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Archive for May, 2010

Pediatric ED to Clinic Diversion Process

Introduction:
The following describes the process by which The Mount Sinai Hospital’s Emergency Department will handle non-emergent pediatric patients during the hours of 8:30am -3:30pm Monday – Friday and 10am – 2:30pm on Saturdays.
Policy:
All patients that present to the Mount Sinai Emergency Department will receive a medical screening exam to determine level of acuity by a health care provider.   In the event the exam indicates that the visit is non-emergent, then the ED staff will refer the patient to the Pediatric Clinic if they are an established Pediatric Clinic patient in the past 12 months and participate in an insurance plan accepted by the Pediatric Clinic.
Procedure:
When a patient presents to the Mount Sinai Emergency Department, the ED-BA located at the Greet Desk will validate the patient’s name and date of birth.  During the look-up of the patient in the Cerner ADT system (between the hours of 8:30am to 3:30pm  Monday –Friday and 10am-2:30pm Saturday) the ED-BA will determine if the patient is an established patient in the Pediatric Clinic (seen within the past 12 months and participates in an insurance plan accepted by the Pediatric Clinic).  If the ED-BA determines that the pediatric patient has met the criteria as a Pediatric Clinic patient then the ED- BA will process the patient in the ADT system (Cerner) as a “Quick Registration.”  The Quick Registration will include the national patient identifiers (Name & DOB), referring source, PC (PEDS Clinic)/the reason for visit along with the onset date.
Once the patient’s Quick Registration has been completed with required data elements, then the patient’s information will be sent from the ADT system to the Emergency department’s electronic medical record system (IBEX).  The patient’s information will be viewed in the triage nurse’s queue and the patient will be called for triage.
The triage nurse will expedite all pediatric patients with the PC designation in the reason for visit field.    Once the triage nurse has assessed the acuity level of the pediatric patient (emergent vs. non-emergent), he/she will call the Attending/Fellow to validate the assessment.
Once the Attending/Fellow assesses the patient and validates the decision that the patient is non-emergent patient, the Attending/Fellow will suggest to the patient/parent that they can go to the PEDS Clinic as a walk-in patient.  If parent agrees, the Attending/Fellow will write a note in IBEX and disposition the patient as “sent to clinic”.  If parent disagrees, they are sent to the ED waiting area to wait as triaged.
The BA will then: 1) identify the patient under “sent to clinic” disposition, 2) discharge the patient from IBEX, and 3) cancel the patient visit from Cerner.

The official MS Word Document is available here.

Introduction:

The following describes the process by which The Mount Sinai Hospital’s Emergency Department will handle non-emergent pediatric patients during the hours of 8:30am -3:30pm Monday – Friday and 10am – 2:30pm on Saturdays.

Policy:

All patients that present to the Mount Sinai Emergency Department will receive a medical screening exam to determine level of acuity by a health care provider.   In the event the exam indicates that the visit is non-emergent, then the ED staff will refer the patient to the Pediatric Clinic if they are an established Pediatric Clinic patient in the past 12 months and participate in an insurance plan accepted by the Pediatric Clinic.

Procedure:

When a patient presents to the Mount Sinai Emergency Department, the ED-BA located at the Greet Desk will validate the patient’s name and date of birth.  During the look-up of the patient in the Cerner ADT system (between the hours of 8:30am to 3:30pm  Monday –Friday and 10am-2:30pm Saturday) the ED-BA will determine if the patient is an established patient in the Pediatric Clinic (seen within the past 12 months and participates in an insurance plan accepted by the Pediatric Clinic).  If the ED-BA determines that the pediatric patient has met the criteria as a Pediatric Clinic patient then the ED- BA will process the patient in the ADT system (Cerner) as a “Quick Registration.”  The Quick Registration will include the national patient identifiers (Name & DOB), referring source, PC (PEDS Clinic)/the reason for visit along with the onset date.

Once the patient’s Quick Registration has been completed with required data elements, then the patient’s information will be sent from the ADT system to the Emergency department’s electronic medical record system (IBEX).  The patient’s information will be viewed in the triage nurse’s queue and the patient will be called for triage.

The triage nurse will expedite all pediatric patients with the PC designation in the reason for visit field.    Once the triage nurse has assessed the acuity level of the pediatric patient (emergent vs. non-emergent), he/she will call the Attending/Fellow to validate the assessment.

Once the Attending/Fellow assesses the patient and validates the decision that the patient is non-emergent patient, the Attending/Fellow will suggest to the patient/parent that they can go to the PEDS Clinic as a walk-in patient.  If parent agrees, the Attending/Fellow will write a note in IBEX and disposition the patient as “sent to clinic”.  If parent disagrees, they are sent to the ED waiting area to wait as triaged.

The BA will then: 1) identify the patient under “sent to clinic” disposition, 2) discharge the patient from IBEX, and 3) cancel the patient visit from Cerner.

Written by reuben

May 25th, 2010 at 5:25 am

Posted in Peds,Policy

Self-Protocol ER-CT

PROGRESS!!! There are now 6 choices for ED CT protocols, (plus “other”). If your patient fits a protocol, choose it.  You do NOT need to call the radiologist if you choose one of these protocols. Choose a protocol ONLY if your patient actually matches a protocol- do not fit everyone into a protocol just because it’s there.

There are now 6 choices for ED CT protocols, (plus “other”).  If your patient fits a protocol, choose it.  You DO NOT need to call the radiologist if you choose one of these protocols.  Choose a protocol ONLY if your patient actually matches a protocol – do not fit everyone into a protocol just because it’s there.  If you do not match one of these protocols, choose other, and call the radiologist.

Remember, DO NOT use the protocol unless your patient fits.
If your patient does not fit a protocol, choose other and call the radiologist.

Here are the protocols…

Appendicitis Protocol
Clinical indication:  acute, atraumatic right lower quadrant pain.
Scan Technique:  abdomen and pelvis with IV, oral and rectal contrast, 3 mm slice thickness with coronal reformations.

Diverticulitis Protocol:
Clinical indication: acute, atraumatic left lower quadrant pain.
Scan technique:  abdomen and pelvis with IV, oral and rectal contrast.

Pancreatitis Protocol:
Clinical indication:  clinical and biochemical evidence for acute pancreatitis.
Scan technique:    IV and oral contrast given as follows – C minus abdomen with 3mm slice thickness. C+ abdomen at 40 sec (3 mm slice thickness). C+ abdomen and pelvis at 70 sec (5 mm slice thickness).

Bowel Obstruction Protocol:
Clinical Indication:  clinical signs and radiographic evidence for either small or large bowel obstruction.
Scan technique:  abdomen and pelvis with IV and oral contrast.  One hour additional delay after oral contrast is finished. One cup of oral contrast on CT table.

Renal Stone  Protocol:
Clinical indication:  flank pain suspicious for urinary obstruction.
Scan technique:  non-contrast abdomen and pelvis with 3 mm slice thickness, patient scanned in prone position.

Pulmonary Embolism Protocol:
Clinical indication:  signs and symptoms of pulmonary embolism, positive D dimer in patients with no risk factors.
Scan technique:  chest CT with IV contrast.
Oral contrast dilution:  Gastrografin (0.8% iodine) 30 ml in 1 liter of water.

Please note that the radiologist (x 47928) or radiology resident (beeper#1490) should consulted for all complex cases, or for patients who do not strictly fit into the above clinical indications.
Scot & Kevin

Written by reuben

May 24th, 2010 at 8:23 pm

Posted in Radiology

Refworks

Our Group Code for RefWorks is: RWMSSM .

If you do not want to remember the Group Code you can access RefWorks off-campus the same way you access the Library’s other resources by going to the Library’s website: www.mssm.edu/library, clicking on RefWorks and logging into the Library.

If you are using the Write-n-Cite program in Microsoft Word from off-campus you must use the Group Code OR you can make one quick change in Write-n-Cite, directions are here: http://library.mssm.edu/reference/refworksfaq.shtml#access (you will still need to log in to the Library).

Written by phil

May 24th, 2010 at 6:08 pm

Posted in Research

Social Media Guidelines

Mount Sinai Medical Center Social Media Guideline

 

 Introduction

Social media are internet-based applications which support and promote the exchange of user-developed content. Some current examples include Facebook, Wikipedia, and YouTube. Posting personal images, experiences and information on these kinds of public sites poses a set of unique challenges for all members of the Mount Sinai community, including employees, faculty, housestaff, fellows, volunteers and students (collectively “Personnel”). All personnel have responsibility to the institution regardless of where or when they post something that may reflect poorly on Mount Sinai. Mount Sinai is committed to supporting your right to interact knowledgeably and socially; however these electronic interactions have a potential impact on patients, colleagues, Mount Sinai, and future employers’ opinions of you. The principal aim of this Guideline is to identify your responsibilities to Mount Sinai in relation to social media and to help you represent yourself and Mount Sinai in a responsible and professional manner.

Guideline

The following Guideline outlines appropriate standards of conduct related to all electronic information (text, image or auditory) that is created or posted externally on social media sites by Personnel affiliated with Mount Sinai. Examples include, but are not limited to: text messages, media messaging service (MMS), Twitter®, Facebook®, Linked-In®, YouTube®, and all other social networks, personal and organizational websites, blogs, wikis, and similar entities. This Guideline applies to future media with similar implications. It also applies whether Personnel are posting to: Mount Sinai-hosted sites; social media in which one’s affiliation is known, identified, or presumed; or a self-hosted site, where the views and opinions expressed are not intended to represent the official views of Mount Sinai. Reference to Other Policies All existing policies of The Mount Sinai Medical Center apply to Personnel in connection with their social media activities. A list of relevant policies is included at the end of this Guideline. Best Practices Everyone who participates in social media activities should understand and follow these simple but important Best Practices: 1. Take Responsibility and Use Good Judgment. You are responsible for the material you post on personal blogs or other social media. Be courteous, respectful, and thoughtful about how other Personnel may perceive or be affected by postings. Incomplete, inaccurate, inappropriate, threatening, harassing or poorly worded postings may be harmful to others. They may damage relationships, undermine Mount Sinai’s brand or reputation, discourage teamwork, and negatively impact the institution’s commitment to patient care, education, research, and community service. 2. Think Before You Post. Anything you post is highly likely to be permanently connected to you and your reputation through Internet and email archives. Future employers can often have access to this information and may use it to evaluate you. Take great care and be thoughtful before placing your identifiable comments in the public domain. 3. Protect Patient Privacy. Disclosing information about patients without written permission, including photographs or potentially identifiable information, is strictly prohibited. These rules also apply to deceased patients and to posts in the secure section of your Facebook page that is accessible by approved friends only. 4. Protect Your Own Privacy. Make sure you understand how the privacy policies and security features work on the sites where you are posting material. 5. Respect Work Commitments. Ensure that your blogging, social networking, and other external media activities do not interfere with your work commitments. 6. Identify Yourself. If you communicate in social media about Mount Sinai, disclose your connection with Mount Sinai and your role at the Medical Center. Use good judgment and strive for accuracy in your communications. False and unsubstantiated claims, and inaccurate or inflammatory postings may create liability for you. 7. Use a Disclaimer. Where your connection to Mount Sinai is apparent, make it clear that you are speaking for yourself and not on behalf of Mount Sinai. A disclaimer, such as, “The views expressed on this [blog; website] are my own and do not reflect the views of my employer,” may be appropriate. 8. Respect Copyright and Fair Use Laws. For Mount Sinai’s protection as well as your own, it is critical that you show proper respect for the laws governing copyright and fair use of copyrighted material owned by others, including Mount Sinai’s own copyrights and brands. 9. Protect Proprietary Information. Do not share confidential or proprietary information that may compromise Mount Sinai’s business practices or security. Similarly, do not share information in violation of any laws or regulations. 10. Seek Expert Guidance. Consult with the Marketing & Communications Department if you have any questions about the appropriateness of materials you plan to publish or if you require clarification on whether specific information has been publicly disclosed before you disclose it publicly. Social media may generate interest from the press. If you are contacted by a member of the media about a Mount Sinai-related blog posting or Medical Center information of any kind, contact the Press Office, a division of the Marketing & Communications Department, at (212) 241-9200 or newsmedia@mssm.edu Failure to abide by Mount Sinai policies may lead to disciplinary action, up to and including termination or expulsion.

Applicable Policies:

These policies include, but are not limited to: Use or Disclosure of Protected Health Information (PHI) or Confidential Mount Sinai Materials; Computer Use Policy; Use of Mount Sinai’s Trademarks and Proprietary Information; Electronic Communications; Confidentiality of the Medical Record; Camera and Video Recorder Use; Portable Electronic Devices; Human Resources Policies 13.5 (Electronic Mail/Email) and 13.6 (Internet Use); and all professionalism policies and codes of conduct. Policies not listed above that are in the Human Resources Manual, the Faculty Handbook, the Housestaff Manual, the Student Handbook and the Bylaws of the Hospital Staff also apply.

Addendum to Social Media Guideline

The following are fictional use-case examples of social media and blogging activities and an explanation of their appropriateness as per the Mount Sinai Medical Center Social Media Guideline: 1. A patient attempts to “friend” an attending physician on Facebook. This is almost always inappropriate, unless the doctor-patient relationship has ended. Even after the doctor-patient relationship has ended, it would be inappropriate to discuss health-related information. (Best Practice 3) 2. A patient comments on a Mount Sinai physician’s blog and discloses protected health information with the expectation that the Mount Sinai physician will continue the discussion. Any health-related discussions by email with patients require a written consent. Similarly, social media discussion with a patient should not directly address health concerns of individual patients. (Best Practice 3) 3. A medical student “twitters” that he just finished rounds with the residents on a patient and describes the clinical findings of that patient. It is difficult to be certain that information disclosed in the Twitter® post is not identifiable to that particular patient. The best type of posting would include very general information. Other posts by the same student could indicate his/her medical school and current rotation, leading to circumstances that indirectly identify the patient, such as by naming a very rare disease. (Best Practice 3) 4. A medical student writes in her blog, naming an attending physician who did minimal teaching on rounds and recommending that other students not take clinical electives with that physician. Legitimate critique of an educational activity is appropriate, so long as professionalism is maintained. There are more effective and less public mechanisms for relaying this type of information, and the student may be counseled accordingly. (Best Practices 1, 2) 5. A graduate student posts to his “wall” on Facebook that half of the class was sleeping during Dr. X’s lecture on biostatistics. This is very similar to the use case above. (Best Practices 1, 2) 6. A pediatric resident posts (on her Facebook wall) a picture of a baby who was just discharged from her service, expressing joy, best wishes to the family, and congratulating everyone involved in this excellent patient outcome. Without written patient/representative consent, this is a clear violation of patient confidentiality, even if the patient is not named. (Best Practice 3) 7. A laboratory technician blogs that the laboratory equipment he is using should have been replaced years ago and is unreliable. The public disclosure of such information increases the liability for the Medical Center and is clearly unprofessional. There are legitimate and confidential mechanisms for improving quality at the Medical Center. (Best Practices 1, 2) 8. A medical student wearing a Mount Sinai t-shirt is tagged in a photo taken at a local bar and posted on a friend’s Facebook page. The medical student is clearly inebriated. The two issues are that: (1) the Mount Sinai logo identifies the affiliation to the institution; and (2) the unprofessional behavior of the student is available for all to see, including future employers and patients. The medical student did not post the photo, but should do everything possible to have the photo removed and remove the tagging link to the student’s own Facebook page. (Best Practices 2, 4) 9. A post-doctoral student blogs that her laboratory technician wears too much cologne, has terrible taste in clothes, and takes overly long lunch breaks. This is an inappropriate forum and set of comments and demonstrates unprofessional behavior by the post-doc student. There are legitimate and confidential mechanisms for addressing valid concerns in the workplace. (Best Practices 1, 2) 10. An oncology nurse practitioner uses an alias and blogs that Mount Sinai has the lowest bone marrow transplantation complication rate in the world. This may be a violation of Federal Trade Commission regulations that prohibit false or unsubstantiated claims, and does not disclose the employee’s material relationship to Mount Sinai. (Best Practice 6) 11. An applicant to the Medical School is given access to a MSSM blog to comment on the experience. The applicant writes that another medical school in NYC is obviously more prestigious and has better housing. Mount Sinai has no recourse against non-affiliated individuals. The administrator of the blog should have established policies and procedures for editorial procedures. If the blog posting meets these editorial guidelines, then the blog posting should remain. It is likely that others will debate the original comment and place MSSM’s reputation and housing status in context. 12. A medical student creates a social media website to discuss medical knowledge (e.g., “Cardiology Interest Group” on Facebook®) This is a learning community environment, in which medical knowledge is exchanged, shared and discussed. While the goal is laudable, there are still risks. A disclaimer is necessary, since postings may be incorrect, taken out of context, or improperly referenced. The moderator should take precautions to prevent the posting of information or photographs that are potentially identifiable to a particular patient. (Best Practices 1, 3 ,6, 7)

Written by phil

May 17th, 2010 at 3:02 pm

Posted in Admin

How to admit patients to general medicine, first week of may 2010

with one comment

If a patient does not have a known MSH internist, and you need to admit a patient, please try and discuss with the MAR first.
then look in AM I ON
List the pt under the “lead hospitalist of the day”
Dr Kathuria is no longer at MSH!

If a patient does not have a known MSH internist, and you need to admit a patient, please try and discuss with the MAR first.

then look in AM I ON

List the pt under the “lead hospitalist of the day”

Dr Kathuria is no longer at MSH!

Kevin Baumlin

Inbox (11 messages)

Written by reuben

May 4th, 2010 at 8:24 pm

Posted in Admitting

Controlled Substance Prescription History Online

NYS DOH has a new program that allows MDs to view patients’ recent controlled substance prescription history online. I recently saw a patient I suspected was selling his narcotics, plugged in his name and date of birth, the results are per the attached screenshot.

How to register:

https://hcsteamwork1.health.state.ny.us/pub/top.html

Select “Request an HCS Medical Professions account application”

Fill out the form and print the .pdf document generated, have it notarized (Joycee Thomas is a notary), and send it to the address as directed. To expedite, you can also fax it and a copy of your drivers license to 518.449.6907. They will call you with your login information in a few days. If they don’t call you, call them 866.529.1890.

How to access a patient’s controlled substance history, once you’ve registered:

https://commerce.health.state.ny.us
1. Log in
2. Click on Applications, then select View All
3. Find “Controlled Substance Information (CSI) on Dispensed Prescriptions”
4. Click on that.
5. Enter the patient’s first name, last name, gender, and birth date (this is on the face sheet) as well as your DEA#.

https://commerce.health.state.ny.us

1. Log in

2. Click on Applications

3. Click on View All on the right side of the screen after all the letter categories.

4. Find “Controlled Substance Information (CSI) on Dispensed Prescriptions”

5. Enter the patient’s first name, last name, gender, and birth date (this is on the face sheet) as well as your DEA#.

Voila. If your are suspicious of abuse but nothing comes up in the database, ask the patient for an ID to verify name/DOB.

Online Practitioner Notification Program

Written by reuben

May 3rd, 2010 at 5:38 pm

Posted in Service Excellence