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Archive for May, 2012

Coronary CT

We now (apparently) have the ability to do an unlimited number of coronary CT scans.

Potential advantages over stress testing includes:
1. Much quicker

2. Allows for same day discharge

3. Can identify early CAD (not just obstructive disease)

4. Less radiation for the patient

5. Can simultaneously look for PE and aortic dissection

Please consider coronary CT for all of your chest pain patients without known CAD and no contraindications to contrast.

1. Order can be placed in EPIC by searching for “CT coronary” (choose the option with angiography)

2. During business hours (8-5) page Aileen to let her know you’ve ordered the study (this page will be going away soon).

a. If it’s not business hours but is a weekday you can still order the test and it will be done in the morning

b. Currently no weekend availability but this will be coming as will overnight testing

3. Give an oral dose of beta blocker to get the heart rate close to 60 (this isn’t essential if you don’t feel comfortable)

If you want to look at additional structures (i.e. pulmonary vasculature or aorta) place separate orders for these structures as well.

Any questions let me know,

Luke

Written by phil

May 25th, 2012 at 4:00 pm

Posted in Cardiology

ED Policy / Protocol online reorganization

We’ve been reorganizing how the ED’s policies and protocols are
presented online, for your use on shift.

This reorganization was an outgrowth of the big ED policies review, in
anticipation of the Joint Commission visit. ED policies were
cross-referenced with hospital policies, and in many cases revised.
This effort was led by Suzanne Young-Mercer, Keri Gardner, and Kevin
Baumlin, with contributions from many of you in the department. I
thought it was a good opportunity to categorize the policies online.

The old way — an alphabetical list — was not easy to use or browse.
The policy about who gets sent to L&D was under “I” for Initial Care
of Pregnant Patients. The protocol for managing Animal Bites was under
“A”, but the protocol for Monkey Bites was under “M” (and yes, we have
a monkey bite protocol).

Policies and protocols are now organized by category. All medical
protocols are together, and we have some sub-sections for protocols
for at-risk populations as well as diversion, EMS and disaster
policies. The policies surrounding admissions and dispositions are
together, as are policies involving consults and interactions of other
departments.

These policies can be really helpful to you, on shift:

— When the MICU is full, who is “responsible” for calling other ICUs
about admission? It’s the MICU fellow – clearly stated in policy 34.5,
ICU Consults and Admissions.

— When Vascular Surgery is giving you trouble about seeing a diabetic
foot ulcer, refer to policy 34.8, Admission of Patients with DM and
Foot Ulceration or Infection. They are supposed to be consulted on ALL
ED DM patients with infections/ulcers of foot or leg, and all
admissions should go to them unless comorbidities supersede.

— If you want to know your responsibilities and resources for
domestic violence patients, check policy 26.3, Domestic Violence.

— Plenty of guidance on transfers, what constitutes crowding or
diversion status, what you can say to patients over the telephone,
what should be reported to the police, to the CDC, etc.

— if you ever need inspiration, we also have a vision statement and
mission statement, under Administration (at the very bottom of the
page).

You can keyword search, as always, by pressing Control-F, though it
will take some familiarity with the policies to search well (“OR”
works but “Surgery” doesn’t…)

Accessing the policies from inside Epic: Click on “My Dashboards” then
click on ED Policy Manual in the middle column.

From the web: http://www.mssm.edu/departments-and-institutes/emergency-medicine/about-us/manual
(there are links to this from mssmEM.com and SinaiEM.org)

If you have suggestions for moving, renaming or clarifying some of
these policies and protocols, please let me know!

Thanks,
Nick

Written by reuben

May 20th, 2012 at 5:20 am

Posted in Epic,Policy

New Radiology Consent

Hey HSC,

There is a new policy change: Starting May 22, anytime you order a contrast-enhanced CT scan, a consent form will print out (attached below for your perusal) that a patient will have to fill out themselves. You will no longer need to get the consent yourself. Please pass on to the residents in your Department.

Thanks and enjoy the extra time in your day!

Go team,
Serge Sicular

IV Contrast Consent May 2012

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Written by reuben

May 9th, 2012 at 9:58 pm

Posted in Radiology

Sinai Large Attachment Server

Written by phil

May 6th, 2012 at 3:42 pm

Posted in Admin