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Archive for December, 2010

Autopsy and Death Certificate FAQ

Includes issues that often come up around the medical examiner, sinai autopsies, and filling out the death certificate.

Autopsy and Death Certificate FAQ Lento 2007

Written by reuben

December 23rd, 2010 at 3:41 am

Posted in Death

EHC ED Admission Guidelines

with one comment

Admission Criteria for A7 – NP, non-teaching service

This unit is for “obs” type patients who are expected to have 0-1 clinical decision points in their inpatient care and a brief stay.

Patients appropriate for the unit include:

Low – Intermediate risk chest pain with negative enzymes
Minor Cellulitis
Uncomplicated Pyelonephritis
Simple cases which require little clinical evaluation or intervention

The unit should not get any:

Social Admissions
Patients with active psych problems
Patients who may have a placement issue
Prisoners or restraints
Patients in or at very high risk of withdrawal
Patients with complicated medical problems
Patients requiring active management for secondary medical issues (eg. diabetes is ok but hyperglycemia is not)

Suggested Indications for A4/CCA:

All downgrades require attending approval

ALL patients on continuous drip medications EXCEPT for heparin, nexium, acetadote (NAC) and octreotide MUST go to A4 or an ICU (nursing)
Patients requiring FSBS Q1-2 hours ongoing (nursing)
Patients requiring Q1-2 hour neuro checks or VS checks (nursing)
UGIB – melena or unstable VS
Respiratory Support – intubated patients, patients requiring Bipap proximate to admission or patient with tenuous respiratory status
Severe Etoh withdrawal. (DT’s will be triaged to the ICU at the discretion of the ED attending)
Medicine subspecialty request – GI, Renal, Cardiology, Pulmonary, etc.
Selected overdose patients not going to the ICU – after discussion with poisons or toxicology
Hemodynamic instability not going to the ICU
Potential ICU patients judged stable for A4
At the discretion of the ED attending

Patients that generally should not go to A4:

Low-intermediate clinical suspicion patients with trop <0.5 Patients who had a single lactate >4 which normalized and pt otherwise does not meet above criteria

Patients not appropriate for A4:

Patients with an a-line (nursing) must to go an ICU
Actively dying patients with DNR/DNI not otherwise meeting any of the above criteria should go to a regular floor bed

Written by reuben

December 21st, 2010 at 12:10 am

Posted in Elmhurst

Winter 2010 Adult Emergency Department Initial Empiric Antibiotic Recommendations

The enclosed are recommendations and are not to substitute for clinical judgment for the following common infections:

Neutropenic fever
Urinary tract infections
Intra-abdominal infections
Skin and soft-tissue infections
Clostridium difficile colitis

When possible draw 2 sets of blood cultures on patients admitted with a documented or suspected infection. This increases diagnostic yield and helps tailor antimicrobial therapy.

Previous culture data should guide empiric antimicrobial choices.
Community and institutional microbiology can change and checking prior culture data on patients with frequent healthcare and antibiotic exposures is strongly recommended.

Does antibiotic need approval? PAGER 9407
Piperacillin-tazobactam, imipenem-cilastatin, meropenem, ertapenem, oral vancomycin, and aztreonam require ID approval.
Initial doses of IV fluoroquinolones, cefepime, and ampicillin-sulbactam may not need ID approval for specific indications in the ED. Documentation in IBEX reflecting indication is required. TDS (inpatient) orders need ID approval.
Between 9am – 5pm, call Antimicrobial Stewardship Program for approval of these antibiotics.
During off hours (5pm – 9am), please fill out “night time request for restricted antimicrobials” form available in IBEX.
When ordering in IBEX, chart must reflect clinical indication for restricted antimicrobial.

Antimicrobial Stewardship Program:
(ID pharmacists and ID physicians available for approvals and recommendations)
Pager 9407 (adults)
Page Pediatric ID on call (pediatrics)

Other Infectious Disease pagers:
General ID consult – Pager 0649
Transplant ID consult – Pager 8678
Jeff Gumprecht – Pager 3043, Office 212-427-9550
Glenn Hammer – Pager 2562, Office 212-427-9550
Eric Neibart – Pager 2962, Office 212-427-9550
John Wolff – Pager 917-975-3175

NOTE: If there is delay in reaching an ID pharmacist/physician, call pharmacy or ED pharmacist directly. A first dose will be released STAT if restricted antimicrobial needed emergently. All subsequent doses will need approval.

C. diff
Neutropenic fever

Written by reuben

December 14th, 2010 at 6:41 am

Posted in Antibiotics,ID

Infection Control Officer for the ED

As of today, the Infection Control Practitioner covering the ED will be Elsa Santos-Cruz – x 89468, beeper 6753.

Written by reuben

December 8th, 2010 at 3:11 pm

Posted in Contacts,ID

New Travel Program – American Express Business Travel(aXiom)

To All Department Staff who Travel:

Effective immediately, per a new medical center policy, all air travel and hotel travel must be made through a company called aXiom. For this, you will require a user profile- instructions are attached. Note: As always, a Travel Request must be initiated and approved before the travel start date. For residents, please use fund 01662210. For faculty who are not funded by your grant, please use fund 02441260. If you have any questions, please let me know. Many thanks to all. I have not used this system yet so we will all be starting to use it together. Thank you!!! Jill

—–Original Message—–
From: Zaheer, Jill []
Sent: Thursday, November 18, 2010 3:20 PM
Subject: FW: [Dept-admins] New Travel Program – American Express Business Travel(aXiom)

Cc: Harvey, Stephen; DeBaun, Joseph; Nanan, Diana; Sandoval, Glenda
Subject: [Dept-admins] New Travel Program – American Express Business Travel(aXiom)

As part of an effort to optimize our business travel processes, we have entered into an agreement with American Express Business Travel to utilize their online booking tool offered through aXiom.

The benefits of this program are as follows:

– Less out of pocket cost for travelers – MSMC will pay for all business related Air travel directly – Traveler will continue to pay for Hotel and Car Rentals and then get reimbursed via the Travel Request/Travel Voucher process.

– Enhanced ability to obtain lowest costs – Low and best rate guarantee for air/hotel/car rentals.

– Significantly lower booking fees – First year of online travel bookings at no charge – $9 thereafter (Compared to $50 per booking charged by BCD Travel).

– Leverage total spend through the program to negotiate better rates with Hotels and Airlines.

– Travel Arranger option – Can book travel for multiple travelers.

– 24/7 Navigation support and assistance with online reservations.

– International rate desk to assist with complex and multi city foreign travel (Additional Fee).

– Ability to book Amtrak through the tool.

Effective immediately, all new business travel must be booked through aXiom. We will be monitoring compliance with this policy. Reservations already made either through other online travel sites or through BCD Travel should not be cancelled. However, new travel reservations should be booked trough aXiom.

Attached to this email is a welcome letter with instructions on setting up a user profile on the tool. Also attached is the security code needed to activate Mount Sinai business travelers and travel arrangers along with an aXiom FAQ document.

Please forward this email to all travelers and travel arrangers within your respective areas.

Note: As always, a Travel Request must be initiated and approved before the travel start date.

Please contact Glenda Sandoval @ 212 731 3544 with any questions.

Thank you for your support in this important initiative.

Rishi Parikh
Director, Finance
The Mount Sinai Medical Center
Tel: (212) 731 3470
Fax: (212) 731 3041

All MSMC Travelers and Travel Arrangers,
The Mount Sinai Medical Center has launched American Express Business Travel, along with aXiom®, an innovative online booking tool, for all domestic, trans-border and single destination international travel reservations originating in the U.S.
Effective today you will begin booking your travel reservations online. Both travelers and travel arrangers will need to register for aXiom® and update your personal profile in advance of booking travel reservations. This profile will be used for both online and offline travel reservations, and ensures your personal preferences are notated whenever possible throughout the travel booking process.
Security Code
The first time you access aXiom®, you will be asked to enter a Security Code. This information will be sent to you shortly in a separate communication.
Please see the instructions below to begin your aXiom® registration process and to access answers to questions you may have regarding American Express and the aXiom® tool.
Access Your Account Today!
To begin using aXiom®, you need to register on the site by following these easy steps:
Enter this URL into your Web browser:
Click on “Create a new account”. Follow the prompts which will instruct you to enter your name, email address and Security Code (to be sent to you shortly in a separate communication). You will then be asked to create a user name and password that you will use to initially access the site.
After supplying this information, you will receive an email from American Express Business Travel within 24 hours that will include instructions on how to complete your registration.
Complete Your Registration and Add Your Profile Information!
To ensure aXiom® is tailored to your personal needs, all profile information must be entered prior to the booking services. To update or edit profile information:
Open the email from American Express Business Travel (notated above) and press the “Get Started Now” button.
Follow the prompts and enter your profile information including contacts, preferences, etc. By entering your profile information you will save time on each booking. Note: You will be asked to supply a 6-10 digit numeric profile pin that will act as a unique identifier. We recommend using a home or mobile telephone number that is easy to remember and is unique to you.
Click “Continue” to complete the registration process.
You will then be taken to the Travel Preferences screen. Please review and update each section.
Upon completion of your travel preferences, you will be redirected to the aXiom® Home Page. Click on the “Profile” link on the upper right corner of the navigation bar. Click on each link to complete your profile.  
Press “Save” to store your information.
Training Options
To help acquaint you with our new tool, a self-paced on-demand tutorial that lasts 30-40 minutes, can be accessed at your convenience

Additional Support
FAQs (Frequently Asked Questions) is attached.
Navigation support and assistance with online reservations is available 24/7, please call 1-800-238-9049.
Travel Invoices:
Immediately after booking a reservation online, an automated travel itinerary will be generated to the traveler and arranger if applicable. The travel invoice will be automatically emailed to the traveler after American Express issues the airline ticket.
Your support of the travel program with American Express is critical to our continuing success in managing travel costs and providing optimal service. If you have any questions regarding our travel program, please contact Glenda Sandoval at (212) 731 3544.
Rishi Parikh
Director, Finance
The Mount Sinai Medical Center
Tel: (212) 731 3470
Fax: (212) 731 3041

All MSMC Travelers and Travel Arrangers,
The Security Code you will need to access your aXiom® account is: 342621
Reminder: In order to activate your account, you will need to:
1.       Enter the URL you received in your Welcome Letter into the Web browser.
2.       Enter your name, email address and the above listed security code and then create a user name and password to access the site.
3.       After supplying this information, you will receive an email from American Express Business Travel within 24 hours with instructions on how to complete your registration.

aXiom FAQs 06Oct09

Written by reuben

December 3rd, 2010 at 7:39 pm

Posted in Travel