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Archive for August, 2010

NYCLIX Update

NYCLIX is back up with a couple of nice new added features:

1) When you log in, you will be brought immediately to the “Patients in ED” screen instead of the “Patient Search” screen (see attached image with a live shot of today’s Sinai tracking board – the names/PHI have been blurred to protect the innocent).  This screen is similar to our tracking board and lists all patients who have registered in the Sinai ED for the last 18 hours, and all columns can be forward and reverse alphanumerically sorted.

2) There is a new column on the screen called “Data From Other Facilities”.  “Y” means they should have data available from elsewhere in NYCLIX, “N” means they do not.  If you click on it twice, it will bring all the “Y”s to the top so you can browse to see if any of your patients have been elsewhere.  Bottom line is that what used to require many clicks after login now requires only 1-2 and browsing, as opposed to targeted searching, should be much easier.

Next NYCLIX Training
Scheduled for 9/8 at 2pm immediately after resident conference in Hatch.  I’ll pass around a sign in sheet that day requesting your :

  • *HOSPITAL* network ID (the one you’d use to log in through the MSONSHITEHEALTH.ORG VPN line from home)
  • *WORK* email address
  • and other vitals (name, rank, etc).

Other friendly reminders:

DATA AVAILABILITY:

-Lab and radiology data, at a minimum, is available from all hospital providers.  Some also provide D/c sums, cardiology reports and more.

-sometimes a patient will tell you that they’ve been to another hospital that is in NYCLIX but you won’t find anything.  This is usually because NYCLIX has not matched the patient automatically.  We have set the matching thresholds to be highly specific at the expense of sensitivity.  This means that there is a VERY low likelihood of a false positive match, but we wind up with a lot of false negative matches.  We are working to improve this.  If this happens, and you really need the data, you still need to pick up the phone and call like the old days

-data should be available from any patient who has been to the following providers in the last 18 months:

  • Saint Vincent’s (yes, we retained their data after closure)
  • NYU
  • BI
  • SLR
  • VNSNY
  • SUNY/UHB

Data from sites not listed above will *NOT* be available in NYCLIX.

CONSENT FLAGS AND DATA ACCESS:

-The consent column has the following flags:
“A” = “accept” = pt consented
“R” = “refused” = pt refused to consent
“P” = “pending” = pt couldn’t make up their mind or lacked capacity
“B” = “bypass” – will be implemented soon and will basically mean that consent was not completed at registration.

-If the consent flag is A, you have access, just click on the record and review.

-If the flag is set to “R”, “P” or “B” you can still ask the BA to consent the pt or do it yourself and then ask the BA to change the pt HIE flag in our registration system (forms are available in copies under “md_forms_hie__nyclix__

consent” and “md_forms_hie__nyclix__fact_sheet”)

-If the pt has a “P”, truly lacks capacity and there is no legal representative who can sign for them, you can use “break the glass” and choose a reason from the drop down list (similar to EM caveats).  Remember, these are being audited.

Feedback:

If you have any questions, comments or problems, please let me know.  We especially want to know about any bugs or performance issues after our recent extended downtime (extremely long wait times for a page to load).  Please send me the date, issue and MRN of the patient if relevant (do not send any other PHI via email).

We also want to know if you have a case where NYCLIX helped.  If so, please send:

  • 1-2 lines describing the case
  • what information was used from NYCLIX
  • how that info affected your management

Thanks, and have a great weekend,
Jason
______________________________

Jason Shapiro, M.D.
Assistant Professor of Emergency Medicine
Department of Emergency Medicine and
Center for Biomedical Informatics
Mount Sinai School of Medicine
(212)  824-8058
_______________________________

Written by phil

August 29th, 2010 at 2:36 pm

Project Hypothermia – Phase 2

Please note that the city has entered Phase 2 of Project Hypothermia.  Whereas Phase I focused on instituting hypothermia in the ED and hospital setting for ROSC patients, during Phase II NYC paramedics will be instituting cooling with infused saline during cardiac arrest.

As a result, your cardiac arrest patients should be arriving cooler than they had in the past.  Hopefully this will reduce some of your induced hypothermia workload in your ROSC patients.  Remember to call AMAC and ask for a HYPOTHERMIA alert for any ROSC patient – this will put you in touch with the consulting hypothermia neurologist and should expedite placement in either the CCU or MICU.

Please see the rationale for preservative hypothermia linked here

NYC Project Hypothermia – Rationale for Phase II (Preservative Hypothermia or Intra-Arrest Cooling) Protocol

.

Thanks,

Phil

Written by phil

August 17th, 2010 at 5:05 pm

Posted in Hypothermia

2009 Antibiogram

Written by reuben

August 17th, 2010 at 12:41 am

Posted in Antibiotics,ID

PCC Study Synopsis

Written by phil

August 16th, 2010 at 7:48 pm

Admitting to Medicine: The MAR Presentation

Written by reuben

August 13th, 2010 at 3:48 am

Posted in Admitting

REASON study

Sinai is part of the national REASON network (Real Time Emergency Assessment with Sonography: Outcomes Research Network).

The first data for this network now being collected is on patients in cardiac arrest.  We need to save 2 clips of cardiac (in)activity in these patients one during a pulse check and one after the code.  Preferably these would come 15 minutes apart.

Full instructions on saving clips on the M-Turbo and for the REASON study are available help.

Multimedia post with more information to come soon at the sinai ultrasound site.

Written by phil

August 12th, 2010 at 6:51 pm

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

GI Bleed Admissions

From: Jasmine Koita
To: “Patel, Vaishali”
Date: Wed, 11 Aug 2010 15:09:12 -0400
Subject: Fw: [Interdept] Interdepartmental Meeting 8/10/10 Minutes– *Importantcorrection re: LGIB/UGIB patients*
Please note the following corrections:

Patients with lower GI bleeding: These patients should always be admitted to a surgical service unless there are specific other recommendations made by the attendings involved.

Patient with upper GI bleeding: These patients should always get a prompt surgical consult, however they do not necessarily require admission to a surgical service.


Malini D. Sur, MD
House Staff
Department of Surgery
Mount Sinai Medical Center

Written by phil

August 11th, 2010 at 10:34 pm

Posted in Admitting

DVT Research Study

As a quick reminder, please remember to call the 4DVT pager (4388) anytime you diagnose a DVT in the Emergency Department. We are doing a study with IR randomizing patients to coumadin vs coumadin+clot removal procedure. For every patient we screen, $50 goes into our residency fund. You don’t need to do anything more because the IR fellow will come in and interview/enroll the patient if eligible.

Thanks again,

Amish

Written by reuben

August 11th, 2010 at 3:06 pm

Posted in Research

PED resident schedule

FYI, the PED resident schedule is on www.amion.com, but under the peds login “mshpeds” then click on “ER”.

Lori

Written by reuben

August 9th, 2010 at 3:45 pm

Posted in Peds,Schedule