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Archive for February, 2012

Geri ED Flow Feb 2012

Dear All ED Faculty, Residents, Nursing and Staff,

Thank you for all your support, comments, suggestions and constructive criticism as we launched the Geriatric ED, a work in progress. The Geriatric Operations Team has revised the Geriatric ED/East Zone Guide attached which incorporates the lessons learned from the first week, your suggestions as well as a schedule which highlights the current available staffing resources for the Geriatric ED. Briefly:

Hours: Accepting New Patients: Monday-Friday 9am-9pm, Beds 23-32 Saturday-Sunday 11am-9pm Beds 29-32
Holding Obs or Admitted Patients that meet the Geriatric ED criteria: 9pm-9am (11am Sat/Sun) Beds 29-32

Capacity: Monday-Friday 8-14 patients (dependant on Patient:RN ratio 1:8)
Saturday-Sunday 8 patients

Criteria for Care and Observation:
Age >/= 65
ESI 3,4,5
Knows their name, oriented to Self
Ambulatory to bathroom before illness or injury, Walk

Staffing:
Attending: M-F Intake/South ED E2s Attending; Sat-Sun South/Fast Track Attending
Resident: T/Th/F ED Geriatrics
PA: M-F East/+/-CB; Sat-Sun Fast Track
RN: M-F East/+/- OT RN; Sat-Sun Fast Track
ER Tech: M-Sun East
BA: M-F East; Sat-Sun Fast Track
SW: M-F ED SW; Evenings, Sat-Sun Oncall SW

This Guide will replace the posted first draft in the Main ED and Geriatric ED. We welcome your input and will continue to revise it to best serve you and our patients going forward.

Geriatric ED Care Protocol 022412 revision

Written by reuben

February 25th, 2012 at 6:29 am

Posted in Geriatrics

Geri ED

Thank you for all your support, comments, suggestions and constructive criticism as we launched the Geriatric ED, a work in progress. The Geriatric Operations Team has revised the Geriatric ED/East Zone Guide attached which incorporates the lessons learned from the first week, your suggestions as well as a schedule which highlights the current available staffing resources for the Geriatric ED. Briefly:

Hours: Accepting New Patients: Monday-Friday 9am-9pm, Beds 23-32 Saturday-Sunday 11am-9pm Beds 29-32
Holding Obs or Admitted Patients that meet the Geriatric ED criteria: 9pm-9am (11am Sat/Sun) Beds 29-32

Capacity: Monday-Friday 8-14 patients (dependant on Patient:RN ratio 1:8)
Saturday-Sunday 8 patients

Criteria for Care and Observation:
Age >/= 65
ESI 3,4,5
Knows their name, oriented to Self
Ambulatory to bathroom before illness or injury, Walk

Staffing:
Attending: M-F Intake/South ED E2s Attending; Sat-Sun South/Fast Track Attending
Resident: T/Th/F ED Geriatrics
PA: M-F East/+/-CB; Sat-Sun Fast Track
RN: M-F East/+/- OT RN; Sat-Sun Fast Track
ER Tech: M-Sun East
BA: M-F East; Sat-Sun Fast Track
SW: M-F ED SW; Evenings, Sat-Sun Oncall SW

This Guide will replace the posted first draft in the Main ED and Geriatric ED. We welcome your input and will continue to revise it to best serve you and our patients going forward. Please feel free to speak to or send your questions, comments and suggestions to: Kevin.Baumlin@MountSinai.org or Denise.Nassisi@MountSinai.org or Gallane.Abraham@MountSinai.org.

Thanks,
Gallane

Gallane Abraham, MD

Written by phil

February 24th, 2012 at 10:25 pm

Setting up NIV / BiPAP / CPAP

1. Notify RESPIRATORY THERAPIST that there will be a patient on NIV.
2. Turn Ventilator On.
3. Select NEW PATIENT.
4. Enter patient’s Ideal Body Weight (IBW) and press CONTINUE.
5. Select VENT TYPE button, turn knob to select NIV.
6. Select MODE button, turn knob to select SIMV.
7. Select MANDATORY type, turn knob to Pressure Control (PC).
8. Select SPONTANEOUS type, turn knob to Pressure Support (PS). Press CONTINUE.
9. For IPAP 10 / EPAP 5, adjust Psupp button to 5, adjust PEEP button to 5. O2% as indicated.
10. Press ACCEPT to apply settings. Airflow will not begin until mask is attached to patient.

Here is the poster in in powerpoint format.

Written by reuben

February 18th, 2012 at 1:03 am

Elmhurst Reminders

A few Elmhurst-related reminders to keep in mind…

1) Discharge instructions:

– please select appropriate dc instructions in the appropriate language
– the instructions can be modified and should be modified to reflect the specifics of your patient
– ALL instructions should include 1) Return to ED if you develop worsening symptoms etc. 2) When to follow up at PMD
– If available provide some diagnosis-related reading material.
– Do your best to provide culture/language-sensitive verbal discharge instructions – (use your discretion – the more potentially dangerous the diseases is – the better understanding a patient should have)

2)Notes:

– We may lose the option to use the template – if used inappropriately
– if you are using a template, modify it to meet the specific patient, and delete the part of the exam that you are not performing.
– Write a progress note – it shows quality care was provided
– Write an assessment and plan – its the classy thing to do, and it shows you have used your 200 000$ brain cells for a good cause
3)Charting:
– Remember to complete as many elements as possible: including social history…there are a number of other elements – try your best to fill them out, but there is a tab for non-contributory.

4)ID Clinic:

Follow up for sexual assault victims at ID clinic should be 2 to 3 days later (NOT THE NEXT DAY). This gives the patients time to deal with other legal and personal issues they need to follow up with. Also, ID clinic wants to observe any side affects from the HIV medications which usually doesn’t take effect until 24 to 48 hours later. In addition, ID clinic appointments are available Monday thru Friday 9:00 a.m or 9:30 a.m which can be made by the ED clerk. If patients show up at later times it interferes with the scheduled ID clinic appointments already made and it makes it harder to get the PEP medications from pharmacy.

5) AMA:

IF patients are sent home AMA, remember that they are still our responsibility. We must ensure that they receive the best care possible – medications, and follow up. Please document that you pleaded with them to stay and discussed fully the need for admission and that they are at risk for disability and/or death by leaving AMA.

6) Riker’s Island discharges:

Print the Riker’s Island discharge summary and send it with the patient/CO.

Approximately 10% of RI patients who are discharged back to RI are done so without a discharge summary.

A percentage of them are sent back to EHC for further eval as a result.

Remember to print the RI Chart when discharging a RI patient ( either back to RI, or transfer to another hospital) and put them in an envelope with the discharge papers. Hand the envelope to the RI Officers to take back to RI.

To print the RI Chart:
1) Go to “Chart Review”
2) Top left of the screen: Pull down to Rikers Island Chart
3) Bottom right screen “print”

NB: Don’t write assessment and plan information in the “Progress Note” section. This is not printed in the RI version of the chart. Write it in the “Assessment and Plan” section under the Dispo tab.
To print a consult to go back to the RI MD’s or Bellevue in “Chart Review” at the bottom right click “advanced print” then “scanned documents” then “consults” then ” print”.
Medications and follow up instructions for RI MD’s can be bolded to emphasize: highlight then “control B”.

7) Discharge Diagnosis:

– PGY1 & PGY 2 should discuss the discharge diagnosis with the Attendings or PGY4s (its not classy to send a patient out on the streets in Queens with EHC paperwork that says AMS)

8) Consultants:

If the service has a wireless phone, call the phone.If the phone is not answered or not turned on then call the 41111 operator. All other services call 41111. Do not call clinics directly.If the phone is not answered or not turned on then call the 41111 operator. All other services call 41111. Do not call clinics directly.You need to give them – Patient’s name and medical record #. Your name and wireless number or extension (fast track/cardiac/trauma room) The Attending’s nameDocument in HMED the consultation request.If the 4111 operator doesn’t get a response from the consult in 5 mins they will re-page that person.After an additional 5 minutes if there is no response they will page the chief resident.If there is no response from the chief resident in 5 minutes they will page the Attending. If the Attending is called the communication should be Attending to Attending.After an additional 5 minutes if there is no response they will page the chief resident.The consult is expected to arrive in ED within 30 mins. If they cannot arrive within 30 minutes this should be communicated to you, If they cannot come within 60 mins they should have a back up plan.After arrival the consult should evaluate and speak to senior etc., within 45 mins. They should give you a verbal consult and document within 45 mins. (In the future we want all services to document in QMED).

9) If possible, avoid presentations to attendings/seniors with less than 40 minutes to the end of their shifts.

10) Paisa: 718-478-7700
– we have an agreement with the car-service
– more info is on sinaiem.org / policies

11) If you have any problems with Elmhurst, please let me know…
– examples are: a particular CT tech consistently giving you a hard time, a particular issue with a nurse, issues with a consultant…
– it always helps to have names, dates and MRNs
– you can either address it to me directly, talk to one of your seniors, or if you’d like to be completely anonymous…there is a feedback for on the mainpage of Sinaiem.org…

12. Blood Orders
– Reminder that you can now place all blood orders in HMED
– This includes types AND blood products
–> You do NOT need to use quadramed anymore!

Also, remember that:
– Patients getting transfused need 2 samples total, and an old specimen counts as one.
– Patients new to Elmhurst need 2 fresh samples. Everyone needs at least 1 fresh sample.
– You can’t draw 2 types at the same time/site
– If you draw a type, you must LABEL and SIGN the tube

This information will also be posted in a google doc ‘Mount Sinai / Elmhurst Rotation Guide’ as well as several other resources – if it hasn’t been shared with you…let me know.


Daniel Lakoff MD

Written by reuben

February 16th, 2012 at 4:47 am

Posted in Elmhurst

Peds Ophthalmology

Hello Group,
We have battled in the past to get in touch with this service. I am told by the chair of peds to contact this person directly:
Tamiesha Frempong

212-241-0939

I have sent this information to AMAC so that when you call them they will reach out to Dr. Frempong directly, but I just wanted you to have it as well…
thanks,
adam


Adam Vella, MD

Written by reuben

February 16th, 2012 at 12:10 am

Posted in Ophthalmology,Peds