• If you are contacted by anyone outside of the hospital about a case (e.g. lawyer, district attorney), please speak to a residency leadership person before engaging in discussion.  This is really important.  You want to go into it with some education from us but you may also not need to go at all or you may want to discuss with Sinai lawyers first.  You’re unlikely to know all the intricacies so contact us.

• A review of subpoenoas from a doctor-lawyer: http://epmonthly.com/article/subpoenas-a-legal-review/

• And another interesting article on the same topic: http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/personal-finance/subpoena-you-dont-always-have-comply

And finally, a general reivew for what to do if a lawyer contacts you: http://www.lustbaderlaw.com/articles/WhatToDoIfALawyerContactsYou.pdf

1) Psychiatry Consults:

CVS PHARMACY OPEN 24 HOURS – Store #1113

89-11 NORTHERN BOULEVARD
JACKSON HEIGHTS, NY 11372

718-426-2508

CVS PHARMACY OPEN 24 HOURS – Store #2057

100-02 QUEENS BOULEVARD
FOREST HILLS, NY 11375

718-520-2334

CVS PHARMACY OPEN 24 HOURS – Store #2975

7960 METROPOLITAN AVENUE
MIDDLE VILLAGE, NY 11379

718-326-4910

CVS PHARMACY OPEN 24 HOURS – Store #7576

31-01 DITMARS BOULEVARD
ASTORIA, NY 11105

718-545-0128

As ED medical staff, the NYSDOH is recommending provision of take-home naloxone by us to appropriate patients. The reasons for this include the following: Prior overdose is the number one predictor of subsequent overdose, and unintentional poisoning is the leading cause of accidental death in the US, mostly from opioids.

Patients you may wish to discharge with take-home naloxone should be those who are at high risk of experiencing or witnessing opioid overdose, such as the following populations: Unintentional heroin or prescription opioid overdose; IV drug use; Suspected or known history of nonmedical opioid misuse; Previous overdose; Methadone prescription; Voluntary request.

Referral for Take Home Naloxone and Counseling:

EHC’s Chemical Dependency service operates an Opioid Overdose Prevention Program (718-334-3195). The program’s purpose is to identify patients, peers, and family members with the potential to prevent opioid overdose.  This program trains Opioid Overdose Responders with skills including the recognition of opioid overdose and appropriate interventions, including the administration of naloxone. You can contact Usha Tandon, MD with any questions about the program: tandonu@nychhc.org<mailto:tandonu@nychhc.org>

Elmhurst Hospital Center

Chemical Dependency Program

79-01 Broadway

Annex O, 2nd Floor

Elmhurst, New York 11373

Director: Tyrone Rodman

718-334-3195

For patients without insurance (who we normally refer to EHC outpatient pharmacy):

Naloxone (NARCAN) O.D. Prevention Kits kit are ordered and dispensed by an Authorized Provider at the EHC Chemical Dependency clinic (see above).  Only intranasal kits are available.  Pharmacy prepares them for the Program.

For patients with insurance (including Medicaid) who cannot fill prescriptions at the EHC pharmacy – must to go to outside/retail pharmacy:

Prescription options*: (1) Intranasal naloxone HCl 1mg/mL 2 x 2mL prefilled syringe and 2 x atomizing device; (2) Intramuscular naloxone HCl 0.4 mg/mL (Narcan) 1 x 10 ml fliptop vial and intramuscular syringe; (3) Auto-injector EVZIO 0.4 mg two-pack (this option may require prior authorization)

*Billing and Payment: As of October 1, 2015, New York State Medicaid covers naloxone vials/prefilled syringes, atomizers, and/or auto-injectors.1 Over-the-counter naloxone is available at participating pharmacies, including Rite Aids, for around $50. Pharmacists are trained to provide patient education when dispensing take-home naloxone kits.

Surgery 6-4734

Diagnostic Clinic, follow up card is BLUE at 718-334-2715 to schedule an appointment within one week.  The Diagnostic Clinic is located on the 1st floor of the D building – Room D1-24.

Medical Primary Care (MPC) clinic, follow up card is RED at 718-334-2424 or (toll-free) 866-939-2424 to schedule an appointment within one to two weeks.  The MPC clinic is located on the 1st Floor of the D building – Room D1-55.

Medical Primary Care (MPC) clinic, follow up card is WHITE at 718-334-2424 or (toll-free) 866-939-2424 to schedule an appointment within one week.  The MPC clinic is located on the 1st Floor of the D building – Room D1-55.

Medical Primary Care (MPC) clinic, follow up card is YELLOW at 718-334-2424 or (toll-free) 866-939-2424 to schedule an appointment within three weeks.  The MPC clinic is located on the 1st Floor of the D building – Room D1-55.

Breast Clinic (The Hope Pavilion), 77-11 Broadway (at 77th St.), 2nd Floor, Elmhurst, NY (718) 334-2398

Dermatology Clinic (H2-19), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-19, (718) 334-1849

ENT/Otolaryngology Clinic (H2-85), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-85, (718) 334-2446

Eye/Ophthalmology Clinic (H2-38), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-38, (718) 334-3235

Gynecology Clinic (H2-104), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-104, (718) 334-6210

GYN Surgery Clinic (H1-85), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, H2-166, (718) 334-6210

Hand Clinic: Tuesday (D2-81), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, D-Wing, Room D2-81, (718) 334-3241.

Hand Clinic: Wednesday (H2-145), Community Medical Center, H-Building, 2nd Floor, Room H2-145, (718) 334-5641.

Hand Clinic: Friday: (H2-145), Community Medical Center, H-Building, 2nd Floor, Room H2-145, (718) 334-5641.

Neurology Clinic will call you for a follow-up visit – do not call the clinic.

Neurosurgery Clinic (H2-104), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-104, (718) 334-3262

Oral Surgery Clinic (H2-85), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-85, (718) 334-2100

Orthopedic Clinic (D2-81), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, D-Wing, Room D2-81, (718) 334-3241

Podiatry Clinic (H2-85), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, Room H2-85, (718) 334-2446

Proctology Clinic (D2-81), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, D-Wing, Room D2-81, (718) 334-3241

Surgery Clinic (D2-81), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, D-Wing, Room D2-81, (718) 334-3241

Vascular/Peripheral Vascular Disease Clinic (D2-81), Community Medical Center, 80th St and 41st Ave, H-Building, 2nd Floor, D-Wing, Room D2-81, (718) 334-3241

Walk In  Mental Hygiene Clinic 718-334-1502

ER/Fast Track

Praxbind (idarucizumab) is now on formulary and in stock at EHC.

Mechanism of action: Praxbind (idarucizumab) is an antibody fragment (Fab) that binds to Pradaxa (dabigatran) and its metabolites with higher affinity than the binding of Pradaxa (dabigatran) to thrombin. It is a specific reversal agent to Pradaxa (dabigatran) and neutralizes its anticoagulant effect. There is NO impact on the effect of other anticoagulant or antithrombotic therapies.

Indications: Life-threatening/uncontrolled bleeding or need for emergency surgery/urgent procedures in patients treated with Pradaxa (dabigatran).

Contraindications: None.

Recommended dose: 5 g, provided as two separate vials each containing 2.5 g/50 mL. A second 5 g dose may be required in patients with clinically relevant bleeding and elevated coagulation parameters or in patients who require a second emergency surgery/urgent procedure and have elevated coagulation parameters.

Administration: Two consecutive infusions by hanging vials or bolus injection by injecting both vials consecutively via syringe. Pre-existing itravenous line may be used. Flush intravenous line 0.9% NaCl solution prior to infusion/bolus injection. No other infusion should be administered in parallel via the same intravenous access.

Consultation: Neurosurgery and/or Surgery  and/or GI as appropriate. Consider Toxicology (NYCPCC) for continued guidance.

Elmhurst Reminders –

1) Novell Access = Qpath Access
– please ensure you are able to log-in to Novell / Qpath
– if you cannot, please call 4-2405 to make this happen

2) Qpath
– if you do a scan you —>  chart the scan –> this is medicolegal
– PGY1/2 –> cannot perform study without attending at bedside with them  ((Take advantage of this as it may be a 1 on 1 moment for education!)
– PGY 3/4–> can perform study alone, however, attending must see images to make decision
– if you are not completing it, your attending must
– How to use Mindray (with Tutorial by J.Faust)
– How to QPATH

* if you are doing an endovaginal study; ask the attending if they’d like to be in the room prior to the study
** if you are not in the system, please inform either Dr Lakoff or Dr. Duque

3) Tracking Clinical Issues at Elmhurst

Observation Unit
– if you are having any issues delaying a transfer of a patient to the
Observation unit i.e. cannot take sign out for a prolonged period of
time, you think a case was inappropriately refused etc

Psychiatry
– if you are having signficant delays, refusal to see patients, CPEP
refusing to accept patient

CT
– if you are having any profesionalism issues with techs, techs
pushing patients back without telling you, refusing to perform scans
for any reasons, any issue compromising/delaying patient care/safey

Anesthesia
– During Red Traumas, If anesthesia interferes with the Airway in any
possible way i.e. stands at the head of the bed uninvited, performs
the procedure etc

* Please email Joe and cc Dan Lakoff with a professional level
email/description of the event, complete with names/dates and medical
records, these will be kept as record keeping of the events to track
the issues.  Though we may not be able to resolve immediately, they
will be considered
* If the case is compromising care, let your attending know, charge
nurse, and AOD as needed and complete an incident form

3a) Trauma Announcements:
– A wall has been cleared in the trauma bay (next to the sink)  for announcements and reminders

3b) Trauma Procedures:
– Truly emergent procedures are to be done by the providers present otherwise, please abide by the Even/Odd rule

Odd Day – Emergency
Even Day – Surgery

* the exact day the procedure needs to be done is the service that performs it (not time of arrival)*
* reasons for any abberancies should be documented in the chart, and/or emailed to your program directors to pre-empt any further issues

4) ED violence –
Always an important topic for residents, please do not ever put yourselves in harms way.

If needed:
–  Get your attending immediately
–  Attempt verbal de-escalation
–  Use protective equipment
–  Call hospital security (4-1945)
–  Restrain with assistance from HP and nursing
–  Chemically restrain with the appropriate medications

* incident reports must be completed for tracking purposes
* if any medical care is needed, REGISTER with the ED (as this is worker’s comp-related) and there should be NO charges.
* a new red siren icon is on HMED that can be applied to the patients who may be violent; this can be done by speaking to the charge nurse (however, this has be applied each and every time the patient presents to the ED).

Special Instructions for Radiologist

The attending radiologists need some clinical information when ordering radiographs.  The simple indication option is for billing purposes and is inadequate for them to properly interpret the films.  Please start making use of the Special Instructions tab.

When appropriate include:
Problem location, clinical suspicion, or any other detail that helps them focus their attention on the area(s) of concern.  I’ve attached screen shots of where the “SPECIAL INSTRUCTIONS” tab is located under “SETS” and “ORDER MANAGEMENT”.