for this year will again be to assign each resident or fellow ~ 3 students to virtual mock interview through either Zoom, Skype, or Face Time. The time commitment would be a 30 minute interview with each assigned student interviewee at a mutually convenient date / time, within the mock interview time frame window of September 27th – October 29th. We would just ask the resident to reach out to each of their assigned students to introduce themselves as the mock interviewer and coordinate the specific date / time, and preferred virtual venue with each of their student interviewees by October 1st to ensure all the mock interviews have been scheduled within the mock interview time frame window.

 

We would appreciate if you could either pass this email along to residents and fellows that are qualified and you think would be interested, or send me the names and emails of residents or fellows by Wednesday, September 22nd  that you know would be interested and I can reach out to them directly. Interested residents / fellows can contact me at foj2101@cumc.columbia.edu. Once I have the list of residents / fellows who will be our mock interviewers for internal medicine, I will provide them with the names and emails for their interviewees, and more details about the mock interview format.

 

We are extremely appreciative of the volunteers’ time and efforts, and for your support of this program. Thank you in advance for your time and for your assistance in recruiting the mock interviewers for Emergency Medicine. We know the students will benefit tremendously from this experience.

 

Best,

Francheska

The Department of Emergency Medicine at the Hospital of the University of Pennsylvania is pleased to announce we are actively recruiting for a position in our EM Administrative Fellowship to start in the 2022 academic year.  The Fellowship includes an MBA from the Wharton School at the University of Pennsylvania, and substantial financial support for that program.  We encourage any interested applicants to review our website and to reach out to Dr. Keith Hemmert, Associate Fellowship Director.

 

Let me know if you’re willing to write a book chapter. We have a 3 month deadline. Should be fairly easy to write. Few pages and few tables. Email me with your interest and I’ll send over the sample chapter.

Approach to Trauma
Approach to Wounds
Approach to Burns

Thanks,
Kaush

Campus Announcements

From our Columbia Critical Care Colleauges: Vitamin C and Sepsis

This week we review the recently hot but now lukewarm topic of vitamin C in sepsis.  This trial compares HAT (hydrocortisone, ascorbic acid, thiamine) to thiamine in patients with septic shock.  Note median tim to dose after ICU admission was 12 hours (in my mind that means 18-24 hours from initial sepsis presentation) Does any late therapy in sepsis work?

From Dr. Betty Chang: ICU sign out process, outpatient MRI workflow

  1. Getting hold of our Care Managers / Social Workers:
    Remember that the best way to reach the Care Coordination or Social Work team in real time is via the Secure Chat group below. The earlier they can be involved in a patient’s care, the better. Even if we don’t know the final disposition, they can help coordinate resources for the patient so that their stay is more efficient.  
  2. NEW:  ED Primary Team to do hand-off to Primary ICU Team (effective: September 1st):
    -In order to better serve our ICU level patients and improve our communication about the care of the patient, we will be doing a verbal hand-off from ED primary team to primary ICU Team starting September 1st.  This is the similar process as regular floor admission process. PPOC will connect the two teams. 
    -If we need to contact the team, we can either chat them via “CUIMC MICU A (Admit Team)”, “CUIMC MICU B (Admit Team)”, etc. or call the ICUs directly. 
    -No change:  ICU triage consult resident / attending will still do the patient allocation between ICU and SD, will help with management of ICU level patients in the ED, etc.   ICU patients in the ED will still be the responsibility of ED primary team.
  3. ED Boarding & Coverage: 
    -As many of you know, our volume is creeping up over the past few months (see below).  Every day, the ED AOC works with MAC (medical admitting clinician) to get teams for the patients. We will continue to escalate to the Hospital senior leadership, and advocate for our patients.  
    I know it may not mean much, but just want to say “thank you” for doing the best you can under the current circumstances.  Your hard work is truly appreciated.  It has not been easy.  I am hopeful that it will be better with overall staffing in the fall.
  1. To end on a positive note, ED to Outpatient MRI process:
    -We just hit the 50 patients mark (since go live in April) in getting our ED patients a non-emergent MRI (in lieu of admission or doing the MRI during an ED visit).  Shout out to Eugene Kim for partnering with me on this initiative!
    -Please keep in mind, that this is for ED patients; and Neurology needs to be involved so the MRI results are passed on to the appropriate people and not to ED providers. 
    -Please make sure you consult Patient Navigators for the PCP portion (Comment: Outpatient MRI).  Neurology will arrange Neurology follow up and get the key stakeholders (call center, radiology, CM/SW, etc.) in a secure chat. 
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: 

 

  1. Save time by getting key ideas from the world’s expert thinkers in 15 minutes or less 
  2. Expand your knowledge and horizon with 4,500+ nonfiction bestsellers in 27 categories 
  3. 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: 

  • Mindfulness & Happiness 
  • Psychology 
  • Personal Development 
  • Motivation & Inspiration 
  • Health & Nutrition 
  • Philosophy 
  • Society & Culture  
  • Leadership & Management 
 
 

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 Dr. Scofi: Survey Regarding New ED Clinician Performance Feedback Dashboard

 

Hi Everyone,

Our ED informatics team and ED leadership are launching an exciting new project in the upcoming year to create a clinical performance feedback dashboard for ED clinicians. Our vision is to design a user-friendly, interactive, and easily accessible tool that gathers performance feedback for operations, quality, patient cases, and other topics in one convenient place for education and review.

Our goal is to design a dashboard that provides meaningful feedback for you as an individual well as the department at large. To better understand your expectations, including what items you would find most and least useful, please answer a few short questions here:

My Feedback Dashboard Preferences  (<5 min to complete)

I’m also forming a focus group to help work on this project. If you would like to contribute to the build process and joint the group, please email me! The group will meet every few weeks to test drive the build and provide input on the dashboard’s design and function.

For more background and some dashboard examples, please check out this excellent presentation by Oliver Wu, one of our 2021 EM Clinical & Research Summer Internship students. Please feel free to contact me at 626-379-6762 if you have any questions. 

All the best,

Jean

Reminders from the Cornell Opertions Leadership: 

Escalation Rolodex: 
  • Any clinically important delays can be escalated using the escalation rolodex
  • Search in nexus on top right “Escalation”
  • Use judiciously– involve your attending or admin attending if needed
LABS vs LWBS:
  • Only select Walked Out Before MSE if no providers have evaluated the patient, meaning there is no MSE Note, ED Provider Note, or ED Progress Note indicating evaluation.  
  • If the patient has an MSE Note or other evaluation documented by any provider (it doesn’t have to be you!), choose Walked Out After MSE instead. 
  • See Nexus > Dispo & Transfer > Elopement. 
Reaching the Unit Coordinator (formerly PM):
  • For any equipment needs in the ED for which you need help, please utilize the epic role “WC GBG ED Unit Coordinator“ to reach the available UC, not the individual
Social Work/CC:
  • Please inform the patients that they often will need to wait substantial amounts of time for ambulette/lance and may need to pay for the ride
  • Refrain from offering ambulette/lance if the patient has the means to get home safely on their own
Patient navigators:
  • Reserve for patients who actually require services (who will fall through cracks if not given appointment)
Activations:
  • 4 Activations:  OB (include out of hospital deliveries), Trauma, Stroke, Acute MI/STEMI
  • Inform the unit clerk

Message from Dr. Peter Steele on ED Walk-Outs:

Our LWBS (left without being seen) rate has sky rocketed. This is a highly-scrutinized QPS metric by executive leadership; our individual chart reviews reveal many of these cases are due to inaccurate disposition documentation.
 
It is critical the ED team accurately documents left after being seen vs left without being seen. Please can you ensure the attached document is reviewed in detail by residents, specifically that LWBS should not be the selected disposition if there is any initiation of care prior to the event, including an APP triage RME. 
 
If the patient walks out while an ED team member is performing an initial evaluation, please document that evaluation as a brief note and identify as pt as left after being seen. 
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September 22, 2021 - Psychiatry Final Week

Time

Topic

Speaker

  • 08:00 - 09:30
  • EKG Workshop
Dr. Emerson Floyd

NYPEM PGY-4

  • 09:30 - 10:00
  • Child and Adolescent Psychiatry
Drs. Juste Buneviciute and Georgina Hartzell

WCMC Psychiatry Attendings

  • 10:00-10:30
  • Is Fellowship Right for Me?
Dr. Mahesh Polavarapu

CUIMC ED Attending, Assistant Medical Director, The Allen Hospital

  • 10:30 - 10:45
  • BREAK
  • 10:45-11:30
  • Delirium/Dementia
Dr. Bernard Chang

CUIMC EM Attending, Vice Chair of Research

  • 11:30 - 12:00
  • PGY4 Grand Rounds
Dr, Daniel Golden

NYPEM PGY-4

ASYNCHRONOUS LEARNING

Tintinalli’s Emergency Medicine 9th Ed – Chapters 293-295 (WCM for residents)

ALiEM: Psychosocial

 

ZOOM LINK

Join Zoom Meeting

https://nyph.zoom.us/j/97646035678?pwd=VzNmUlZkTURHOTRUZ2FBUXl6Ump3QT09

Meeting ID: 976 4603 5678

Passcode: 041917

 

John Kamler

Dr. Jon Kamler

Cornell ED Social Worker extraordinaire Seth Herman was “was really impressed with [Jon’s] professionalism and kindness” in managing the very upset family of an A1 trauma patient. 

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