From Department of Internal Medicine:
Starting tomorrow, Tuesday May 30th at 7-8PM an attending intake unit will start to expedite ED admissions (or further assessments) to medicine. This will consist of attendings who will evaluate and admit patients without house staff. They will work from 7PM to 7am on nights. In the am they will sign out admitted patients to the MTAR who will give them teams. We will show everyone the flow on Tuesday. However, in order for this to work, it is imperative that all admitted patients to medicine (except MICU, CCU or A4 ) go through the MTAR. The MTARs will than assign teams starting at about 8 PM when the shift starts. The MTAR will assign cases to the attending intake as well. This will decrease the number of admissions that the MTAR and night floats will be admitting. Therefore, having the MTAR assign all admissions after 8 PM (irrespective of whether the teams have capped or NOT) is mandatory. A4 admissions will be called directly to the resident on A4 or TR once the team has capped or after 2 PM. MICU and CCU will continue to function as at present.
Addendum from ED Admin:
There is no change to the current admission process on the part of the ED provider. The change is related to the way medicine will assign admitted patients to their service.
Patients may be referred to the TSTU (Tuberculosis Surveillance and Treatment Unit) following an ED visit for the next available non-holiday weekday.
1. Ask the patient to go to J1-05 Immunology Clinic from 8 AM to 3:30 PM. (the earlier the better). After they enter the Immunology Clinic, the first door to their immediate left is the TSTU (door is marked IPaC TSTU Clinic).
2. Provide the patient with a mask and ask him/her to wear it to the TSTU.
3. The patient should state that he/she was seen in the ED and was asked to come to the TSTU.
4. The referring ED need NOT write orders for sputum nor write a referral.
5. IF, the patient is strongly suspected of having active PULMONARY tuberculous disease but is clinically stable following an evaluation in the ED during off-hours, weekends or holidays, the same process may be followed however, the medical provider should call 43077 and leave a voice message indicating that the patient is strongly suspected of having disease.
6. The TSTU extension is 46058
Please understand that patients presenting with strongly suspected active PULMONARY tuberculosis should be carefully evaluated to reasonably assess that they will return for follow up. Clinically unstable patients or patients that will likely not follow up with the TSTU following evaluation in the ED on a weekend or holiday should be considered for admission (e.g., homeless person).
During weekdays, cases with a low level of suspicion may be referred to the TSTU in the manner described above.
During weekdays, cases with a high level of suspicion should be called into IPaC at 43077. The patients can be evaluated in the ED and referred to the TSTU prior to admission. Admitted patients are evaluated in the same manner and offered the workup in the TSTU with the consent of the medical-surgical admitting team.
George Alonso, M.D.
Director, Infection Prevention and Control (IPaC)
Elmhurst Hospital Center
For Ultrasound in Trauma –
- Place patient Baxter number, provider user ID and attending user ID
- Complete POCUS study
- Place order in Epic
- Open Q-path
- Find Baxter ID and replace with patient MRN
- Document Study
- 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.
And finally, a general reivew for what to do if a lawyer contacts you: http://www.lustbaderlaw.com/articles/WhatToDoIfALawyerContactsYou.pdf
If a patient is being considered for a one-person trauma:
1) OVERHEAD PAGE: “Trauma Senior to the Trauma Room “
2) Trauma Senior will then triage/assess the patient with the attending to decide if the patient is appropriate for one resident and which resident will take the case.
This will ensure the juniors feel supported in these cases, that the Trauma Senior is aware of the case and can learn as well.
Also, Stu would like to remind you that ALL RED AND YELLOW TRAUMAS require a full Trauma Team activation.
As a summary of the below corporate email –
1) E-Prescribe 100% of your discharge prescriptions.
2) You can E-Prescribe to the Elmhurst pharmacy which is open 8am-4pm M-Fri (closed weekends and holidays)
3) If a patient cannot fill a prescription from a community pharmacy after-hours; E-prescribe the medication to the Main Pharmacy then call them and let them know the script has been sent to their queue and ask them fill at least the minimum needed prescription for a safe discharge. The AOD can then be contacted to pick up the script.
As of today our e-prescribing waiver has expired, which means that all prescriptions must be transmitted to pharmacy electronically.
Electronic prescriptions for non-insured patients may be send to the facility’s Outpatient Pharmacy, which is open from 8:00 a.m. to 4:00 p.m., Mon – Friday (closed on weekends and holidays). During off hours, e-Rxs need to be transmitted to community drugstores and patients need to be advised accordingly. In urgent situations (when a patient is uninsured, must have his prescription filled and cannot access a community drugstore), the Main Pharmacy pharmacist can process the prescription from 4:00 to 11:30 p.m. provided:
- An e-Rx is transmitted to the facility’s Outpatient Pharmacy
- A phone call is made to alert the pharmacist that a prescription was send to his queue
- Arrangements are made for picking-up and signing off the medications internally (via the AOD) as Main Pharmacy is not equipped to handle patients and patient’s bags cannot be sent via the pneumatic tube.
Effective tomorrow, in order to comply with NYS law, we’ll have to discontinue the OPD med cart (see attached) and also remove from Pyxis the percocet packaged for outpatient use.
Please share this info with appropriate staff
ETOH level is needed for all Trauma Admissions (Activated and Non-Activated).
a. The ETOH level needs to be drawn on all activated trauma patients (Red and Yellow) at the time of ED arrival.
b. For Non-Activated patients getting admitted with any Traumatic Injury, it needs to be added to the first specimen sent to lab, at the time decision to admit the patient is made. These patients can be in any area of the ER
c. It must be drawn on all >=15 year old patients (even if it’s likely to be irrelevant).
Please see attached SBIRT policy, which clearly states:
Alcohol levels will be drawn for all activated trauma patients (>=15 years of age). Alcohol level will be added to the serum specimens drawn upon ED arrival on non-activated trauma patients admitted to the hospital.
Providers – please be sure to place an order for psych consults.
This should be done whenever a psych consult is going to come to the ED to see a patient.
Dr. DePena-Nowak and Dr.Givre will be monitoring the time is takes from calling for the consults to transfer to CPEP. We will be working together to improve communication and patient care between the ED and CPEP. Let me know when you have any issues.