Announcement Archive
Sept 20, 2023 Announcements
COVID, PPE, and COVID testing
COVID numbers are rising, in our peds ED patients, the community, and our team. Our testing positivity rate increased to 15.9% in August, and this month it is 22.2%, to date. To protect ourselves and others, please make sure to wear your mask at all times when in the ED, wash in and wash out as usual, and, if you prefer, consider wearing an N95 with patient interactions.
OHS now offers COVID testing for staff. OHS is open M-F 8a-12p, 1p-4p. They recommend to call them at 718-519-3118 to set up a nurse screening televisit, during which they can then approve you for testing. Their office is on the 6th floor, area 6B.
If you already have a positive COVID test, you can call them (718-519-3118) or email them at NCBOHS@nychhc.org, in order to receive further instruction.
CDC recommendations at this time are 5 days at home s/p positive test, and then can return to work while masked if symptoms are improving. You can see the CDC recommendations here, which includes a tool to calculate return to work date: https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html
You can also set up an appointment to receive a COVID vaccine booster, if you require one, by calling OHS as above.
They do not yet have information on the timing for the influenza vaccine this year, but we will update you when we hear more.
QA and QI/PI
We presented our quality assurance, metrics, and quality/performance improvement work at the pediatrics faculty meeting, to celebrate all of the great work you do here at NCB PED. I’ll be sharing this information with the team at our upcoming talk on Tuesday, Sept 19th at 2:30p via webex.
Good catches
If anyone has a good catch they would like to share, please enter this into the VOICE system (on the desktop), to celebrate the great work being done. This could be celebrating a peds ED team member’s good catch, or members of our interdisciplinary team. For example, we recently entered a good catch by HP in helping to deescalate a behavior health patient.
Patient food and art kits
Many of you are already aware of the wonderful collaboration we have embarked upon with Ronald McDonald House. They are providing food kits, for patients, siblings, and their parents, as well as art kits for the patients, which are recommended for each specific age group. The nurses are primarily spearheading giving out these kits at triage, so the patients and families can enjoy them as they wait to be seen, but please feel free to provide them as well, if the patient has not already received. The kits are in the peds head nurse office, and we have a clipboard on which to note how many kits are distributed (please tally as we go). Please also include a survey with each kit, which we’ve printed in English, Spanish, and Bengali, and return to the box holding the remaining kits, once completed.
April 5, 2023 Announcements
Positive Comments
Some of you may have already seen the positive comments I posted in the ED in the nurse/provider workstation area, taken from recent months of patient surveys. When you have a moment, please take a look, as these show the great appreciation our patients have for the wonderful care they receive here at NCB Peds ED!
POC Competencies
If you haven’t already, please sign your point of care competency eval as soon as possible and get it back to me. This enables us all to do guaiac testing here in the ED, rather than having to send up to the lab.
Asthma PI Project
We are currently working with peds clinic on a departmental PI project aimed at improving the care of our pediatric asthma patients. In an effort to avoid incorrectly augmenting the “asthmatic” population that the peds clinic is targeting in their efforts, please do not give a discharge diagnosis of asthma to a patient with first-time wheeze or bronchiolitis.
Our definition should follow the following criteria, as per Fleisher & Ludwig’s PEM textbook:
-acute trouble breathing and/or wheezing
-age >12 months
-prior diagnosis of asthma or history of two significant wheezing episodes
Patients meeting the above three criteria could then be given a diagnosis of asthma if appropriate. Otherwise, please use the diagnosis of “reactive airway disease”.
Nutrition course
H+H has provided a free nutrition course for anyone interested at the following link (flyer attached):
Essentials | American College of Lifestyle Medicine, Promo Code ESS-NYCHH
COVID PPE
Please see attached updated guidance re: COVID PPE. Masks are still required in all patient care areas (including the emergency department).
Transportation
H+H is rolling out a new ambulance system called Ambulanz, in addition to the ambulance designated for moving patients between JMC and NCB only. This hopefully should deepen the bench of ambulances available. Please keep us updated with any transportation issues. If you are having difficulty with the JMC transfer center, please ask the clerical staff to escalate the issue in real-time, reaching out to Carrie Shumway and Janice Halloran for assistance as needed.
Gastrograffin
As there is a ongoing evolving shortage of omnipaque, radiology has requested that our first-line oral contrast agent used be gastrograffin for CT studies requiring oral contrast.
Risk management
Please remember that if risk management happens to be involved in a patient’s care, it is important that this NOT be documented in the EMR. Their work is more supportive of our clinical team, and should not be explicitly documented, as this leads to more questions/concerns.
EMTALA Trainings
There are two upcoming EMTALA trainings, for all those interested. The available dates are Wed 4/12 at 11am-12:30pm and Tuesday 4/25 2pm – 3:30pm; there will be webex available. Please send mailto:Jarissa.Acevedo@nychhc.org an email if you are interested in attending, and which date/time.
Adolescent confidential interviews and urine pregnancy tests
When performing urine pregnancy tests and confidential HEADSS interviews for our adolescent patients, please be mindful of and sensitive to any parental concerns around these delicate issues. It is best to always provide education and reassurance that we perform urine pregnancy tests on all patients with a menses in the ED and a confidential HEADSS interview for all adolescent patients, just as their PMD would. Emphasizing the application of these processes to the entire adolescent patient population can help reassure parents that their child is not being specifically targeted in any way with these standard of care procedures.
Jan 10, 2023 Announcements
Congratulations to Ayisha!!!
We want to extend a huge congratulations to our very own Ayisha Ayinla, who has been appointed Assistant Head Nurse of the ED. Very much deserved, and long overdue, we are so happy to celebrate Ayisha’s long history of leadership being formally recognized.
SART cases
Please ensure we are all familiar with the appropriate process for SART patients. These patients can consent to have a SART evidence collection kit performed by the SART nurse, irrespective of if they would like to press charges or not. Then if they later change their decision, the opportunity is not lost as the kit will be held. Although the SART nurse should also be well aware of this information, we want to convey this to patients as their medical provider as well.
Transfers out
Just a friendly reminder to include in our notes the reason for transfers out of H+H system. We also will be moving back to asking the providers to notify the ADN in real time of each transfer out (although of course not delaying clinical care with this process).
BiPAP masks
No new change, just reminding everyone that we have pediatric biPAP masks, including small/medium/large masks, nasal masks, and infant nasal CPAP masks (also multiple sizes). These are kept in the resuscitation bay (Room 4), in the bottom right cabinet. If for any reason we don’t have enough of these supplies, please let the respiratory therapist know, and they can bring the necessary supplies with them to the ED.
Code Red
If you have any difficulties, obstacles encountered, or even minor delays in activating a Code Red Transfer, please let me know. Also please escalate in real-time to the clerical shift supervisor. I’ve again attached the transfer/admit flowsheets as reminders on the process.
PA Student
We have a new PA student, Mark Tamarin, rotating with us this month, starting today through early February. Please extend a warm welcome to him and broaden his educational experience as much as possible by including him on any interesting cases you have. This is his very first clinical rotation, so likely expect a bit of a learning curve, but he seems very pleasant and eager to learn, and I expect him to work well with our team. His schedule is as below, and I’ve designated some wonderful primary preceptors for each shift, but please feel free to share your vast clinical knowledge with him even when not directly assigned.
https://docs.google.com/spreadsheets/d/10Z28YMCAFBp1x5D8P0veSZHkAFZZuhI6XTuV-JOtzkI/edit?usp=sharing
Child Trafficking conference
Please see the following link for some great resources for child trafficking prevention education:
ct-prevention-conference.pdf (nyc.gov). I also attached the pdf of the same information.
Performance Improvement projects
I’m currently looking into which quality improvement/performance improvement projects we will focus on for 2023. Please let me know if anyone has an idea or specific passion for a possible project! I’m more than happy to explore any and all ideas, as I would ideally love our projects to arise directly from our team’s experience and suggestions.
Also please don’t forget to implement the pARC score for our r/o appendicitis patients! If you’d like a refresher on pARC and our NCB PED r/o appendicitis data, please see the following:
PARC- Pediatric Appendicitis Risk Calculator - Pediatric Emergency Room (pedser.org)12/20/22 Announcements
Megan Away
Megan will be away 12/21-12/29. Please contact Jimmy for any peds ED issues during this time.
Transfer/Admit Flowsheets
Please see new flowsheets for transfers/admissions, which you can find under "Transport Protocols" under "contact info", along with much other useful transfer information!
SW Contact updates
Please check out the updated social work contact information (see "social work" under "contact info").
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12/16/22 Announcements
Volume and LWBS
As everyone is well aware, our volume has been extraordinary recently, with the recent flu and RSV surges (see attached information on these). In November, we saw over 2000 patients, which is double that of Nov 2021. Thank you all for your hard work in serving each and every patient that presents to our doors.
As our volume has spiked, our number of patients “Left Without Being Seen (LWBS)” has also spiked, now up to 5%. I know we are all doing our best to prevent this number from climbing. Please be aware that many of our patients in this category end up bouncing back to our ED, often more ill than the previous presentation. For both the patients’ well-being and to ameliorate our current volume/flow crisis, we should be making every effort to see every patient. Please try our best to not convey an apathetic attitude towards patients walking out.
We also know that patient complaints have been rising throughout the hospital as well as in our peds ED during this surge. Please continue to put our best foot forward and maintain a high level of respect and professionalism in each and every interaction, even when tensions are high.
HIPPA and other Annual In-Services
Please be sure to complete all required in-services on ELM/peoplesoft. Particularly HIPPA, as those not completing by Dec 31st will have EPIC access denied by the system. I know there are often tech glitches with ELM functioning appropriately. I was able to troubleshoot my own by working closely with Ms. Betty Diaz-Rodriguez; see the 12/16/22 update email for her contact info, and she can help one-on-one as needed.
Toy Drive!!
If you have any toys or clothing or other items you would like to donate, please let me know and place them in the peds head nurse office. We are also reaching out to the volunteer office, but any donations are appreciated!!
Flu-like illness
All patients with a flu-like illness should be tested for COVID and influenza. Sending a cepheid test is a great way to accomplish both of these.
Admit to Jacobi
Thank you everyone for your patience in using the JMC transfer center during this time, rather than HHC. Three quick updates about this:
1) If you have a patient that needs a code red transfer, or if you have a transfer that has a very delayed ETA and would benefit from expediting, you can use the HHC transfer center as a backup.
2) In addition to the “ALT Campus Form” we complete for admits to JMC, we also need to complete the transfer cover sheet when using the JMC transfer center. This can be found in the files to the left of the clerical desk; just as a clerk for assistance if you have questions.
3) If you arrange transportation yourselves rather than through the clerical staff, you must notify the clerical staff of the impending transportation/transfer/admit. They must be aware so as to be able to track transportation times/obstacles.
Amox shortage
Please see attached AAP recommendations for the amox suspension shortage. I personally have used the capsule technique they describe for patients whose weight-based dosing can be rounded to these doses, which has worked well for many patients.
Peds Ortho
We once again have a peds ortho surgeon at JMC and NCB! Please ensure patients follow-up with ortho here at JMC/NCB whenever possible, rather than CHAM.
Candida auris
Please see attached info on Candida auris, which has been a recent global health threat.
Asthma diagnoses
Please be sure to denote asthma exacerbations in patients’ diagnoses when applicable. The clinic is working to improve the care of their asthma patients, and this helps their ability to find this cohort via the EMR.
Pregnancy termination referrals
We can now place specific referrals to “abortion and miscarriage management” clinic as a subset of GYN. I’ve attached a screenshot of the associated order to place in Dispo. Other patients requiring GYN for whom this does not apply can simply utilize the usual GYN referral.
Substance Use Disorder Team
Please remember to utilize our ED addiction services team. I asked the group, and they are happy to see our adolescents/young adults with THC abuse, which is unfortunately a large group of our patient population. I’ve attached the contact information for each individual, as well as the team’s general hours. Don’t forget, even after hours we can place an inpatient consult to “ED LEADS” and the team will follow-up the next day.
Transfers to JMC CPEP
We have had some success recently with transfers to JMC CPEP for our behavioral health patients requiring overnight stay while awaiting either reassessment in the AM or INPT placement for admission. This can occur when the JMC CPEP has less than 4 patients under 18yo. Please continue to use this avenue for opening up some space in our medical peds ED especially during these high volume times. Let me know if you have any issues.
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10/12/22 Updates
Flu vaccine
The flu vaccine is now available! We have the Fluarix quadrivalent vaccine, for patients 6 months and older, stocked in pyxis. Attached is the algorithm for patients requiring a second dose. For our team, flu vaccine is available via OHS (walk-in 8a-4p M-F on 6th floor, 6B OHS, 718-519-3118), or Wiley has flu vaccines available to give to staff as well. If you do not wish to receive flu vaccine, please sign the waiver; the forms are available at OHS, and Wiley has forms as well.
Ebola
Please see the attached fact sheet on Ebola, as well as the donning/doffing checklists.
Admits to Jacobi
For admissions to Jacobi, the transfer can be arranged one of two ways:
1) Via the HHC transfer center, who will call us back for signout
2) Via the Jacobi transfer center; we need to call the team (INPT admitting resident or ED attending or PICU attending) to give signout ourselves.
-Code red can be called either via the HHC transfer center, or we can call Empress directly (which would necessitate our calling to give signout ourselves).
-The clerical staff can arrange all of the above transportation, we should only need to give clinical signout, no matter which transfer center is used. However, if you do arrange transportation yourself, you need to make the clerical team aware.
Transfer to JMC CPEP
Please remember that for patients awaiting INPT psych placement, we can transfer to JMC CPEP, if they have 4 or less peds patients at that time. In order to achieve this, please call the JMC CPEP attending and discuss the case. They will then contact their chair and/or director for approval. Please let us know about any cases for whom this doesn’t go smoothly.
Follow-up
Day teams, please make sure we are doing the follow-ups, and noting their completion in the follow-up binder accordingly. Please ask me if you have any questions on how to do this.
Referrals
There is unfortunately a huge delay in patients getting subspecialty appointments, sometimes several months after we place the referral. We can do our part to help alleviate this somewhat by referring only patients that absolutely cannot be followed by the primary care doctor and therefore require a subspecialist.
The following diagnoses can be followed by the patient’s PMD:
-Constipation
-Chronic abdominal pain
-Failure to thrive
-Obesity
-Polycystic ovary syndrome
-Stable proteinuria without hematuria
-Mild hypertension
-Eczema
For the above diagnoses, or others that may be followed by PMD according to your clinical judgment, please do the following:
-For patients of NCB peds clinic, advise the patient/parent to reach out to their PMD via Mychart for an appointment. If they do not have mychart, they can call the appointment line at 718-918-5700.
-For patient with an outside PMD, advise the patient/parent to reach out to their PMD directly for an appointment.
Finally, for any patient requiring a subspecialist referral, please make sure to ask the patient/family if they would like to (as well as are able) to follow-up with an NCB/JMC specialist before making a referral. Let me know if you have any questions at all.
Clinic follow-up appointments
We now should have access to both in-person as well as televisit follow-up appointments for our patients, up to 72hrs after the ED visit. Patients requiring resp checks can use these regular appointments, they do not require asthma-specific appointments. For more complicated asthma patients requiring a pulmonary subspecialty visit, you can continue to refer to Dr. Serebrisky (peds pulm). Please let me know if there is any problem in obtaining the ED follow-up appointments, and we can escalate the issue.
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9/27/22 from Megan
Welcome Brigette!
We are very happy to announce that Brigette Bernhardt is starting the transition to work fully as an NCB NP! We’re ecstatic to have her officially join the NCB Peds ED family, so please help us to welcome her as she gets settled here after several months over at Jacobi.
COVID booster
The bivalent booster is available; you can schedule an appointment for vaccination at this link: COVID-19 Vaccination Scheduler (nychealthandhospitals.org), and choose “NO OHS” in the scheduling options for NCB. I’ve also attached a FAQ on the booster.
Peds EM Conference
Please see the following link for a free conference on Thursday, September 29th, covering pediatric emergencies, with up to 8 hrs of CME credit.
Pediatric Emergencies: Early Assessment & Treatment of Children (cecentral.com)
Respiratory Illnesses
We have been seeing so many patients with severe respiratory disease lately, and there have been a hefty majority of our patients testing positive for human rhino/enterovirus. Please see attached notification from DOH re: this recent increase in severe respiratory illnesses associated with rhinoviruses and enteroviruses.
Transfers Out
There has been an increase in transfers to CHAM recently from our ED. Please try our best to keep patients going to Jacobi as much as possible. Of course, for unstable patients, or those for whom the required services are not available at Jacobi, or those parents that strongly request CHAM over Jacobi, we can transfer to CHAM as needed, to do what’s best for our patients. But for the large majority, please ensure our default is Jacobi admissions/transfers, whenever possible. If we do need to transfer outside to CHAM, please notify the ADN at the time of transfer.
Code Red
A reminder that we can call a code red for more emergent, expedited transfer to Jacobi for specific high severity cases (such as severe resp patients on BiPAP or HFNC, major trauma patients, suspected testicular torsion, confirmed intussusception, etc). I’ve attached the guide as to how to call Empress to initiate this, when needed.
Nebulizers
When giving out nebulizers from the ED, please ensure you complete the form, in the head nurse’s office, as well as print out a patient facesheet and a prescription. Then place these three stapled together in the nebulizer folder. The nebulizer prescription can be found in EPIC under a search for “compressor”.
Lyft services
We have an exciting new resource available for some of our most vulnerable patients needing transportation from the ED. There is now a Lyft cab service for patients deemed eligible by our clinical team. These would include patients such as SART cases, victims of assault, DV cases, child abuse with significant injuries or intense emotional distress, sexual abuse cases. Please see attachment which includes standard work flow for this service, as well as on the second page lists the qualifying criteria. Please use the dotphrase “.ncbedlyft” in your note to document your reason for using this great service. A quick breakdown of the standard workflow for this:
Asylum Seekers
Please see attached NYC H+H information on resources for asylum seekers and newly arrived immigrants (both guidance for providers as well as appendix with resources).
Adolescent Health Conference
NYC H+H is holding the adolescent health conference on October 26th, 8a-5p. You can register at the link on the attached flyer.
Sexual Assault Conference
The second annual sexual assault regional conference at Jacobi is being held on Wednesday, October 12th, 7:30a-2:30a. Free CME available; see attached flyer for more information, and you can either scan the QR code for registration link or register at the following: https://ww2.highmarksce.com/nyh/activity/1173.
Monkeypox
For more information on Monkeypox, see attached NEJM article as well as attached technical bulletin from Northwell on how to collect specimens for possible cases.
Childhood Literacy
There is a webinar “Beyond Books: Early Childhood Literacy is Public Health”, part of the Pediatrics for an Equitable Developmental Start Network Learning Collaborative Webinar Series, that will take place Wednesday, 9/28, 1p-2:15p. Click on the link below to register.
Register Here
Paxlovid
NCB pharmacy now has paxlovid available, also in ED pyxis. Please see attached screenshot for how to order Paxlovid in EPIC, to give one dose in ED and a packet to take home. Eligible patients are those 12yo and above, weighing at least 40kg, with a known risk factor (such as asthma) for progression to severe COVID. Please see attached fact sheet for more information.
Pharmacy
NCB outpatient pharmacy now accepts commercial insurance plans, in addition to patients without insurance.
Zumba and Yoga at NCB
H3 (Helping Healers Heal) is hosting Zumba and Yoga classes in October and November. The classes take place on Wednesdays at 5pm, on the 12th floor in the dining room, 12A-02. Zumba will be held in October (10/5, 10/12, 10/19, 10/26) and Yoga will be in November (11/2, 11/9, 11/16, 11/23). Please register using this link: http://airtable.com/shrTJHHZjr7uvpOVL . Email tiburcid@nychhc.org
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8/21/22
Megan Away
I will be away tomorrow, August 22nd, through Sunday, September 4th. For any peds ED-related issues, please email me, and I will address upon my return, or for more urgent matters, please also reach out to Jimmy.
Lactation Room
We understand that the interview room can be a very useful area, both for provider computer use as well as for RN breaks, etc, when it is available. However, please be mindful that it is designated as a lactation space for nursing mothers, patients and/or staff. If someone needs to use the room for this purpose, for nursing and/or pumping, please ensure we are gladly and quickly turning over the space to this person without difficulty.
Monkeypox
Please see the following link for a great summary for peds for monkeypox: Clinical Considerations for Monkeypox in Children and Adolescents | Monkeypox | Poxvirus | CDC.
Back to School Healthfair
The Annual NCB Back-to-School Healthfair will take place on Thursday, August 25th, 11a-2p, on Kossuth Avenue. Please join in to celebrate with our patients!
Follow Up
Just a quick reminder to everyone on how to do our daily follow-ups in EPIC. I’ve attached the policy for follow-up, which has great step-by-step instructions on how to complete follow-up, and can also be found on the intranet.
CME Policy
Please review the attached PAGNY CME policy for using CME hours. Of note, please ensure CME hours are completed on a weekday, not the weekend, and send your CME form to be approved to rosangela.foitl@nychhc.org (cc'ing Jimmy and I) prior to completing your CME time.
Hypertension in Pregnancy
Please see attached key points for hypertension in pregnancy. This is a topic that we don’t often see in peds, but critically important to address when we are presented with such a patient.
PPE
Please ensure we are using appropriate PPE. For all patient encounters, wear an N95 and eye protection. For suspected monkeypox cases, please add gown and gloves to this PPE standard.
Peds Surgery
Two important reminders about peds surgery. First, please ensure any patients <18yo requiring clinic follow-up with surgery receive referrals for Jacobi appts, as there is only adult peds surgery clinic here at NCB. Second, if a patient <18yo requires a surgical consult, particularly with a strong likelihood of requiring surgical intervention, please give signout to and transfer to JMC Peds ED, where the attending can call peds surgery at Jacobi. This helps to avoid any confusion between JMC and NCB surgery teams’ coverage, which can put our providers in a difficult position. We will let you know if our NCB peds surgery capabilities change, as we are in the process of looking into the best solution for our patients.
Ortho
Please continue to let me know about any issues with the ortho on-call service. To be clear, we do not have plastic surgery available at NCB, so for hand consults, the service consulted should always be ortho. We also should not transfer to JMC just for ortho consult, unless the patient requires operative management or admission. If you have any difficulty with obtaining in-person consultation when needed, please escalate as appropriate to the on-call ortho attending. Please also let me know, including MRN of patient, via PHI-safe nychhc email.
EPIC patient status
Please see attached EPIC tipsheet on new EPIC trackboard updates to patient status colors.
Visitor policy
Our visitor policy is still restricted to one parent per patient, due to ongoing COVID restrictions. This parent must be wearing a visitor pass, as distributed by e-FAST. If you note anyone in the ED not wearing a hospital ID, a visitor pass, or an EMT/NYPD uniform that is not a patient, please help us to identify them and either escort to e-FAST and/or obtain a visitor pass. Adhering to this policy can help immensely with workplace safety in the ED.
FEMA Decon training
There are FEMA trainings available to those interested in a week-long intensive session learning more about decontamination, mass casualty incidents, and more ED-specific scenarios. Please see attachment for more information, provided to us by our associate director of operations and emergency preparedness coordinator, Carrie Shumway (shumwayc@nychhc.org).
Tobacco and Nicotine Use Webinar
Please see attachment for more info on an available webinar next Wednesday, covering nicotine use in our adolescent and young adult population.
Abbreviations
Please see the attached list of approved medical abbreviations. Please refrain from using any abbreviations outside of this exhaustive list in our EMR documentation.
Annual Training
Please ensure your annual required trainings are complete on peoplesoft. See attachment for more information.
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7/26/22
From Megan:
A/C in the ED
Speaking of the heat wave, thank you everyone for bearing with us as we had some cooling issues in the ED this past week. Engineering has assured us that the problem should be resolved going forward, but if for any reason you again note an abnormal temp in the ED, please call Engineering at 5-3560 as well as put in a Maintenance Connection ticket.
DOH Monkeypox updates
Please see the following video for DOH monkeypox updates: Monkeypox Guidence Updates for Healthcare Providers, July 14, 2022 - YouTube. Of note, the rule-out cases they’ve been seeing at Jacobi Peds ED have often been a case of Enterovirus, so make sure to send an RVP on any rule-out cases, as well!
Transfer paperwork
For patients going to JMC (ED/INPT/PICU), we no longer need to fill out any paperwork for the transportation process. Just print the ALT campus form that you fill out in EPIC, and give this to the clerk, notifying them of the transfer. They can then call HHC transfer center to arrange the transportation, no other paperwork necessary.
In order to print the ALT campus form, go to the “Notes” tab, then under “Other” along the left-hand side, click “Discharge Documents”. There you can print the ALT Campus form. See screenshot for a visual of this process.
CHAM transfers
Although I’m aware we often call the CHAM transfer/logistics line and arrange ourselves, please ensure the clerical staff is aware of every transfer. Ideally it is best to go through the clerical staff for the transfer setup, whenever possible.
Patient Satisfaction
We’re re-implementing our point of care patient satisfaction survey! In a review of our Press Ganey patient satisfaction scores, it seems June took a bit of a dip compared to our usual trends (which are generally excellent!). This may have been due to the week-long saga in green zone, as the situation was less than ideal. However, let’s take this opportunity to double-down on our goal of always ensuring our patients have the best clinical experience possible here in our NCB Peds ED. Thank you all for keeping exceptional patient care as our utmost priority and ensuring our patients always feel welcome and valued!
De-escalation Skills Webex
Please see attached resources from the de-escalation skills webex earlier this month. We already do a great job with de-escalation with patients and parents (particularly behavioral health patients), but a quick refresher is always beneficial.
Downtime resources
Last week, we met to review the downtime boxes and resources available to ensure we are prepared for future downtime. Ms. Reed ensured copies were made of all forms needed (including provider notes, progress notes, after visit summaries/discharge papers), and Wiley is ensuring that the full prescription pad is available in the pyxis for downtime. Please also see the two attached resources and review to become familiar with the limited version of EPIC accessible during downtime.
COVID updates
Please see the below COVID updates from Dr. Allen:
-NYC remains on HIGH alert due to the prevalence of BA.5 (majority of virus now circulating in NYC)
-All clinical encounters with patients require an N95 respirator and eye protection
-Paxlovid is our treatment-of-choice for those who meet eligibility:
-Be age 12 years and older and weigh at least 88 pounds
-Have mild to moderate COVID-19 symptoms
-Are able to start treatment within five days of symptom onset
-Are not hospitalized due to severe or critical COVID-19 when treatment is initiated
-There is an anticipated upcoming nationwide shortage of Bebtelovimab- please use judiciously and only if Paxlovid cannot be used
-Please continue to distribute at-home test kits to patients and staff as needed
EPIC Violence Risk Alert
There will be an update implemented tomorrow, 7/27, which will include a shading of red or orange over a patient’s name on the trackboard, if that patient has a violence risk that is determined to be high or moderate, respectively. This will replace the prior “FYI” feature on the trackboard. See attached tipsheet for more details.
STI Testing
Please ensure with every beta-hCG sent (including urine qualitative testing), a gonorrhea/chlamydia test is also sent, for all patients 16yo and above.
Arts in Medicine
Please see attached flyer on an Arts in Medicine opportunity for self-care here at NCB next month. Please let me know if you would like to RSVP to attend, and I can let Ms. Tiburcio know, as she is looking for a head count by the end of the week, if possible. If working clinically at that time, would need coverage for that hour, as it is occurring in-person this time. However, we’ve been told future events may be able to take place remotely, picking up a kit beforehand; we’ll keep you updated!
PA Student
Please welcome our new PA student, Sarah, who started her rotation today. Her schedule can be found at the below link. Please include her on any interesting cases and enrich her educational experience as much as possible, even if not an “assigned” preceptor for a particular day. Thanks to everyone for your excellent teaching; it’s a wonderful opportunity for the students to benefit from your wealth of knowledge!
https://docs.google.com/spreadsheets/d/1WEVQXXb6c9Uiigs_FK0r4M1vgbrfcNHUtb1aly0deNM/edit?usp=sharing
Pathway to Excellence Celebration
Tomorrow, July 27th, there will be a celebration (including food and refreshments!) for all NCB staff, marking the start of the hospital’s application for it’s “Pathway to Excellence” designation for excellent patient care. Please feel free to join the kickoff festivities at the following times/locations:
-Ceremony: 10a-12p in the 17th floor auditorium (Rm 1718)
-Food and Refreshments: 1p on the 2nd floor patio
-Food and Refreshments: 7p in the 17th floor auditorium (Rm 1718)
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05/19/22 - For all Sexual Assaults that you are not calling Dr Jimenez on, please do the following:
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05/10/22
1. Our Joint Commission visit has been scheduled. Please remember:
a. Personal belongings should need to be put away and out of sight (e.g. bags). Please place them in your locker or in the break room or minimize what you bring.
b. There should be no food or drink anywhere at the workstations.
c. Remember there is a poster with the past PI projects along the wall near the head nurses office. Also the upcoming PI projects for this year are:
----1. reducing radiation for children with suspected appendicitis.
----2. increasing mychart usage in PED patients.
2. COVID is surging now (6% --> 13%):
a. Hospital policy is to wear an N95 and eye protection for every patient encounter.
3. There will be CT down time on 5/11 from 12p to 5pm. Consider transfer to Jacobi for emergent scans.
4. Vaginitis swab- please use if performing a pelvic exam. There has been an increase in BV noted since these swabs have began being used.
5. Transfers to Monte - please remember every effort should be made to keep patients in the system and to admit patient to Jacobi. Let me know if there are any issues.
6. New Resuscitation Medication signage- I created 3 new signs for the resuscitation room similar to what is over at Jacobi Peds ED. I reviewed the signs with pharmacy and Dr Cunningham. The signs are now being printed and should come over soon. I'm working with Carrie Shumway to make this happen.
7. Omnipaque shortage- I am sure you have received e-mails regarding the nationwide shortage of IV and oral omnipaque contrast for CT scans. I am working on a protocol for appendicitis scans with Dr Goldwasser and Dr Blumberg. I will get this to you in the next few days.
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Prior to 5/10/22
--> Return to work guidelines after COVID are placed under the Schedules tab above.
-> You can now access the radiology techs for ultrasound, CT, and MRI via EPIC secure chat! The groups are called “NO Radiology Ultrasound Dept”, “NO Radiology CT Dept” and NO Radiology MRI Dept”.
-> When an ACS form or other social work form is filled out, please place it in the social work/ACS form bin on the wall at the provider desk. Then email NCB SW (see update email for contact info) to make them aware of the form.
-> Please ensure when we place a referral for GI, we are entering an order for “ambulatory referral to NO Gastroenterology Peds” (not JA). This will then fall into a queue for GI to make the appointment.
-> In order to improve on safety concerning visitors in the ED, there is a new workflow being implemented at E-fast! This will involve all visitors (including parents of patients!) receiving a visitor pass sticker from e-fast before being allowed to enter the ED. We will continue with the one visitor per patient rule as well. Go live date of December 6th!
-> Please remind respiratory therapy as needed that we do indeed have high flow and BiPAP capabilities for all peds patients, including those <20kg. If there is any confusion about this on their end, we can show them our available equipment for these smaller patients (in the ED equipment room, along with a high flow machine), as well as ask they contact their supervisor, if needed to clarify.
-> There are some updates in EPIC that you may have noticed starting 11/17 for patients with sickle cell disease. There is a new SCD navigator to document hydroxyurea use, a smartform that shows the disease history and assessments, as well as a pain management reference for ED providers! Please see the tip sheet in update email for more details!
-> You can find trainings for the "Good Catch" reporting system now in ELM/peoplesoft, just search for the word "VOICE" to sign up for one of these training opportunities!
-> Please ensure for ambulatory referrals to clinic, we are selecting NCB primary care pediatrics, not primary care alone. “Primary care” defaults to adults, therefore it’s important to select “NO Primary care peds” specifically.
-> Please see Peds COVID-19 vaccine frequently asked questions, the flyer attached to the update email. You can also see the other vaccine FAQ flyers at this link: https://ess.nychhc.org/QandA.html.
-> For opioid addicted patients, buprenorphine can be a great tool in their care to prevent opioid overdose. If you are interested in getting x-waivered to prescribe buprenorphine, you can apply at the following link for the 30 patient waver, no training or fee required: https://buprenorphine.samhsa.gov/forms/select-practitioner-type.php. There is also an approximately 50 minute lecture from 2018 here (https://www.youtube.com/watch?v=XxNwwioqTlA) if you’d like to learn more about buprenorphine!
-> Please see list of outpatient addiction services attached to update email. Also, if you place a CATCH consult, this notifies the addiction services team and connects them with your patient. To place this order, in the Dispo section, order “IP consult to addiction services/catch team” under the Database tab.
-> You may have noticed that starting 11/17, decision support for radiology orders went live. This is for CT and MRI, and the main change is that a BPA will pop up recommended exams for the indication chosen. I’ve attached a tipsheet to the update email with further detail.
COVID, PPE, and COVID testing
COVID numbers are rising, in our peds ED patients, the community, and our team. Our testing positivity rate increased to 15.9% in August, and this month it is 22.2%, to date. To protect ourselves and others, please make sure to wear your mask at all times when in the ED, wash in and wash out as usual, and, if you prefer, consider wearing an N95 with patient interactions.
OHS now offers COVID testing for staff. OHS is open M-F 8a-12p, 1p-4p. They recommend to call them at 718-519-3118 to set up a nurse screening televisit, during which they can then approve you for testing. Their office is on the 6th floor, area 6B.
If you already have a positive COVID test, you can call them (718-519-3118) or email them at NCBOHS@nychhc.org, in order to receive further instruction.
CDC recommendations at this time are 5 days at home s/p positive test, and then can return to work while masked if symptoms are improving. You can see the CDC recommendations here, which includes a tool to calculate return to work date: https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html
You can also set up an appointment to receive a COVID vaccine booster, if you require one, by calling OHS as above.
They do not yet have information on the timing for the influenza vaccine this year, but we will update you when we hear more.
QA and QI/PI
We presented our quality assurance, metrics, and quality/performance improvement work at the pediatrics faculty meeting, to celebrate all of the great work you do here at NCB PED. I’ll be sharing this information with the team at our upcoming talk on Tuesday, Sept 19th at 2:30p via webex.
Good catches
If anyone has a good catch they would like to share, please enter this into the VOICE system (on the desktop), to celebrate the great work being done. This could be celebrating a peds ED team member’s good catch, or members of our interdisciplinary team. For example, we recently entered a good catch by HP in helping to deescalate a behavior health patient.
Patient food and art kits
Many of you are already aware of the wonderful collaboration we have embarked upon with Ronald McDonald House. They are providing food kits, for patients, siblings, and their parents, as well as art kits for the patients, which are recommended for each specific age group. The nurses are primarily spearheading giving out these kits at triage, so the patients and families can enjoy them as they wait to be seen, but please feel free to provide them as well, if the patient has not already received. The kits are in the peds head nurse office, and we have a clipboard on which to note how many kits are distributed (please tally as we go). Please also include a survey with each kit, which we’ve printed in English, Spanish, and Bengali, and return to the box holding the remaining kits, once completed.
April 5, 2023 Announcements
Positive Comments
Some of you may have already seen the positive comments I posted in the ED in the nurse/provider workstation area, taken from recent months of patient surveys. When you have a moment, please take a look, as these show the great appreciation our patients have for the wonderful care they receive here at NCB Peds ED!
POC Competencies
If you haven’t already, please sign your point of care competency eval as soon as possible and get it back to me. This enables us all to do guaiac testing here in the ED, rather than having to send up to the lab.
Asthma PI Project
We are currently working with peds clinic on a departmental PI project aimed at improving the care of our pediatric asthma patients. In an effort to avoid incorrectly augmenting the “asthmatic” population that the peds clinic is targeting in their efforts, please do not give a discharge diagnosis of asthma to a patient with first-time wheeze or bronchiolitis.
Our definition should follow the following criteria, as per Fleisher & Ludwig’s PEM textbook:
-acute trouble breathing and/or wheezing
-age >12 months
-prior diagnosis of asthma or history of two significant wheezing episodes
Patients meeting the above three criteria could then be given a diagnosis of asthma if appropriate. Otherwise, please use the diagnosis of “reactive airway disease”.
Nutrition course
H+H has provided a free nutrition course for anyone interested at the following link (flyer attached):
Essentials | American College of Lifestyle Medicine, Promo Code ESS-NYCHH
COVID PPE
Please see attached updated guidance re: COVID PPE. Masks are still required in all patient care areas (including the emergency department).
Transportation
H+H is rolling out a new ambulance system called Ambulanz, in addition to the ambulance designated for moving patients between JMC and NCB only. This hopefully should deepen the bench of ambulances available. Please keep us updated with any transportation issues. If you are having difficulty with the JMC transfer center, please ask the clerical staff to escalate the issue in real-time, reaching out to Carrie Shumway and Janice Halloran for assistance as needed.
Gastrograffin
As there is a ongoing evolving shortage of omnipaque, radiology has requested that our first-line oral contrast agent used be gastrograffin for CT studies requiring oral contrast.
Risk management
Please remember that if risk management happens to be involved in a patient’s care, it is important that this NOT be documented in the EMR. Their work is more supportive of our clinical team, and should not be explicitly documented, as this leads to more questions/concerns.
EMTALA Trainings
There are two upcoming EMTALA trainings, for all those interested. The available dates are Wed 4/12 at 11am-12:30pm and Tuesday 4/25 2pm – 3:30pm; there will be webex available. Please send mailto:Jarissa.Acevedo@nychhc.org an email if you are interested in attending, and which date/time.
Adolescent confidential interviews and urine pregnancy tests
When performing urine pregnancy tests and confidential HEADSS interviews for our adolescent patients, please be mindful of and sensitive to any parental concerns around these delicate issues. It is best to always provide education and reassurance that we perform urine pregnancy tests on all patients with a menses in the ED and a confidential HEADSS interview for all adolescent patients, just as their PMD would. Emphasizing the application of these processes to the entire adolescent patient population can help reassure parents that their child is not being specifically targeted in any way with these standard of care procedures.
Jan 10, 2023 Announcements
Congratulations to Ayisha!!!
We want to extend a huge congratulations to our very own Ayisha Ayinla, who has been appointed Assistant Head Nurse of the ED. Very much deserved, and long overdue, we are so happy to celebrate Ayisha’s long history of leadership being formally recognized.
SART cases
Please ensure we are all familiar with the appropriate process for SART patients. These patients can consent to have a SART evidence collection kit performed by the SART nurse, irrespective of if they would like to press charges or not. Then if they later change their decision, the opportunity is not lost as the kit will be held. Although the SART nurse should also be well aware of this information, we want to convey this to patients as their medical provider as well.
Transfers out
Just a friendly reminder to include in our notes the reason for transfers out of H+H system. We also will be moving back to asking the providers to notify the ADN in real time of each transfer out (although of course not delaying clinical care with this process).
BiPAP masks
No new change, just reminding everyone that we have pediatric biPAP masks, including small/medium/large masks, nasal masks, and infant nasal CPAP masks (also multiple sizes). These are kept in the resuscitation bay (Room 4), in the bottom right cabinet. If for any reason we don’t have enough of these supplies, please let the respiratory therapist know, and they can bring the necessary supplies with them to the ED.
Code Red
If you have any difficulties, obstacles encountered, or even minor delays in activating a Code Red Transfer, please let me know. Also please escalate in real-time to the clerical shift supervisor. I’ve again attached the transfer/admit flowsheets as reminders on the process.
PA Student
We have a new PA student, Mark Tamarin, rotating with us this month, starting today through early February. Please extend a warm welcome to him and broaden his educational experience as much as possible by including him on any interesting cases you have. This is his very first clinical rotation, so likely expect a bit of a learning curve, but he seems very pleasant and eager to learn, and I expect him to work well with our team. His schedule is as below, and I’ve designated some wonderful primary preceptors for each shift, but please feel free to share your vast clinical knowledge with him even when not directly assigned.
https://docs.google.com/spreadsheets/d/10Z28YMCAFBp1x5D8P0veSZHkAFZZuhI6XTuV-JOtzkI/edit?usp=sharing
Child Trafficking conference
Please see the following link for some great resources for child trafficking prevention education:
ct-prevention-conference.pdf (nyc.gov). I also attached the pdf of the same information.
Performance Improvement projects
I’m currently looking into which quality improvement/performance improvement projects we will focus on for 2023. Please let me know if anyone has an idea or specific passion for a possible project! I’m more than happy to explore any and all ideas, as I would ideally love our projects to arise directly from our team’s experience and suggestions.
Also please don’t forget to implement the pARC score for our r/o appendicitis patients! If you’d like a refresher on pARC and our NCB PED r/o appendicitis data, please see the following:
PARC- Pediatric Appendicitis Risk Calculator - Pediatric Emergency Room (pedser.org)12/20/22 Announcements
Megan Away
Megan will be away 12/21-12/29. Please contact Jimmy for any peds ED issues during this time.
Transfer/Admit Flowsheets
Please see new flowsheets for transfers/admissions, which you can find under "Transport Protocols" under "contact info", along with much other useful transfer information!
SW Contact updates
Please check out the updated social work contact information (see "social work" under "contact info").
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12/16/22 Announcements
Volume and LWBS
As everyone is well aware, our volume has been extraordinary recently, with the recent flu and RSV surges (see attached information on these). In November, we saw over 2000 patients, which is double that of Nov 2021. Thank you all for your hard work in serving each and every patient that presents to our doors.
As our volume has spiked, our number of patients “Left Without Being Seen (LWBS)” has also spiked, now up to 5%. I know we are all doing our best to prevent this number from climbing. Please be aware that many of our patients in this category end up bouncing back to our ED, often more ill than the previous presentation. For both the patients’ well-being and to ameliorate our current volume/flow crisis, we should be making every effort to see every patient. Please try our best to not convey an apathetic attitude towards patients walking out.
We also know that patient complaints have been rising throughout the hospital as well as in our peds ED during this surge. Please continue to put our best foot forward and maintain a high level of respect and professionalism in each and every interaction, even when tensions are high.
HIPPA and other Annual In-Services
Please be sure to complete all required in-services on ELM/peoplesoft. Particularly HIPPA, as those not completing by Dec 31st will have EPIC access denied by the system. I know there are often tech glitches with ELM functioning appropriately. I was able to troubleshoot my own by working closely with Ms. Betty Diaz-Rodriguez; see the 12/16/22 update email for her contact info, and she can help one-on-one as needed.
Toy Drive!!
If you have any toys or clothing or other items you would like to donate, please let me know and place them in the peds head nurse office. We are also reaching out to the volunteer office, but any donations are appreciated!!
Flu-like illness
All patients with a flu-like illness should be tested for COVID and influenza. Sending a cepheid test is a great way to accomplish both of these.
Admit to Jacobi
Thank you everyone for your patience in using the JMC transfer center during this time, rather than HHC. Three quick updates about this:
1) If you have a patient that needs a code red transfer, or if you have a transfer that has a very delayed ETA and would benefit from expediting, you can use the HHC transfer center as a backup.
2) In addition to the “ALT Campus Form” we complete for admits to JMC, we also need to complete the transfer cover sheet when using the JMC transfer center. This can be found in the files to the left of the clerical desk; just as a clerk for assistance if you have questions.
3) If you arrange transportation yourselves rather than through the clerical staff, you must notify the clerical staff of the impending transportation/transfer/admit. They must be aware so as to be able to track transportation times/obstacles.
Amox shortage
Please see attached AAP recommendations for the amox suspension shortage. I personally have used the capsule technique they describe for patients whose weight-based dosing can be rounded to these doses, which has worked well for many patients.
Peds Ortho
We once again have a peds ortho surgeon at JMC and NCB! Please ensure patients follow-up with ortho here at JMC/NCB whenever possible, rather than CHAM.
Candida auris
Please see attached info on Candida auris, which has been a recent global health threat.
Asthma diagnoses
Please be sure to denote asthma exacerbations in patients’ diagnoses when applicable. The clinic is working to improve the care of their asthma patients, and this helps their ability to find this cohort via the EMR.
Pregnancy termination referrals
We can now place specific referrals to “abortion and miscarriage management” clinic as a subset of GYN. I’ve attached a screenshot of the associated order to place in Dispo. Other patients requiring GYN for whom this does not apply can simply utilize the usual GYN referral.
Substance Use Disorder Team
Please remember to utilize our ED addiction services team. I asked the group, and they are happy to see our adolescents/young adults with THC abuse, which is unfortunately a large group of our patient population. I’ve attached the contact information for each individual, as well as the team’s general hours. Don’t forget, even after hours we can place an inpatient consult to “ED LEADS” and the team will follow-up the next day.
Transfers to JMC CPEP
We have had some success recently with transfers to JMC CPEP for our behavioral health patients requiring overnight stay while awaiting either reassessment in the AM or INPT placement for admission. This can occur when the JMC CPEP has less than 4 patients under 18yo. Please continue to use this avenue for opening up some space in our medical peds ED especially during these high volume times. Let me know if you have any issues.
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10/12/22 Updates
Flu vaccine
The flu vaccine is now available! We have the Fluarix quadrivalent vaccine, for patients 6 months and older, stocked in pyxis. Attached is the algorithm for patients requiring a second dose. For our team, flu vaccine is available via OHS (walk-in 8a-4p M-F on 6th floor, 6B OHS, 718-519-3118), or Wiley has flu vaccines available to give to staff as well. If you do not wish to receive flu vaccine, please sign the waiver; the forms are available at OHS, and Wiley has forms as well.
Ebola
Please see the attached fact sheet on Ebola, as well as the donning/doffing checklists.
Admits to Jacobi
For admissions to Jacobi, the transfer can be arranged one of two ways:
1) Via the HHC transfer center, who will call us back for signout
2) Via the Jacobi transfer center; we need to call the team (INPT admitting resident or ED attending or PICU attending) to give signout ourselves.
-Code red can be called either via the HHC transfer center, or we can call Empress directly (which would necessitate our calling to give signout ourselves).
-The clerical staff can arrange all of the above transportation, we should only need to give clinical signout, no matter which transfer center is used. However, if you do arrange transportation yourself, you need to make the clerical team aware.
Transfer to JMC CPEP
Please remember that for patients awaiting INPT psych placement, we can transfer to JMC CPEP, if they have 4 or less peds patients at that time. In order to achieve this, please call the JMC CPEP attending and discuss the case. They will then contact their chair and/or director for approval. Please let us know about any cases for whom this doesn’t go smoothly.
Follow-up
Day teams, please make sure we are doing the follow-ups, and noting their completion in the follow-up binder accordingly. Please ask me if you have any questions on how to do this.
Referrals
There is unfortunately a huge delay in patients getting subspecialty appointments, sometimes several months after we place the referral. We can do our part to help alleviate this somewhat by referring only patients that absolutely cannot be followed by the primary care doctor and therefore require a subspecialist.
The following diagnoses can be followed by the patient’s PMD:
-Constipation
-Chronic abdominal pain
-Failure to thrive
-Obesity
-Polycystic ovary syndrome
-Stable proteinuria without hematuria
-Mild hypertension
-Eczema
For the above diagnoses, or others that may be followed by PMD according to your clinical judgment, please do the following:
-For patients of NCB peds clinic, advise the patient/parent to reach out to their PMD via Mychart for an appointment. If they do not have mychart, they can call the appointment line at 718-918-5700.
-For patient with an outside PMD, advise the patient/parent to reach out to their PMD directly for an appointment.
Finally, for any patient requiring a subspecialist referral, please make sure to ask the patient/family if they would like to (as well as are able) to follow-up with an NCB/JMC specialist before making a referral. Let me know if you have any questions at all.
Clinic follow-up appointments
We now should have access to both in-person as well as televisit follow-up appointments for our patients, up to 72hrs after the ED visit. Patients requiring resp checks can use these regular appointments, they do not require asthma-specific appointments. For more complicated asthma patients requiring a pulmonary subspecialty visit, you can continue to refer to Dr. Serebrisky (peds pulm). Please let me know if there is any problem in obtaining the ED follow-up appointments, and we can escalate the issue.
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9/27/22 from Megan
Welcome Brigette!
We are very happy to announce that Brigette Bernhardt is starting the transition to work fully as an NCB NP! We’re ecstatic to have her officially join the NCB Peds ED family, so please help us to welcome her as she gets settled here after several months over at Jacobi.
COVID booster
The bivalent booster is available; you can schedule an appointment for vaccination at this link: COVID-19 Vaccination Scheduler (nychealthandhospitals.org), and choose “NO OHS” in the scheduling options for NCB. I’ve also attached a FAQ on the booster.
Peds EM Conference
Please see the following link for a free conference on Thursday, September 29th, covering pediatric emergencies, with up to 8 hrs of CME credit.
Pediatric Emergencies: Early Assessment & Treatment of Children (cecentral.com)
Respiratory Illnesses
We have been seeing so many patients with severe respiratory disease lately, and there have been a hefty majority of our patients testing positive for human rhino/enterovirus. Please see attached notification from DOH re: this recent increase in severe respiratory illnesses associated with rhinoviruses and enteroviruses.
Transfers Out
There has been an increase in transfers to CHAM recently from our ED. Please try our best to keep patients going to Jacobi as much as possible. Of course, for unstable patients, or those for whom the required services are not available at Jacobi, or those parents that strongly request CHAM over Jacobi, we can transfer to CHAM as needed, to do what’s best for our patients. But for the large majority, please ensure our default is Jacobi admissions/transfers, whenever possible. If we do need to transfer outside to CHAM, please notify the ADN at the time of transfer.
Code Red
A reminder that we can call a code red for more emergent, expedited transfer to Jacobi for specific high severity cases (such as severe resp patients on BiPAP or HFNC, major trauma patients, suspected testicular torsion, confirmed intussusception, etc). I’ve attached the guide as to how to call Empress to initiate this, when needed.
Nebulizers
When giving out nebulizers from the ED, please ensure you complete the form, in the head nurse’s office, as well as print out a patient facesheet and a prescription. Then place these three stapled together in the nebulizer folder. The nebulizer prescription can be found in EPIC under a search for “compressor”.
Lyft services
We have an exciting new resource available for some of our most vulnerable patients needing transportation from the ED. There is now a Lyft cab service for patients deemed eligible by our clinical team. These would include patients such as SART cases, victims of assault, DV cases, child abuse with significant injuries or intense emotional distress, sexual abuse cases. Please see attachment which includes standard work flow for this service, as well as on the second page lists the qualifying criteria. Please use the dotphrase “.ncbedlyft” in your note to document your reason for using this great service. A quick breakdown of the standard workflow for this:
- The Providers must wait until the patient’s care is 100% complete and the patient is ready to walk out the door to refer Lyft transportation requests -the cabs come quickly!
- The Unit Clerks will call admitting and request the Lyft-providing the patient’s name, tel #, and the patient’s drop-off address—unit clerk will stay on the line and receive the Lyft car info at once (Driver Name and License Plate) and immediately hand this info off to the patient.
- Nursing staff will escort the patient out to the Hospital Main Entrance 3424 Kossuth to await the Lyft arrival and see that the patient gets in safely. A clerk may accompany the patient/nursing staff if requested.
- The Unit Clerk will document the transportation on the log.
Asylum Seekers
Please see attached NYC H+H information on resources for asylum seekers and newly arrived immigrants (both guidance for providers as well as appendix with resources).
Adolescent Health Conference
NYC H+H is holding the adolescent health conference on October 26th, 8a-5p. You can register at the link on the attached flyer.
Sexual Assault Conference
The second annual sexual assault regional conference at Jacobi is being held on Wednesday, October 12th, 7:30a-2:30a. Free CME available; see attached flyer for more information, and you can either scan the QR code for registration link or register at the following: https://ww2.highmarksce.com/nyh/activity/1173.
Monkeypox
For more information on Monkeypox, see attached NEJM article as well as attached technical bulletin from Northwell on how to collect specimens for possible cases.
Childhood Literacy
There is a webinar “Beyond Books: Early Childhood Literacy is Public Health”, part of the Pediatrics for an Equitable Developmental Start Network Learning Collaborative Webinar Series, that will take place Wednesday, 9/28, 1p-2:15p. Click on the link below to register.
Register Here
Paxlovid
NCB pharmacy now has paxlovid available, also in ED pyxis. Please see attached screenshot for how to order Paxlovid in EPIC, to give one dose in ED and a packet to take home. Eligible patients are those 12yo and above, weighing at least 40kg, with a known risk factor (such as asthma) for progression to severe COVID. Please see attached fact sheet for more information.
Pharmacy
NCB outpatient pharmacy now accepts commercial insurance plans, in addition to patients without insurance.
Zumba and Yoga at NCB
H3 (Helping Healers Heal) is hosting Zumba and Yoga classes in October and November. The classes take place on Wednesdays at 5pm, on the 12th floor in the dining room, 12A-02. Zumba will be held in October (10/5, 10/12, 10/19, 10/26) and Yoga will be in November (11/2, 11/9, 11/16, 11/23). Please register using this link: http://airtable.com/shrTJHHZjr7uvpOVL . Email tiburcid@nychhc.org
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8/21/22
Megan Away
I will be away tomorrow, August 22nd, through Sunday, September 4th. For any peds ED-related issues, please email me, and I will address upon my return, or for more urgent matters, please also reach out to Jimmy.
Lactation Room
We understand that the interview room can be a very useful area, both for provider computer use as well as for RN breaks, etc, when it is available. However, please be mindful that it is designated as a lactation space for nursing mothers, patients and/or staff. If someone needs to use the room for this purpose, for nursing and/or pumping, please ensure we are gladly and quickly turning over the space to this person without difficulty.
Monkeypox
Please see the following link for a great summary for peds for monkeypox: Clinical Considerations for Monkeypox in Children and Adolescents | Monkeypox | Poxvirus | CDC.
Back to School Healthfair
The Annual NCB Back-to-School Healthfair will take place on Thursday, August 25th, 11a-2p, on Kossuth Avenue. Please join in to celebrate with our patients!
Follow Up
Just a quick reminder to everyone on how to do our daily follow-ups in EPIC. I’ve attached the policy for follow-up, which has great step-by-step instructions on how to complete follow-up, and can also be found on the intranet.
CME Policy
Please review the attached PAGNY CME policy for using CME hours. Of note, please ensure CME hours are completed on a weekday, not the weekend, and send your CME form to be approved to rosangela.foitl@nychhc.org (cc'ing Jimmy and I) prior to completing your CME time.
Hypertension in Pregnancy
Please see attached key points for hypertension in pregnancy. This is a topic that we don’t often see in peds, but critically important to address when we are presented with such a patient.
PPE
Please ensure we are using appropriate PPE. For all patient encounters, wear an N95 and eye protection. For suspected monkeypox cases, please add gown and gloves to this PPE standard.
Peds Surgery
Two important reminders about peds surgery. First, please ensure any patients <18yo requiring clinic follow-up with surgery receive referrals for Jacobi appts, as there is only adult peds surgery clinic here at NCB. Second, if a patient <18yo requires a surgical consult, particularly with a strong likelihood of requiring surgical intervention, please give signout to and transfer to JMC Peds ED, where the attending can call peds surgery at Jacobi. This helps to avoid any confusion between JMC and NCB surgery teams’ coverage, which can put our providers in a difficult position. We will let you know if our NCB peds surgery capabilities change, as we are in the process of looking into the best solution for our patients.
Ortho
Please continue to let me know about any issues with the ortho on-call service. To be clear, we do not have plastic surgery available at NCB, so for hand consults, the service consulted should always be ortho. We also should not transfer to JMC just for ortho consult, unless the patient requires operative management or admission. If you have any difficulty with obtaining in-person consultation when needed, please escalate as appropriate to the on-call ortho attending. Please also let me know, including MRN of patient, via PHI-safe nychhc email.
EPIC patient status
Please see attached EPIC tipsheet on new EPIC trackboard updates to patient status colors.
Visitor policy
Our visitor policy is still restricted to one parent per patient, due to ongoing COVID restrictions. This parent must be wearing a visitor pass, as distributed by e-FAST. If you note anyone in the ED not wearing a hospital ID, a visitor pass, or an EMT/NYPD uniform that is not a patient, please help us to identify them and either escort to e-FAST and/or obtain a visitor pass. Adhering to this policy can help immensely with workplace safety in the ED.
FEMA Decon training
There are FEMA trainings available to those interested in a week-long intensive session learning more about decontamination, mass casualty incidents, and more ED-specific scenarios. Please see attachment for more information, provided to us by our associate director of operations and emergency preparedness coordinator, Carrie Shumway (shumwayc@nychhc.org).
Tobacco and Nicotine Use Webinar
Please see attachment for more info on an available webinar next Wednesday, covering nicotine use in our adolescent and young adult population.
Abbreviations
Please see the attached list of approved medical abbreviations. Please refrain from using any abbreviations outside of this exhaustive list in our EMR documentation.
Annual Training
Please ensure your annual required trainings are complete on peoplesoft. See attachment for more information.
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7/26/22
From Megan:
A/C in the ED
Speaking of the heat wave, thank you everyone for bearing with us as we had some cooling issues in the ED this past week. Engineering has assured us that the problem should be resolved going forward, but if for any reason you again note an abnormal temp in the ED, please call Engineering at 5-3560 as well as put in a Maintenance Connection ticket.
DOH Monkeypox updates
Please see the following video for DOH monkeypox updates: Monkeypox Guidence Updates for Healthcare Providers, July 14, 2022 - YouTube. Of note, the rule-out cases they’ve been seeing at Jacobi Peds ED have often been a case of Enterovirus, so make sure to send an RVP on any rule-out cases, as well!
Transfer paperwork
For patients going to JMC (ED/INPT/PICU), we no longer need to fill out any paperwork for the transportation process. Just print the ALT campus form that you fill out in EPIC, and give this to the clerk, notifying them of the transfer. They can then call HHC transfer center to arrange the transportation, no other paperwork necessary.
In order to print the ALT campus form, go to the “Notes” tab, then under “Other” along the left-hand side, click “Discharge Documents”. There you can print the ALT Campus form. See screenshot for a visual of this process.
CHAM transfers
Although I’m aware we often call the CHAM transfer/logistics line and arrange ourselves, please ensure the clerical staff is aware of every transfer. Ideally it is best to go through the clerical staff for the transfer setup, whenever possible.
Patient Satisfaction
We’re re-implementing our point of care patient satisfaction survey! In a review of our Press Ganey patient satisfaction scores, it seems June took a bit of a dip compared to our usual trends (which are generally excellent!). This may have been due to the week-long saga in green zone, as the situation was less than ideal. However, let’s take this opportunity to double-down on our goal of always ensuring our patients have the best clinical experience possible here in our NCB Peds ED. Thank you all for keeping exceptional patient care as our utmost priority and ensuring our patients always feel welcome and valued!
De-escalation Skills Webex
Please see attached resources from the de-escalation skills webex earlier this month. We already do a great job with de-escalation with patients and parents (particularly behavioral health patients), but a quick refresher is always beneficial.
Downtime resources
Last week, we met to review the downtime boxes and resources available to ensure we are prepared for future downtime. Ms. Reed ensured copies were made of all forms needed (including provider notes, progress notes, after visit summaries/discharge papers), and Wiley is ensuring that the full prescription pad is available in the pyxis for downtime. Please also see the two attached resources and review to become familiar with the limited version of EPIC accessible during downtime.
COVID updates
Please see the below COVID updates from Dr. Allen:
-NYC remains on HIGH alert due to the prevalence of BA.5 (majority of virus now circulating in NYC)
-All clinical encounters with patients require an N95 respirator and eye protection
-Paxlovid is our treatment-of-choice for those who meet eligibility:
-Be age 12 years and older and weigh at least 88 pounds
-Have mild to moderate COVID-19 symptoms
-Are able to start treatment within five days of symptom onset
-Are not hospitalized due to severe or critical COVID-19 when treatment is initiated
-There is an anticipated upcoming nationwide shortage of Bebtelovimab- please use judiciously and only if Paxlovid cannot be used
-Please continue to distribute at-home test kits to patients and staff as needed
EPIC Violence Risk Alert
There will be an update implemented tomorrow, 7/27, which will include a shading of red or orange over a patient’s name on the trackboard, if that patient has a violence risk that is determined to be high or moderate, respectively. This will replace the prior “FYI” feature on the trackboard. See attached tipsheet for more details.
STI Testing
Please ensure with every beta-hCG sent (including urine qualitative testing), a gonorrhea/chlamydia test is also sent, for all patients 16yo and above.
Arts in Medicine
Please see attached flyer on an Arts in Medicine opportunity for self-care here at NCB next month. Please let me know if you would like to RSVP to attend, and I can let Ms. Tiburcio know, as she is looking for a head count by the end of the week, if possible. If working clinically at that time, would need coverage for that hour, as it is occurring in-person this time. However, we’ve been told future events may be able to take place remotely, picking up a kit beforehand; we’ll keep you updated!
PA Student
Please welcome our new PA student, Sarah, who started her rotation today. Her schedule can be found at the below link. Please include her on any interesting cases and enrich her educational experience as much as possible, even if not an “assigned” preceptor for a particular day. Thanks to everyone for your excellent teaching; it’s a wonderful opportunity for the students to benefit from your wealth of knowledge!
https://docs.google.com/spreadsheets/d/1WEVQXXb6c9Uiigs_FK0r4M1vgbrfcNHUtb1aly0deNM/edit?usp=sharing
Pathway to Excellence Celebration
Tomorrow, July 27th, there will be a celebration (including food and refreshments!) for all NCB staff, marking the start of the hospital’s application for it’s “Pathway to Excellence” designation for excellent patient care. Please feel free to join the kickoff festivities at the following times/locations:
-Ceremony: 10a-12p in the 17th floor auditorium (Rm 1718)
-Food and Refreshments: 1p on the 2nd floor patio
-Food and Refreshments: 7p in the 17th floor auditorium (Rm 1718)
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05/19/22 - For all Sexual Assaults that you are not calling Dr Jimenez on, please do the following:
- Email Dr Jimenez through Epic or outlook.
- Send me a text message through the Epic chat.
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05/10/22
1. Our Joint Commission visit has been scheduled. Please remember:
a. Personal belongings should need to be put away and out of sight (e.g. bags). Please place them in your locker or in the break room or minimize what you bring.
b. There should be no food or drink anywhere at the workstations.
c. Remember there is a poster with the past PI projects along the wall near the head nurses office. Also the upcoming PI projects for this year are:
----1. reducing radiation for children with suspected appendicitis.
----2. increasing mychart usage in PED patients.
2. COVID is surging now (6% --> 13%):
a. Hospital policy is to wear an N95 and eye protection for every patient encounter.
3. There will be CT down time on 5/11 from 12p to 5pm. Consider transfer to Jacobi for emergent scans.
4. Vaginitis swab- please use if performing a pelvic exam. There has been an increase in BV noted since these swabs have began being used.
5. Transfers to Monte - please remember every effort should be made to keep patients in the system and to admit patient to Jacobi. Let me know if there are any issues.
6. New Resuscitation Medication signage- I created 3 new signs for the resuscitation room similar to what is over at Jacobi Peds ED. I reviewed the signs with pharmacy and Dr Cunningham. The signs are now being printed and should come over soon. I'm working with Carrie Shumway to make this happen.
7. Omnipaque shortage- I am sure you have received e-mails regarding the nationwide shortage of IV and oral omnipaque contrast for CT scans. I am working on a protocol for appendicitis scans with Dr Goldwasser and Dr Blumberg. I will get this to you in the next few days.
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Prior to 5/10/22
- Emergency Preparedness: There is a hospital-wide emergency alert system that will contact you via text and/or e-mail to let you know when there is a disaster, active shooter, etc. Everyone is encouraged to sign-up for Everbridge Emergency Alerts, and update their contact info.
- Joint Commission Evaluation
- Please familiarize yourself will all of the NCB Peds ED policies.
- Go to the intranet --> Facility --> North Central Bronx --> Policy and Procedures --> Children Health Service Emergency Department.
- Please make sure all of your mandatory online courses are completed ASAP- annual in-service, sex trafficking, etc.
- Please familiarize yourself will all of the NCB Peds ED policies.
- Nebulizers
- If you take a nebulizer from Chu's office for a patient. You must fill out the paperwork. I've been made aware of several patients where the paperwork was not filled out and the company who supplies the nebulizers was not reimbursed. If the paperwork continues to not be filled out, the supplier will stop giving us nebulizers. So please fill out the paperwork each and every time.
- Website
- Please check the site frequently for these updates, the current schedules, and for each week's educational conference recording.
--> Return to work guidelines after COVID are placed under the Schedules tab above.
-> You can now access the radiology techs for ultrasound, CT, and MRI via EPIC secure chat! The groups are called “NO Radiology Ultrasound Dept”, “NO Radiology CT Dept” and NO Radiology MRI Dept”.
-> When an ACS form or other social work form is filled out, please place it in the social work/ACS form bin on the wall at the provider desk. Then email NCB SW (see update email for contact info) to make them aware of the form.
-> Please ensure when we place a referral for GI, we are entering an order for “ambulatory referral to NO Gastroenterology Peds” (not JA). This will then fall into a queue for GI to make the appointment.
-> In order to improve on safety concerning visitors in the ED, there is a new workflow being implemented at E-fast! This will involve all visitors (including parents of patients!) receiving a visitor pass sticker from e-fast before being allowed to enter the ED. We will continue with the one visitor per patient rule as well. Go live date of December 6th!
-> Please remind respiratory therapy as needed that we do indeed have high flow and BiPAP capabilities for all peds patients, including those <20kg. If there is any confusion about this on their end, we can show them our available equipment for these smaller patients (in the ED equipment room, along with a high flow machine), as well as ask they contact their supervisor, if needed to clarify.
-> There are some updates in EPIC that you may have noticed starting 11/17 for patients with sickle cell disease. There is a new SCD navigator to document hydroxyurea use, a smartform that shows the disease history and assessments, as well as a pain management reference for ED providers! Please see the tip sheet in update email for more details!
-> You can find trainings for the "Good Catch" reporting system now in ELM/peoplesoft, just search for the word "VOICE" to sign up for one of these training opportunities!
-> Please ensure for ambulatory referrals to clinic, we are selecting NCB primary care pediatrics, not primary care alone. “Primary care” defaults to adults, therefore it’s important to select “NO Primary care peds” specifically.
-> Please see Peds COVID-19 vaccine frequently asked questions, the flyer attached to the update email. You can also see the other vaccine FAQ flyers at this link: https://ess.nychhc.org/QandA.html.
-> For opioid addicted patients, buprenorphine can be a great tool in their care to prevent opioid overdose. If you are interested in getting x-waivered to prescribe buprenorphine, you can apply at the following link for the 30 patient waver, no training or fee required: https://buprenorphine.samhsa.gov/forms/select-practitioner-type.php. There is also an approximately 50 minute lecture from 2018 here (https://www.youtube.com/watch?v=XxNwwioqTlA) if you’d like to learn more about buprenorphine!
-> Please see list of outpatient addiction services attached to update email. Also, if you place a CATCH consult, this notifies the addiction services team and connects them with your patient. To place this order, in the Dispo section, order “IP consult to addiction services/catch team” under the Database tab.
-> You may have noticed that starting 11/17, decision support for radiology orders went live. This is for CT and MRI, and the main change is that a BPA will pop up recommended exams for the indication chosen. I’ve attached a tipsheet to the update email with further detail.