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Archive for September, 2011

when to consult surgery for c. diff diarrhea

Written by reuben

September 23rd, 2011 at 5:09 pm

Posted in Surgery

Call-backs

just a reminder about placing callback requests in epic

1. there is no need to request Gc/Chlam or urine culture results be followed up. all culture results are sent to us and receive follow up

2. if you place a callback request you MUST put the reason that you want us to call them. if not we will not know why you want them called and the callback will be cancelled. we can’t go searching through the chart to try to find the reason.

if you have any questions please let me know!
thanks
carolyn

Written by reuben

September 20th, 2011 at 7:09 pm

Posted in Call-Backs

Oncology fellows clinic is now closed

Just spoke to Dr. Nieto of heme/onc. The fellows clinic which was seeing oncology/bone marrow transplant service patients was closed. All patients that were seen there are now handled by the private attending group. (I had a long runaround today looking for the right person).

Dr. Nieto suggested that if we need to call someone for these patients, we should look in Epic for the last attending who saw the patient and call them directly. Just passing on the message to save everyone frustration.


Amish Shah

Written by reuben

September 14th, 2011 at 5:17 am

Posted in Oncology

Epic Charts

did you know that there is a difference between an ED chart & a regular chart?

if the pt has been seen in the ED post go live, you can use the “ED chart” button along the top pane of the window to search for that pt’s name or mrn & navigate to their chart. (you will also notice that the “use sounds-like” is now auto unchecked! yay!)

if the pt has not been to the ED in the past few months or you are searching for a pt that was seen in the clinic or for whatever reason, you can use the “chart” search function. this is found under “Epic” à “Patient Care” à “Chart” & this will allow you to search for any Sinai Epic encounter.

happy searching!

vaishali

Written by phil

September 11th, 2011 at 12:29 am

Posted in Epic

Bioterrorism Response

As I am sure many of you are aware there has been reported, a credible, specific but unconfirmed threat this weekend for terrorist activity. There is already enhanced security around the city and the hospital because of the anniversary of 9/11. While chemical and radiological incidents are more easily detected, your increased vigilance for unexplained illness is requested by NYC DOHMH to detect biological events. Please review the attached document or read the information below. NYC DOHMH also included a link to a document for providers to review some specific biological illness http://www.nyc.gov/html/doh/downloads/pdf/chi/chi26-7.pdf.

Please contact me with any questions or concerns.

Kevin Chason, DO

Dear HAN Subscriber:

We have just released a DOHMH Alert concerning the 10 year anniversary of September 11th. It is available on the HAN home page, is appended to this email, and is also attached as a pdf file. To read the attachment, you will need the Adobe reader. If you do not have that software, it can be downloaded at no cost at http://www.adobe.com/products/acrobat/readstep2.html .

To log into the HAN, for this alert and many related documents, go to www.nyc.gov/health/nycmed . If you have any questions or problems with accessing or using the HAN website, call 1-888-NYCMED9 or write to nycmed@health.nyc.gov.

2011 Alert #21:
Reminder to Clinicians on the 10 Year Anniversary of September 11th

Please distribute to staff in the Departments of Internal Medicine, Pediatrics, Family Medicine, Neurology, Infection Control, Infectious Disease, Emergency Medicine, Critical Care,
Obstetrics and Gynecology, and Laboratory Medicine

September 9, 2011

With the tenth anniversary of 9/11 and the news that there is a credible threat of a terrorist attack against New York City this weekend, we remind clinicians to be alert for agents of terrorism, including biologic agents, chemicals and radiation. We are not aware of any specific intelligence on chemical, biologic or radiologic threats, but at times like this, we should all be especially alert to anything unusual.

Please report:

1. Any unusual increase or clustering in patients presenting with clinical symptoms that suggest an infectious disease or toxin-mediated outbreak (e.g., > 2 patients presenting with unexplained pneumonia, respiratory failure or sepsis, or foodborne illness – especially if occurring in persons who are otherwise healthy. In addition, please notify us regarding a sudden increase in patients presenting with flu-like symptoms).

2. A suspect case of any of the following infectious diseases or poisonings:

Anthrax
Brucellosis
Q Fever
Tularemia
Botulism
Plague
Smallpox
Ricin

(NOTE: More information on potential bioterrorism agents can be found in our 2007 City Health Information bulletin available at http://www.nyc.gov/html/doh/downloads/pdf/chi/chi26-7.pdf )

3. Any cluster of patients presenting with signs and symptoms related to possible exposure to radiation or chemical agents such as organophosphates, cyanide or chlorine.

Please report any concerning health events to the NYC Department of Health. During business hours, report to the Provider Access Line at 1-866-NYCDOH1 (1-866-692 3641) and After Hours and for any suspect poisonings please call the Poison Control Center at 212-764-7667.

The New York City medical community has a long history of serving as the eyes and ears of the department. We greatly appreciate your cooperation. If you see something, call us.

Marci Layton, MD
Assistant Commissioner
Bureau of Communicable Disease

Nancy Clark, MA, CIH, CSP
Assistant Commissioner
Bureau of Environmental Disease Prevention

2011 BT agent reminder on anniversary of 9-11

Bioterrorism Preparedness for Health Care Providers

Written by reuben

September 9th, 2011 at 10:55 pm

Posted in Disaster

Chest tube insertion: the stab thoracostomy tray

If you are inserting a chest tube, you need a stab thoracostomy tray. Many useful items are in the stab thoracostomy tray, including kelly clamps, and 0-silk suture. The tray also contains some items that are not useful, such as trocars. DO NOT USE THE TROCARS.

Written by reuben

September 8th, 2011 at 12:34 am

Posted in Resus / Crit Care

Peds asthma protocol

Written by reuben

September 7th, 2011 at 11:38 pm

Posted in Asthma,Peds

Products of Conception

with 3 comments

there is a mandatory DOH form that MUST be filled out for any products of conception – either delivered in the ED or brought into the ED by the patient. the form is attached to this email for your review & will be available from “my dashboard” within epic. we also plan to have the form rubber banded to the formalin containers. the form must be returned to suzanne young-mercer on its completion.

Vaishali Patel

note from reuben: please be wary of determining that anything coming from the uterus of a pregnant woman is products of conception. calling such tissue POC when it isn’t, therefore inaccurately ruling out ectopic pregnancy, is an important pitfall. unless the “products of conception” have the unequivocal form of a human, they may not be products of conception, and ectopic might still be in the differential. unless clearly POC, send it to pathology and procede in a “pregnancy of undetermined location” mindset (unless the pregnancy has been proven to be intrauterine in the past). you can follow the path, and if chorionic villi are noted, you can call the patient and tell her that ectopic pregnancy has been excluded and if everything else is well, she can skip the 36-48h followup and follow with her obstetrician as a routine.

Spontaneous Termination of Pregnancy Form

Written by reuben

September 2nd, 2011 at 5:09 am

Posted in OB/GYN