Category Archives: Infectious Disease


Changes, Updates, Important Information

  • When you are on a cardiac room shift or trauma shift, please arrive a few minute early to check that your supplies are well stocked and airway boxes are ready to go. When you use supplies and airway boxes, don’t forget to reset.
  • ​If a patient leaves during evaluation (this means “provider in” is clicked, orders of any kind are placed, any note is written by a midlevel or attending provider) please indicate “Left During Evaluation” and NOT “Eloped” or “LWBS…”in the Dispo section of the chart.
  • Current drug shortages: kayexelate, epipen
  • Psychiatry consults: (Do not use the paging operator, amion is not yet updated)
    • ​Mon-Fri 8a-5p call 6-6934 (cordless); OR as backup page 40524 for the consult attending
    • Mon-Fri 5p-8a, weekends, holidays page 15094 – consult resident; OR as backup call the Bell attending 6-4750 (cordless)
  • Patients from Rikers Island who are discharged back to Rikers should have printed copies of their:
    • (1) H&P and consultant notes (i.e. psych notes);
    • (2) “ED to PCP summary” (i.e. results of diagnostic studies); and
    • (3) AVS (i.e. clear discharge instructions with medication recommendations)
    • (4) placed in a sealed envelope and handed to the Corrections Officer, NOT the patient​
  • Please provide “Procedural Sedation” and “Stroke and TIA Prevention”  discharge instructions to patients as appropriate.
  • Please take the time to schedule appropriate follow up appointments for patients. This is especially important for our Elmhurst population with generally poor health literacy.
  • All patients diagnosed and treated or suspected and treated for a sexually transmitted illness (STI) MUST be followed up in the Sexual Health Clinic (SHC).  Discharge clerks can schedule appoints as early as the next business day. This includes women treated for possible PID, men with confirmed or suspected GC/Chlamydia and anyone with suspected/confirmed syphilis.  
  • Newly diagnosed HIV positive patients are to be referred to the ID clinic NOT to the SHC.  There are resources in the SHC for face-to-face patient counseling, HIV pre-exposure prophylaxis (PreP) medication and partner surveillance.  They’ll also refer female patients to the gynecologic clinic, if necessary, after they’ve met with these patients.
  • ​​Do NOT overbook Proctology Clinic.  If there is no availability, in the timeframe you need, then send the patient to the General Surgery clinic.
  • Patients with suspected ectopic pregnancy should follow up in GYN Surgery clinic. ​
  • ​​Transfer formsMUST be completed on all transfer patients regardless of the service requesting the transfer.You’ll find the Transfer Form after you’ve selected “Transfer to Another Facility” on the Disposition Tab >> TRANSFER/EMTALA Forms >> complete the form – especially the ACCEPTING HOSPITALand ACCEPTING ATTENDING PHYSICIAN (not resident)! Then save, print, and give the form to the sending RN.  
  • For radiology studies select an indication AND include a brief comment on the reason for exam
  • When ordering PLAIN X-ray imaging place a patient transport request in EPIC. On the main tracking board select the patient, click on “patient transport”, select “EL Radiology” as the location and priority “high”.  
  • If you change the admitting service or level of care, you need to (1) change the admission service order in EPIC AND (2) also call Admitting
  • The ED attending makes the final admission decision, please check with them before admitting.
  • Any patient with a traumatic injury MUST be admitted to a surgical service. If they need telemetry or have complex medical diagnoses, the SICU fellow or attending should be consulted for SICU or surgical step down bed assignment.
Epic Quirks 
  • ​​Please use the “quick lists” to order medications. These are set up to have appropriate dosing, administration and titration instructions for the ED. In addition the IV push doses of relevant medications have now been added to this list
  • Click the provider in button and indicate the time you first saw the patient for every patient you see (if it has not already been done).
  • Uses the physical exam checkboxes in EPIC to document guaiac results.​

  • ​​Vaginal ultrasound probe cleaning (Trophon)/use monitoring: Name-sticker placed in the black folderwhen we use the pelvic ultrasound probe.  This must be done every time by either the ED provider, chaperoning PCA, or the Gyn consultant.
  • Ultrasounds: Please clean the ultrasounds and plug them in after use. Please order, save images, and read all ultrasounds performed in the ED.
  • We have Naloxone kits available for free distribution to at risk patients. Most of the attending physicians have completed the training to dispense the kits. Please consider this for your patients and ask the attendings when appropriate.
  • Apply a patient label or baxter label to the EMS notification sheet when applicable. Continue to place these sheets in the bin by the phones. ​
  • ​Continue to save all ultrasounds, especially all FAST exams done during trauma to Q-path. These should be linked to ​​the patient in Q-path, interpreted by the resident and signed by the attending. 
  • ​​​P​lease help us meet sepsis treatment criteria. We are missing sepsis marker primarily because of these four things: 
    • Blood cultures not marked as collected prior to antibiotic being marked as given – REMIND YOUR RN;
    • Time to fluid and antibiotic administration – We have 3 hours from arrival;
    • Failure to repeat elevated lactate by 6 hours;
    • Failure to write a sepsis reassessment note after fluids are given.

Colleen and Moira

​FULL BLOCK 4 UPDATE  Elmhurst Updates SEPTEMBER 2018

2016 EHC ANTIBIOGRAM 2016 EHC Antibiogram
The most recent EHC Traumatic spine and brain injury protocols. Both can be found permanently linked under the cardiac/trauma tab

Hand & Extremity Cellulitis

The observation unit will accept patients with hand cellulitis after they’ve been seen by the covering consult service in the AED. They’ll also accept cellulitis cases that crosses joints where there is a concern about septic arthritis – as long as orthopedics sees the patients in the AED and documents their impressions.


TB and ED discharges and disposition

Good morning

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

Zika Flow Sheet

Zika Flow Sheet

  • Symptoms: Rash, Fever (including report of fever at home), Arthralgia AND/OR Conjunctivitis
  • Travel (Locations may change so check the CDC/DOH websites): Caribbean, South and Central America
  • “Recent Travel”: 4 weeks

 1) Pregnant, no symptoms but exposure (recent travel or sexual partner who has recently travelled)

  • Refer to WHC clinic
    • FP make appointment for next clinic session
      • M-F 8:00 AM to Noon and 1:00 PM to 3:00 PM
    • Send email to Director Dr. Barry Brown
    • Send message to follow up nurse to check patient’s compliance

2) Pregnant with symptoms and recent travel but doesn’t need hospitalization:

  • Refer to WHC:
  • FP make appointment for next clinic session
  • Send email to Director Dr. Barry Brown
  • On AVS write “Referred for Zika testing” in the comment section
  • Send message to follow up nurse to check patient’s compliance

3)Pregnant with symptoms but need hospitalization for complication of pregnancy or other reasons:

  • Notify the admitting team of the Zika risk/concern so they can test and contact DOH

4)All Adults (including non-pregnant women) who are symptomatic and have positive travel history

  • Refer to Zika testing clinic on Wednesday afternoon:
    • FP clerk should schedule for this clinic specifically not Diagnostic clinic. If they have difficulty they are to call Ben Mendez.
    • On the AVS write “Referred for Zika testing” in the comment section
  • Send message to follow up nurse to check patient’s compliance

5)Symptomatic patients with NO travel history (DOH Surveillance Project)

  • Order urine for Zika PCR (not blood)
  • Call Sandy Sallustio (718) 369-6166 and if she is not available call Don Weiss (347) 386-4911

MERS Protocol

1.  Any patient with travel history (14 days) to the Arabian peninsula (Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen).presenting with fever (>=100.5 F) and respiratory symptoms (cough, shortness of breath) OR pneumonia (chest x-ray finding)

2.  Any patient with travel history (14 days) to South Korea with fever and contact with an ambulatory or inpatient medical facility.

3.  Any patient with fever and contact with a traveler to either the Arabian peninsula or South Korea that has met or potentially fulfills the above criteria

Patients should be placed on airborne, contact and faceshield precautions; the ED should contact IPaC or the NYC DoH and report as a possible MERS PUI (person under investigation).  If, the ED contacts the DoH directly, they should still contact IPaC for subsequent reporting to the DoH.

I’m available to the ED off hours and Saturday.  there is an IPaC nurse in the hospital on Sunday.

The DoH will “advise” as to whether the patient will be worked up as a MERS PUI.

As the DoH decision to test will likely span a day(s), the patient will likely leave the ED and go to either the floor or an ICU depending on the clinical judgment of the ED attending.  If, the patient proceeds to a non-icu area, the nursing supervisor should be contacted to provide faceshields to the target admission area.

a log should be kept of all staff and visitors entering the room(s) where the patient is kept.
Visitors should be limited to 2, until we’ve ruled out MERS or the PUI status has been lifted
Visitors should wear surgical masks with shields NOT N95 respirators
The DoH will likely want an induced sputum, a nasopharyngeal culture and a red top for PCR.  These should be kept in accessioning for DoH pick up

Nota bene: a traveler from an affected area falling within the target time span with bacterial bronchitis may have fever and a negative x-ray in the setting of respiratory symptoms.  This case would qualify for PUI.  For the DoH, the decision to perform or not perform a test can be leisurely discussed, but for hospital staff, there is no difference between a rule-out case and a true case.

thank you

George Alonso, M.D.
Director, Infection Prevention and Control (IPaC)
Elmhurst Hospital Center
718 334-3078