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Archive for the ‘Consults’ Category

Cardiothoracic Surgery

Written by phil

April 6th, 2013 at 3:27 pm

Posted in Consults

EHC Facial Trauma

Written by phil

December 26th, 2012 at 5:20 pm

Posted in Consults,Elmhurst

Geriatric Consultations

-Geriatric consultations are currently available for elderly ED patients Mon-Fri 9am-4pm. Reach the Geriatric Consult Liaison service through AMION or AMAC.

-Consider Geriatric consultation for assistance with high risk and complex elderly patients, particularly for help with coordination and transition of care issues in patients with a potential for discharge. See attached for further details.

-Patients do NOT need to have a prior PCP in Geriatrics/Martha Stewart to obtain consultation.

-For patients already know to Geriatrics/Martha Stewart, you may continue to call their PCP directly (via AMION or AMAC) to discuss any issues related to their care or disposition.

Please let me know if you have any questions or issues.

Thank you,

Denise

Written by phil

September 7th, 2012 at 2:25 am

Posted in Consults,Geriatrics

Interventional Radiology Pager

Written by phil

August 28th, 2012 at 12:53 pm

Consult Policy / Medical Board Rules&Regs

Written by phil

June 15th, 2011 at 7:51 pm

Posted in Consults,Policy

Sickle Cell Pain Crisis Admissions

For sickle cell pain crisis admissions, the chronic pain service wishes to be called instead of the hematology fellow. They will come down 24/7 to write analgesia orders. The resident/fellow covering this service carries a cell phone:

(646) 592-0084

If a sickle cell patient has another reason for admission (e.g. medically ill with an infection, chest crisis, hemolytic crisis, etc.) the case should be discussed with the heme fellow.

Written by reuben

May 12th, 2011 at 9:35 pm

VNS Referrals

Good morning, just a reminder. If it is off hours, and you think that your pt would benefit from VNS services, you may print out a consultation form write your concerns on it, and leaving it under the door of the social worker. The VNS will review the case in the morning.
VNS would rather too many referrals rather than too few.
thanks
meika

Written by phil

July 29th, 2009 at 12:44 pm

Radiology & Surgery Update

Hi everyone,

Lisa and I had an interdepartmental meeting with Radiology and Surgery at Sinai today – some matters they want us to pass along.

1.  Gastrografin will not be used anymore.  Instead, for g-tube placement confirmation – we are going to use Isovue.  Isovue is the same substance as the IV contrast we use for CTs and can be obtained from almost anywhere in the Department of Radiology.  So please throw out the gastrografin you guys have hoarded in your mailboxes.

2.   When ordering radiological studies – please include your call back # on it.

3.  When ordering CT (-) for acute stroke, please include onset of symptoms.

4.  Radiology is reducing the number of CT scanners in operation from 2 to 1 at night.  ‘Night’ being 10pm – 8AM.  Radiology promises this will NOT affect the ED.  Please let me know if this becomes an issue [with specific instances, patient MR#s, etc] if it does.

5.  Radiology will still not have an u/s tech at night despite efforts by their own residents and other departments to encourage this.

6.  Lastly – per Surgery.  Patients awaiting a liver transplant AND who are on the list – in situations involving surgical issues – call Liver Transplant FIRST via.  Cirrhotic patients who are NOT on the transplant list – call SURGERY for consults.

Written by reuben

June 10th, 2009 at 5:36 am

Posted in Consults,Radiology

Deaf or Mute Patients

We are required to offer/arrange for an interpreter for patients who are deaf or mute.  These can be arranged viat the Languages Assistance Program (42700)  or the Patient Service Center (88990).
 
Should the patient decline the use of an interpreter (because they do not feel the need for one or prefer to use someone that has accompanied them) we should document that the patient declined and that we were comfortable with the level of communication. 
 
Thanks. 
 
Maria,
 
 
Maria M. Cardona
LEP Coordinator
212-659-8995

Written by phil

May 8th, 2009 at 10:47 am

Posted in Consults

Corrective Action Plans

We have had several ED cases with poor outcomes over the past year that triggered root cause analysis and resulted in corrective action plans.  The following corrective actions directly or indirectly involve our ED practice. The department may be monitored by the state for compliance with these plans.

• New onset adult seizures, syncope, and chest pain will all be treated as if potential cardiac ischemia:  ECG within 15 minutes.

• Initial dosing of hydromorphone is 0.5 -1.4 mg, initial dosing of Morphine is 4 mg.

• Higher doses of pain medications may be given if there is a note in the chart documenting the medical reasoning for choosing a higher dose.

• More than 3 doses of IV pain medication in 3 hours should prompt a pain consult for consideration of PCA pump, or medical reasoning why there is no consult.

• All transfers of patients with thoracic aneurysm or dissection should be discussed with the MSH ED attending before transfer from another institution.

• CT surgery will use AMION for on call and chain of command contacts.  Non-compliance should be reported to Scot Hill.

• Consultants should respond by phone within 10 minutes, and be present within 30 minutes.  Non-response should trigger a call to the next higher level in the chain of command.

Written by phil

April 8th, 2009 at 7:16 pm

Pediatric Surgery Consults: Saturday Night

Whoever is on for peds surgery is on call all the time, 6 days a week.  The exception due to 405 rules is Saturday (their one calendar day off per week).  From Friday midnight through Saturday overnight the general surgery resident on consult (the same person the adult side calls) is on for pediatric E.D. consults as well.  There is a designated person up to midnight friday, at 12:01AM its the general surgery consult resident.

Written by reuben

January 7th, 2009 at 5:13 am

Posted in Consults,Peds

Ophthalmology Consults

Procedure- Emergency Department (ED).

Stable Patients
I. For the ED patient that is stable and presents with a chief complaint of an eye problem and will also be discharged. The following referral process must be followed:
i. The emergency department will contact the ophthalmology clinic on 8east of the Center for Advanced Medicine (CAM) at 212-824-7653 or 7655.
ii. The ED will provide the clinic physician with pertinent information related to (1) chief complaint and (2) any actions and/or interventions undertaken in the ED.
iii. The patient will be discharged from the ED and directed to the CAM building with a consult form.

Emergent Patients
II. For the ED patient that requires an ophthalmology evaluation in the ED (i.e. trauma or eye injury) or is unable to ambulate to CAM. The following process will be followed:
i. The ED will contact the ophthalmology resident via beeper # 917-641-1556 during the hours of 8:30-5p Monday, Tuesday, Thursday, Friday and 12:30p-5p Wednesday.
ii. After hours, weekends and holidays, the ED will contact the page operator for the on-call ophthalmology resident.
iii. The resident will come to the ED and provide the necessary ophthalmology evaluation and treatment.
iv. The ophthalmology resident will transport the patient to Annenberg 2 if needed and return the patient back to the ED.

Admitted Patients
III. For the patient that present to the ED and is admitted for a diagnosis unrelated to ophthalmology but has an eye condition that requires an eye consult (i.e. CVA). The following procedure is followed:
i. The admitting physician will order an ophthalmology consult during the admission process.
ii. The referral will follow the inpatient ophthalmology referral /consult process outlined below.

Written by reuben

November 17th, 2008 at 8:55 pm