Farrell Updates

Administrative PTO

Joanne Dempster will be away on 4/7-4/8 and 4/17-4/18 - Dr Julie Berenyi will cover for issues except on 4/18 (coverage TBD)

Julie Berenyi will be away on 4/11 and 4/18 - Joanne Dempster will cover on 4/11.  Coverage for 4/18 (TBD)

Healthy Steps - patient instructions:

The healthy steps team created some epic patient instructions for various topics ie...positive parenting, sleep, tantrums etc....

Dr Berenyi added them to her dot phrases, and we encourage you to take them. They are listed under .acnpedshs

Social work update

New social worker: Elizabeth "Beth" Vazquez

The last day for Emily Enriquez was Friday March 14th.  Thank you Emily for your dedication to our Farrell patients !!!

Our social work team began working one day remotely from Monday, March 17th, 2025. 

SW Julia: remote on Wednesdays

SW Beth: remote on Tuesdays

SWA Raheem will be remote on Fridays

Provider Templates

Providers may see their NEW OB slots converted to regular patient slots in order to accommodate their continuity patients off their waitlist.

Washington Heights public health threat announcement

The memo sent below from our Emergency Department.  Unfortunately the attachments did not come through with the message.

In Washington Heights, please be advised that there may be large quantities of zinc phosphide being sold in our neighborhood. Phosphides are highly dangerous pesticides that release phosphine gas. This is an illegal pesticide, which is why most clinicians have little experience with this class of poisons in the United States. Phosphide use in residential areas has led to deaths of entire families due to the poison gas filling residential spaces:

https://www.google.com/amp/s/amp.cnn.com/cnn/2017/01/02/us/amarillo-texas-pesticide-deaths

I'm attaching photos I took of packages of zinc phosphide on 181st street and St Nicholas. The package is yellow and depicts the character "Remy" from the movie Ratatouille. There are hundreds of these packages being sold. This material is sadly already in our community, and I expect we will see serious illness and possibly fatalities related to it. Without violating HIPAA, I am aware of at least 1 fatality related to this product in the past month.

Signs and symptoms of phosphide poisoning include multi-organ system dysfunction, shock, notable lactatemia (often greater than 10), seizures/AMS, and cardiogenic shock. Patients may arrive individually or in groups. Consider phosphine poisoning in critically ill patients without clear etiology. Fatality rates of phosphide poisoning are in excess of 50%.

There is no specific antidote for phosphide poisoning, however, standard critical care, insulin/dextrose infusions, and ECLS have been used. See Adel et al., attached.

Onset is typically abrupt with phosphide ingestion, but may be insidious when individuals are exposed to phosphine gas.

I'm attaching a review article by Proudfoot. If you have any questions, please call or text me or the NY poison center at 1-800-222-1222. The poison center is a 24-hour help line where you can speak with a medical toxicologist.

MRI Orders

A reminder to do the following when you are considering an MRI to avoid ordering the study when it is contraindicated.

1. Verify by history that the patient has no known metal hardware.

2. Review the chart especially in the surgical history that there patient does not have metal hardware.

3. Update the problem list with the problem "MRI contraindicated due to metal implant" so that it is not missed.

Orders

A reminder to providers to place recurring orders when appropriate for orders such as B12 or Depo-Provera for nursing.  This significantly improves the flow and experience for patients and nurses.

Forms

For patients who need to have the original form and not a copy to be sure to place a sticky note on the original form so that staff is aware that the original form is needed and does not get shredded after it is uploaded in Media.

If you leave an envelope at the front desk for a patient to pick up besides the patient's name, please include the MRN to avoid any mix-ups with patients who have the same name.

Billing and coding

G2211 Code update (article attached)

Farrell Unified Project: next meeting Thursday, April 3rd, 8 - 8:45 am 2nd floor conference room.  Breakfast will be served. 

Thank you for the work that you do to provide excellent care to our patients and create a great work environment for each other despite the challenges we face daily. We are dedicated to improving the experience and outcomes for everyone.

FRL SW-IMP workflow guidance_Farrell_January_20… 

ACN Communicable Disease Screening Algorithm.pdf 

HOUSE_STAFF_MENTAL_HEALTH_FLYER.pdf 

Wellness

NYPBeHealthy Wellbeing Coaches are here to support your wellbeing. They offer personalized, complimentary, onsite or virtual wellbeing coaching on various topics, including enhancing resilience, work-life harmony, healthy eating, weight management, and more! Reach out directly to a Wellbeing Coach or email nypbehealthy@nyp.org to set up a coaching session or learn more about available resources designed to support your wellbeing.

Administrative PTO

Joanne Dempster will be away 1/21-1/24.  Dr Julie Berenyi will cover.

Lab cut off times

The cut off time for labs for the PM session is at 5pm and for the EVE session is at 6:40 pm.  

Isolation recommendations

see the ACN screening guidelines attached.

Condolence cards

The ACN provided condolences cards if needed for any of your patients if either the patient or a family member passed away.   The cards are in Pamela's office.

Re: Patients with an isolation status.

The provider should send a secure chat to the PFA letting them know if the patient is no longer on ISO before sending them to the front desk.

OB patients with new GDM diagnosis.

To help facilitate an earlier appointment with a Diabetes Educator for DSME:

Upon GDM diagnosis, provider will enter orders for:

- testing supplies (glucometer, lancets, testing strips, alcohol pads)

- DSME

- Perinatal consult using the Preference list "Diabetes in Pregnancy Perinatal Program".

·       the MFM PFA's picks up both of these referrals and schedules DSME (within 3-5 days with next available Diabetes Educator

·       MFM PFA's will schedule Perinatal MFM consult 1-2 weeks after initial DSME in Wednesday clinic (in-person or virtual).

Vaccines

The last day for vaccinating OB patients for RSV is on January 31st 2025 until the next season. 

The timeframe for the Meningococcal B vaccine has changed for the 2nd changed to 6 months after the first dose.

Forms

Forms should be routed to Norma David for completion.  

A reminder that Home care forms need an attending signature

Food Challenge

We unfortunately are not able to perform food challenges at Farrell.  For patients needing this service, they can be referred to the Allergy clinic.

Results Managment

Providers should not send messages to the  nursing pool to call patients to discuss normal results.  For normal results if the provider is not able to reach the patient, a message can be sent via connect or letter.  Nurses are able to relay messages for abnormal results however are not able to relay abnormal genetics results.

See the attachment for a reminder of appropriate nursing referrals

Attending Schedules - High risk slots

Please note the following regarding the 11 am high risk attendings

• Should always be 40 minutes

• Does not need provider approval

• Can be used for any patient (peds, OB, post partum, adult)

• If a provider requests, it can be split into 2 -20 minute slots.

IMP services change

Juan de Marchena’s last day at NYP was last week.

Please follow the attached guidance document and pause referrals to Social Work Mental Health for now.

Instead, please refer to Farrell Social Work or Farrell Adult Psychiatry – Onsite.

The next meeting for the Farrell Unified Project is Thursday January 30th from 2-3:30 pm 

If you are not able to meet in person in the second-floor conference room see the meeting link below.

Link for lectures

https://columbiacuimc.zoom.us/j/132240397?pwd=WWNMNlJsV2FIWGFPbktTNjZieFBaZz09 

password 960575

 One tap mobile

+16465588656,,132240397# US (New York)

Transportation

Medicaid Transportation (MAS) Guidelines for Providers and Clinic Staff

Overview of MAS Transportation and Social Work's Role:

• Scheduling Rides: Patients are responsible for scheduling their own transportation rides 72 hours in advance through Medicaid transportation. Social work assists by helping doctors complete the necessary forms, but patients must handle their own ride scheduling.

• When Social Work Assists: Social work gets involved only if a patient needs assistance with rescheduling a ride after a scheduled trip to the clinic or has trouble returning home after an appointment. In such cases, social work can support with rebooking.

Scheduling and Confirming Rides:

• Clinic Staff Can Call for Rides: If clinic staff needs to schedule transportation for a patient (for example, for return trips), they can contact Medicaid transportation by calling 1-844-666-6270.

  • Important: When calling, you need to confirm the patient’s visit by stating that you work at New York Presbyterian.

• Referral for Social Work Assistance:

  • Paula (Adults) and Raheem (Pediatrics/OB) are the main social work assistants handling transportation requests.

  • If neither is available, Emily or [Your Name] (you) can be contacted via secure chat for clarification or assistance.

Handling Transportation Issues (Same-Day Requests & Medical Necessity):

• Same-Day Requests:

  • If a patient requires a ride home from the clinic and did not have transportation arranged for the appointment, they need to have a follow-up appointment scheduled at the clinic (this is typically not a same-day appointment).

  • In this case, the patient will need to return home via the method they used to get to the clinic.

• Medical Necessity for Same-Day Transportation:

  • If a patient has Medicaid and a visible medical necessity (e.g., in a wheelchair, blind, etc.), social work will attempt to arrange a same-day ride. However, this is not guaranteed, and the patient’s eligibility will need to be confirmed by Medicaid Transportation (MAS).

Assessing Transportation Requests at the Front Desk:

When a patient approaches the front desk with a transportation-related question, the following steps should be taken:

1. How did the patient get to their appointment?

   • If the patient used Medicaid transportation:

     • Secure chat Paula (adults) or Raheem (pediatrics/OB) first for follow-up.

     • If further clarification is needed, you can also secure chat Emily or [Your Name].

   • If the patient did not use Medicaid transportation:

     • Schedule a Social Work appointment with Emily or [Your Name] to assess if a future transportation request can be fulfilled. This can be done via phone or video and is not urgent—does not need to be scheduled same-day.

2. Have transportation needs been discussed during the visit with the provider?

   • If Yes:

     • Check if a Social Work referral (SW referral) was placed. If not, please schedule a follow-up with social work. This is not urgent and can be done by phone or video.

   • If No:

     • Please schedule a follow-up with social work (either phone or video). It’s not urgent unless the patient expresses a time-sensitive need, in which case, secure chat with social work first to confirm next steps.

Important Notes:

• Same-day Requests for Transportation: Only allowed if the patient has an immediate medical need (e.g., they cannot use public transportation due to a medical condition). This is not guaranteed, as eligibility for transportation must be confirmed by MAS.

• Provider Visits & Referrals: Ensure that if a provider hasn’t discussed transportation with a patient, social work gets involved to assess and complete the necessary forms.

• General Guidance:

  • Social work referrals are generally not urgent, unless indicated otherwise by the patient’s immediate needs.

  • For urgent issues, please secure chat the social work assistants (Paula or Raheem) or Emily and Julia to clarify.

Quick Reference Chart for Front Desk Staff:

Question

Next Step

How did the patient get to their appointment?

If Medicaid transportation: Secure chat Paula/Raheem. If needed, chat Emily/Julia.

If not Medicaid transportation: Schedule Social Work follow-up appointment (not urgent).

Have they discussed transportation with the provider?

If Yes: Check for SW referral; if none, schedule follow-up (not urgent).

If No: Schedule follow-up with Social Work (phone/video).

Patient needs a same-day ride home

If they didn’t have transportation to the appointment, the patient must go home via the same method they arrived. If medical necessity is clear, a same-day ride may be attempted.

How to Reach Social Work Assistants:

• Paula (Adults)

• Raheem (Pediatrics/OB)

• For clarification, contact: Emily or Julia via secure chat.

Remember to review all Farrell Update messages and use them as a reference for key information and relevant links.  If you have questions or concerns, don't hesitate to reach out to the leadership team.

 All updates can be found on our CFCM Provider Website: https://www.cfcmresources.com/farrell-health-center/farrell-update

Wellness

NYPBeHealthy Wellbeing Coaches are here to support your wellbeing. They offer personalized, complimentary, onsite, or virtual wellbeing coaching on various topics, including enhancing resilience, work-life harmony, healthy eating, weight management, and more! Reach out directly to a Wellbeing Coach or email nypbehealthy@nyp.org to set up a coaching session or learn more about available resources designed to support your well-being.

Annual Hospital Training

The AHT this will take some time to complete, and you may need more than one sitting to get it all done.  We encourage you therefore to pace yourself.  You should also log in to be sure that you don't have any technical issues. You will be locked out of our system if you are not compliant by December 9th.

(See prior emails for details and links).

Same Day & PCE Coverage

Norma David will be away until further notice.  As a result, there are some days when we don't have Same Day and/or PCE coverage.  We are relying on volunteers to fill in the gaps.  On days when we don't have Same Day/PCE coverage, CCTC is available to provide assistance.  

Note the following - We encourage review of the Nursing and Lab tallies at least on day prior to the session to send any request needing assistance by CCTC in advance via in-basket messaging.  This will make the process easier for staff and patients if the requests are sent in advance.  If you have any questions about the workflow, please ask your direct supervisor.

• For any patient emergencies please call 911.

Beginning February 1st additional providers will be assigned to the Same Day and PCE role to avoid future gaps. The expectations above are therefore temporary until January 31st 2025. 

EPIC status

A reminder to providers to change your status to available in Epic when in session. 

Diabetes Documentation

Providers: use the smart phrase .AMBDIABETESMANAGEMENT in your notes for comprehensive documentation of diabetes care especially in your panel management sessions.

NYC Prenatal Services

NYC Nurse-Family Partnership: Personal Nurses for First-Time Parents

This free program offers personal nurse services to first-time parents in NYC who are less than 28w EGA and eligible for Medicaid or WIC. 

Provider info: NYC Nurse-Family Partnership: Information for Providers - NYC Health

General info: NYC Nurse-Family Partnership - NYC Health

Referral form: nfp-client-referral-form.pdf

IDT rounds 

IDT rounds will resume on the week of December 1st.

You will receive more details regarding the new workflow and the new zoom link. 

Updated IDT/Behavioral Health Resources

See the updated Behavioral health resources for your reference attached.

Psychiatric emergencies 

See the workflow for psychiatric emergencies at Farrell attached. 

Referral workflow for IMP Psych NP/Psychiatrist

Providers - To refer to the IMP psych NP / psychiatrist, use the internal referral order for Adult Psychiatry – Onsite – see below.

Additionally, you can send an inbasket message or chat message.

Those messages do not replace the referral order.

Billing and Coding

TCM (Transition of Care). 

Providers : When you see patients post hospital discharge you should use the correct  CPT billing code.  If seen in within 7 days use billing code 99496 after day 7 to day 14 code 99495. The revenue and reimbursement for these visits better reflect the work we do for patients who are discharged from the hospital.  Note that these codes should not be used for post-ED visit. 

Wellness

NYPBeHealthy Wellbeing Coaches are here to support your wellbeing. They offer personalized, complimentary, onsite or virtual wellbeing coaching on various topics, including enhancing resilience, work-life harmony, healthy eating, weight management, and more! Reach out directly to a Wellbeing Coach or email nypbehealthy@nyp.org to set up a coaching session or learn more about available resources designed to support your wellbeing.

Upcoming Webinar:

• Chill Out at Work: 5 Easy Techniques - Join CopeNYP clinician, Steve Nisbet, LCSW, on Wednesday, October 30, from 1:00 p.m. – 1:45 p.m., to learn relaxation skills and techniques to help stay calm and relieve stress in the midst of chaos. Click here to register.​

Update on SW team

Emily Enriquez is our new social worker who will replace Paige Paschall.

She will primarily see patients on Team III and the purple team and will be in Room 213.

Reminders to improve flow and patient care

Forms 

When Norma is out, forms should be send to the PCP for completion.

Providers - Remember to document any information in the encounter related to the form, so that everyone is updated on the status of the form.  This should include why it cannot currently be completed (if that information is relevant), and what the attempts to contact the patient/family have been.

When placing forms in the brown patient folder, please staple them together, so that pieces don't get lost. 

Referrals

Providers who place Referrals or imaging orders after their session is over, should send an in-basket message to their PFA color team.

Huddle

Evening Huddle - A reminder to huddle for your evening session so that patients can get labs and vaccines on time.

The cut off time for vaccines are - 

5 pm - Monday, Thursday and Friday

7 pm - Tuesday and Wednesday

RSV Vaccine

Providers - When emailing Pam about the patient information regarding RSV vaccine - you must include the following.

• Patient's name

• Patient's MRN

• Type of Vaccine (RSV / Shingrix)

• Date of RSV shot

• Reason for vaccine at health center - you are to choose from the following reasons

• Mobility Issue

• Unable to go to the Pharmacy

• Other - You must provide a reason for selecting other

MFM referrals.

Providers : A reminder regarding high risk OB referrals - you must send an email to  MFMperinatal@cumc.columbia.edu

See the attachment for more details. 

Psychiatry referrals to Dr Lightbourne

Providers must use the Farrell Adult Psychiatry Onsite order; they should also use the .IMPREFERRALsmartphrase that includes referral elements and provide as much information as they can.

Sleep Study Referrals

There are current issues with sleep medicine referrals.  We usually refer for sleep studies via the Pulmonary Department who currently do not have the ability to perform them at this time.  ACN leadership is aware of the problem, and we will provide updates as soon as we have them.

NYP Influenza program

Getting vaccinated against the flu is the best way to protect ourselves, our families, our coworkers, and our patients. Flu vaccines are available free of charge to all NYP team members, volunteers (ages 18 and over), and medical staff. Please see below for important details on the Influenza Vaccination Program as well as information on the new COVID and RSV vaccines. - See Farrell Updates 9/27/24 for more details and important links

Deadline to be Vaccinated or Submit a Medical or Religious Exemption Request - December 9th 2024.

Infectious Disease Notice

Please review the NYSDOH advisory attached regarding the Marburg Virus Outbreak in Rwanda 

At this time, NYP strongly discourages travel to Rwanda to work in or visit a healthcare facility.

 Required Annual Training 2024 Now Available - These courses must be completed by December 9, 2024

Every year, we complete important training to help us stay up to date and help make sure we continue meeting our compliance and regulatory standards. In addition, understanding this information is critical to supporting patient and team member safety while maintaining our high standards of care. The required annual training courses for this year are now available in Workday Learning.

 Next All Staff Meeting - Thursday, November 21st at 8 am.

Next Meeting Re: Unified Farrell Projects.

Thursday, October 31st 2-3:15 pm in the 2nd floor conference room.  

Zoom link 

https://columbiacuimc.zoom.us/j/132240397?pwd=WWNMNlJsV2FIWGFPbktTNjZieFBaZz09 

password 960575

General Practice information

Beginning the week of October 7th attendings will have their first patients booked at 8:40 am.

Huddle will be at the vision board at 8:20 am.  

Patients will be allowed to enter the practice beginning at 8:15 am

When we have All Staff meetings, the meeting will end by 8:45 am so that patients can enter the practice.  On days when we have All Staff meeting the first patient for attendings will be scheduled at 9:00 am. 

There will be a PDSA with the huddle time of 8:20 for 4 weeks and afterwards there will be a determination of the official time for the huddle.

Depo-Provera workflow

See the workflow for Depo-Provera attached.

Note the following:

A urine pregnancy test should be ordered and confirmed negative before administration of the initial dose of Depo-Provera.   

Patients should be counseled to use back up protection for the first 7 days after the injection.    

Patients are encouraged to take a pregnancy test 3 weeks after the first injection, however since most patients don't ...

A pregnancy test should be ordered and confirmed negative before administration of the second dose (even if it is done within the appropriate time frame).   

A pregnancy test should be done for any re-injection if it is past 13 weeks after the last Depo-Provera injection.

Vaccines

See the last Farrell updates on  9/14 for more vaccine details.

Note that for RSV vaccines - Elderly patients should be sent to the pharmacy.  Providers can make a decision to order the vaccine at Farrell for patients who have difficulties getting to the pharmacy, for example, limitations on health and mobility. If a patient over the age of 65 is given the vaccine at Farrell instead of the pharmacy due to hardship (as noted before), the provider will send the patient information including the MRN to the practice administrator via email for follow up so that the patient does not get a bill. (note this is a correction from the last email - for Shingles vaccine the nurse sends the email however for the RSV vaccine the provider sends the email).

RSV vaccine in pregnancy - timing

CDC recommends one dose of Pfizer’s Abrysvo for people who are 32 0/7 weeks’ through 36 6/7 weeks’ gestation. Pregnant people who are more than 36 weeks 6 days pregnant should not be vaccinated, as it is unlikely there will be enough time for the antibodies to develop, cross the placenta, and protect the infant. Instead, their infant should receive RSV immunization (i.e., nirsevimab) just before or at the start of the RSV season.

In most of the continental United States, pregnant people should receive RSV vaccine from September (1–2 months before the anticipated start of RSV season) through January (2–3 months before the anticipated end of the RSV season) so that their babies are protected against severe RSV disease at birth.

RSV Infants

Providers can order RSV antibody for infants starting on October 1st. 

Nirsevimab Antibody Administration

• Target Group:

  • Infants (up to 8 months old): Administer Nirsevimab to infants who did not receive a valid dose of Abrysvo during pregnancy. Note: Healthy infants only need protection through either maternal vaccination (Abrysvo) or Nirsevimab—not both.

EPIC updates

Carry Forward Preferred Pharmacy on prescription orders- 

When you reorder a medication to an outpatient pharmacy, the previously used pharmacy will carry forward for that order. If that pharmacy differs from the patient's preferred pharmacy, there will be a banner to highlight the orders that have had their associated pharmacy carried forward. The default pharmacy for new orders will still be the patient's preferred pharmacy.

Ambulatory Patient-entered Questionnaire responses are now available in the Sidebar - 

• See attachment. 

Diabetes follow-up SmartPhrase

Providers can use the smartphrase   .AMBDIABETESFOLLOWUP  in their note for comprehensive diabetes documentation.

See the attachment for more details.

Masking and sick visitors

See the message below from Steve Chang regarding sick visitors that also applies to us at Farrell

As we enter flu season, there was a question re: “essential visitors”. Here is guidance from IP&C:

Allowing sick visitors to come into the hospital (inpatient or outpatient) is against the hospital’s visitation policy (https://infonet.nyp.org/Attach/COVID19_VisitationGuidelines.pdf). Having said that, if the patient has no other caregiver to bring them to the hospital, other than a sick caregiver, the caregiver should be treated like a sick patient must wear a well-fitting face mask at all times, perform meticulous hand hygiene and use proper cough etiquette, etc.

Steve

Influenza Vaccine Program for Employees

See the entire email sent on September 23rd by HR and WHS for more details. 

Please note that an influenza vaccination, or accepted exemption, is required.

KEY INFLUENZA PROGRAM DATES

Flu Campaign Launch Date 

September 23, 2024

Deadline to be Vaccinated or Submit a Medical or Religious Exemption Request* 

December 9, 2024 

RECEIVING THE VACCINE AT WHS

The flu vaccine will be available at your local NYP Workforce Health & Safety (WHS) clinic. Please click here for hours of operation. The flu vaccine will also be provided through vaccination carts and events. Find the local events schedule here.

RECEIVING THE VACCINE OUTSIDE OF NYP

 Instructions on how to schedule your vaccine with CVS are here, and you can schedule an appointment here.

You may receive the flu vaccine at a doctor’s office or local pharmacy. In this case, please be sure to obtain proof of vaccination including the date of administration, the type/brand of the flu vaccine received, the contact information of the office, pharmacy or licensed provider who administered the vaccine, and the employee’s full name. Proof of vaccination must be uploaded to VaxApp in order to update your compliance status in Workday. 

REQUESTING AN EXEMPTION 

Team members seeking an exemption based on a medical contraindication or a religious/deeply held belief reason must submit a request via VaxApp by December 9*.  More information on the exemption process can be found here. 

OTHER VACCINE GUIDANCE

We will also be providing the new COVID vaccine as well as the RSV vaccine at your local NYP Workforce Health & Safety (WHS) clinic.

Wellness

A reminder to take advantage of the NYPBeHealthy resources - link here

Administrative PTO

Dr Julie Berenyi will be away from 9/18 - 9/23.  Dr Joanne Dempster will cover any issues during this time.

We welcome our new psychiatrist Dr Taber Lightbourne to Farrell.  She will see the patient on-site on Thursdays.  

Dr. Lightbourne (Dr. L) will see patients who would benefit from primarily short-term services (2-3 months) so she maintains access for your patients.  These are the services/interventions that would be in her scope:    

1. People needing a psychiatric consultation where pt could benefit from diagnostic assessment, stabilization, and referral back to PCP for ongoing care

2. People needing a psychiatric consultation where pt could benefit from diagnostic assessment, stabilization, and referral to community or ongoing outpt care

3. People new to treatment and needing psychiatric consultation

4. People who are treated by the PCP who have recently become destabilized and may require a psychopharm reassessment or diagnostic evaluation for new sx

Change in Attendings templates.

Beginning the week of October 2nd, attendings who have patient care in the morning will have their first patient scheduled at 8:40 am except on Thursday mornings when the first patient sill be scheduled at 9:00 am.   Resident tallies will not be affected. 

Vaccine Update

At Farrell, we currently have:

Influenza vaccines

Flu vaccines for all age group and insurance categories : 

Influenza vaccine >=6 months (FLULAVAL trivalent) VFC

Influenza vaccine >=6 months (FLUCELVAX ,Egg Free) VFC

Influenza vaccine >=2 -49 yrs (FLuMIST ) VFC

Influenza vaccine >=6 months- 64 yrs (FLULAVAL trivalent) Private insurance (1199) pediatric patient and all adults 

Influenza vaccine >=65 years( FLUAD trivalent) High dose for adults 65 yrs +

We have COVID 19 Moderna for adults and for private insurance( 1199) pediatric patient 12 yrs+, we are still waiting for the delivery of the 6 months to 11 years Moderna for private pediatric patients. 

We have COVID 19 PFIZER vaccine for VFC pediatric patients for age 5-11 yrs and 12yrs+. We are still waiting for the delivery of the 6 months to 4 years PFIZER for our VFC pediatric patients.

We also have RSV vaccine for adults/ pregnant women ABRYSVO and RSV antibody NIRSEVIMAB for infants and children .

We are able to give the RSV vaccine to our pregnant patients.  Note that older patients should be sent to the pharmacy unless have difficulties getting to the pharmacy, for example, limitations on health and mobility. If a patient over the age of 65 is given the vaccine at Farrell instead of the pharmacy due to hardship (as noted before), the Nurse will send the patient information including the MRN to the practice administrator or follow up so that the patient does not get a bill.

See more vaccine details attached.

Farrell Unified Projects Update

The last meeting with staff was held on 8/30/24.  

See the summary of issues raised and the next steps below. 

Issues discussed 

1. Appointments - 

   1. PFA feedback - seeing a positive difference with finding follow-up appointments for patients.  PFA's report very positive feedback from patients. 

   2. Provider feedback - no clear difference noted so far.

2. Orders - Blue dots

   1. MA/Nursing feedback - some providers still changing orders after placing the blue dot (both residents and attendings) for labs and for vaccines.  Providers can review vaccines with nurse at huddle (can help with any confusion). Patients sometimes don't wait for the nurse and leave when they are waiting for too long, especially when they are placed in the waiting room to wait for the nurse (usually for education about ½ leave). 

   2. Provider feedback - 

   3. (NO discussion on green and black dots - to follow up)

3. Equipment

   1. MA feedback - providers should let the MA assigned to them know when they need something in a room so that they are aware of stocking needs.  The MA will provide anything that is missing in the session and will follow up on re-stocking the room.  Some frustration among some MA's who consistently stock their rooms, but things get taken out and they are not aware.  Request to follow up with Pam to enforce the expectations for room stocking uniformly among the MAs as this is not happening consistently. 

   2. Provider feedback - It is faster usually to just get what is needed from another room.  Providers understand the rationale for discussing with the MA first but are concerned about additional delays.  Printers in the rooms often don't have paper.  When stocking MA's should also check the printers and add paper when needed. 

4. Rooming Use and collaboration

   1. MA feedback - improved with being in charge of flow.  

   2. Nursing feedback - when staffing ratios are off it affects flow including when down on provider/nurse ratios

Next Steps

1. Appointments - A survey will be completed to see how many patients were scheduled prior to leaving the practice (may add to cycle time)

2. Orders/Blue dots - Dr Dempster to remind providers about placing the blue dot only when ready to avoid confusion, errors and delays. Will also remind providers to discuss vaccines with nursing if appropriate to avoid any confusion. Follow up needed on timely placement of green dots since this is another step that affects cycle time.

3. Equipment - Pam to follow up with MA staff and monitor for appropriate room stocking.  Stocking should also include printer paper. 

4. Rooming use and collaboration.  Continued flexibility needed since we have more providers (SW, Psych, and soon nutritionists seeing patients in session so less rooms will be available in session.). 

5. Next cycle time survey - Survey to be completed during a busy session eg. Tuesday, Wednesday and compare to the cycle time data generated in EPIC.  Dr Dempster to review the survey and distribute before the next meeting with staff on 9/20.  Leadership team to follow up with staff to encourage participation.  

6. Data review - Data will be reviewed as a practice and also reviewed with removing OB patients since with nursing education and GCT and GTT testing can skew the data for the entire practice.  New OB patients also take longer and can skew the data. 

The next All Staff Meeting is Thursday September 19th, at 8am.

The next meeting to discuss the Farrell Unified Projects is Friday September 20th at 8:30 - 8:50 am - breakfast will be served. 

Wellness

Wishing everyone a safe and enjoyable Labor Day weekend.  

Staffing

We welcome Dr. Melissa Encarnacion who will be back as a fellow beginning Tuesday, September 3rd.  She will remain on the Blue team.

Reminders to improve flow and patient care

Rooms stocking/equipments are each assigned rooms to keep stocked.  If a provider does not have anything for the room that they are assigned they should notify the assigned MA for the session instead of going to another room and taking supplies from the other room.  The MA will provide the equipment/supplies needed and restock the room.  This helps the MA's with keeping track of supplies in their rooms.  MA's will be proactive to be sure that all rooms are appropriately stocked at all times.  

Self Swabbing for GBS, GC/Chlamydia instructions.

The directions for self-swabbing should be completed by the provider and posted in all rooms.  This is a reminder for GC/CT to let patients know that they should not puncture the top of the vial to place the swab but should open the vial, place the swab, break it and cover it securely before returning it to the room.

Blue Dot

Providers should not place the blue dots until they are ready to have labs drawn, or for the nurse to see the patient.  Residents should not place blue dots until they are done with precepting in case changes need to be made to the orders.

Medication Reconciliation

Thank you for increasing our compliance rate from 49% to 64.3%

Our goal is to get to above 80% compliance, and we must be able to do this within the next couple of weeks as this can adversely affect our PCMH recertification.  Please check the medication reviewed tab while charting or before closing your notes.

From the Department of Health,

FREE Youth Vaping Cessation Service Promotional Materials for Upcoming School Year

With back-to-school season approaching, healthcare professionals can play an important role in educating youth and young adults about the harms of using e-cigarettes, including nicotine addiction, increased anxiety, lung damage, and stunted brain development. E-cigarettes are the most commonly used tobacco product among high school students in New York State (18.7 percent) as well as among high school students national (10 percent). Research has shown that most students who use tobacco products want to quit.   

 The New York State Department of Health offers This is Quitting, a free text-based cessation service tailored for youth ages 13- to 17-year-olds and young adults, ages 18- to 24-year-olds, developed by Truth Initiative. To use the service, young people can text DropTheVape to 88709. Healthcare professionals can order  FREE promotional posters, rack cards, and palm cards in English and Spanish developed for schools, health clinics, and community centers.  At this time, This is Quitting services and texts are not provided in Spanish. 

 In addition, the New York State Quitline provides free nicotine replacement therapy for those 18 years of age and older, along with coaching, support, and resources. For more information, visit nysmokefree.com or call 1-866-NY-QUITS (1-866-697-8487). 

 The NYS Quitline provides healthcare professionals with free tools and resources, including the Patient Referral Program, to assist your patients in quitting tobacco product use. For more information about their free services, including a supply of nicotine replacement medications, Quit Coach phone and chat support, and the Learn2QuitNY text program, call 1-866-NY-QUITS (1-866-697-8487) or visit nysmokefree.com. 

Opiate prescribing

See the message from ACN leadership below.  The full policy is attached.

Dear NYP Medical Group and ACN Colleagues,

Based on your feedback, NYP has updated the opioid policy. As a reminder, opioid prescriptions should not be ordered for a provider’s own use, or the use of the provider’s family members:

1. Prescribing Controlled Substances

1. 1. Only physicians, nurse practitioners, and physician assistants may prescribe controlled substances within the scope of their licensure and their clinical privileges.

   2. Prescriptions for controlled substances may not be made for the prescriber’s own use or for the use of the prescriber’s immediate or extended family.

   3. Prescriptions for controlled substances may not be made for peers, nursing, hospital or other medical staff, or friends or acquaintances unless the individual is a registered patient under the prescriber’s active care.

   4. Prescriptions must be entered into the electronic prescribing system (or on paper during downtime) in the patient’s chart and must include name of medication, dosage, route, and frequency of administration.

   5. If the opioid is being administered in the outpatient setting, incomplete or unclear orders should be questioned and clarified prior to acknowledging the order, dispensing, and administering the medication.

To view the full opioid policy, click here. The full policy is attached to this email.

Thank for your support and for helping us maintain a safe environment for all.

Deepa Kumaraiah, M.D., MBA

Senior Vice President and Chief Medical Officer

Tiffany Sullivan, M.P.H.

Senior Vice President and Chief Operating Officer, NYP Physician Services

Online DEIA Resource Toolkit for Precepting, Didactics, Independent Learning, etc

From Dr Hima Ekanadham

Thanks to those who were able to attend our CFCMSO advocacy session today. In today's meeting, I reviewed our involvement as one of the residency programs across the country who signed up to pilot a carefully curated toolkit of DEIA resources across the domains of peds, outpatient primary care, inpatient care, OB, and women's health. This toolkit was put together by a diverse group of individuals within STFM (students, residents, seasoned faculty, etc) with broad ranges of expertise in various topics. The toolkit is being piloted over this academic year to assess for its utility in increasing DEIA teaching, learning, and discussion in an integrated and longitudinal fashion across all rotations. My hope is that the use of this toolkit will enhance and progress our current curriculum into a richer space where DEIA is interlocked with the educational components of all our rotations, conversations, and patient care plans 

Here is the link to the toolkit: https://www.stfm.org/DEIACurriculum

The next All Staff Meeting is Thursday, September 19th, at 8am 

General Reminders to facilitate flow and patient care.

Forms

Our primary PCE - Norma David will be away from 8/26 - 10/11/24 - During this time all forms should be sent to the pcp for processing.

For patients who need appointments just for homecare forms (< 30 days) and really don't have other clinical needs, providers can use dates from any appointment they had (eg, cardiology, vascular) at our institution.  These forms have not been rejected.  This reduces any unnecessary appointments especially when the patient was seen in a timeline that is appropriate and/or already has follow up.

Huddle

Providers are reminded to huddle at the beginning of each patient care session.  Include issues such as when a chaperone is needed,  and labs such as the GCT and GTT test so that the MA can coordinate with you and the patient to ensure that the patient gets what they need in session. Consider sending a secure chat message if an initial attempt to huddle in person was unsuccessful.

Specialty referrals (new vs follow up)

Referrals should be placed for specialists for new or follow up appointments using EPIC orders.

Providers should write new or follow up in the comments of referral or in the wrap up, if able.

If the provider has not written new or follow up in the referral, the PFA can check in epic to make a determination and schedule appropriately.

Self-collected Vaginal Swabs.

The instructions that providers give to patients for the self-collected vaginal swabs for Gonorrhea and Chlamydia (copy attached) are laminated and posted in all of the exam rooms for use as a reference. 

Video Visits

Starting on August 26th scheduled video visits for all CUIMC outpatient practices will take place on Epic’s integrated Video Client, instead of Zoom.

Note, this applies only to single patient visits. Group Video Visits will continue to use Zoom. Practitioners who also work in ACN departments and have already started using EVC will now have EVC available for ALL visits in all departments.

How this will affect you:

When a patient or provider joins a video visit, instead of launching in Zoom, it will load Epic Video Client (EVC) in the internet browser. The first time it launches you and the patient may need to ‘allow access’ to the microphone and camera.

Some features, such as adding guests or interpreters, are now completed in Epic rather than via Zoom.

Click here for further instructions on adding interpreters. Interpreters for Spanish, Vietnamese, Russian, Cantonese, Mandarin, Arabic, and ASL are available directly through Epic. Other languages are only available on audio. Click here for instructions for adding an audio interpreter.

Please also note - blurring backgrounds is available only on desktop/laptops, it is not available in Haiku or Canto.

Only the video client is changing – the scheduling and documentation of video visits will not change. Full details can be found on the Video Visit tipsheet by clicking on the link:  Video Visit tip sheet

Prescription Monitoring Program Registry (PMP) update.

Providers please note:-

The Health Commerce System (HCS) is implementing Multi-Factor Authentication (MFA) functionality for the Prescription Monitoring Program Registry (PMP) application in HCS. MFA protects applications and data by using a second source of validation to verify user identities before giving them access to critical systems.

Effective September 2024, all HCS users will be required to use MFA to access PMP Registry. 

To ensure continuity of access, users needing access to PMP are strongly encouraged to set up MFA using the MFA Enrollment tool as soon as possible. Types of available authentication are Voice, SMS (text message), Time Based One Time Password Authenticator (e.g., Google Authenticator), or RSA token (only available to New York State employees).

See the attached guide.

VNS program for fall prevention (flyer attached)

See the at-home fall prevention program offered by VNS.

The next meeting for the Unified Farrel Project is on Friday, August 30th in the 2nd-floor conference room from 8:30 - 8:50 am.  Breakfast will be served.

 The next All Staff Meeting is Thursday, September 19th, at 8am 

COVID-19 Return to Work Policy for Healthcare Personnel

Currently, transmission of COVID-19 is rising in the community. While CDC has updated guidance for individuals in the community who are returning to work after a COVID-19 infection, please note that CDC guidance, and thus NYP guidance, for healthcare facilities and for healthcare personnel (HCP) with COVID-19 has not changed.

As a reminder:

• HCP with COVID-19 can return to work after Day 5 (i.e., on Day 6) of their isolation period (day 0 is day of symptom onset or, if asymptomatic, day of positive test) if additional criteria below are met.*

• HCP who return after a COVID-19 infection must wear a mask (well-fitting surgical mask or N95 respirator) when around patients, visitors, and other HCP through Day 10 after their date of symptom onset or date of positive test (if asymptomatic).

• HCP with COVID-19 should continue to report their illness through NYP’s COVID tracker (https://covidtracker.nyp.org/#/)

• If returning to work on Day 6, HCP should not be assigned to work on Days 6 and 7 in a clinical area or service dedicated to severely immunocompromised patients, e.g., dedicated transplant areas (inpatient and outpatient), dedicated oncology areas (inpatient and outpatient), or neonatal ICU. If HCP cannot be reassigned to another area, then they must stay home and return to work after Day 7 (i.e., on Day 8) if additional criteria below are met.*

  • It is the responsibility of the HCP’s supervisor to ensure that HCP with COVID-19 are not assigned to work in a clinical area or service dedicated to severely immunocompromised patients on Days 6 and 7 as listed above.

  • Supervisors can either reassign the HCP on Days 6 and 7 or have them return to work after Day 7.

  • Supervisors will be notified by WH&S of HCP with COVID-19.

See Guidance for Ill HCP and HCP with Exposure to COVID-19 for full details.

*Additional criteria to return to work: no fever for at least 72 hours without the use of fever-reducing medications (such as Tylenol, ibuprofen, or aspirin); AND other symptoms (e.g., runny nose, cough) are improving and are minimal enough to wear a well-fitting surgical mask or N95 respirator continuously when around patients, visitors, and other HCP. HCP who are moderately or severely immunocompromised may not return to work until after day 7 and all other criteria are met.

Brian G. Donley, MD

Executive Vice President & Chief Operating Officer

Deepa Kumaraiah, MD, MBA

Senior Vice President & Chief Medical Officer

Breastfeeding week and raffle

On Monday 8/5/24, Farrell will be celebrating Breast Feeding week with a tabling in the foyer starting at 8:30 AM.  We will be raffling off a Boppy Pillow, please encourage your patients to stop by and register for the raffle and receive great information and some giveaways.

Flyer attached

Huddle

Providers are expected to huddle with their MA and nurse prior to each session (includes PM and EVE sessions).

Hypertension

Blood Pressure Machine 

When ordering a blood pressure machine for patients, it is recommended that you use Parachute to place orders and choose Landauer as the vendor. This increases the likelihood that the patient receives the machine and the correct cuff size.  

Forms

Forms needing to be filled out by the provider should be given to the PFA for processing.  This ensures that the form is uploaded into the media tab and time stamped.  

E- Consult Update

A new CUIMC E-Consult use case for adult Cardiology Lipid Disorders is now available to ColumbiaDoctors and ACN West providers. 

Referring providers can request E-Consults for adult Cardiology Lipid Disorders by selecting the AMB Referral to CUIMC E-Consult Adult Cardiology order and clicking the Lipid Disorders button next to Reason.  General Cardiology E-Consults can be placed by selecting the General Cardiology button.  Providers must select either button in order to proceed with the order.  

Please review the below ordering scenarios for each adult Cardiology use case.

Order Name

Reason/Use Case

Ordering Scenarios

AMB Referral to CUIMC E-Consult Adult Cardiology 

Lipid Disorders

·  Interpretation of lipid profiles and management of lipid disorders

·  Advice to manage statin intolerance, or whether patients should be referred for advanced lipid management clinic

General Cardiology

·  Test interpretation / follow-up questions – “What does this mean? Do I need to order another test versus referring?” (E.g., ECG, echo, Holter, stress testing)

·  Medication management for common cardiac conditions

·  E-Consult are NOT appropriate for

o   Symptom triage (acute chest pain/SOB)

o   Expediting testing/referral

 Other Available E-Consult Orders:

Adult: 

·           AMB Referral to CUIMC E-Consult HTN Center 

·           AMB Referral to CUIMC E-Consult Benign Hematology 

·           AMB Referral to CUIMC E-Consult Adult Otolaryngology 

·           AMB Referral to CUIMC E-Consult Cancer Pain and Symptom Management (Palliative Care) 

·           AMB Referral to CUIMC E-Consult Psychiatry 

·           AMB Referral to CUIMC E-Consult Adult Infectious Disease 

·           AMB Referral to CUIMC E-Consult GYN ONC 

·           AMB Referral to CUIMC E-Consult Gastroenterology (Esophageal)  

·           AMB Referral to CUIMC E-Consult Endocrinology (Diabetes) 

·           AMB Referral to CUIMC E-Consult Rheumatology 

Pediatric: 

·           AMB Referral to CUIMC E-Consult PEDS Cardiology 

·           AMB Referral to CUIMC E-Consult Peds Otolaryngology 

·           AMB Referral to CUIMC E-Consult Pediatric Psychiatry 

The next All Staff Meeting is Thursday August 15th at 8am

Wellness

NYPBeHealthy Wellbeing Coaches are here to support your wellbeing. They offer personalized, complimentary, onsite, or virtual wellbeing coaching on various topics, including enhancing resilience, work-life harmony, healthy eating, weight management, and more! Please reach out directly to a Wellbeing Coach or email nypbehealthy@nyp.org to set up a coaching session or learn more about available resources designed to help you.

Message from the NYP wellness team

 Ultraviolet (UV) Safety Awareness Month and year-round, remember these three tips from the American Academy of Dermatology while outdoors:​

• ​Seek shade when appropriate.

• Wear sun-protective clothing.

• Apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.  

Check out this NYP Health Matters podcast featuring essential summer skincare advice from a dermatologist who debunks myths about sunscreen and offers advice on how to best protect your skin in this sunny weather. You can also read more tips to protect your skin from the sun​ and what to know about moles in Health Matters.

​

Let’s keep our skin safe, stay cool, and BeHealthy​! 

Recommendations to improve flow and patient care

Follow up appointment requests

Providers, when placing a request for a follow up visit consider the following

• Consider the appropriateness of the follow-up timeframe when requested.

• Whenever possible give the PFA a window in which to schedule the patient.

• Remind patients that they may see another member of the care team if you are not available.

• For OB and Pediatric patients, you can request more than one appointment when needed eg.  at the 2 months visit for a pediatric patient you can request a follow-up in 2 and 4 months for follow up (let your PFA know that the child should not be scheduled before they are 4 months old or for the second before 6 months old - to avoid issues with vaccines).  This helps with access and continuity. 

Late Policy

A reminder to providers to notify your PFA via secure chat when you are able to see a patient late or if you have any special request for your patients.

Chief Complaint

MA's please remember to avoid using "per HPI" as this is only to be used as a last resort when you cannot get a chief complaint from the patient.  If the patient is not able to say why they were scheduled, consider asking "What would you like to have done at today's visit".   

Normal Results Workflow

Providers, remember that for normal labs results patients should be sent a message via connect and if not on connect the provider can send a normal letter.  Normal results should not be sent to nursing to call the patient.  Continue sending messages to the nursing pool for issues that require a discussion with clear instructions for the nurse in your note. 

Huddle

Providers should huddle with their MA and nurse prior to starting the session (AM, PM and EVE).

Lab Orders

If labs are placed and the MA is not able to draw labs when it is past the pick-up time, the MA will notify the Provider.  The provider will then notify the patient and come up with a plan together on the next steps. Providers can request a lab visit and place the orders on hold. 

The cut off time for lab draws in the evening is at 6:40 pm.  This gives the MA's enough time to have specimens ready for pick up at 7pm.

Vaccines

We do not have flu vaccines until the next flu season.  We will update staff when the flu vaccine is available at the practice.

We currently have increasing cases of COVID infections.  Patients who would like to receive the COVID vaccine can.

Measles

See the bulletin (attached) that was sent previously from the DOH regarding measles outbreaks.  Educate patients about measles-containing vaccines. This is especially important before international travel.  Note that we have had cases of Measles in NY and at NYP. 

Key points - 

Patients should get vaccinated against measles at least 2 weeks before international travel.  

Infants under 12 months traveling internationally should get an early dose of the MMR vaccine.   

Children, teens and adults without evidence of immunity should get the first dose immediately and the second dose 28 days after the first.  

Click on this link for more detailed guidance from the CDC. 

Transmission and Infection Control

• To promptly identify suspected cases of measles and prevent exposures, consider

screening patients for rash with fever at the point of entry of a healthcare facility and

inquire about recent international or domestic travel and possible exposure to measles.

• Immediately institute standard and airborne precautions for patients with known or

suspected measles and call ahead for patients being referred to other healthcare

facilities to prevent healthcare-associated exposures.

• Place the patient in a single-patient airborne infection isolation room.

o If a single-patient airborne infection isolation room is unavailable, place the

patient in a private exam room with the door closed and have them wear a

mask. After the patient leaves, it should remain vacant for at least two hours.

The next Farrell Unified Project Meeting is Friday July 26th at 8:30 am in the 2nd floor conference room (breakfast will be served).

Updates since our last session :-

The overall no show rates for the past 6 months = 23%

The total number of no-show visits at Farrell for the past 6 months = 3,749

Areas of focus for PDSA cycles for No Show:

1. OB patients - OB patients sometimes don't understand why they need so many appointments.  Nursing created a patient friendly flyer that they will use for education regarding visits.  The flyer will be used by the PFA team when needed to help patients understand the visit frequency. They often see different providers so not connected and are more likely to no - show.  Multiple appointments needed not always scheduled before they leave the practice.  Some of the appointments may be scheduled when they are not available. PFA's will schedule appointments for follow up before the patient leaves the practice.  All staff must remind patients to stop at the front desk for their appointment before they leave. 

2. Appointment scheduling - Patients do not always get appointments before they leave. (see above)  Providers are not giving enough flexibility to PFA's for scheduling.  No appointments available so patients sometimes have to go on the waitlist. Providers will remember to give the PFA team a window for scheduling when they can and will also include whether a telemedicine visit can be given instead if it is appropriate and can prevent a no-show.   When patients are scheduled when they are not in the office, they can't always be reached to confirm their appointment.  Limited appointment availability.  Provider PTO request times was extended to improve availability for appointments.  Some patients only want to see their pcp.  All staff will remind patients that every attempt will be made to schedule follow up with their pcp however at times they will need to see another provider on the team when the pcp is not available when appointments are time sensitive.
   
   

3. Appointment reminders - Not sure how consistently messages are sent. Messages may only be in Spanish and English. Patients report messages are sometimes incorrect.

4. Late Policy - Should we make exceptions for OB and pediatric patients? Should providers be more flexible when in session?

The next All Staff Meeting is Thursday, August 15th at 8:00 am. 

Administrative PTO

Dr Berenyi will be out July 1st - 5th.  Dr Dempster will cover on July 1st - 3rd .  Drs Diaz and Chaco will cover on Friday July 5th .

Dr Dempster will be out July 5th - 9th.  Drs Diaz and Chacko will cover on Friday July 5th.  Dr Berenyi will cover July 8-9th. 

Pamela Lamb-Wilkins will be out July 3rd - 5th.  Gina Gelin will cover for any issues 

Resident Transitions.

Congratulations to our resident graduates.

Welcome to our new interns !!!

Please refer to the updated color teams (attached) to know which team our interns are assigned to and to know which resident will adopt the patients from the graduating class.  Note that patients who still had Dr Nancy Bermon as pcp will be transferred to Dr Haorui Sun as their new pcp. 

NYP community outreach events

MOMMY & BABY COLLECTION DRIVE - for Asylum Seekers

Rhonda and Yudy will be coordinating a diaper drive at Farrell between Monday July 1st to Wednesday July 17th.  

The location for the collection box will be behind the security desk.  As soon as the flyer is ready, Rhonda and Yudy will send it for distribution and advertising. 

Vaccines

We can now offer the Shingrix vaccine to all patients who are eligible at Farrell regardless of age or insurance.  When the order is placed by the provider, the nurse will verify the insurance and will notify Pamela of any patient who has Medicare so that the patient will not be billed. 

CT Lung Cancer Screening 

Providers, please use the CT lung screen consult IMG320 order when ordering lung cancer screening for patients. This triggers a visit with a Nurse Practitioner who will counsel the patient, order the CT scan and take care of any prior authorizations. 

When this order is used the PFA's don't need to call to schedule the CT.

See the tip sheet attached 

The next All Staff Meeting is Thursday, July 18th. 

The next meetings for the Farrell Unified Projects are Friday July 12th and 26th at huddle from 8:30 - 8:50 am.  Breakfast will be served so we encourage you to arrive early.

From the Farrell Leadership Team:  

We appreciate the work that you do to provide excellent care to our patients and create a great work environment for each other despite the challenges we face daily. We are dedicated to improving the experience and outcomes for everyone.  

Juliana Berenyi, Joanne Dempster, Pamela Lamb-Wilkins, Kim Moore, and Julene Stephenson.

Wellness

A reminder from the NYP Health and Wellbeing team :

• 
  Sign up for our 2024 NYP Steps Challenge via your Virgin Pulse account, whether you’d like to participate solo or on a team of up to 10 colleagues (departments can have multiple teams). An astounding 7,800 NYP team members are currently participating. We have collectively traveled a total of 200,700 miles together—that's like walking around the earth eight times! 

• Log/sync your daily steps/activity in Virgin Pulse. You will be automatically entered into random prize drawings to win generous gift cards each week by logging your daily steps. Plus, if you log your daily steps for all four weeks and meet with an NYP wellbeing coach twice this May, you will have the chance to win 5,000 Appreciation Points. 

Prize winners will hear from our NYPBeHealthy team directly. Questions? Email nypbehealthy@nyp.org.

Administrative PTO

Dr Julie Berenyi will be out of the office on May 22nd - 24th.  Dr. Joanne Dempster will cover for any issues.

Community Health Worker (CHW) Services

Eligibility Criteria – Adults, Peds, OB

• 1 or more chronic condition(s)/pregnant (14+ weeks) and social need

• Patient is engaged and ready to receive support

• Referring provider must include Goals associated with referral

*Exclusion: Patients with unstable mental health condition, unstable

substance use disorder, lacking capacity without a legal guardian, concerns

for an unsafe home environment.

See a full description of the services and workflow attached. 

Social Work Services

We are excited to welcome our two new, full-time social workers to Farrell: Julia Blum and Paige Paschall!!

Raheem Cassell has also joined the team as a social worker assistant, and he will be onsite Wednesday - Friday.  

Paula-Annette McKay, who most of you already know, will be onsite Monday - Tuesday to assist our social workers as well. 

From Paige Paschall--

Immediately prior to this I was working at an inpatient state psych hospital, though I have held a myriad of roles over the past decade or so, and have probably worked with just about every population. Inpatient, outpatient, case management, clinical, non-clinical (risk management, public health, program evaluation, etc.)... Yo hablo solo un pequito de Espanol, pero estoy intentando! (Tengo Rosetta Stone!) I have absolutely nothing fun to share about myself. However, I'm happy to share that I am a huge lover of non-human animals and have two kitty children named Taco Bella and Jack. My dream after retirement is to spend the rest of my days volunteering at an animal sanctuary, perhaps in some charming, sleepy little town in the Hudson Valley. Extremely grateful for this new and exciting career opportunity with NY Pres, and very happy to be here at the Farrell Clinic!!!

From Julia Blum--

Hello! My name is Julia Blum, one of the new social workers here at Farrell! I will be here Monday through Friday in person. I look forward to getting to know everyone more, and really assisting in the care of our patients together! A little bit about me 🙂 I am from Massachusetts, and moved to NYC to complete my Master in Social Work program which led to the beginning of my social work career at The Door - A Center for Alternatives where I worked as the Community Mental Health Advocate for ages 12-24 runaway homeless youth, doing crisis counseling and case management like work. Fun facts about me are I love caffeine, cooking (into salmon currently), and I am an avid participant in this month's steps challenge #goSWAllstars. I look forward to being able to support you all, and I am committed to being a trauma informed, culturally competent, social worker who can not only support our patients but I love teams, and I am grateful to be joining and supporting this one. Let me know if you want to grab coffee, and please bear with me while I learn EPIC!

Social Worker services referral workflow

We are changing the workflow for social work referrals. We will now utilize the social work referral for general social work needs. The PFAs will then schedule patients onto the social workers schedule for a visit. The social workers will be assigned to teams to facilitate continuity. Paige will be working with Team 3 and the purple team. Julia will be working with Team 1 and the orange team.

The social workers will also be available in person for warm handoffs for more urgent needs for patients who are currently in the office. To initiate a warm handoff, please send an epic chat to both social workers. 

You can still use the social work pool to send a message with a question if needed, but in general, patients will benefit from a referral and visit with the social worker. 

Social Work EPIC orders

The social work referral is "Farrell SW." 

For general social work needs, click the button "Social Work" and then choose the reason for referral.

For mental health needs, click the button "Social Work Mental Health."

As always, this new workflow will be an adjustment. Please reach out with questions or concerns, so we can continue to adjust as needed.

IDT Rounds

Cynthia Martinez-Feliz returned on April 30th and resumed the coordination of IDT rounds.  Please refer to her messages for follow up and meeting links.

Welcome back Cynthia 

MAC IMP Services and referrals

See slides attached for more details including orders

Masking Level - Green

Currently, transmission of respiratory viruses including COVID-19 and influenza are low in the community.

Therefore, effective immediately, NYP, Weill Cornell Medicine, and ColumbiaDoctors are moving from action level Yellow to action level GREEN.

The masking guidelines apply to Weill Cornell Medicine and ColumbiaDoctors clinical and non-clinical spaces as well.

Action Levels for Masking for Patient Care

ACTION LEVEL

Interpretation

Masking for HCP

Masking for Visitors

Green

Respiratory virus transmission is low in the community and hospital

OPTIONAL,

EXCEPT where consistently required (see below and link)

OPTIONAL

Yellow

Respiratory virus transmission is moderately elevated in the community and/or hospital

STRONGLY ENCOURAGED for ALL patient care in all locations,

EXCEPT where consistently required (see below and link).

OPTIONAL but strongly encouraged

Red

Respiratory virus transmission is high in the community and hospital, leading to elevated infection rates and clusters among patients and HCP

REQUIRED for all patient care or direct patient contact in all locations

REQUIRED for direct patient contact in all locations

Regardless of action level, masking is always consistently required for patient care for certain locations (e.g., EDs, ICUs, hematology/oncology and transplant) or certain patient types (immunocompromised patients regardless of location).

For additional details on the approach to masking guidance, please see link.

Fraudulent RX requests.

We sometimes receive fraudulent calls or faxes requesting a change to a new pharmacy or for a prescription for a new medication for patients.  Any calls from a new pharmacy requesting that refills or new prescriptions be sent to them should be confirmed with the patient before ePrescribing or faxing.  The PFA should call the patient to confirm before sending the request to Norma or to the pcp.  When completing forms Norma and the pcp will do a second check to ensure that the requests is legitimate.

Forms

A reminder that providers should not keep forms and should send them with the patient to the front desk for scanning into the patient record. If the patient needs the original form to return to work, then be sure to scan the completed form into the record before giving it to the patient. If the form is completed and needs to be faxed, please notify your PFA.  If the form is incomplete, please indicate that it is incomplete either by using a post-it  note, OR notifying the PFA via secure chat.  

Farrell Unified Project

We will all get involved in PDSA cycles to improve our cycle times and no-show rates.  

Our overall no-show rate for the first quarter of this year is 23 %.  Our average cycle time from check in to check out for the practice is between 91 - 100 minutes for the months of January to March 2024 from our sample that was reviewed.  

Our teams met at huddle to work on PDSA cycles and will meet again on Thursday May 30th between 2-4 pm to discuss implementation of our interventions and data collection.  Everyone's input as a member of the Farrell team is important.  Send any comments and ideas for the projects to Dr Dempster via email.  

NEW Requirement for Universal Hepatitis C Screening

Effective May 3, New York State, in alignment with CDC recommendations, will require healthcare providers to offer a hepatitis C screening test to:

• Every person of age 18 or older (at least one time and routine periodic for those at ongoing risk)

• people younger than 18 if there is an indication of risk; and

• all pregnant people during each pregnancy; screening test results must be recorded in the pregnant person's medical record at or before the time of hospital admission for delivery.

The medical settings where providers are required to offer a hepatitis C screening test are:

• All Inpatient or emergency departments

• Outpatient departments that offer primary care
  (regardless of board certification of the provider).

If the hepatitis C RNA test is detectable, the healthcare provider must either offer the person follow-up hepatitis C healthcare and treatment or refer the person to a provider who can.

More information on the requirements can be found on the DOH website.

Resources:

New York State Department of Health AIDS Institute Clinical Education Initiative

New York State Department of Health Viral Hepatitis Web Resources

New York Cures Hep C Campaign Materials.

Guidance on Hepatitis C Reflex Testing

New York State Department of Health Guidelines on the Management and Treatment of Hepatitis C 

American Association for the Study of Liver Disease

Centers for Disease Control and Prevention

Patient comments and shoutouts !!!

Dr. Patos was friendly, well-informed regarding my health history, and offered good advice.

Dr. Richman is a great professional, you feel very safe and secure as a patient of hers

Dr. Richman cares about my health and mental health issues, I consider myself privileged to be her patient

Dr. Younge is very respectful and kind and listens to the needs of his patients. It's just that sometimes you have to wait a long time for the consultation.

The next Farrell All Staff Meeting is Thursday, June 20th, 2024, at 8 am. 

Resident Quality Project - Team I - improving screening mammograms

Team 1 is working on a quality improvement project to help patients 40-65 get their mammograms scheduled. A major barrier for patients in this age range is remembering to schedule these appointments since they have to call on their own. The QI team is planning to have pink pieces of paper available for PFAs to give to patients due for mammograms in this age range (40-65) with scheduling information to make it easier to remember and call.

Pink Slips for Mammogram Scheduling.

Starting April 26th, you will see pink papers at the front desk. PFAs - will give the pink flyers to your patients aged 40-65 who are due for a mammogram to help them with scheduling appointments.

Reminders to improve patient care and flow

Nursing visits: 

Providers should remember to include in their notes and or wrap up the reason for the nursing visit.  All vaccines should be placed on hold.  

For nursing or lab visits - labs should be placed on hold.

Pediatric patients should not be placed in the nursing template for Weight checks or blood pressure checks.  Pediatric weight and blood pressure checks if needed in a short period of time and there is no provider follow-up, can be placed on the same-day tally.  

DSME referrals remain an option for patients to receive education and reinforcement of medications, diet, etc. In general, we underuse this support.

Social Work Coverage:

We now have 2 new social workers at Farrell, they are Paige Paschall and Julia Blum . They are still in the process of being oriented and getting EPIC access so are not yet able to see patients.  In the meantime, please see the updated SW coverage schedule attached.  We will share more details as we have them.   If there are any issues needing escalation, please reach out to Farhat Choudhry. 

Secure Chat Etiquette:

See the guide to secure chat etiquette attached for your review.

Financial Aid/Charity Care

For uninsured patients who need charity care, see the forms and reminders attached.

Patient Experience - required course

• Last year, our patient experience scores were the highest we’ve had as an organization, and our first quarter results so far this year are better than last year. To continue to improve, there is a new interactive online module, “Always Delivering an Amazing Patient Experience” for all of us to take in Workday by Friday, June 14.

NYP Steps Challenge

• The 2024 NYP Steps Challenge is now open for registration. It’s a great way for us to increase our movement, bond with our fellow team members, and allow us to enhance our wellbeing

Healthy Steps

The e-learning information is below.

Foundations I Application & Practice - Live virtual session

https://elearn.zerotothree.org/p/unita-nypresbfarrell-april2024

The attendance verification code is: apple

Your Farrell Healthy Steps implementation team members are:

Julie Berenyi

Joanne Dempster

Pamela Lamb-Wilkins

Yorgos Strangas

We have meetings to follow up on the implementation of the Healthy Steps program and workflow at Farrell and will meet with you again to discuss the details including the screenings, the referral process, meeting our Healthy Steps specialists, and sharing the schedule for when the specialists will be available in person at Farrell and workflows.

If you have any questions or concerns don't hesitate to reach out to any member of the local team.

See the links below for more information/resources.

Easy-to-Read Topical Articles for Caregivers - HealthySteps

Early Learning Resources for Caregivers (English) - HealthySteps

The Evidence Base - Early Childhood Development Science - HealthySteps

The next Farrell All Staff Meeting is Thursday, May 16th, 2024, at 8 am. 

Farrell Rapid Response

If you encounter a person (patient or staff member) in distress -> overhead page “Stat Team” to your Location 3 times. For example, if the person in distress is in room 112 then page “Stat Team to room 112, Stat Team to room 112, Stat Team to room 112”.  The stat team will respond accordingly.  

The Stat Team = Same Provider (NP or Resident and attending preceptor or Attendings as assigned that day), Charge nurse, MA (assigned to the Same Day provider that day).   Anyone can page the rapid response team. 

See the protocol attached

Wellness

From the NYP wellness team:

April is recognized as National Stress Awareness Month to bring attention to the negative impacts of stress. Managing stress is an essential component of a healthy lifestyle. Knowing how to manage stress can improve mental and physical wellbeing. Here are some healthy ways to cope with stress from the CDC.

NYP wellbeing coaches are available to all team members to support them in managing their stress levels and guiding them to resources to help them take care of themselves. Connect directly with a coach for personalized support reaching your own wellbeing goals or to set up an activity for your team, such as aromatherapy, breathing exercises, and more. 

Below are some ideas and resources to manage stress. Consider:

• Taking time to breathe deeply and consciously, which can calm the mind and body.

• Trying this 5-minute workout video to move your body, as any type of physical activity helps with stress relief.

• Practicing kindness to yourself and others. Send out an appreciation card and make a colleague’s day!

• Lastly, check out this coach-led webinar: Stress: Managing It Before It Manages YOU.

Let’s each make some time to relax daily, seek out support as needed, and BeHealthy!

Administration:

Joanne Dempster will be out from 4/15 - 4/19/24.  Dr Julie Berenyi will cover any issues.

Julie Berenyi will be out on 4/19/24.  Dr Daniela Diaz will cover secure chat messages for both Drs. Dempster and Berenyi. 

BHC referrals to Dr. Pilipenko

• Dr Pilipenko will be on leave 5.24.24 - 9.16.24. The last BHC care day is scheduled for 5.13.24. Please send any BHC referrals on/before May 1, 2024, to ensure that patents can be seen. If needed, evaluations and follow-ups will be scheduled on/after 9.30.24. During Dr. Pilipenko's leave, please direct all inquiries to the SW team. 

Joint Commission Survey - NYP

As most of you already know, we were one of the sites surveyed by the Joint Commission last Wednesday. The survey included staff interviews and chart reviews and we did an amazing job.  Thank you all.  

If you missed the video by Brian Donolly and Steve Corwin, see an excerpt from their message below.

• Last week, The Joint Commission visited us as they do every three years. They work on behalf of the federal government to ensure that all hospitals across America are safe.

• We had the best survey we’ve ever had at NewYork-Presbyterian—because of you. Out of 2,800 standards that were surveyed, we were cited on 54 across eight hospital campuses.

• A surveyor commented that they were impressed that day after day, location after location, they saw the same culture. Of course, another strategic priority is to advance our world-class culture and talent. The culture, based on respect and belonging, that they saw is truly remarkable.

• Not only is this the best Joint Commission survey in our history, but it’s also probably the best in the country. Thank you for everything that you do. You’re the reason why we’re able to achieve that.

EPIC/IT 

Hip & Lower Back Pain Imaging Clinical Decision Support Tool (see the entire message sent by the clinical IT department on 4/9/24)

A new integrated clinical decision support (CDS) workflow was launched for advanced imaging orders for Hip and Lower Back Pain. This is to ensure advanced imaging studies are ordered for appropriate clinical indications.

While placing imaging orders for hip or low back pain, the Decision Support Module will automatically evaluate information in the order and chart including indications and associated diagnosis. Based on this information, most orders will be determined to be appropriate or unable to be evaluated by our appropriate use criteria and you will be able to sign the order without any interruption.

Deceased Patient 

The way to update the patient status to deceased is to open a postmortem encounter. You will first see the patient status which will allow you to you mark the patient as deceased. You will receive warnings before being allowed to change the patient status.  Once a patient's status is changed to deceased there are several downstream effects including automatic discontinuation of medication refills and canceling appointments etc. (Job Aid attached)

KEEPSAFE Updates

• When reporting the KEEPSAFE event, you’ll notice that the locations now align with the EPIC convention.

• The unit is organized by building.

• The easiest way to navigate the list is to search by service: when you start typing Ped, it will show you all Pediatrics sites, Med - Medicine etc.

• Anyone can enter events. Access rights are only needed if you review the events and close them out. Link to KEEPSAFE

·    Any questions or staffing changes should be sent to KEEPSAFE@nyp.org

·    Lifecycle of a patient safety event (See attached slides):

• Identification: Report incidents, near misses, and unsafe conditions via KEEPSAFE.

• Escalation: Reviewed daily; escalated events go to Patient Safety Debrief.

• Analysis: Investigated at three levels: Closeout, eQA, RCA; trends reviewed.

• Risk Reduction: Strategies developed for deviations from standards.

• Communication: Lessons shared at appropriate forums.

• Event Close Out Finalize steps and document risk reduction.

• Loop Closure: Reporters receive the outcome; staff can seek more info.

·    New closure sections for transparency launching next week.

·    Updated KEEPSAFE reporter guide will be available soon.

The next Farrell All Staff Meeting is Thursday, April 18th, 2024, at 8am.  There will be required training needed for our site to become an official Healthy Steps site.  It is therefore important that you participate.  More details will be sent before the session.

Remember to review all Farrell Update messages and use them as a reference for key information and relevant links.  Messages will be sent about twice per month.  If you have questions or concerns, don't hesitate to reach out to the leadership team.

Administrative PTO

Dr Julie Berenyi will be away on Friday April 5th and 12th - Dr. Joanne Dempster will cover for any issues. 

Pamela Lamb-Wilkins will be away from April 9th - 12th - Gina Gelin will cover for any issues. 

Joint Commission Preparation 

Please review the slides attached on key reminders for our Joint Commission survey that can occur at any time.

See the Slides attached. 

OB follow up appointments

A reminder to providers to please schedule out OB appointments when possible.  For example, if 3 appointments are needed in a row, then in the wrap up request 

CT Lung cancer screening

 If there are issues with CT lung cancer screening orders, please place an order or ask the provider to place the order for CT lung cancer screening consultation. 

Once patients are referred to the lung cancer screening consultation and have their first lung cancer screening CT, they are entered on a registry and there is proactive outreach for subsequent imaging.  If a patient does not get scheduled for a follow up CT screening, the doctor can plan the lung cancer screening consultation order again. 

See the  provider tip sheet attached

GI referrals - Dr Rieber

Providers should be noticing that Dr. Rieber's progress notes and endoscopies/colonoscopies from his outside site should be in EPIC.

1. 1. Colonoscopy/endoscopy should be in procedure tab as usual

   2. Progress notes should be a documentation only encounter

2. Please let us know how this going and if you are seeing this information now in EPIC.

Behavioral Health Consult (BHC) reminders for physicians (see the slides attached for more details).

Continue sending referrals via In-basket messages to Dr Pilipenko. 

Who to refer:

· Any adult patient who needs assessment, education, and brief interventions.

BHC is not a psychotherapy service but can provide brief interventions and connect to psychotherapy, if needed (e.g., psychology extern) · 

Not appropriate for: Minors Patients unable to provide consent Psychiatric emergencies

What Services will the patient receive:

• Diagnoses: Depressive d/os, anxiety d/os, somatic symptom d/os, adjustment or stressor-related difficulties, insomnia and sleep-related d/os, chronic pain, tobacco use disorder, obesity, physical inactivity, Any chronic medical conditions

• Goals of service:  Symptom clarifications, improved adjustment to illness, improvement of adherence to medical treatment, symptom reduction, improved health behaviors, improved illness understanding, Stress management, More proactive participation in treatment/self-management of symptoms.

Wrap Up tab

To avoid confusion with scheduling, providers should enter information only in 1 place. If you have multiple items to include, please only use the check out note.

See the provider tip sheet attached. 

SECURITY UPDATES

• Situational awareness: Safety should be our top priority when walking outside. No call is more important than our safety. Please refrain from using phones while on the street.

• Recent incidents in the parking lot: Two employees' cars were stolen. To prevent such incidents, separate car keys from home keys and keep registration and insurance cards in your wallet, not in the car.

• Consider using tracking devices (such as apple Air Tag) to track your car and belongings.

• General awareness: Stay vigilant in all public places, including shopping centers, malls, and movie theaters, as incidents can occur anywhere.

HELPFUL LINKS FROM THE IT TEAM

How to open an incident ticket (Please allow the team 24-48h to respond to your ticket before you escalate to Tier 3 huddle):

https://exfonet.nyp.org/IT/operations/Documents/NYPServicePortalQuickReferenceGuide.pdf#search=how%20to%20open%20service%20desk%20ticket

How to reach the Service Desk:

https://exfonet.nyp.org/IT/operations/Documents/HowToReachServiceDesk.pdf#search=how%20to%20open%20service%20desk%20ticket

NYP IT Device Searches:

https://exfonet.nyp.org/IT/operations/Documents/Hardware%20Detail%20Search%20Job%20Aid.pdf

IT Hardware Status by Asset Tag:

assetSearchPage - NYP Portal (service-now.com)

Document to direct links:

https://exfonet.nyp.org/IT/ce/Documents/IT%20FAQ.pdf

Measles Update

Measles is highly contagious and spreads to others by the airborne route, such as coughing and sneezing.

   Numerous cases of measles have been recently reported in New York City and neighboring states (Pennsylvania and New Jersey). Outbreaks are also occurring in other U.S. states, (e.g., Florida), and globally.

• In 2023, 58 measles cases were reported in the U.S. and thus far in 2024, 41 measles cases have been reported by 16 states, including a case in New York City.

·    Clinicians should consider measles in a patient with compatible signs or symptoms, e.g., febrile rash and cough, coryza (runny nose), or conjunctivitis. The clinical bulletin describes how to IDENTIFY, ISOLATE, INFORM, and test for measles.

·         Click here to read the full measles clinical bulletin or see the information attached to this email. 

PFA team : IMMEDIATELY place patients with measles symptoms in an isolation room and notify the provider via secure chat.  Any patient who reports a rash and fever should be placed in an isolation room and the door should be kept closed.  All of the flags should be raised outside of the room. 

MA team: If while taking the chief complaint the patient reports fever and a rash.  The room she be made into is isolation room, the provider should be notified and N95 mask should be worn by anyone caring for the patient.  

The room should be left empty for 2 hours. If necessary to enter the room earlier, please don an N95 respirator.

Farrell Clinic Closure Times

The official time that security must close the practice on Monday, Thursday and Friday is by 7 pm.

Tuesday and Wednesday it is by 8 pm.We ask that staff begin leaving at least 30 minutes before closing.  So, on Monday, Thursday and Friday staff should try to be out by 6:30 pm and on Tuesday and Wednesday by 7:30 pm.  This gives security enough time to do thorough rounding and not inadvertently lock anyone inside the practice.

The next Farrell All Staff Meeting is Thursday, April 18th , 2024, at 8am.

Wellness

Hoping that you enjoy your time off for President's Day and return rested and rejuvenated.  If you have to work, we hope that you have some time to enjoy the day.

Administrative PTO

Dr Joanne Dempster 2/26/24 - Dr Juliana Berenyi will cover for any issues. 

Dr. Juliana Berenyi 3/01/24 - Dr. Joanne Dempster will cover for any issues.

Social work coverage

See the updated SW coverage schedule attached.

Reminders for improving flow and patient care:

Provider rescheduling instructions - Rescheduling instructions to the PFA team should include only when the patient should be rescheduled; ie 1 week same day, routine with PCP, etc.. They do not need to include extraneous clinical information.

Forms - Providers should not hold onto forms even when incomplete, return them to brown patient folder at front desk

SW Referrals - A reminder that Social Work referrals should be via in-basket messages.  For urgent messages use secure chat.

Please do not use the SW order set.

Urgent Secure Chat Messages: When sending urgent secure chat messages for issues needing immediate action.  Click on the exclamation icon (see screenshot below).

Disabled Order Comments to Display on the Ambulatory AVS

Providers and staff who create referral orders should be aware that the comments section in a referral order will no longer display on the patient’s After Visit Summary.  The 500-character limit has also been removed. Comments that need to be displayed to patients on the AVS can be placed in the Patient Instructions field on the Wrap Up tab

EMS Delays

The ACN leadership is aware of the EMS delays across the borough of Manhattan and are working on algorithms to help and are in contact with NYP EMS/FDNY/911

When there is a delay on site, call EMS -CU Campus: (212) 305-9999

It is Important to specify that this is an NYP site where an NYP patient needs to be transported to an NYP facility

If the wait is > 30 mins, staff should text Mark Krugman directly to intervene

New Family Medicine specialty profile in Epic

Dr Chacko and her team updated the profiles of Family Medicine physicians who practice full spectrum FM care to provide some necessary tools in Epic, so we don’t have to manually search for it all.  Some significant improvements include our ability to access tools to see children and for women’s health including the prenatal tools.  See attachment.

All users who are logged into FRL Family Medicine [501007005] will have access to the new family medicine tools.  Some providers logged into different departments when in session.  It is recommended therefore that you change their context and log into FRL Family Medicine [501007005] when seeing patients onsite.

Surgical/Procedural Consent Updates

Starting February 6th, there will be a new feature in Epic. If there are multiple provider’s name on the consent form, any of the listed providers on the form can sign. Previously, the printed name at the bottom of the consent form defaulted to the first physician's name on the consent. However, now the name can be updated without having to re-do the consent. The physician signing the consent will authenticate with their credentials and the primary physician's name will update.

This enhancement will reduce the number of consents that need to be re-done due to a mismatch with primary physician name and physician signature.

See the feature attached

Breast Imaging Clinical Guidelines

See the clinical guidelines for breast imaging orders attached.

Blood Pressure Measurement

Accurate Blood Pressure measurement in the office:

From the American Medical Association: Measuring blood pressure is one of the most common procedures performed at a medical office. Yet, studies have shown that nurses, medical assistants and even doctors make numerous mistakes when taking readings. Failing to support a patient’s back, for example, or engaging in conversation with the person while trying to measure his or her blood pressure can throw off a reading by as much as 25 mm Hg.i

If the blood pressure is elevated.  Repeat using proper techniques in 5-15 minutes.

The MA staff should not be asked to repeat the BP more than once for 2 checks.  Providers can repeat the BP if warranted. 

Pap Smear Results Management

Message from Dr. Emmanuel:

Hi Everyone-

There have been several questions about pap results over the past weeks from both nursing and providers, so I just wanted to make sure that we are all on the same page.  Attached is the job aide that Dr. Kondragunta created for us. 

The pap tracking hyperlink at the bottom of the results page is for the PATIENT- it sends out a reminder to the patient when it is time for their next pap smear.   

The result note is for INTERNAL documentation.  This should ideally be performed for all paps with recommendations for when the next pap smear should be performed but definitely required for abnormal pap smears including normal paps with yeast, BV or trich present. Included in this documentation should be both patient notification and plans for treatment/ follow-up. 

Both need to be completed please. 

Please let me know if you have any questions or concerns.  Happy to demonstrate at one of our provider meetings if this is unclear. 

Thanks,

Charlene

Jury Duty Workflow

See the workflow for providers if they are called for Jury Duty attached.

Telemedicine Documentation

Message from Lauren Solomon. 

Due to the need for additional compliance review, this Smart Phrase is not ready for implementation. I apologize for any confusion but please do not start using. ACNTELEHEALTH in your telehealth notes yet.

However, the following best practices should be followed:

• Use .TELEMEDICINE Smart Phrase in all telehealth notes (video and audio only)

• Use appropriate billing codes (E/M or time-based codes for video visits and 99441-3 for phone visits) 

  • Residents are unable to complete time-based billing therefore audio-only phone visits conducted by residents are not billable. They may continue to enter codes, as a backend process is in place to capture this.

• Update visit type – immediately once the need is identified, ask front desk staff to update the visit type to match the mode in which the visit took place or complete Epic Provider Self-Scheduling eLearning to gain access to do-it-yourself 

Additionally, the patient location questionnaire and BPA is live - patients now indicate their physical location in a questionnaire incorporated into eCheck-in. If a patient does not complete eCheck-in, the provider will be alerted to ask this question and document where the patient is located through a BPA.

 HEATERS ARE BEING LEFT ON IN WORKSPACES AT THE END OF THE DAY. PLEASE REMEMBER TO TURN OFF YOUR HEATERS BEFORE YOU LEAVE YOUR WORKSPACE AS THIS PUTS us AT RISK FOR A FIRE. IF YOU NOTICE THAT SOMEONE FORGOT TO TURN OFF THEIR HEATER PLEASE TURN IT OFF.

 The next Farrell All Staff Meeting is Thursday, March 21st  2024 at 8am.

 The next meeting to discuss the Farrell Unified Project is on Thursday, February 29th promptly at 4pm.

Hello everyone,

Remember to review all Farrell Update messages and use them as a reference for key information and relevant links.  Messages will be sent about twice per month.  If you have questions or concerns, don't hesitate to reach out to the leadership team.

Administrative PTO : 

Jose Martir Feb 5, 2024.  Murielle Frederick is available for any PCD concerns.  She can be reached via email, text, or phone.

Shout Outs

Thank you Drs Encarnacion and Richman for making us proud.  See patient comments below on the patient experience survey.

Re: Dr Encarnacion

"I trust my doctor Melissa Encarnacion is an excellent person."  "Dr. Encarnacion is an excellent doctor, really helpful." "Very respectful, professional, and concerned doctor."

Re: Dr. Richman

"I have never had a provider as skilled as my Dr: Richman always looks for the best solutions for my health. She is a highly trained professional."

January & February Birthdays 

 * Velma McMillan 2/13                                             

  * Tiesha Moore 2/26

Happy January and February Work Anniversary                                                            

        * MA - Velma McMillan 1/6                                       

         * MA - Yersy Arriola - 1/9,                                            

        * PFA - Martha Rodriguez - 1/10,                                   

         * MA - Chery Guzman - 1/23                                   

         * RN - Allison Weston - 2/6

After Visit Summary

A reminder to use the AVS for patient education information including post-procedure instructions, pain management, etc.  

Note the below-regarding comments that you put on referrals in the "comments section".  Your comments will be pulled into the AVS and patients will have this information.  

Consults/Referrals

Pediatric Surgery Clinic for Spanish-speaking patients:

There is a new Pediatric Surgery Clinic where all of the providers speak Spanish for our Spanish-speaking patients. You can use the standard Amb Referral to Pediatric surgery and write in the comments box the following smartphrase:

ACNPEDSSPANISHSURGERYCLINIC

or type in 

Schedule for Pediatric Surgery  Spanish Speaking Clinic - call 212-342-8586 and ask to speak with Danielle Mendoza, Vincent Duron 

E-Consults

E-Consults to Endocrine (Diabetes) is now available for diabetes-related issues (see original clinical IT message 1/23/24 for more details)

This E-consult is to assist referring providers of adult patients with common, NON-urgent diabetes questions related to starting GLP1 agonists or SGLT2 inhibitors for type 2 diabetes, starting basal insulin for type 2 diabetes, or adjusting diabetes medications for steroid treatment.  Most recent GFR and BMI should be included in the consult request.

To place an E-Consult order, follow the steps in the attached job aid. As a reminder, E-Consult referrals are for brief clinical questions for the specialist. It is not intended for administrative requests like arranging an office visit.

Providers: Referral Reminder 

Just a reminder if you place a referral after your session is over, including weekends you MUST send a message via the in-basket (per the workflow) to your PFA team letting them know you placed a referral.  This needs to be done to ensure your PFA team does not miss any after-hours referrals.  

Nursing Visits

Providers should remember to include in their note and or wrap up the reason for the nursing visit.  All vaccines should be placed on hold.  

For nursing or lab visits - labs should be placed on hold.

Pediatric patients should not be placed in the nursing template for Weight checks or blood pressure checks.  Pediatric weight and blood pressure checks if needed in a short period of time and there is no provider follow-up, can be placed on the same day tally.  

See the attached REVISED document for general guidelines on appropriate referrals for nursing visits.  The first update is under appropriate Nurse visit the 3rd collum for Rhogam injection. The second update is under inappropriate nurse visit the 7th collum for Blood glucose log review.

ACN Narcan program updates January 2024

A reminder that there is Narcan at Farrell to distribute to patients/families.

NURSE TRAINING TO DISTRIBUTE KITS TO PATIENTS/FAMILIES:

Nursing had a refresher training in late October.  

The training included information on fentanyl and xylazine test strips, which are also being provided to clinic

PROVIDER TRAINING ON NARCAN AND/OR WORKFLOW/EPIC DOCUMENTATION

Providers please let us know if you would like to include more information in the Farrell Focused meeting.

Rhogam

Providers: The provider should send a secure chat request to RN, so RN can initiate RhoGAM pick up from blood bank.

RSV vaccine in pregnant women and infants

Our last day for RSV vaccination of pregnant women was on Wednesday January 31st .  We will continue to offer  Nirsevimab to newborns and babies up to 8 months and children ages 8-19 months with the specific criteria as there is still RSV occurring, albeit at low levels.  See prior update sent on 1/19 for more details.

Farrell Unified Project 2023 - 2024

Based on our discussion and votes, the winning projects are listed below in the order votes (most votes at the top):

1. Improving Cycle time 

2. Decreasing No Show/ late cancellation rates 

3. Medications (reconciliation/adherence)

Next Steps:

The leadership team will get some preliminary data on each topic (if possible) to share at our next meeting to help guide next steps for the projects.

The entire team will create Smart Aims for each project on February 29th.

The entire team will develop fishbone diagrams for each project to direct next steps.

For each project please be prepared to describe:

What are we improving?

By what date and how much we want to improve: Time-bound and measurable (how much? by when?)?

For/with whom are we doing this work: Define the specific population whose lives will be affected by the improvement effort?

Where is the improvement taking place?

See examples of AIM statements below.

• Increase colon cancer screening rates among patients ages 50+ who have a Farrell pcp assigned, from 50% to 70% by May 2024.

• Reduce waiting time to see a provider while in session for all patients ages 65+ to less than 10 minutes by July 2024.

• Decrease the no show rates for all visit types at Farrell from 26% to 10 % by June 30th 2024.

• Reduce the time that a patient who is seen at Farrell for a routine visit is registered and roomed to 5 minutes in 90% of the patients who are seen at Farrell for a routine visit.

• Increase the percentage of patients who have an updated medication list from 25% to 50% by March 2024.

• Reduce time (for all visit types) that patients spend in the practice from time of registration to time of discharge to less than 30 minutes in 90% of all patients seen at Farrell by December 31st 2024.

Don't hesitate to send any comments or concerns to the Farrell Leadership team.

 Change to How Remote Staff Access Epic Icons

Who this message is for:

 All staff who access Epic without using VPN or Institutional Network.

What is happening:

On Sunday, January 28 at 8am, NYP IT will be making a change to how Epic is accessed remotely.

Why we are making this change:

Users who access Epic remotely, not through their institutional network or VPN, will see a new layout to the login page and workspace. This is part of the NYP initiative to move away from the Citrix Workspace for hosting the Epic icons.

How this will affect you:

Users who login to Epic remotely from home or other off network sites, will notice a change to the login page and workspace when logging into the following:

• apps.nyp.org

• myapps.med.cornell.edu

• nypcc.nyp.org

The same Epic ions will be available, but the screen layout will change, see below.

After clicking on the Epic Hyperspace Production icon, Epic will launch as expected. Only the initial workflow, getting to the App Store page with the Epic icons, is changing.

Who to contact with Questions/Feedback:

Submit a message to Epic Support directly by clicking on the “Epic Help” button within Epic itself, email epictogethersupport@nyp.org, or call your institutional Service Desk:

• NYP: 4-HELP or 212-746-4357

• CUIMC: 5-HELP or 212-305-4357

• WCM: 212-746-4878

Current Workflow Screens:

New Workflow Screens:

The next Farrell All Staff Meeting is Thursday, February 15th 2024 at 8am.

The next meeting to discuss the Farrell Unified Project is on Thursday, February 29th promptly at 4pm.

From the Farrell Leadership Team:  

We appreciate the work that you do to provide excellent care to our patients and create a great work environment for each other despite the challenges we face daily. We are dedicated to improving the experience and outcomes for everyone.  

Pamela Lamb-Wilkins, Jose Martir, Julene Stephenson, Juliana Berenyi, and Joanne Dempster.

Wellness

From the NYP BeHealthy team.  Posted on January 17th, 2024

This snowy week, check out these articles from NYP Health Matters with tips on staying warm, protecting your heart health and back, and more:

• Cold-Weather-Ready: How to Enjoy the Outdoors Safely This Winter A primary care physician shares tips on how to stay warm, recognize signs of trouble, and understand what to avoid in chilly temperatures.

• How Can Cold Weather Affect Your Heart? A cardiologist shares tips for protecting your heart health in chilly temperatures.

• How to Avoid Back Pain When Shoveling Snow An expert from Och Spine at NYP offers tips to help reduce the chance of back pain when someone is out shoveling snow.

• The Unexpected Benefits of Winter Workouts Exercising outdoors in the winter has benefits for your body and mind. Here’s how to make the most of your workouts.

• Winter Sports Safety: How to Prevent Injuries While Enjoying Outdoor Activities A sports medicine specialist offers safety tips for kids and adults heading outside for winter sports and activities.

Remember to exercise caution and allow for extra travel time during winter weather.

Stay safe and warm and BeHealthy!

click here for more tips 

Administrative PTO: 

1/26/24 : Dr Juliana Berenyi - Dr. Joanne Dempster to cover issues. 

Social Work Coverage and updates

Wan-Hai Tseng's last day at Farrell is today 1/19/24.  We are grateful for the service that she has provided for our patients and wish her success in her future endeavors.

Effective 1/22/24, three Social Workers (SW) will provide temporary coverage based on a rotation attached until we have replacements for Wan and Rachael.  The covering SW are:

Alyssa Wynn

Nadiuska (Nadia) Vasquez

Yira Rivas

SW Referrals: Continue sending SW referrals via In-basket message to the SW pool.  For now, there is no change in the workflow.  

Continue sending urgent messages via secure chat. 

Social Workers will be added to the SW Farrell Provider pool and will be checking in-basket messages as per their schedule (attached).

Monday & Tuesday (Monday 8:30am-4:30pm for urgent concerns, Tuesday morning for urgent & afternoon until 4:30pm for routine/urgent)

Wednesday Yira Rivas (onsite at Farrell 8:30am-4:30pm)

Thursday & Friday Nadia (Thursday onsite 9am-5pm, Friday morning for urgent & afternoon for routine/urgent)

Social Work Care Manager, Christina Toro will continue to attend Farrell IDT and reach out to the assigned SW for follow up.

Health Priority Specialist, Cynthia Martinez- Feliz attends IDT and will continue to reach out to assigned SW for follow up as discussed at IDT.

Social Work Assistant Paula-Annette McKay will be onsite at Farrell Mondays & Tuesdays.  She will continue to assist with DME/transportation M-F at Farrell 8:30am-4:30pm.

Behavioral Health SW Juan de Marchena is onsite at Farrell Mondays and working on increasing his onsite days. He is assigned to Farrell 4 days (Mon-Thur) 9am-5pm.

Psychiatric Case Manager, Elisa Mejia is onsite at Farrell Fridays. She works M-F at Farrell 9am-5pm

Reminders to improve patient care and flow

Nursing visits: 

Providers should remember to include in their note and or wrap up the reason for the nursing visit.  All vaccines should be placed on hold.  

For nursing or lab visits - labs should be placed on hold.

Pediatric patients should not be placed in the nursing template for Weight checks or blood pressure checks.  Pediatric weight and blood pressure checks if needed in a short period of time and there is no provider follow-up, can be placed on the same day tally.  

See the attached document for general guidelines on appropriate referring for nursing visits.

Panel management - see message from the last update on 1/8/24 - attendings can request a panel management session to work with patients on improving diabetes or hypertension metrics.  

DSME referrals remain an option for patients to receive education and reinforcement of medications, diet etc. In general, we underuse this support.

Chief complaint - see previous messages - it is extremely important for MA's to get specific chief complaints from patients.  "As per HPI" should only be used if all other attempts fail.

In-basket/Note policy - See the most updated policy attached for review as it will now be reinforced.  Residents can ask preceptors for assistance if they have questions/ need guidance during precepting sessions.  Preceptors will periodically check residents in-baskets when in session.

Forms: When using form filler, providers can sign forms without printing them.  Screenshots below.

Residents to expedite follow-up with your attending you can complete the form without signing it and send it directly to your attending. The attending can then review and sign the form electronically, which will then be uploaded automatically in the media tab.

1. The resident should open the form filler and complete it as usual.  It is important that the resident closes the form filler by clicking on the X and does NOT sign the form.  

2. They then need to click the back arrow to get to the screen where they can send the form.

3. Click on send and put the attendings name as the recipient.

It will then show up in the cc'd charts folder in the attendings in basket.  The attending can then open the form, use the sign feature to add their electronic signature, add their license and NPI if needed, and sign the form.  The form will now be saved in the media tab with their electronic signature.  The patient can find it in Connect in their "document center".

Update on VFC Supply and Recommendations for Use of Nirsevimab

From Dr. Ashley Stephens: more information is attached. 

Now that some of the shortages of nirsevimab have subsided, CDC and VFC are saying we can go back to providing the antibody to all babies up to 8 months of age (not just up to 6m as we had been doing) as long as the supply is sufficient. There are no changes to eligible children ages 8-19 months with the specific criteria below:

• patients ages 8-19 months 

  • chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6 months period before the start of the second RSV season  

  • severely immunocompromised  

  • severe cystic fibrosis   

  • American Indian and Alaska Native children  

Here's the CDC newsletter about offering to patients 0-8m in setting of increasing supply:

https://emergency.cdc.gov/newsletters/coca/2024/010524a.html as well as the notification from VFC.

The next Farrell All Staff Meeting is Thursday, February 15th, 2024 at 8am.

 The next meeting to discuss the Farrell Unified Project is on Thursday, February 29th promptly at 4pm.

Happy New Year

Influenza, RSV, and COVID are on the rise, we therefore strongly encourage you to all wear masks in the clinical setting and encourage patients to wear masks as well. 

Wellness

Click on this link to see the tips and resources shared by the NYP Be Healthy Team.

Administrative PTO

Dr. Julie Berenyi will be away on 1/12/23.  Dr. Joanne Dempster will cover any issues.

Allen Hospital Blood Drive Wednesday

, January 24th from 10 am - 5pm in the Thayer Conference Room.

 See the attached flyer for the QR code to schedule an appointment. 

Reminders for improving flow and patient care

Providers: Remember to give the PFA team clear instructions with flexibility when requesting appointments.  For example, it is best to give a range for follow-up whenever possible.  

MA team: Regarding documenting the patient's chief complaint, remember to only use "as per HPI" as a chief complaint only when you tried several times without success getting a chief complaint from the patient.  If the patient is not sure why they were scheduled, then ask the patient "What do you want to have addressed today". This information is extremely important for billing and guiding providers before they go into the room to see the patient.

Compass Program - ACN/West (reminder of this program that provides gender-affirming care that was launched last year)

What is happening:

 New ambulatory referral process for the Compass Program, a dedicated gender-affirming care clinic for patients up to age 19 years.

How this will affect you:

 Effective Thursday, February 9, 2023, a new ambulatory referral order and process will be live in EPIC to connect patients to the Compass Programs either at Columbia University Medical Center or Weill Cornell Medical Center.

Description of The Compass Program:

 Compass is a comprehensive and interdisciplinary gender-affirming care program for transgender and gender-diverse individuals and their caregivers to be seen in a safe, welcoming, and nonjudgmental space.

Services can include:

• Comprehensive and individualized needs assessment

• Family support

• Collaboration with schools and other organizations

• Sexual and reproductive health counseling

• Gender-affirming medicines

How to refer patients to Compass:

 Search for “AMB Referral to Compass Program” as an order. Providers can also search for any of the following terms:

• “Compass

• “Transgender”

• “Gender”

Who to contact with Questions/Feedback:

 Questions about the program: Compass Program: 646-369-6905 | obk7001@nyp.org

E-Consults

The AMB Referral to CUIMC E-Consult Gastroenterology (Esophageal) is available for CUIMC clinicians as of 1/3/2024.

As a reminder other availabe e-consults are:

AMB Referral to CUIMC E-Consult HTN Center

AMB Referral to CUIMC E-Consult Adult Cardiology

AMB Referral to CUIMC E-Consult PEDS Cardiology

AMB Referral to CUIMC E-Consult Benign Hematology

AMB Referral to CUIMC E-Consult Adult Otolaryngology

AMB Referral to CUIMC E-Consult Peds Otolaryngology

AMB Referral to CUIMC E-Consult Cancer Pain and Symptom Management (Palliative Care)

AMB Referral to CUIMC E-Consult Psychiatry

AMB Referral to CUIIMC E-Consult GYN ONC

AMB Referral to CUIIMCE-Consult Adult Infectious Disease

See the job aid attached.

COVID-19 Update: Interim IP&C Guidance on Aerosol-Generating Procedures (AGP)

KEY UPDATES:

·         Recent studies have shown that some procedures/treatments previously considered to be aerosol-generating DO NOT generate more aerosols than breathing, speaking, coughing, or low-flow supplemental oxygen. Thus, these procedures/treatments - CPAP, BiPAP, high-flow nasal cannula, and nebulized medications - have been REMOVED from the NYP list of AGPs.

·         Several protocols and practices have been updated based on the changes noted above:

• CHANGES TO VISITATION:

·         Visitors to patients WITH suspected or confirmed COVID-19 are now allowed during CPAP, BiPAP, high-flow nasal cannula, and nebulized medications. Visitors must wear appropriate PPE. 

• CHANGES TO UNIVERSAL N95 RECOMMENDATIONS for Healthcare Personnel (HCP):

·         For patients NOT on Airborne or Enhanced Droplet Precautions, UNIVERSAL N95 respirator use (with eye protection) is now strongly recommended only for certain AGPs, specifically: uncontrolled/emergent intubation, bronchoscopy, and sputum induction. For all other AGPs, either an N95 respirator OR well-fitting surgical mask may be worn with eye protection.

·          

UNCHANGED protocols and practices include:

·         Visitors to patients WITHOUT suspected or confirmed COVID-19 are allowed during AGPs.

·         Visitors must wear appropriate PPE based on Transmission-Based Precautions requirements for patients on Airborne Precautions, Enhanced Droplet Precautions or Droplet Precautions.

·         PPE requirements for HCP are UNCHANGED for Airborne or Enhanced Droplet Precautions (e.g., COVID-19):

o   N95s are still required at all times for patients on Airborne Precautions.

o   N95s are still strongly encouraged for patients on Enhanced Droplet Precautions.

See the full guidance attached.

COVID-19 Update: IMPORTANT CHANGES TO COVID-19 TESTING REQUIREMENTS 

Effective TUESDAY, December 19, 2023:

• COVID-19 testing for asymptomatic patients transferred from outside hospitals is NO LONGER REQUIRED.

• COVID-19 testing for asymptomatic patients admitted to Labor and Delivery Units is NO LONGER REQUIRED. This includes Obstetrics triage, Cesarean deliveries, and inductions of labor.

• UNCHANGED:

  • COVID-19 testing for all admissions through the Emergency Departments continues to be required.

  • As of November 27, 2023, pre-procedural COVID-19 testing for asymptomatic patients, including same-day admissions, is no longer required. See preprocedural guidance for details.

  • As of November 27, 2023, direct admits do NOT generally require testing, UNLESS required by the specific unit or service (e.g., certain hematology/oncology or transplant services). Testing on admission for these patients may be ordered by the primary team.

ALSO UNCHANGED:

• Admitted patients with symptoms consistent with COVID-19 should be tested for COVID-19 as well as for other respiratory viruses using the Respiratory Pathogen Panel.

• Admitted patients should be screened for COVID-19 exposures so that appropriate isolation can be implemented.

The next Farrell Allstaff Meeting is Thursday, January 18th, 2024 at 8am.

Wellness Tips from the NYP BeHealthy team

Healthy Holiday Drinks:

 Holiday drinks, such as a peppermint mocha or a hot cocoa, are the perfect treat for a cold day! However, these beverages can contain extra calories and added sugar that may not promote your health goals. You may wish to try the healthy hot cocoa recipe below.

This recipe uses low-fat or skim milk, which has fewer calories and saturated fat than whole milk and contains vitamins A and D. The milk also provides a serving of protein and calcium, which cannot be found in the powdered hot chocolate mixes prepared using water. It also contains natural cocoa powder, which contains important minerals such as iron, zinc, selenium, and magnesium. 

Healthy Hot Chocolate 

(Adapted from registered dietitian's recipe)

Ingredients: 

• 1 tablespoon natural, unsweetened cocoa powder

• 1/2 tablespoon sweetener of choice (recommend brown sugar but can substitute for stevia, agave, or even maple syrup for an added flavor)

• 1 cup low-fat or skim milk, warmed to steaming (either on stove top or microwave) 

• Add-ins like orange zest and ground cloves; ground cardamom and vanilla extract; or chili powder and ground cinnamon (optional)

You may wish to substitute dairy milk for a non-dairy alternative, such as soy or almond milk. Find out more here about non-dairy milk.

Directions: 

• Combine cocoa powder and sweetener of choice in a mug; swirl in warmed milk. Add in one of the flavor additions, if desired.

Remember, it is okay to permit yourself to enjoy the sweet treat drinks every once in a while! 

For more tips, register for NYPBeHealthy Healthy Desserts for the Holidays: Wednesday, December 20, from 6:00 p.m. - 6:30 p.m. Join Wellbeing Coach Dionne Smith in the kitchen to learn how to make a delicious and healthy treat to enjoy solo or share with your family and friends. Also, check out the Healthy Holiday Challenge and register here!

Stay warm, and be healthy!

Mask Mandate

DOH Declares “Masks On” For All Healthcare Workers Not Vaccinated Against Influenza

​Influenza is now prevalent in New York State and the New York State Department of Health has declared "masks on" for all healthcare workers who have not been vaccinated against influenza.

Effective Friday, December 8, 2023, all unvaccinated employees, including those who have a medical contraindication or approved religious/deeply held belief exemption, must now wear a surgical mask when they are in areas where patients are typically present. This includes all inpatient and outpatient locations, lobbies, elevators, corridors, cafeterias, gift shops, common areas, and any other location where patients may typically be present. Masks for employees will be available at Hospital entrances and clinical locations.

In keeping with State regulations, while the "masks on" mandate is in effect, unvaccinated staff who do not comply with this requirement will be subject to corrective action. The masking requirement will continue until the Department of Health Commissioner determines the date for "masks off," when masks will no longer have to be worn.

Employees, including those who previously declined the flu vaccine, can still be vaccinated free of charge at their site's Workforce Health & Safety clinic. A list of clinic locations and more information about the influenza vaccination program are available on the Infonet by clicking here. 

If you have any questions, please speak with your manager, or contact the WHS Contact Center at 646-697-9470.  

Electronically signing form filler in Epic

You can now electronically sign form filler forms in Epic.  You click on the box that says sign and then use your mouse to electronically add your signature.  When you sign the form, it will automatically be saved to the Media tab with your electronic signature.  See the Job Aide attached. 

Labs

Providers, when ordering labs for patients who have to go to 161st Street please order as an "internal" draw.

Farrell Emergency Closing and Severe Weather Procedures

See the procedures for emergency closing or severe weather attached. 

Video interpreter machine Tips:

VRI technology offers video interpretation in over 40 languages and is strategically placed on the first floor at Farrell. Instruction for use and language availability are affixed to each device. For further details contact your respective campus, Monday through Friday from 9:00a.m. -5:00p.m. During off-hours, contact the Administrator on Call or On-site Administrator.

Tips

If a patient prefers a particular sex/gender please request the preferred interpreter as per the patient's request.

If you forgot to document the interpreter ID number, to recover it, you can click on the "Help and settings" button on the bottom left of the machine, then "call history".

Consider using the "Note Pad" feature to spell out any medications being discussed.

See more information on the Infonet.

The next Farrell All Staff meeting is Thursday, December 21st   at 8am.

 BREAKFAST WILL BE SERVED AT 8:30 AM IN THE SECOND-FLOOR CONFERENCE ROOM 

Remember to review all Farrell Update messages and use them as a reference for key information and relevant links.  Messages will be sent about twice per month.  If you have questions or concerns, don't hesitate to reach out to the leadership team.

 All updates can be found on our CFCM Provider Website: https://www.cfcmresources.com/farrell-health-center/farrell-updates

Administration PTO:

Pamela Lamb-Wilkins 12/7 and 12/8 as well as 12/14 and 12/15 - Covering administrator - Gina Gelin - gig9038@nyp.org

Sick Call

Providers: When you call out sick, please remember to include whether a Farrell patient care session is affected and whether a Farrell precepting session is affected.

 Please send rescheduling instructions via email for patient care sessions.  

Residents should include their preceptor in the email.

Double booking requests

Residents must include the preceptor for approval when sending a double book request to the PFA staff.

Requests for scheduling patients post-hospitalization

For non-urgent follow-up visits for patients who are being discharged from the hospital, the PFA team will verify that the insurance is accepted at Farrell before scheduling the patient.  Note that patients who have insurance not accepted at Farrell cannot be seen at Farrell. 

For patients who need an urgent visit for follow-up, the inpatient team must include Drs. Berenyi and Dempster to approve and assist as needed via secure chat message.

Immunization Updates

Summary of changes to the CDC immunization schedule for 2024

The following key changes have been made in the CDC 2024 immunization schedule:

• Headers were changed from “Vaccine” to “Vaccines and Other Immunizing Agents” to include monoclonal antibodies.

• New entries, indications, notes, and contraindications and precautions were added for:

  • RSV-mAb (nirsevimab) for children from birth through <8 months and for certain high-risk groups from 8 to 19 months, including information describing timing of immunization and guidance for jurisdictions with respiratory syncytial virus (RSV) seasonality that differs from most of the continental United States;

  • RSVPreF vaccine (Abrysvo) for pregnant persons, including information describing timing of immunization and guidance for jurisdictions with RSV seasonality that differs from most of the continental United States; and

  • mpox vaccine (Jynneos) for those who are age 18 years and at risk.

• The following vaccines were deleted from the schedule because they no longer are distributed or recommended for use in the U.S.:

  • bivalent mRNA COVID-19 vaccines,

  • 13-valent pneumococcal conjugate vaccine (PCV13),

  • diphtheria and tetanus toxoid vaccine (DT), and

  • Menactra

• COVID-19: The routine vaccination and “Special situations” sections were revised to reflect the current COVID-19 (2023-’24 formula) vaccination recommendations for children and adolescents.

• Influenza: A note was added to state that people with a history of egg allergy of any severity can be vaccinated with any influenza vaccine indicated for the recipient’s age and health status with no additional safety considerations.

• Meningococcal (Men): Information was added about the use of the newly licensed MenACWY-TT/MenB-FHbp (Penbraya) vaccine. A resource to assist healthcare providers with shared clinical decision-making recommendations for MenB vaccination was added.

• Pneumococcal: Recommendations were added for the use of the 15-valent pneumococcal conjugate vaccine (PCV15), PCV20, and 23-valent pneumococcal polysaccharide vaccine (PPSV23) for routine vaccination, catch-up vaccination and “special situations.”

• Poliovirus: “Catch-up” vaccination was revised to include updated recommendations for adolescents aged 18 years, and the “Special situations” section was revised to describe administering one lifetime inactivated polio vaccine (IPV) booster to adolescents age 18 years who have completed the primary series and are at increased risk for exposure to poliovirus.

Security Alert

(Message from the security department)

Information for all,  our local NYPD Precinct has recently alerted us to a rash of car thefts and break-ins in the vicinity of the hospital.    This trend involves newer-model Hondas/Acuras which are being targeted along Riverside Drive, from West 158th Street - to the G.W. Bridge entrance.

As a result, NYPD is increasing their patrols of the area.

We ask that if anyone sees anything out of the ordinary along Riverside Drive, they are encouraged to call 911 so that NYPD can respond and investigate.

Also, we encourage anyone who owns these types of vehicles to consider adding a security device (i.e., steering wheel lock/club).

If you’re parking on public streets, please do not leave any valuables inside of your vehicle.

Call 911 immediately if you see anything suspicious (i.e., person lingering around vehicles, trying door handles, etc.). 

VNS Home Hospice Program

See the information attached. 

Important dates to remember 

Flu Vaccine:  The deadline to be Vaccinated or Submit a Medical or Religious Exemption Request is Friday,  December 8, 2023. Failure to receive your vaccine or submit an exemption by the required due date may result in being locked out of the system.

 Required training that is assigned in Workday

• • The two trainings on updated chaperone policy are due December 8th  

  • Annual Hospital Training AHT23 is due December 8th

The next Farrell All Staff meeting is Thursday, December 21st  at 8am.

Normal lab letter workflow

If providers need to send a letter to a patient regarding normal lab results, please route the letter to your PFA team for printing and mailing. 

Rhogam workflow

1) Provider orders a recent Type and Screen

2) Provider places an order for the Rhogam itself

3) Provider gives a warm hands-off and/or secure chat to make the nurse aware that Rhogam is ordered for the patient

4) The nurse coordinates Rhogam pick up with lab and the driver 

5) The nurse contacts the patient to arrange a nurse visit after the Rhogam arrives to the practice

6) Once the patient arrives to the practice another order to administer the Rhogam is placed by the PCE

OBGYN referrals - Farrell

Dr Nalgonda will resume her OBGYN sessions at Farrell beginning Tuesday November 21st.  There is no change in the referral process. 

NYP/Farrell Smoking cessation referrals

Message from Dalia Mejia - Tobacco cessation program coordinator at NYP.

Dear ACN West,

I hope this message finds you well. We would like to take a moment to remind and encourage you to refer patients to our Tobacco Treatment Services program. Your referrals are instrumental in helping patients quit smoking and achieve better health outcomes. There are several convenient methods to refer patients who express interest in receiving treatment to quit smoking cigarettes:

1. Email/In-basket: Send the patient’s Medical Record Number (MRN) to dxm9022@nyp.org, mab9391@nyp.org, and jur9034@nyp.org

2. Telephonic Referral: Call us at 646-317-7062 or 347-266-7447

3. Workqueue Referral: ID 37559 ACN West Tobacco Treatment Services > Referral Order/ID Ref279

We have noticed a significant drop in the number of patient referrals to our program since January 2023. According to the NYC ACN West Active Smoker report, there are currently 1,527 patients in our network who are nicotine users and could benefits from our services.

We greatly appreciate your ongoing help and support in referring patients to the Tobacco Treatment Services program. Your referrals make a substantial impact on the lives of those struggling to quit smoking, and we remain committed to providing the best care possible to these individuals.

If your have any questions or need assistance with the referral process, please do not hesitate to contact us. Thank you for your cooperation and dedication to our shared mission.

Thank you,

Dalia Mejia

Columbia/New York Presbyterian Hospital

Program Coordinator – Tobacco Cessation

E: dxm9022@nyp.org

Tel: 646.317.7062

Cell: 347.266.7447

NYC Smoking cessation resources 

https://www.nyc.gov/site/doh/health/health-topics/smoking-nyc-quits.page

Chaperone Policy FAQ's (attached)

Orders for nursing and Lab visits:

Providers:

A reminder when in session, be sure that the order is "normal" and not future for orders placed in session. 

For future orders

The 3 areas for consideration are

Status - Future

Expected date - can check the approx.  box and the time frame you anticipate

Expires - consider checking and expiration of 1 yr

priority - routine

Providers:

For return for labs or nursing visit please include the reasons the lab and or nursing in your note 

Farrell Quality Projects

November 30th 2 - 2:45pm.  All Staff will meet in the first floor waiting area to discuss current quality projects.  Residents will present their current projects and get feedback from staff.   We will also discuss and vote on a unified Farrell project that involves all staff participation. 

Current suggestions for a Unified Farrell Project are:

Decreasing the Late cancellation and No-show rates.

Improving cycle time

Improving safety through updating medication lists

Improving the recognition and assessment of Obesity

improving the rates of patients bringing their medications to the clinic: using the Show-Your-Medication (SYM ) Project

Reducing Idle room time

Screening for and tracking Social Determinants of Health

Improving our Farrell online reviews

Important dates to remember 

Flu Vaccine:  The deadline to be Vaccinated or Submit a Medical or Religious Exemption Request is Friday,  December 8, 2023. Failure to receive your vaccine or submit an exemption by the required due date may result in being locked out of the system.

Required trainings that are assigned in Workday

• • Two training on updated chaperone policy are due December 8th  

  • Annual Hospital Training AHT23 is due December 8th

The Farrell Quality session is scheduled for Thursday November 30th at 2pm in the first-floor lobby. 

Hello everyone,

Remember to review all Farrell Update messages and use them as a reference for key information and relevant links.  Messages will be sent about twice per month.  If you have questions or concerns, don't hesitate to reach out to the leadership team.

All updates can be found on our CFCM Provider Website: https://www.cfcmresources.com/farrell-health-center/farrell-updates

Wellness

Wellbeing Webinars

CopeNYP Tune-Up: Home for the Holidays on Monday, November 6, from 12:00 p.m. - 12:15 p.m.  Are you feeling anxious about upcoming holiday gatherings? Join CopeNYP Licensed Clinical Social Worker Sofia Rivkin-Haas to learn practical tips to alleviate tension and increase your enjoyment of family gatherings during the holiday season and beyond. Register here.

The Joy of Giving: Wednesday, November 8, from 12:00 p.m. - 12:30 p.m. or 8:00 p.m. - 8:30 p.m., hosted by Senior Wellbeing Coaches Hajra Jaffer and Carena Lowenthal. In this webinar, they will talk about the scientific benefits of giving back, and the power of gratitude. They will share upcoming programs and activities available to you as an NYP team member. Register here.  

NYPBeHealthy Recipes for the Holidays: Tuesday, November 14, from 6:00 p.m. - 6:30 p.m. Join Wellbeing Coach Cynthia Wong in the kitchen to learn tips and tricks to fuel your body with nutritious foods this season and beyond. Register to receive a grocery list with tips to prepare for the demo so you can cook alongside Cynthia or bookmark it for your next potluck. Register here. 

Good Grief! Strategies for Navigating the Grief Journey on Friday, November 17, from 1 p.m. – 1:30 p.m., hosted by CopeNYP Licensed Clinical Social Worker, Gail Purvis and Spiritual Care Coordinator, Linda Golding. Grief and loss are part of everyday life and even more so in healthcare. This webinar will offer strategies to support integrating and navigating our experiences of grief and loss rather than avoiding them. Register here.

Reminders:

• REGISTER NOW for NYPBeHealthy’s Healthy Holiday Challenge for a chance to win $500. Receive personalized support from an NYP wellbeing coach (onsite or virtual) at no cost. Our skilled coaches can work with you to revitalize your routine, mitigate health risks, and achieve your wellbeing goals. Connect directly with a coach or email nypbehealthy@nyp.org for more information.

• NYP offers the CopeNYP Employee Assistance Program (EAP) to support you and your household members. Staffed by licensed mental health professionals from the Weill Cornell Medicine Department of Psychiatry, CopeNYP can provide you with emotional support through free, confidential counseling. To schedule an appointment, call 646-962-2710, email CopeNYP@med.cornell.edu, or complete the online intake form.

• NYP Spiritual Care is available to team members on all campuses. Professional chaplains provide support to staff or any religious or no religious background with an inter-faith model of care. Spiritual resources and conversation are tailored to your needs and practices. For information call 212-305-5817 or email us at spiritualcare@nyp.org

Reminders for improving flow and patient care:

CSSRS screen - A reminder that the CSSRS screen must be completed if the PHQ9 is positive.

Referrals to SW and Mental Health Services (except with Dr. Pilipenko).

Please do NOT use the referral order to the adult psychiatry clinic (eye6) NOR the referral order to social work.  All of our referrals for mental health (except referrals to Dr. Pilipenko)  and SW services should be sent via in-basket to the SW pool.  For patients with mental health concerns use the dot phrase .FRLSWMENTALHEALTH

for those needing concrete services use the dot phrase .FRLSWGENERAL

Orders placed outside of the patient visit

Providers must make all efforts to place orders during the patient care session.  This ensures appropriate follow-up by the assigned PFA.  If an order needs to be placed outside of the session, please send an in-basket message to your PFA to notify them. 

Orders placed by preceptors

If a preceptor needs to place an order during precepting for a resident, please PEND the order and have the resident sign the order.  This prevents any confusion with the PFA's since they only look for orders placed by their assigned provider.

Chief Complaint

A reminder to the MA team to get specifics as much as possible from the patient regarding the chief complaint.  If the patient is not sure why they came in the ask the patient what they would like to get done during the visit.  

Closing charts

A reminder to the care team to exit the patient chart in epic when you are done with your work, so that providers can close the chart.

Vaccines

We have the RSV vaccine at Farrell for pregnant patients between 32 - 36 weeks. 

We also have the RSV antibody at Farrell for pediatric patients who meet criteria.  (see previous Farrell Updates for more details)

E-Consults

(see the original message sent on 10/24/23 and attachments for guidance). 

Available E-Consult Orders (see list with ordering scenarios attached): 

• AMB Referral to CUIMC E-Consult HTN Center 

• AMB Referral to CUIMC E-Consult Adult Cardiology 

• AMB Referral to CUIMC E-Consult PEDS Cardiology 

• AMB Referral to CUIMC E-Consult Benign Hematology 

• AMB Referral to CUIMC E-Consult Adult Otolaryngology 

• AMB Referral to CUIMC E-Consult Peds Otolaryngology 

• AMB Referral to CUIMC E-consult Cancer Pain and Symptom Management (Palliative Care) 

• AMB Referral to CUIMC E-Consult Psychiatry 

• AMB Referral to CUIMC E-Consult Adult Infectious Disease 

• AMB Referral to CUIMC E-Consult GYN ONC 

Eastern Daylight-Saving Time will end at 2:00 a.m. on Sunday, November 5, 2023, as we “fall back” and set our clocks back one hour.

New York-Presbyterian employees who are paid on an hourly basis and on duty when the time change occurs will be paid for the additional hour, even if it requires premium overtime pay since they will be required to work one more hour than usual. If you have questions, please speak with your manager or HR Business Partner.

Important deadlines

Required trainings that are assigned in Workday

• • Two training on updated chaperone policy are due December 8th  

  • Annual Hospital Training AHT23 is due December 8th
    
    

NYP 2024 Annual benefits enrollment ends November 6th – make changes before then through Workday

The next Farrell All Staff meeting is Thursday November 16th at 8am.

Hello everyone,

Remember to review all Farrell Update messages and use them as a reference for key information and relevant links.  Messages will be sent about twice per month.  If you have questions or concerns, don't hesitate to reach out to the leadership team.

All updates can be found on our CFCM Provider Website: https://www.cfcmresources.com/farrell-health-center/farrell-updates

Wellness

On Tuesday, October 10th, Dr. Corwin, NYP’s President and Chief Executive Officer, shared a message with NYP staff about the tragedy in Israel and the ongoing crisis in the region. To view the full message, click here.

GME also sent a statement and shared resources for faculty and residents. (see the full message in the email sent on 10/11/23 by GME and shared on 10/12/23 by Diana Suarez).

Message from the NYP wellness team.

October 10, 2023

Did you know that October 10th is World Mental Health Day? This year’s theme is Mental Health is a Universal Human Right. Mental health is a basic human right for all people, regardless of their background or circumstances. Everyone has a right to the highest possible standard and care for mental health. 

Taking care of our mental health is vital to our overall health and well-being. It is important to set aside time to reflect on how we can nurture our mental health. Most importantly, actively taking steps to de-stigmatize mental health conditions can help make those experiencing mental health challenges feel less isolated. 

There are no guaranteed methods to prevent mental health challenges, but there are practices that can support your mental health and well-being.  Below are some suggestions: 

1. Get professional support. CopeNYP provides you (and your household members) with confidential no-cost emotional support and counseling. 

2. Spend time outdoors, even if it is for 2 to 5 minutes. Being around or in nature has proven to reduce feelings of stress and anxiety, as well as to improve mood. 

3. Engage in movement. Whether it is going for a walk or trying a yoga class, any type of movement is a great way to de-stress.

4. Get some quality sleep. Quality sleep can positively impact both our physical and mental health. Check out NYP's Health Matters podcast episode with sleep medicine expert, Dr. Ana Krieger, for tips to prioritize quality sleep.

5. Practice gratitude. Research demonstrates that embracing gratitude has many health benefits for our physical health, mental health, and relationships. Check out NYP’s Gratitude Toolkit to learn more about gratitude, why it’s important, as well as individual and group gratitude exercises.

6. Make an appointment with an NYP Wellbeing Coach. Our well-being coaches are certified resiliency trainers and can support you in any aspect of your well-being. 

7. Check out this video with tips for coping with stressful times.

Take time to prioritize your mental health, and BeHealthy!

Wellness

A reminder to take advantage of wellness opportunities. See more information in the NYP Infonet.

Fall for Wellbeing Bingo: Check out our interactive Fall for Wellbeing Bingo and see if you can complete five boxes in a row or four across! Be proud of your accomplishments and enjoy focusing on YOU and your well-being. For personalized support, connect directly with an NYP wellbeing coach or email nypbehealthy@nyp.org to set up an on-site or virtual appointment – at no cost. 

Fall for Wellbeing Coaching: Learn more about our skilled team of coaches who can work with you to revitalize your routine, mitigate health risks, and help you achieve your personalized well-being goals. Register for one of our virtual information sessions or contact your on-site coach to set up a visit.

• Wednesday, October 4: 12:00 p.m. to 12:15 p.m.

• Wednesday, October 4: 8:00 p.m. to 8:15 p.m.

Reminder: As an NYP team member, you are eligible for a 2023 biometric screening and wellbeing assessment (WBA) – at no cost. As part of this screening, your cholesterol levels will be checked. Complete both your 2023 biometric screening and WBA by December 31, 2023, to receive 1,000 NYP Everyday Amazing points, redeemable for various gifts. 

Opioid Agreement

Patients are now able to sign the opioid agreement electronically and a provider signature is no longer required.  

Providers, please remember that the agreement includes TRAMADOL (most commonly missed at Farrell).

See the tip sheets for providers and for PFA's attached.

Reminders to improve workflows and patient care

Chaperone Policy: A reminder to providers to include the name of your chaperone in your documentation.  You can use the dotphrase .CHAPERONE for documentation.  

Chief Complaint - MA's you must ask the patient what is the reason for the visit and document their response in the chief complaint.  If the patient is not able to say why they were scheduled, consider asking "what would you like to have done at today's visit".   

Vaccinations 

For Employees: From HR

Dear Colleagues,

We are pleased to announce the kick-off of our annual influenza vaccination program. We will also be providing the new COVID vaccine as well as the RSV vaccine. Please note that an influenza vaccination (or accepted exemption) is required. Getting vaccinated against the flu is the best way to protect ourselves, our families, our coworkers, and our patients. In 2022, 98% of our NYP team was vaccinated against the flu. We are pleased to offer flu vaccines in an injectable formulation free of charge to all NYP team members, volunteers, and medical staff.

KEY INFLUENZA PROGRAM DATES

Flu Campaign Launch Date 

September 26, 2023 

Deadline to be Vaccinated or Submit a Medical or Religious Exemption Request* 

December 8, 2023 

RECEIVING THE VACCINE AT WHS

We are pleased to note that the flu vaccine will be available starting Tuesday, September 26, at your local NYP Workforce Health & Safety (WHS) clinic. Please click here to learn when and where the vaccines will be offered. Depending on supply, the high-dose flu vaccine (for those age 65 or older) and egg-free vaccines may be available at WHS clinics. Those interested should check the availability here.

RECEIVING THE VACCINE OUTSIDE OF NYP

You can also receive the flu vaccine outside of NYP (e.g., at a local pharmacy or doctor’s office). If you do so, please be sure to submit proof of vaccination to VaxApp. The documentation should include the date of administration, the type/brand of the flu vaccine received, the contact information of the office, pharmacy or licensed provider who administered the vaccine, and the employee’s full name on the proof of vaccine document.

REQUESTING AN EXEMPTION
Employees seeking an exemption based on a medical contraindication or a religious reason must submit a request via VaxApp by December 8. Those with approved medical or religious exemptions will need to wear a mask once the DOH declares “masks-on.”

*Permanent medical and religious exemptions from the 2022 seasons will roll over. Employees who received a permanent medical or religious exemption last season do not need to reapply. More information on the exemption process can be found here. 

For more information, please visit the NYP Influenza page or call the WHS Contact Center at 646‐NYP‐WHS0 (646‐697‐9470).

OTHER VACCINE GUIDANCE

NEW COVID-19 BOOSTER VACCINE

Beginning September 26, the new COVID-19 booster vaccine will be available at our WHS clinics. If you choose to receive your COVID vaccine at NYP, please schedule an appointment in MyConnect. This is a single dose vaccine.

1. CDC recommends that everyone ages 6 months and older receive the updated COVID-19 vaccine formulation this fall as a booster dose.

2. The updated COVID vaccine is a much closer match to currently circulating variants of COVID-19, including BA.2.86 and EG.5, and continues to be the best way to protect yourself against severe disease.

3. It is safe to receive the COVID vaccine and the flu vaccine at the same time. However, please note that you will need to schedule an appointment for your COVID vaccination. Also please note that you can receive the COVID vaccine as well as the flu vaccine outside of NYP (e.g., at a local pharmacy or doctor’s office). If you do, please follow the VaxApp instructions above.

RSV VACCINE

RSV is the respiratory syncytial virus, a common respiratory virus that causes mild, cold-like symptoms. CDC now recommends RSV vaccine for adults ages 60 and over, using shared clinical decision-making. This means these individuals should talk to their healthcare provider about whether RSV vaccination is appropriate for them at this time. WHS is making this vaccine available to NYP employees ages 60 and over, who may receive the vaccine at our NYP WHS clinics on a walk-in basis. Eligible employees can also receive the RSV vaccine outside of NYP (e.g., at a local pharmacy or doctor’s office).

CDC also recommends that pregnant persons between 32 and 36 weeks of pregnancy may receive the RSV vaccine. Pregnant persons should work with their OB/GYNs to receive this vaccine.

The health and well-being of everyone who works at NYP is a priority for us, and vaccination against seasonal influenza, COVID 19 and RSV can help protect all NYP team members and our families, as well as everyone who comes to us for care. Please review the FAQs to learn more about these three vaccines.

For Patients:

We have influenza vaccines available for all patients.  When not in session, patients can be added to the Vaccine tally.  Note that the vaccine tally will be only for Influenza and/or COVID vaccines.   For any other vaccine needs outside of the patient care session, the patient should be placed on the nursing tally (examples include MMR vaccine, HPV vaccine, Tdap etc.)

Unified Farrell Quality Project

Let your voices be heard.  Send any ideas you have for a unified project to leadership by email.  We will be sending out the list soon so that everyone can vote on which project we choose.  Keep in mind that the project should involve all staffing groups.  

We will meet as a team to follow up on Thursday November 30th from 2-3 pm.

The Team Member Experience Survey deadline has been extended to October 4th.

The 2023 Team Member Experience Survey participation deadline has been extended to Wednesday, October 4 so that across NYP, every voice is heard.

As of today, September 27, 59% of team members have responded, and we thank those who have shared their valuable feedback with us. We encourage you to participate so that you may help us strengthen our culture of respect, inclusion, and belonging, and weigh in on important topics across the enterprise.

If you have not done so already, please click the survey link to participate.

When you click the link, you will be prompted to enter your access code, which is your 6-digit Employee ID (located on your NYP ID card underneath your photo) or NPI number. Your results will be grouped with your team members and forwarded to your manager. The survey is confidential- no one at NYP can see your responses.

If you experience a technical problem or have any questions, please contact Gallup Client Support by sending an email to support@mail.gallup.com or by calling 1-888-486-9104. Support is available 24 hours a day, every day of the week.

Other

If you ever find yourself locked in the health center after hours, please contact security at the main hospital 

Contact Information (nyp.org)

Closing Erroneous Encounter workflow

See the workflow attached on how to close erroneous encounters in EPIC.

In-basket management tips

When your results are available at different times, you should not wait until all of the results are in before writing your results note. 

You can comment on the results that are available with the plan to inform patients at another time when you have more results back.  The key is to document a plan within 48 hours. 

Telephone Documentation

All attempts to reach patients by phone must be documented in the chart for any reason (including - scheduling, forms pick up, results review).

Immunization Orders

For nurses and Providers: Immunization orders will no longer need a diagnosis code.

CDC and DOH Notifications

Re: Vibrio infections

The CDC has issued an advisory about severe Vibrio vulnificus infections in the United States associated with warming coastal waters, based on recent reports of fatal infections, including wound and foodborne infections.

Why is this information important?

Healthcare professionals should consider V. vulnificus as a possible cause of infected wounds that were exposed to coastal waters, particularly near the Gulf of Mexico or East Coast, and during periods with warmer coastal sea surface temperatures. Rapid identification, evaluation, and treatment are key to successful intervention.

Re: RSV

Please see the attached CDC Advisory in Partnership with NYS: Increased Respiratory Syncytial Virus (RSV) Activity in Parts of the Southeastern United States: New Prevention Tools Available to Protect Patients. This advisory, being sent jointly by NYS and NYC, supplements information that was previously provided in alerts by DOH. Please see the following press release: https://www.health.ny.gov/press/releases/2023/2023-08-08_rsv.htm. If you have questions, please email bcdc@health.ny.gov. 

Covid -19 (Coronavirus)

Click on this link for information regarding COVID on the NYP Infonet.

See interim guidance for ill health care persons copied below. 

The 2023 NYP Team Member Experience Survey

It’s Here! 2023 Team Member Experience Survey: Together, We Share Our Voices

​We invite you to help make NYP an even better place to work by participating in our 2023 Team Member Experience Survey, administered by Gallup. This year’s theme is Together, we share our voices.

The 2023 Team Member Experience Survey is open until Wednesday, September 27, and should take less than 10 minutes to complete. The results will help us identify how we can work together to further enhance our culture and provide the best possible care to our patients. The 2023 Team Member Experience Survey focuses on a wide range of topics, including our culture of safety, respect, engagement, diversity, well-being, and more.

How to take the Survey

You will receive a survey invitation link from Gallup to your NYP email address. This will be your unique survey link; please do not forward or share the link. You can take the survey online at any time, 24/7, until the survey closes on September 27.

Survey Confidentiality

Recommendations to improve flow and patient care

No Show Notes

Providers should avoid sending automatic recalls to patients who no show.  PFA's should be instructed to reschedule appointments when there is an actual reason for follow-up. Residents, if you are not sure remember to check in with your preceptor. 

Referrals to Columbia Practices

Referral information to Columbia is bring printed and given to patients so that they can call as needed to follow up on their referrals.

Dots

Providers should place the red dot after the 15-minute grace period. 

Referrals

If any referral is placed after the patient is checked out, a message must be sent to the color team pool notifying them.

Referrals to SW and Mental Health Services (except with Dr. Pilipenko).

Please do NOT use the referral order to the adult psychiatry clinic (eye6) NOR the referral order to social work.  All of our referrals for mental health (except referrals to Dr. Pilipenko)  and SW services should be sent via in-basket to the SW pool.  For patients with mental health concerns use the dot phrase.FRLSWMENTALHEALTH and for those needing concrete services use the dot phrase.FRLSWGENERAL

Vaccines

We have pediatric Influenza vaccines on site.  Providers can therefore order during the pediatric visits.

As soon as we have more information regarding the adult influenza vaccine, COVID vaccine, and RSV we will send an update.

Late Policy

Providers can make exceptions to the late policy on a case-by-case basis.  Providers, however, must communicate their wishes effectively to the PFA team.  Providers are reminded to respond to the secure chat initiated by your PFA at the start of the clinical session.  Providers must let the PFA know if there are any exceptions to the late policy for that session.  Examples are "No exceptions to the late policy today"';  " If my 9:20 patient shows up late, please go ahead and register her since I must see her today";  and " I may be able to see my 9am patient if he shows up late today so, please send me a secure chat message to confirm if he comes in late";  " I will see all of my OB patients even if they are late, no need to send me a chat message just register them when they come in, please reschedule any other late patient on my tally".  

If a patient arrives on time, and there are delays in registering the patient that is not related to the patient, the patient MUST be seen and should not be turned away. It may be necessary to add the patient to a Walk-In slot if the provider is no longer available.

Chaperone Policy

Documentation of the chaperone used in the session should include : confirmation that a chaperone was present, and the full name and title of the chaperone.  You can use the secure chat message sent at the beginning of your session to see the full names of your assigned MA. 

You can use the smart phrase.CHAPERONEDOCUMENTATION in the body of your note.

Farrell Team Quality Improvement

We will work together on one Farrell quality improvement project with the goal of participation from everyone at Farrell.  If you have any suggestions about what the project should focus on, send your suggestions by email to Dr. Dempster.  We will discuss the Farrell Team Quality Project more at the next All Staff meeting.  

Increase in COVID cases 

Because of the increase in COVID-19 cases, at this time:

It is STRONGLY ENCOURAGED (not required) that all team members wear MASKS when providing direct patient care to ALL PATIENTS in any location.

• Masking continues to be one of the most effective ways to prevent transmission of SARS-CoV-2 (the virus that causes COVID-19) and other respiratory viruses.

• Health care providers who develop symptoms should NOT continue to work.

The guidance for Health Care personnel exposure and return to work is found on the Infonet and attached to this email. 

Opioid agreement

A reminder that patients receiving opioid prescriptions (including Tramadol), should have a signed opioid agreement in the medical record.  Only one signed agreement is needed.  

See the workflow attached.

Screening Reminders

If the Depression screen is positive the CSSRS must be completed as well.  

Providers, please check to be sure that the patient and not their parents or guardian (including children of older patients) completed the screenings before their visits. One way to verify - see the screenshot below - in this example it was correctly done by this infant's proxy  for this adolescent - it was correctly done by the patient

Providers - If the proxy/parent completed the screening questions be sure to have teen complete the questionnaires when they see you. 

There are ongoing conversations currently about how to manage this and you will be updated with any changes.

Another way to view/track screenings and results is in the SYNOPSIS tab. See screenshot below. 

Forms Workflow

Our NP Norma David will continue to assist with the completion of all forms.  

There will only be one form folder at the front desk for forms whether it is incomplete or completed.  

Note that some forms require an MD signature so residents are encouraged to include the attending if necessary to avoid any delays in the process.

Some forms are only acceptable when completed on the original papers brought by patients.  In this case it is important that providers go to the form folder to use the original forms dropped off by the patient.  In this case Norma will complete any necessary information and notify the provider that the original form will be placed in the patient folder.   All other forms will be uploaded in the media tab as per the usual workflow. 

Late Policy

Providers can make exceptions to the late policy on a case-by-case basis.  Providers, however, must communicate their wishes effectively to the PFA team.  Providers are reminded to respond to the secure chat initiated by your PFA at the start of the clinical session.  Providers must let the PFA know if there are any exceptions to the late policy for that session.  Examples are "No exceptions to the late policy today"';  " If my 9:20 patient shows up late, please go ahead and register her since I must see her today";  " I may be able to see my 9am patient if he shows up late today so, please send me a secure chat message to confirm if he comes in late";  " I will see all of my OB patients even if they are late, no need to send me a chat message just register them when they come in, please reschedule any other late patient on my tally".  

If a patient arrives on time, and there are delays in registering the patient that is not related to the patient, the patient MUST be seen and should not be turned away. It may be necessary to add the patient to a Walk-In slot if the provider is no longer available.

PCP Assignments

Interns are encouraged to actively build their patient panel by discussing adding appropriate patients as their PCP when precepting.  

Providers can also change the PCP assignment while is session and appropriate. 

Patients to consider are those of graduating resident or fellow who have not yet seen their assigned PCP and wish to stay with the provider with whom were scheduled with that day.  Patients who have Drs. Urmi Desai or Nancy Bermon as PCP and would like to change PCP.

Providers should NOT change PCP for patients assigned to a PCP who is still seeing patients at Farrell without having a discussion with the current PCP.

Billing and Coding Reminders

ED and post-hospital follow up visits

When you see a patient post ED or Post hospitalization :

If the patient was seen within 14 days of discharge the billing code should be CPT 99495 and if it was within 7 days post discharge it should be CPT code 99496.

See the website for commonly used codes.

Encounter closures - Residents must complete their note and submit it for co-signatures no more than 48 hours after the session.  Attendings must attest and submit notes no more than 7 days after the precepting session.

EPIC Tips

In Basket Management Pearls

To avoid clutter, remove messages that need no follow up action.  Get in the habit of checking your in-basket messages daily.  Residents can ask for help with follow up when needed from the team members on their color team.  

Results management: If you need to follow up on abnormal results for a patient and you are not able to reach the patient, route the results note to the Farrell Nursing team for follow up. 

Create your own dot phrases for common statements that you use when charting. This will help tremendously with efficiency

Specialty referrals

Providers should include "New" or "Follow up" in the comments section of their referrals. The designation impacts who will do the scheduling for the referred patient. The definition of "New" is a patient who has not been seen by the specialty in 3 years

Patient Verification (see attached)

TWO unique identifiers must always be used to identify the correct patient against a secondary source – (MAR, test requisition, orders, barcode scanning technology, mother's ID band and baby's ID bands): 

o Identification Band unique identifiers include: Patient’s full name AND medical record number; if the patient’s ID band is missing – it must be replaced before care is rendered.

o Where identification band are not used the two unique identifiers include: Patient’s full name AND date of birth (Month/Day/Year)

National Suicide Prevention Lifeline - 988

• 988 is a collaboration between NYS Office of Mental Health (OMH), Office of Alcohol and Substance Abuse Services (OASAS), and OPWDD (Office for People with Developmental Disabilities) – this means anyone with a mental health or substance use concern can call 988 and receive:

  • Verbal crisis intervention

  • Linkage with mobile crisis

  • Referrals for mental health and/or substance use programs, including within OPWDD programming

• 988 does NOT have geolocation – what does this mean?  Please let patients know …

  • A person calling 988 from a NYS landline or a cell phone with a NYS area code will reach the NYS Suicide Prevention Lifeline (which is the same as calling NYCWELL)

  • A person calling 988 from a cell phone with another state area code will reach the Suicide Prevention Lifeline based in that state

• The Safety Plan document in Epic has been updated to include 988

Opioid agreement reminder to sign an opioid agreement on patients who are prescribed opioids.  The most common error is forgetting to complete one when Tramadol is prescribed.

CCTC Issues:

Three common medications for follow up often needed from patients are refills for GLP1 agonists, Vitamin D and PPI's. For a more seamless process please note the following:

Orders for GLP1 agonists - when ordering a tapering of the dose use the "taper/ramp" icon.

Vitamin D a reminder to include a plan of care in the chart, especially of > 12 weeks.  This allows the NP to know whether refills can be given. 

Long-term PPI use - include a plan in your note, especially for planned use > 4 months.  This facilitates refilling decisions.

EPIC

Tip: Create your own dot phrases for common phrases that you use.  This can save a lot of time.

EPIC Pools to remember:

 For Prior Authorization assistance message the ACN Med Prior Auth Pool 11728F

For CCTC message the  ACN CCTC NP pool #14895

E-Consults

Encouraging you to make use of our E-consults.  The updated E-consult tipsheet for PCPs is attached.  Note the most recent additions include ID, gyn oncology (for abnormal pap smears). AMBULATORY E-CONSULTS OVERVIEW 

OB care

(from previous OB updates from Dr. Strangas)

Referrals to Maternal Fetal Medicine (MFM) for high-risk patients: many of our patients are medically high-risk, and so benefit from consultation and/or transfer of care to our high-risk MFM OB colleagues. MFM clinic is at 21 Audubon, and occurs Monday, Wednesday, and Fridays; Monday is for fetal indications, Wednesday is for gestational diabetes, and Friday is for other maternal indications. Exactly which patients to refer is determined largely by the provider's comfort and expertise. A non-exhaustive list, dating back to 2009, is attached, along with a separate set of indications for delivery at CHONY (which largely overlaps the high-risk indications). Many prenatal conditions, such as chronic hypertension, diet-controlled diabetes, or dichorionic-diamniotic twins may be managed at Farrell and at the other low-risk clinics. 

• For Diabetes, the referral process is through the EPIC order (Refer to Perinatal Clinic for Diabetes, REF288)

• For all other indications, the referral is made by reaching out to the MFM fellows via email at mfmperinatal@cumc.columbia.edu. This may result in a transfer of care to 21 Audubon or in a co-management situation, where the MFM team provides occasional guidance, but care remains at Farrell. 

DME

For any assistance with Durable Medical Equipment (DME) orders please contact Paula-Annette McKay via. EPIC or via. email. 

Consider using Parachute as an option.

Recommendations to improve flow and patient care

Orders placed outside of the patient visit

Providers must make all efforts to place orders during the patient care session.  This ensures appropriate follow-up by the assigned PFA.  If an order needs to be placed outside of the session, please send an in-basket message to your PFA to notify them. 

Late Policy

A reminder to providers to notify your PFA via secure chat when there will be an exception or special request for your patients.

Orders placed by preceptors

If a preceptor needs to place an order during precepting for a resident, please PEND the order and have the resident sign the order.  This prevents any confusion with the PFA's since they only look for orders placed the their assigned provider.

Accurate Blood Pressure measurement in the office:

From the American Medical Association: Measuring blood pressure is one of the most common procedures performed at a medical office. Yet, studies have shown that nurses, medical assistants and even doctors make numerous mistakes when taking readings. Failing to support a patient’s back, for example, or engaging in conversation with the person while trying to measure his or her blood pressure can throw off a reading by as much as 25 mm Hg.i

If the blood pressure is elevated.  Repeat using proper techniques in 5-15 minutes.

EPIC Letters

-Message from Dr. Chacko 

Dear Clinicians,

On behalf of the Wellness Committee, I’d like to share this list of commonly used letters. A big thank you to all of you who contributed your letter suggestions as well as the Wellness Committee who took time to review the existing templates and draft content. The attached job aid includes information on how to save particular letters as favorites to make it easier to find them during patient care.

Please reach out with any questions.

Thank you,

Wellness Committee

Referrals to specialists

Dr. Nalgonda: Dr. Nalgonda is out.  For any urgent GYN referrals please notify Dr. Dempster and Berenyi so that appropriate follow-up can be arranged.  

Dr Weitz: Dr. Weitz's last day with us is Monday July 31st.  We do not have a replacement for him as yet so until further notice we will be giving patients alternatives outside of NYP.  Dr Bar-David is located on 161 Fort Washington Avenue New York, NY 10032 on the second floor - patients can call 212-355-4229 to schedule appointments.

Outside Specialty referrals:

To assist with scheduling please include in the comment section of all referrals whether the patient is NEW or FOLLOW UP.  

Pediatric Obesity

A reminder to refer pediatric obese patients to the Health 4 Life program when warranted.

A description of the program is attached.

Lung Cancer Screening. - Preferred Order

Please use the referral for Lung Cancer Screening consult with includes navigation and follow up services for patients instead of ordering the CT.  

The order is in the preference list.

Pharmacy assistance at Farrell

The pharmacist who is at Farell Vyacheslav (Slav) Gorelik is available to assist providers with specific requests and can be reached via EPIC chat for urgent issues and via in-basket for non-urgent issues.

Clinical Corner

See the summary article attached on recommendations for patients with newly diagnosed type 2 Diabetes.

Reminders to improve flow and patient care

Providers are reminded to let the PFA know if you will accept Late patients otherwise, they will reschedule your patient if they are more than 15 minutes late. 

iPads for screening will be given to patients at registration is they did not complete the screening questionnaire prior to registration.  Providers should check to be sure that the patient and not their parent completed the questionnaires.

All staff members should be using interpreter services for patient interactions if the patient's language is not your native language or if you are not an approved interpreter.

Patient identifiers - Please remember to ask the patient to confirm their name and date of birth and verify the information on the wrist bands. 

WIC Form Requirements:

Patient Medical Information: 

Current height and weight measurements are to be taken no more than 60 days before the patient’s WIC appointment. 

Women:

 For all women patients complete current height and weight and the date taken; the hemoglobin or hematocrit value and the date taken; the number of previous pregnancies; the number of previous deliveries; and the date prenatal care began. 

Pregnant Women: Eligible for WIC for the duration of their pregnancy and up to 6 weeks postpartum. Hemoglobin or hematocrit blood work must be taken during current pregnancy. Complete the estimated date of delivery, number of fetuses, and pre-pregnancy weight. Postpartum/Breastfeeding Women: Non-breastfeeding postpartum women are eligible for WIC for up to 6months after delivery/termination. Breastfeeding women are eligible for up to one year after delivery. Hemoglobin or hematocrit blood work must be taken during the postpartum period. Complete the delivery/termination date and the total weight gain during pregnancy.

 Infants and Children Less than 24 Months of Age: 

A hemoglobin or hematocrit blood work value is required once during infancy between 6 to 12months of age (preferably between 9 to 12months of age) and once between 1 to 2 years of age (preferably 6months from the infant blood work value). If available, include a venous lead value and the date it was taken. 

Children 2 to 5 Years of Age: 

 Children are eligible for WIC up to their fifth birthday. A hemoglobin or hematocrit blood work value is required once a year if found to be normal. If the value presents outside of the normal range (<11.1 hemoglobin or <33% hematocrit), the value must be tested again at 6month intervals. If available, include a venous lead value and the date it was taken.

Closing Erroneous Encounters

See the workflow attached on how to close erroneous encounters in EPIC.

 The next Farrell All Staff Meeting is Thursday July 20nd at 8 am.  Looking forward to your participation.

Reminders to improve flow and patient care

Patient Check out:  Some patients do not stop at the front desk to check out.  MA's and providers can remind patients to check out at the front desk before they leave the practice.

Huddles: Providers are expected to huddle with their MA and nurse at the start of each session. 

Follow up appointments:  Providers are reminded to give the PFA team a range if possible, when requesting follow-up appointments.

PHQ9A and CRAFFT Screens for teens.

Providers, please check to be sure that the patient and not their parents completed the screenings before their visits.

To verify - see the screenshot below.

If the proxy/parent completed the screening questions be sure to have teen complete the questionnaires when they see you. 

There are ongoing conversations currently about how to manage this and you will be updated with any changes.

Guidance on resident prescription denials.

From Dr. Robbins (sent in April)

 For those who may have missed it I am forwarding an email from IT about resident and fellow prescriptions that might recently have been rejected from the pharmacy with the code 889 <Provider Not Enrolled in State Medicaid Program>.  This is occurring because the New York State Department of Health (NYSDOH) has implemented a policy which requires all Medicaid Managed Care in-network and out-of-network furnishing, ordering, prescribing, and referring providers to enroll as a qualified Medicaid provider in the NYS Medicaid Program with an exception for resident/fellow prescriptions. IT has created a smartphrase  .medicaidrx which can be placed in the notes to pharmacy box in any prescription to help pharmacies understand the requirement and how to process the prescriptions. 

Who this message is for: Areas where residents and fellows prescribe outpatient medications (including ambulatory, ED/inpatient discharge prescriptions) for patients with Medicaid as their insurance.

What is happening:

Recently, some pharmacies have incorrectly denied filling prescriptions written by residents and fellows since those providers are technically not enrolled as Medicaid providers. The state of New York does allow residents and fellows to prescribe medications for patients, and pharmacies are expected to fill those prescriptions. Attached is a memo from one of our Medicaid payor partners that outlines the exception codes that permit these prescriptions to be honored. We also created a Smartphrase that can be used in the “Notes to Pharmacy” box in the prescription writing activity to help pharmacies understand their requirements and how to process the prescription. The Smartphrase is .medicaidrx. Medicaid is also actively contacting pharmacies to instruct them on the correct policy.

When is this happening:

The Smartphrase is available now.

Why are we making this change:

To assist our patients in receiving their medications.

How this will affect you:

There should be no changes in your workflow, unless you choose to add the .medicaidrx to the “Notes to Pharmacy” field in the prescription writing activity.

Your staff may also provide the attached memo to any pharmacy that has incorrectly rejected a prescription written by a resident or fellow.

HF Resident RX Pharmacy Override Guidance

Who to contact with Questions/Feedback:

Submit a message to Epic Support directly by clicking on the “Epic Help” button within Epic itself, email epictogethersupport@nyp.org, or call your institutional Service Desk:

• NYP: 4-HELP or 212-746-4357 | servicedesk@nyp.org

• CUIMC: 5-HELP or 212-305-4357 | 5help@cumc.columbia.edu

• WCM: 212-746-4878 | support@med.cornell.edu

Billing codes for Transition of Care - Post discharge

 When you see a patient post ED or Post hospitalization :

If the patient was seen within 14 days of discharge the billing code should be CPT 99495 and if it was within 7 days post discharge it should be CPT code 99496.

For any billing code, if it isn't already in your boxes that you use commonly then, In the search box type in the numbers eg. in this 99496 

Monkey Pox (mpox) Updates

Update

New cases of mpox continue to be identified, including among vaccinated individuals. Two cases were identified in NYC last month and the Chicago Department of Public Health reported 24 cases within the last 30 days. As we approach warmer weather, cases may rise due to gatherings that have potential for skin-to-skin or sexual contact. Though less common, transmission can also occur through contact with clothing, bedding, and items used by a person with mpox or through prolonged face-to-face contact. Anyone can get and spread mpox but cases continue to be primarily seen in gay, bisexual, and men who have sex with men (MSM). Providers should be on alert for new cases of mpox, have a low threshold for testing, and encourage vaccination.

Infection Prevention and Control 

·         Patients with suspected or confirmed mpox should be placed on Enhanced Droplet precautions. A negative pressure room is NOT required. 

·         Healthcare personnel wear the following personal protective equipment: gown, gloves, N95 respirator, and eye protection.

·         For inpatients, notify IP&C of any patients with suspected/confirmed mpox.

Testing

• Test ordering remains unchanged and can be found in Epic using “Monkeypox Panel.”

• See “Guidance for Collecting and Submitting Specimens for Mpox Testing” for instructions.

• If mpox is suspected, perform testing regardless of prior infection or vaccination status.

• Test for other sexually transmitted infections (HIV, syphilis, gonorrhea, chlamydia) at the time of mpox testing given risk of concurrent infections.

Treatment

·         All patients highly suspected or confirmed to have mpox should be informed about and encouraged to enroll in a clinical trial (STOMP) where they may receive tecovirimat, regardless of disease severity.

·         Providers at Weill Cornell affiliated sites can email mpx@med.cornell.edu and providers at Columbia affiliated sites can send an Epic chat to “CUIMC Monkeypox Treatment Team.”

·         Any provider can visit www.stomptpoxx.org to find a nearby research site.

·         If the patient cannot enroll in STOMP or declines to participate, tecovirimat can be requested via EA-IND per CDC’s clinical guidance for treatment.

Vaccination

• Anyone of any sexual orientation or gender identity at risk for mpox can now get vaccinated unless they have previously had mpox.

• Minors <17 years old do not need parental consent for vaccination.

• Encourage anyone with only 1 dose of the 2 dose JYNNEOS series to complete vaccination to optimize their protection.

• Vaccine sites are available throughout NYC. NY state residents outside of NYC can contact their local department of health for vaccine availability/locations.

• Providers at Columbia affiliated sites can also send an Epic chat to “NYP Sexual Health Program” to coordinate Jynneos vaccine at the Comprehensive Health Program at the Columbia campus.

Additional Resources:

• NYP: Mpox Resources (Infonet) for additional guidance and further details

• CDC: Mpox | Poxvirus | CDC

• NYCDOHMH: Mpox (Monkeypox) - NYC Health

Why is this information important?

This information is important to keep staff and patients safe.

What we need from you:

Please carefully review this information. 

For any questions, please contact Infection Prevention & Control: 

• NYP-AH: 212-932-5219

• NYP-BMH: 718-780-3569

• NYP-CU and NYP-MSCH: 212-305-7025

• NYP-LMH: 212-312-5976

• NYP-W: 914-787-3045

• NYP-WBHC: 914-997-4377

• NYP-WC: 212-746-1754

• NYP-HVH: 914-734-3950

• NYP-Q: 718-670-1255

 The next Farrell All Staff Meeting is Thursday June 22nd at 8 am.  Looking forward to your participation.

Reminders for improving flow and patient care:

OB encounters - Pregnancy Episodes

Providers : When you become aware of a patient having delivered outside of the organization, miscarried, terminated or moved, please make a note and close the pregnancy episode. 

CSSRS screen - A reminder that the CSSRS screen must be completed if the PHQ9 is positive.

Forms

Attendings/Residents are reminded to sign the forms within the 7-10 business days to avoid delays.

If a patient gives the provider a form for completion during the session the provider must send the form with the patient for scanning by the PFA at the front desk.

If a form is completed during the session the form should also be sent to the PFA for uploading into the media tab.  This creates a time stamp and gives access to anyone who needs access to the form.

Mirrors for patient's use during GYN exams

We have handheld mirrors for use during GYN exams for patients who would like to see their exam while it is being performed.  Providers can give the patient the option since some patients may decline.

Mirrors are in each exam room.  The MAs would clean the mirrors when they are cleaning the room for the next patient.

Referrals to SW and Mental Health Services (except with Dr. Pilipenko).

Please do NOT use the referral order to the adult psychiatry clinic (eye6) NOR the referral order to social work.  All of our referrals for mental health (except referrals to Dr. Pilipenko)  and SW services should be sent via in-basket to the SW pool.  For patients with mental health concerns use the dot phrase .FRLSWMENTALHEALTH

for those needing concrete services use the dot phrase .FRLSWGENERAL

Vaccines

We have used the last doses of PCV-13 vaccines from our VFC stock and transitioned over to the PCV-15vaccine stock effective 5/30/23.  Providers therefore should no longer order PCV-13 and should order the PCV-15 vaccine instead. 

On October 20, 2021, the Advisory Committee on Immunization Practices recommended 15-valent PCV (PCV15) or 20-valent PCV (PCV20) for PCV–naïve adults who are either aged ≥65 years or aged 19–64 years with certain underlying conditions. When PCV15 is used, it should be followed by a dose of PPSV23, typically ≥1 year later. Eligible adults may receive either PCV15 in series with PPSV23 or PCV20 alone.

EPIC Updates

Patient Location Attestation for Video Visit Scheduling

Who this message is for:

All schedulers and all providers who conduct video visits.

What is happening:

For both Connect and Website self-scheduling (via a decision tree), patients will now be prompted to confirm the state they will be located in when joining their scheduled video visit.  The patient's location will be matched to the provider’s approved telehealth licensures/registrations, to ensure that providers are licensed/registered in the state the patient is joining the video visit from.  If there are no providers available for the state the patient selects, the patient will be unable to schedule the video visit.

For scheduling in Epic, a new scheduling warning will be created. Schedulers will be prompted to ask the patient which state they will be located in when joining the scheduled video visit. Schedulers should compare that state with the states where the provider is licensed/registered to conduct telehealth. If there are no providers available for the state the patient selects, the patient will be unable to schedule the video visit.

When this is happening:

Tuesday, May 30th

How this will affect you:

Schedulers will now be required to ask the patient where they will be located for the video visit, prior to scheduling the appointment.

The workflow for providers who conduct video visits will not change from the clinical standpoint.

Link to tipsheet (tip sheet attached).

Why we are doing this:

Telemedicine guidelines require patients to be located in a state where providers are licensed/registered to conduct telehealth.

Who to contact with Questions/Feedback:

Submit a message to Epic Application Support directly by clicking on the “Epic Help” button within Epic itself, email epictogethersupport@nyp.org, or call your institutional Service Desk:

• NYP: 4-HELP or 212-746-4357

• CUIMC: 5-HELP or 212-305-4357

• WCM: 212-746-4878

Allen Labor and Delivery Tours

Allen L and D tours will resume next week.  Please see attached flyer for details.  Pregnant patients 28 weeks and above are able to self-register using the QR code. 

Pediatric Screening

Take Home Points from Dr. Evelyn Berger-Jenkins' presentation

Recommendation for Surveillance at every well visit and use of Standardized development screening at 9, 18 and 30 months.

We use the SWYC screening tool for pediatric patients at 9, 18 and 30 months and focus on the Behavioral and Developmental sections.  

Results and scoring will be pulled into the note once the screen is completed.

Most parents complete the screening questionaire before the visit. 

Dr Dempster will send the slides to providers as a resource.

The Farrell team will work on a standardized workflow for all screening that will include, Depression or adults and adolescents, Intimate Partner violence and Fall Risk.

Providers are reminded to use the pediatric templates for all pediatric well child notes.  They usually begin with .ACNPEDSWCC---- The peds template for adolescents should also be used