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Archive for January, 2013

ED resources and personnel for patients 65 and older

as of 1/29/13

Several resources are available to ALL ED patients aged 65 and older (NOT just those physically in the Geri ED). These are available as a result of the GEDI WISE grant.

Physical Therapy Consultation
Physical therapy is on call for ED consults for geriatric patients
M-F from 8a-4p
Pager #917-218-1059>
Criteria for consult: Plan for discharge from the ED plus one of the following
– Fall or musculoskeletal chief complaint
– Failed Get Up and Go test
– In conjunction with social work, need for PT assessment for direct rehab/nursing home placement

Pharmacy Consultation
A dedicated geriatric pharmacist is available in the ED for consultations and assistance.
M-F from 11a-7p, (weekend ED pharmacist is also available 3p-11p on Sat/Sun)
Criteria for consult include:
– Use of 10 or more medications
– Anticoagulant therapy
– Diabetes therapy
– Use of pain medication
– Asthma/copd medications
-Suspicion of an adverse drug event

Social Work
A dedicated geriatric social worker is available, Lara Markovitz
M-F from 5p-8p (in addition to the usual social work coverage, soon to be extended)

Geriatric Clinical Coordinator
Billie Brown is the clinical coordinator for the Geri ED. In addition to operations for the unit, she can assist in determining the availability of space for the triage and transfer of patients to the Geri ED.
M-F from 11a-7p

Transitional Care Nurse Practitioner
Liz Sabella is available to help with care coordination and transition for elderly patients who are being discharged home from the ED.
M-F 11a-7p (hours soon to extend when NP Gloria Nimo joins)
Blackberry 347-344-7893

For any issues or questions please contact:
Denise Nassisi, Geri ED Director,

Written by phil

January 30th, 2013 at 2:00 am

Posted in Geriatrics

GYN disposition

A little helpful information for obtaining f/u for your gyn patients who need to be seen soon (days to weeks)

1. Choose category misleadingly labeled “GYN follow-up within 1 month”

a. Patient will be seen in a range of 2 days to 1 month based on the clinical issue

2. Please be specific about what the clinical issue is (i.e. “needs evaluation of post menopausal bleeding”, or “follow-up after I and D of Bartholin Cyst”)

a. See 1a above- if you don’t write it, they don’t know why you are requesting rapid follow-up

3. If you are able- put the patient’s cell phone # in the request or document in the chart

a. The follow-up can only be arranged if the clinic can contact the patient

b. Patients may not give correct phone # at registration because of billing concerns

Our colleagues in gyn want to provide good service (appropriately time follow-up) for patients with gyn complaints but need your help- steps 1,2, and 3 above to facilitate.



Written by phil

January 24th, 2013 at 4:17 pm

Geri Social Work Coverage

The GEDI WISE grant provides for additional social work coverage for ED patients aged 65 and older.

For patients 65 and older, Monday through Friday from 5pm- 8pm, social worker Lara Markovitz can be reached via zone phone at x78749.

Please continue to call the on call social worker (via the operator or AMAC) if needed after 5pm for patients under age 65. We hope to further increase ED social worker availability in the near future.

Thank you,

Written by phil

January 23rd, 2013 at 3:10 am

Posted in Geriatrics

2013 Homeless Outreach Contact Info

Manhattan (Goddard-Riverside)
Cesar Vanegas
212-785-6690 x426

Queens (Common Ground)
Shane Cox

Bronx (Bronxworks)
Shaylen Roberto
718-893-3606 x2010

Brooklyn (Common Ground)
Chris Tabellario

Staten Island (Project Hospitality)
Elizabeth Wright
718-720-0079 x18

Written by reuben

January 21st, 2013 at 11:37 pm

Posted in Social Work

Finding Charts

Do you ever want to look up a patient that you saw a week or two ago, but you already attested to their chart, marked it as complete, and cleared it from your inbasket?

In those situations, I usually run a “My Patients Last 7 Days” report in Reporting Workbench, and play with the date range until I find my patient. But that’s time-consuming (even for Epic).

Recently I learned the Search function in the Chart Completion area is not as bad as I imagined and actually lets you search “done” (completed) charts pretty fast:


When you select just the “Done” charts and the date range you want, click the Search button.

It may seem that zero results are returned because of the unhelpful results screen. At that point, just click “Chart Completion” or “My Incomplete Charts” (somehow I always get those mixed up) and you should see all your done charts, in a grayed-out (but still clickable) format.

Screen Shot 2013-01-20 at 6.48.16 PM

Happy searching,

Written by phil

January 20th, 2013 at 11:50 pm

Posted in Epic

The Admit Decision Note

Hello all,
As you may have noticed, there is a new note type in the “Attending note” field titled “Disposition decision note”. As the name suggests, this template will help you document your decision to admit as painlessly as possible. (see screen shots provided by Nick below).

I have broken the decision to admit into a few categories (i.e. severity of illness, risk to decompensate, etc.) Your clicks will be used to populate a paragraph of text that will appear in the chart. Please fill out this template on every admission and click as many boxes as apply to your patient (be generous). Let me know if you have concerns or ideas to improve it…

And thanks as always for your help!


Screen Shot 2013-01-15 at 6.50.23 PM

Screen Shot 2013-01-15 at 6.50.44 PM

Written by phil

January 15th, 2013 at 11:53 pm

Posted in Admitting

Influenza Dispo

ou might have noticed new green signs around MC level directing patients to the new flu clinic.

We’re trying to track who is sent there, from the ED.

If you have a patient who you think can be safely sent to this clinic, when you’re dispo’ing them in Epic, click the new Flu Clinic button (see below):

The new flu clinic is open from 9a-9p and is intended for treat & release patients. They have a limited capacity to give IV fluids or meds (If you have a patient with markedly abnormal vitals or substantial comorbidities, or you think your patient may end up getting admitted, this is NOT a good candidate for the flu clinic).

Written by phil

January 15th, 2013 at 5:36 pm

Posted in Influenza

Influenza Update

the young and old
–anyone with co-morbidities (looks like if your only issue is HTN though, you can withhold on these patients)
–pregnant (though be careful with the Pregnancy Class of the anti-viral you use), immediately post-partum women
–longterm care facility patients
–the above, ESPECIALLY if it’s within 48 hours; as well as the healthy (i.e., no co-morbidities, but maybe they look particularly miserable), within 48 hours

In more detail below:

Persons at higher risk for influenza complications recommended for antiviral treatment include:

Children aged <2 years;* Adults aged ?65 years; Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); Persons with immunosuppression, including that caused by medications or by HIV infection; Women who are pregnant or postpartum (within 2 weeks after delivery); Persons aged <19 years who are receiving long-term aspirin therapy; American Indians/Alaska Natives; persons who are morbidly obese (i.e., body-mass index ?40); and Residents of nursing homes and other chronic-care facilities. Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still be beneficial in patients with severe, complicated or progressive illness and in hospitalized patients when started after 48 hours of illness onset In the meanwhile, a few simple things you should be doing at Sinai and Elmhurst: * Get masks on patients! The point is to prevent transmission to staff and to that liver transplant patient lying 14 inches away from your patient. Even before you make the diagnosis, if the triage complaints might be flu, bring a mask with you to the bedside. (Yes, we will work with triage to see this happens there.) When you send such patients home, give them a handful of masks * If the diagnosis is influenza or you think it might be, list the diagnosis as ‘influenza-like illness.’ Don’t just put down ‘viral syndrome’ or ‘uri’ – though you could list these as secondary diagnoses. * I tried to prescribe Tamiflu for a friend today (HIV+ and didn’t get vaccinated) and discovered that many Duane-Reade pharmacies are OUT of Tamiflu. Consider using Relenza. The full info on whom to treat is below in the CDC recs. * Consider ILI in your admitted patients as well. - There will be LOTS of communications about this so keep your eye on your inbox. More info is at: - CDC influenza activity tracking can be found at: - NYC tracking info is at - CDC summary including treatment options

Written by phil

January 14th, 2013 at 9:32 pm

Posted in ID,Influenza

Cause of Death Reporting

Improving Cause of Death Reporting: Update 2012
Accurate and detailed cause of death reporting is critical for disease surveillance, public health research, and forensic investigations.
Cause of death reporting requires:
Review of the medical record
Identification of all conditions and events leading or contributing to the death
Ordering the conditions and events in a medically probable sequence

Death certificates are both important legal documents and essential public health tools. Rapid reporting enables families to arrange funerals and settle estates quickly and helps government agencies prevent the fraudulent use of birth certificates, driver’s licenses, Social Security benefits, and other entitlements. Timely and detailed documentation of cause of death (and other significant conditions and events related to that cause) is crucial to public health reporting and surveillance. The New York City (NYC) Health Department and the Centers for Disease Control and Prevention (CDC) rely on cause of death data to identify outbreaks and emergencies, such as pandemic flu and heat waves. For these reasons, the NYC Health Code requires that all deaths be reported within 72 hours.
The NYC Health Department and other government agencies, as well as hospitals, researchers, and community-based organizations, use statistics from death certificates to identify public health priorities and develop appropriate interventions. Detailed cause of death reporting yields accurate information about neighborhood differences in the number of deaths due to diabetes, for example, enabling policymakers to target community interventions such as healthy food initiatives or physical activity programs. Incomplete or nonspecific reporting can lead to inaccurate statistics that can affect interventions, policy, and funding. Reporting cardiac arrest as the cause of death without recording the underlying condition (eg, metastatic breast cancer or chronic obstructive pulmonary disease) may cause an underestimation of mortality due to the true underlying illness (1-3). Chart review studies have identified substantial inaccuracies in cause of death reporting in NYC (4). Educating providers can improve the quality of death certificate information, making it a more useful tool for assessing population health (5).
Because the quality of cause of death data is critical for legal and public health purposes, each death undergoes multiple levels of review. Medical providers must understand how to document cause of death in sufficient detail to meet review requirements and avoid the need for resubmission. Electronic reporting in the NYC Electronic Vital Events Registration System (EVERS) has simplified the death certification process, but misconceptions still affect the quality and timeliness of reporting (Box 1).

The “Burial Desk” at the NYC Health Department will not register the death if the cause provided is too complex.
Not true. Both the Burial Desk and the Office of the Chief Medical Examiner (OCME) prefer detailed and complete descriptions of the cause of death.
You must use a cause from the “list” of acceptable causes.
Not true. There is no list of acceptable causes of death. Use your clinical judgment and the patient’s medical history to detail causes of death.
Funeral directors have the authority to request a specific change to the Cause of Death section.
Not true. The funeral director is not authorized to tell the provider what to write as the cause of death, but may tell the hospital staff or health care provider to contact OCME or the Health Department about the cause of death.
Information from the death certificate doesn’t really matter anyway; it’s just to determine whether the death is a Medical Examiner case or not.
Not true. Death certificate information has many important public health and legal uses.
The certificate cannot be submitted if the cause of death fields in the Electronic Vital Events Registration System (EVERS) are yellow.
Not true. If you see an error message and yellow highlighted field, you must verify or update your entry and hit Validate. If the field remains yellow, but you feel the entry is complete and accurate, check the Override box, save the override, and submit the case. The data entry field will remain yellow after the override.

Written by phil

January 14th, 2013 at 6:48 am

Posted in Death

Healthix Update

Dear faculty, residents and PAs,

Healthix is live and available in EPIC to view patient data from > 50 hospitals and other provider organizations across NYC and Long Island.

Simply click on the “Healthix” tab on the lower left from within any patient’s EPIC record and the Healthix portal window will automatically launch. There is no need for a separate login or patient search.

If nothing appears initially, and there is a message on the top that says “patient records from other facilities are available. If the clinical situation dictates, please check “break the glass” on the left” you may do so if appropriate, which circumvents the required patient consent in emergency situations. You should then see visits from multiple facilities. You will need to look through the list and make sure that the demographic information for each visit you select is indeed for your patient (DOB, address, etc). Check the boxes next to each facility that you want to view and then select “view selected patient records”. This will bring you to a results review screen that should be pretty straight forward.

The first time you click on the “Healthix” tab in Epic you will be brought to the registration screen. Please fill in only the required fields (ones with a red asterisk). Once done, you should have immediate access to the portal and will not see this registration screen again. This is what allows us to have one click access to Healthix from within Epic.

Attached is a training manual specific to our Healthix build. There is also a training video available at:, but please skip the first 4 slides which do not pertain to us since we have one-click access.

If you have any questions, experience any problems, or have any good stories about how Healthix helped care for a patient, please let me know.


Written by phil

January 7th, 2013 at 3:41 pm

Posted in HEALTHIX

BBFE Orders

Please use the Sexual Assault order set when sending labs on patients with a blood or body fluid exposure to ensure that the correct labs are sent.

We recently had several cases of incorrect hepatitis profiles ordered. If you type in “needle stick” (with a space) or “sexual assault” the order set “Sexual Assault aka needle stick” will come up. We are working with EPIC to have a separate order set in the future.

Thank you,


Written by phil

January 3rd, 2013 at 8:16 pm

Posted in Needlestick