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Archive for March, 2011

Pain Pagers

From: David L. Reich, M.D. Horace W. Goldsmith Professor and Chair of Anesthesiology Mount Sinai School of Medicine Stelian Serban, M.D. Interim Director of Pain Management Department of Anesthesiology To: All Attending Physicians, House Staff, Nurse Practitioners, and Physician Assistants Re: Pain Management Cellular Telephone Contact Numbers Date: March 29, 2011 In order to further our efforts to improve inpatient pain management at Mount Sinai, the Department of Anesthesiology FPA Pain Management Division has obtained cellular telephones to contact the Acute and Chronic Pain Services 24 hours per day, 7 days per week. Below are the new numbers for each service:

· Acute Pain Service: (646) 592-0145 (For patients within one week of surgery or interventional procedure)

 · Chronic Pain Service: Phone (646) 592-0084 (For patients with cancer pain, chronic non-malignant pain, or more than one week after surgery or interventional procedure)

The Mount Sinai Page Operator (212-241-1800) has these numbers should you need to be reminded of them. These telephone numbers should not be used for existing patients of other services, such as Palliative Care or voluntary pain management physicians. The FPA Pain Management team is committed to having a physician at the patient’s bedside within 20 minutes of receiving a call. Thank you for your efforts towards improving pain management at Mount Sinai.

Written by phil

March 29th, 2011 at 9:49 pm

Posted in Analgesia & PSA

BBFE Handout March 2011

Written by reuben

March 10th, 2011 at 11:33 pm

Posted in Needlestick

ED / Dept of Medicine Admission Policy: March 1, 2011

New Admission/Triage Policy – Effective March 1, 2011

1. Triage
• ED decides to admit vs. discharge patient
• The ED attending /resident enters order in IBEX (not a formal bed request) which acts as a signal to the MAR that the patient is a potential medicine admission
• MAR should immediately evaluate this patient and assign a team
• If MAR agrees with admission to medicine, the MAR will assign an appropriate inpatient team/accepting attending
• If there is any disagreement between the MAR and ED that cannot be resolved so that the patient can be triaged, this must be escalated to the MAR’s supervising attending (Medicine Consult attending or on call hospitalist)

2. Listing with Bedboard and Hand off
• After Medicine team assignment, MAR will submit bed request to Bed Mgt
• The MAR will then provide AMAC with the patient’s name and the admitting team contact info
• AMAC will connect the inpatient team with the ED team caring for the patient to facilitate direct verbal communication and proper handoff
• Direct verbal communication and proper handoff must occur before a patient is transferred from the ED to the floor

3. Transition of care
• The accepting inpatient team will evaluate the patient and write admission orders
• Once orders appear, this is a signal to ED that the transfer of care has occurred
• Until this hard signal exists, the ED team remains responsible for the care of the patient
• The time frame from the ED’s admission request (order entered to signal MAR to evaluate) to the completion of the inpatient admission orders must be 3 hours or less
• This time frame assumes no discrepancy between ED and MAR regarding appropriateness of admission and the availability of appropriate data. If there is any disagreement between the MAR and ED concerning necessary available data that cannot be resolved, this must be escalated to the MAR’s supervising attending (Medicine Consult attending or on call hospitalist)
• If there is a decompensation in a patient’s condition requiring emergent intervention while the patient is still in the ED, the ED team will manage the resuscitation
• BUT the team currently responsible for the care of the patient at the time of his/her decompensation remains responsible for that patient and must work with the MAR or TR to arrange proper inpatient placement
• After direct verbal communication and proper handoff between the inpatient team and the ED team, a patient may be transferred from the ED to a bed on the inpatient floor at which point the inpatient team is responsible for the care of the patient (even if inpatient orders have not yet been completed)

4. MAR role
• The MAR will perform a focused assessment to determine the inpatient team
• The MAR will not place orders for medications, laboratory testing or consults
• Any recommendations or requests along those lines will be communicated to the ED provider who will place the order
• If the MAR feels that an ICU consult is warranted, they will communicate this to the responsible ED resident or attending who will then request a consult as they see fit
• Any discrepancy which may arise between the Emergency Medicine attending or resident and the MAR regarding the need for an ICU consult should be resolved via discussion between the ED attending and the MAR’s supervising attending
• The chain of command for the MAR will be the Medicine Consult Attending listed in AMION. This will clarify attending to attending communication as needed.

Important Numbers
Bed Board: 47461
AMAC: 43611

Written by reuben

March 1st, 2011 at 5:36 am

Posted in Admitting