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For +24/7 Cardiothoracic Surgery emergencies please call:

347-346-0254

This cell phone will be carried by the cardiac fellow on call. This number will also be published in AMION.

The service covering facial trauma (ENT, Plastic Surgery or OMFS) covers ED calls from 7 am to 7 am and is responsible for the patient based on the patient’s registration time not the time the consultant is called. Thanks,

Phil (Fairweather)

-Geriatric consultations are currently available for elderly ED patients Mon-Fri 9am-4pm. Reach the Geriatric Consult Liaison service through AMION or AMAC.

-Consider Geriatric consultation for assistance with high risk and complex elderly patients, particularly for help with coordination and transition of care issues in patients with a potential for discharge. See attached for further details.

-Patients do NOT need to have a prior PCP in Geriatrics/Martha Stewart to obtain consultation.

-For patients already know to Geriatrics/Martha Stewart, you may continue to call their PCP directly (via AMION or AMAC) to discuss any issues related to their care or disposition.

Please let me know if you have any questions or issues.

Thank you,

Denise

f you have a case that may need urgent / emergent IR involvement (and would prefer not go through the rads resident to explain your clinical decision making), the in-house pager is RADS (7237).

Luke

Is available on the intranet here.

That link does work on the intranet. here is the document.

For sickle cell pain crisis admissions, the chronic pain service wishes to be called instead of the hematology fellow. They will come down 24/7 to write analgesia orders. The resident/fellow covering this service carries a cell phone:

(646) 592-0084

If a sickle cell patient has another reason for admission (e.g. medically ill with an infection, chest crisis, hemolytic crisis, etc.) the case should be discussed with the heme fellow.

Good morning, just a reminder. If it is off hours, and you think that your pt would benefit from VNS services, you may print out a consultation form write your concerns on it, and leaving it under the door of the social worker. The VNS will review the case in the morning.
VNS would rather too many referrals rather than too few.
thanks
meika

Hi everyone,

Lisa and I had an interdepartmental meeting with Radiology and Surgery at Sinai today – some matters they want us to pass along.

1.  Gastrografin will not be used anymore.  Instead, for g-tube placement confirmation – we are going to use Isovue.  Isovue is the same substance as the IV contrast we use for CTs and can be obtained from almost anywhere in the Department of Radiology.  So please throw out the gastrografin you guys have hoarded in your mailboxes.

2.   When ordering radiological studies – please include your call back # on it.

3.  When ordering CT (-) for acute stroke, please include onset of symptoms.

4.  Radiology is reducing the number of CT scanners in operation from 2 to 1 at night.  ‘Night’ being 10pm – 8AM.  Radiology promises this will NOT affect the ED.  Please let me know if this becomes an issue [with specific instances, patient MR#s, etc] if it does.

5.  Radiology will still not have an u/s tech at night despite efforts by their own residents and other departments to encourage this.

6.  Lastly – per Surgery.  Patients awaiting a liver transplant AND who are on the list – in situations involving surgical issues – call Liver Transplant FIRST via.  Cirrhotic patients who are NOT on the transplant list – call SURGERY for consults.

We are required to offer/arrange for an interpreter for patients who are deaf or mute.  These can be arranged viat the Languages Assistance Program (42700)  or the Patient Service Center (88990).
 
Should the patient decline the use of an interpreter (because they do not feel the need for one or prefer to use someone that has accompanied them) we should document that the patient declined and that we were comfortable with the level of communication. 
 
Thanks. 
 
Maria,
 
 
Maria M. Cardona
LEP Coordinator
212-659-8995

We have had several ED cases with poor outcomes over the past year that triggered root cause analysis and resulted in corrective action plans.  The following corrective actions directly or indirectly involve our ED practice. The department may be monitored by the state for compliance with these plans.

• New onset adult seizures, syncope, and chest pain will all be treated as if potential cardiac ischemia:  ECG within 15 minutes.

• Initial dosing of hydromorphone is 0.5 -1.4 mg, initial dosing of Morphine is 4 mg.

• Higher doses of pain medications may be given if there is a note in the chart documenting the medical reasoning for choosing a higher dose.

• More than 3 doses of IV pain medication in 3 hours should prompt a pain consult for consideration of PCA pump, or medical reasoning why there is no consult.

• All transfers of patients with thoracic aneurysm or dissection should be discussed with the MSH ED attending before transfer from another institution.

• CT surgery will use AMION for on call and chain of command contacts.  Non-compliance should be reported to Scot Hill.

• Consultants should respond by phone within 10 minutes, and be present within 30 minutes.  Non-response should trigger a call to the next higher level in the chain of command.

Whoever is on for peds surgery is on call all the time, 6 days a week.  The exception due to 405 rules is Saturday (their one calendar day off per week).  From Friday midnight through Saturday overnight the general surgery resident on consult (the same person the adult side calls) is on for pediatric E.D. consults as well.  There is a designated person up to midnight friday, at 12:01AM its the general surgery consult resident.

Procedure- Emergency Department (ED).

Stable Patients
I. For the ED patient that is stable and presents with a chief complaint of an eye problem and will also be discharged. The following referral process must be followed:
i. The emergency department will contact the ophthalmology clinic on 8east of the Center for Advanced Medicine (CAM) at 212-824-7653 or 7655.
ii. The ED will provide the clinic physician with pertinent information related to (1) chief complaint and (2) any actions and/or interventions undertaken in the ED.
iii. The patient will be discharged from the ED and directed to the CAM building with a consult form.

Emergent Patients
II. For the ED patient that requires an ophthalmology evaluation in the ED (i.e. trauma or eye injury) or is unable to ambulate to CAM. The following process will be followed:
i. The ED will contact the ophthalmology resident via beeper # 917-641-1556 during the hours of 8:30-5p Monday, Tuesday, Thursday, Friday and 12:30p-5p Wednesday.
ii. After hours, weekends and holidays, the ED will contact the page operator for the on-call ophthalmology resident.
iii. The resident will come to the ED and provide the necessary ophthalmology evaluation and treatment.
iv. The ophthalmology resident will transport the patient to Annenberg 2 if needed and return the patient back to the ED.

Admitted Patients
III. For the patient that present to the ED and is admitted for a diagnosis unrelated to ophthalmology but has an eye condition that requires an eye consult (i.e. CVA). The following procedure is followed:
i. The admitting physician will order an ophthalmology consult during the admission process.
ii. The referral will follow the inpatient ophthalmology referral /consult process outlined below.