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Archive for the ‘Discharge: Clinics & F/U’ Category

GYN disposition

A little helpful information for obtaining f/u for your gyn patients who need to be seen soon (days to weeks)

1. Choose category misleadingly labeled “GYN follow-up within 1 month”

a. Patient will be seen in a range of 2 days to 1 month based on the clinical issue

2. Please be specific about what the clinical issue is (i.e. “needs evaluation of post menopausal bleeding”, or “follow-up after I and D of Bartholin Cyst”)

a. See 1a above- if you don’t write it, they don’t know why you are requesting rapid follow-up

3. If you are able- put the patient’s cell phone # in the request or document in the chart

a. The follow-up can only be arranged if the clinic can contact the patient

b. Patients may not give correct phone # at registration because of billing concerns

Our colleagues in gyn want to provide good service (appropriately time follow-up) for patients with gyn complaints but need your help- steps 1,2, and 3 above to facilitate.

Thanks,

Luke

Written by phil

January 24th, 2013 at 4:17 pm

Peds Ortho Clinic

Hi Adam,

Just a quick e-mail to make things run smoother:

1. Regarding transfers from other facilities: if something is
being transferred that is thought / known to be operative, please call
the ortho resident first to ensure that we can accommodate them when
they get here. Calling will also help in the opposite way: it may not
need to be transferred if it is something that can be scheduled
electively. This will save the patient an ER visit and we can likely
just give them a clinic visit. (I’m writing this now secondary to the
fact that a type III supracondylar was transferred over here tonight,
but now the OR can not accommodate us and we can’t do the case in the
relatively timely fashion it should be done…. I am also trying to fix
this separate OR problem as well… but that is a much harder problem to
fix at the present time.)
2. Regarding peds ortho clinic: just wanted to reiterate that this
is not a walk-in clinic. Every patient seen in peds ortho clinic needs
to be run by the ortho resident in order to get there. The only time
they don’t need an official appointment is if they come during weekend
hours, but it still needs to be approved by the resident. This helps
because the resident may be able to delineate which clinic would be the
best clinic for them to go to (example: it may not just be the next
Monday … but it may be 3 Mondays away that is the better date for them
based on their injury) or they may be better off being seen by their
primary care doctor first and then they can refer them if there is still
a problem.

Thanks for your help, Adam!

Abby

Abigail Allen, MD

Director, Pediatric Orthopaedic Clinic

Written by reuben

July 8th, 2011 at 8:34 am

Dubin Breast Clinic Follow Up

FYI, today I had a patient with a breast mass and lots of trouble getting her plugged into breast clinic. Finally I found a “Breast Social Worker” who is happy to help us.

Her name is Jen Kolton and she can be reached at 212-987-3063. Call her if you need an urgent appointment in the Dubin Breast Clinic.

Amish Shah

Written by reuben

June 27th, 2011 at 9:27 pm

PACT team

Hi All,
Many people have been asking about that yellow notification on certain charts regarding contacting the social worker for a PACT patient. The PACT program is run by the inpatient social workers to prevent hospital readmissions. These patients are given quick follow up with either their private MD or if no pmd, have their own clinic in the IMA, and have intensive services provided for them. Therefore if you are seeing them in the ED, please please let our social workers know or you can call 4-PACT directly and talk to Maria Basso-Lipani. It’s really a great program. If it is after hours and noone is available, please email me or liza the names of patients you see regardless of discharge or admission. Thank you!

Qualifications- 2 or more admits in the past 6 months
All diagnoses are welcome, but there is more information/education/concentration on CHF patients.

Exclusion criteria: No JMF patients, No heart transplant patients.

Our NICE program for frequent ED visitors will be working with their program to give these patients the best chance possible.

Best,
Neesha

Written by reuben

February 9th, 2011 at 9:42 pm

ED Patients to IMA

If a pt is followed at IMA and they come to the ED for non emergent care, they can be asked to go to IMA for care. IMA has walk-in slots available from 9am to 7p Mon-Friday. The process as described below began yesterday afternoon:
pt arrives, ED BA notes during quick reg that the pt is cared for in IM—they enter the reason fro visit as “IM-xxxcough”
triage nurse sees IM-XXX in complaint and briefly evaluates pt, if low acuity..
RN asks MD/provider for medical screening –
MD/provider sees pt (north zone doc or designee, or intake doc or PA)
MD/provider documents in ibex “mse performed…”
pt goes to IMA
if pt needs assistance, call for pt transport

This process has been working with peds clinic pts for the last week, with good success.
Thank you for your cooperation
Kevin

Written by reuben

October 22nd, 2010 at 4:47 am

IMA Medical Screening Exams

If a pt is followed at IMA and they come to the ED for non emergent care, they can be asked to go to IMA for care. IMA has walk-in slots available from 9am to 7p Mon-Friday. The process as described below began yesterday afternoon:

1. pt arrives, ED BA notes during quick reg that the pt is cared for in IM—they enter the reason fro visit as “IM-xxxcough”
2. triage nurse sees IM-XXX in complaint and briefly evaluates pt, if low acuity..
3. RN asks MD/provider for medical screening –
4. MD/provider sees pt (north zone doc or designee, or intake doc or PA)
5. MD/provider documents in ibex “mse performed…”
6. pt goes to IMA
7. if pt needs assistance, call for pt transport

Written by phil

October 22nd, 2010 at 12:35 am

Homeless Outreach Initiative

Hi all- if you have a patient who i:
-homeless and living in the streets for at least 9 months (not living on others’ couches or in shelters) and
-will be discharged from the ED
please refer these patients to Liza or Jessica the ED social workers who will then start the process of the homeless outreach initiative to help with possible housing options. Not for admitted patients.
Thanks
–NSD

Written by phil

August 12th, 2010 at 4:51 pm

Discharging Admitted Patients in the ED

1. Disposition in ibex changed to- discharge from inpt.
2. Inpt team discharges pt. They give pt inpt discharge paperwork.
3. ED BA notifies supervisor to convert case back to ED and discharge case.

1. Disposition in ibex changed to- discharge from inpt.

2. Inpt team discharges pt. They give pt inpt discharge paperwork.

3. ED BA notifies supervisor to convert case back to ED and discharge case.

Kevin Baumlin

Written by reuben

July 8th, 2010 at 5:16 pm

Discharging Admitted Patients

From Dr. Baumlin.

When an admitted pt goes home:

  1. Please change the disposition in Ibex to “discharge from inpt”.
  2. Please make sure that the pts RFID tag is removed.
  3. The RFID tag goes in the bin next to the pnuematic tube system.

Written by phil

December 15th, 2009 at 3:51 pm

Discharge Update

Wounds

  1. All pts with cellulitis should follow up at IMA
  2. All I and D’ed pts should follow up in IMA
  3. All sutured pts should follow up in IMA (except hand and face lacerations)
  4. Any wound cared for or repaired by surgery, plastics or ortho should have follow up arranged by the consultants.  Care will be provided in those specialties respective clinics. (or private offices)

IMA is open Monday – Friday 9a to 3p on a walkin basis for care of the above mentioned patients.

If a patient has a pmd, pts should be requested to “follow up with your pmd”

Discharge Desk

  1. You all have been doing a great job at making sure pts get to the discharge desk!
  2. Remember to review the instructions with the pts (or have the nurse review the instructions), then leave the paperwork with the Registrar at the Discharge Desk.  T

Written by phil

December 9th, 2009 at 3:11 pm

Discharging Patients

1. All pts must be discharged at the conclusion of their ED encounter. Peds pts at the peds desk, east at the east BA desk and adults at the specimen desk. (The south end of the desk).
2. All pts will be asked for co pay (if appropriate).
3. All uninsured pts will be asked for partial payment.
4. Please make sure yours pts have signed the dc receipt prior to arrival at the appropriate discharge area.
5. All pts should have documented follow up. –
6.  ima clinic will see all of our pts for first follow up visit if they have no other access to care.
Thanks
Kevin.

Written by phil

October 5th, 2009 at 4:52 pm

Discharge desk and co pays

Just a reminder about discharging patients:
1. All pts must be discharged at the conclusion of their ED encounter. Peds pts at the peds desk, east at the east BA desk and adults at the specimen desk. (The south end of the desk).
2. All pts will be asked for co pay (if appropriate).
3. All uninsured pts will be asked for partial payment.
4. Please make sure yours pts have signed the dc receipt prior to arrival at the appropriate discharge area.
5. All pts should have documented follow up. –
6.  ima clinic will see all of our pts for first follow up visit if they have no other access to care.
Thanks
Kevin

Written by reuben

October 5th, 2009 at 3:37 pm

IMA Policy

Written by phil

August 13th, 2009 at 2:16 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

Discharge Assistant

Good afternoon, the discharge assistant is now sitting outside of the discharge desk.
Any patients who are being discharged can stop by and see him, Angel. He will assist in making appointments and helping with insurance issues for all clinics.
His zone phone is 44969.

Written by phil

May 26th, 2009 at 5:16 pm

Peds Asthma Clinic Followup

This is just a reminder about the operation of the Peds Assoc Asthma Follow Up Clinic. We go on hiatus over the summer months (June, July, and August) so there are no specific slots starting June 1, 2009.

However, the program should continue in spirit over the summer. ANY Peds Assoc patient who is seen in the ER or has been admitted to the hospital with asthma should receive a 24-48 hour follow up on discharge. Appointments need to be made through the general number (659-8559) and the patient should be given an urgent appointment. If a patient presents to the ER in the middle of the night, the family should be told to call the following morning for an urgent appointment.

The clinic will restart this coming September.
Carolyn Rosen, MD

Written by reuben

May 20th, 2009 at 5:25 pm

Follow-up for the uninsured

with 2 comments

This is the latest policy from IMA.

Earlier announcement:

All uninsured patients are sent to the Patient Service Center (1st flr CAM). Where they are put on a Level 1 sliding scale fee and only have to pay $16.44 per visit, until they are on Medicaid. The PSC also gives the patient a referral/appointment to the REAP office.

Only patients who cannot provide documentation (ss card, License, etc), are unable to be put on a sliding scale, have to pay the full price for a visit.

REAP: patient should call 212.423.2800 to get set up with Medicaid.

Written by reuben

May 20th, 2009 at 4:16 pm

Dispositioning Patients

with 4 comments

Discharge Process Summary as of 4/14/09

To discharge a patient safely from the ED, a complete check of the administrative information is done by the BA at the discharge desk. To accomplish this, the BA reviews the information in the patient’s physical red chart, adds any new information (such as phone numbers, address) that the patient provides and scans the signed discharge sheet. To do this the BA needs: the patient or responsible person, the red chart and the patient’s signed discharge instructions. For adult patients, from midnight to 8AM, the discharge desk function is performed by the BA at the specimen desk. No more trips to the hallway.

Patients with no insurance

The IMA is now taking patients without insurance! and patients with healthfirst! but NOT patients with Metroplus.  Patients without insurance will pay $16 at the first visit, and at that visit, IMA will assist them in getting insurance.  If there are any problems with this please send Meika Neblett the patients name and MRN.  Can be given REAP information (available at discharge desk) to initiate process of obtaining insurance.  Patients with Metroplus can follow up at Settlement Health.  Should be referred to REAP as well.

Patients with Medicaid

Can follow up at IMA or any of the clinics.

Patients with Private Insurance (i.e. blue cross, affinity, united, 1199, etc)

Can follow up at the FPA (faculty practice associates). The color FPA brochures for medicine and specialty are in the urgent care. In addition, there are business cards in the East Zone for bothe primary care and specialists who will accept patients within the week after being seen in the ED. This is not walk-in. The patient must call for an appointment.

GYN Follow up

GYN patients can follow up at the Klingenstein Pavilion E-Level GYN clinic for repeat B-hCG or for patients with ectopic pregnancy treated with methotrexate regardless of insurance.

Call ext 47238 and leave the following information:

  • Last and first name, date of birth and the medical record number of the patient.
  • An active telephone contact.
  • The time range that the patient should be scheduled for follow-up care.

The assigned clinic business associate will retrieve the messages, schedule the appointment and call the patient to advise them of the date and time of the appointment.

Dental

We have been trying to improve flow of dental patients up to dental and avoid keeping their charts open while they go for a consult. For bureaucratic reasons, they cannot simply be directed upstairs without first receiving a screening evaluation which currently can only be done by a PA or MD (this will hopefully change). Patients with a dental complaint being seen in the ED should receive an expedited screening exam and then:

Between 8 am and 3 pm – be quick registered, quick triaged, and seen by an md or pa who confirms that the problem is dental and stable.  Minimal documentation is needed in IBEX.  The patient is then discharged with an instruction sheet directing them to the dental clinic (Second floor of the Annenberg Pavilion).

Discharge of patients with HIV

Patients with HIV who do not have primary care should be referred to the Jack Martin Fund Clinic.

By Insurance

Metroplus:

Written by phil

April 13th, 2009 at 10:05 pm

Dentistry / Dental Referrals

we have been trying to improve flow of dental patients up to dental and avoid keeping their charts open while they go for a consult
for bureaucratic reasons they can not simply be directed upstairs without first receiving a screening evaluation which currently can only be done by a pa or md (this will hopefully change)
between 8 am and 3 pm, patients with a dental complaint should receive an expedited screening evaluation, discharged from the ed and sent to dental.
between 8 am and 3 pm, patients with dental complaints should be quick registered, quick triaged, and seen by an md or pa who confirms that the problem is dental and stable.  minimal documentation is needed in ibex.  the patient is then discharged with an instruction sheet directing them to the dental clinic, annenberg, second floor.
please be proactive with these patients and help them through the system.
thanks
andy

Written by reuben

January 30th, 2009 at 5:57 pm

Discharge of HIV patients

Written by phil

January 2nd, 2009 at 4:58 pm

Updates

East zone: the zone formerly known as UC, now changed in Ibex.  The bed numbers are a continuation of the AED bed numbers, i.e. 23, 24, 25…

Discharge Desk: The discharge desk for adult has now moved to the specimen desk from 12MN to 8AM.  No more trips to the hallway.

Stocking:  we have started a new electronic accountability program for stocking.  Please send me any stocking problems that you find, especially any critical inadequacies.

Thanks – Scot

Written by admin

November 25th, 2008 at 9:24 pm

Clinic Follow-Up

1. There is an “IMA Navigator” by the discharge desk from 1-5pm Monday through Friday. This person can assist in making all IMA and clinic appointments.

2. There are NO GYN WALK-IN appointments. Patients must make an appointment.

3. GYN pts for follow-up b-HCG, can be seen at the GYN clinic, we need to leave the follow up info with the clinic, and they will set it up. The number and info is posted on the bulletin board where the schedules are in the Main ED, on the north side.

4. Medicaid patients- can follow up at IMA or any of the clinics.

5. Health first pts (in general) CANNOT follow-up at Mount Sinai. They can go to Settlement health. (they can follow-up at sinai if they are previously established in the outpt clinics

6. Private patients (i.e. blue cross, affinity, united, 1199, etc) can follow up at the FPA (faculty practice associates). The color FPA brochures for medicine and specialty are in the urgent care.

7. Private specialists- there are business cards in urgent care for docs who will accept pts within the week after being seen in the ED. This is not walk-in. The pt must call for an appointment.

I hope this reminder helps. Please email me or contact me with any questions or clarifications. Thank You, Meika

Written by reuben

August 12th, 2008 at 7:01 am