NEW Communication Tool to the VA (VIQ/QIPS)

Kudos to our residents Sophie Cannon, Ibrahim Selevany and Diego Vargas for successfully launching a communication aid tool at the VA based off a QIPS case presented by Nandi Shah. Look out for these signs at the bedside to indicate communication deficits and improve the patient experience.

GREAT WORK TEAM!!

Donate Blood!

Make an appointment!

San Diego blood bank has multiple of locations where you can sign up to donate. Look up available slots and type of donation (RBC, platelet, etc): https://www.sandiegobloodbank.org/
The website only lets you make an appointment at least 10 days in advance of the appt…but if you call them, you can schedule over the phone for whenever!

San Diego Blood Bank: Donor Centers and Mobile Drives. Donating blood is convenient with locations across Southern California. Locate a donor center or blood drive near you.www.sandiegobloodbank.org

There is also the Red Cross: https://www.redcrossblood.org/give.html/drive-results?dt=all&zipSponsor=92101

Thank you Puja Takiar for helping organize this information!

COVID-19 Program Update

Dear UCSD IM Family,

I want to reach out to you regarding the COVID-19 situation.

I realize this is a stressful time and that there is a lot of confusing information. We have been in constant communication with leadership in infection control at both of our hospital systems (UCSD and VA) regarding the evolving recommendations.  We are gathering information and will share everything with you as we know more!

I want to reassure you that our most important goals remain, as always:

  1. Your safety and wellness
  2. Patient safety and wellness
  3. Providing you with the best education possible to prepare you for anything that may come next!

I want to briefly address each of these.

  1. Your safety and wellness

A. Please watch this video on how to put on and take off Personal Protective Equipment:

COVID-19 PPE Guidelines Video

  • After you have viewed it, please email chiefucsd@gmail.com so we can make sure that you get credit for your video training!
  • Both UCSD and the VA have ordered substantial supplies of N95 masks, so the acute shortage caused by hoarding should soon be relieved!
  • Eye protection (face shield or goggles), N95 mask or PAPR, gown and gloves are required for care of all patients suspected to have COVID-19

B. FIT testing for N-95 masks and PAPR (for those with facial hair) is ongoing at all sites; this should continue to be worn for patients with known or suspected TB, and those with known or suspected COVID-19.  The chiefs will be in touch with you and will be posting on WordPress as these fittings come to your worksite (VA, Hillcrest, Jacobs). Here are some upcoming FIT testing sessions:

  • Tuesday, 3/10, 1pm, JMC 7-744 workroom: residents on rotations at any La Jolla campuses (Jacobs, Thornton, CVC, VA) are welcome and encouraged to come
  • Thursday, 3/12/20, 8am-2pm: ACTRI, Room LL-1E-111
  • Thursday, 3/19/20, 8am-2pm: ACTRI, Room LL-1E-111
  • Nearly all residents at Hillcrest have been fit tested; if you have not, please contact Gary Ma
  • We are setting up testing at the VA; stay tuned for more details from Sean Kenmore

C. Please strongly consider avoiding travel to Level 2 or 3 countries for your own safety, and because you will have to remain in quarantine for 14 days after returning; plus you run the risk of being stuck in the country you are visiting if a “lockdown” is instated. The situation is fluid; please see this CDC travel website for guidance before you travel!

https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.htm

2. Patient safety and wellness

I have included below UCSD’s Ill-Worker Policy

If you have a fever >100F:

  • Do not come to work
  • Do not take fever-reducing medication in order to come to work  
  • You may return to work after 24 hours of being fever-free without fever-reducing medications

If you have mild Illness without fever:

  • Wear a mask to work if you feel well enough to work but you have cough or cold symptoms
  • Do not interact with immunosuppressed patients
  • Disinfect your hands before touching items others may touch
  • Do not shake hands with (or hug—this is my recommendation to myself, not UCSD policy) others

How to stay healthy:

  • Caring for sick patients is part of what we all signed up to do when we decided to be doctors!
  • The ACGME has explicitly stated that residents may care for COVID-19 patients, with the appropriate supervision and training. It is our goal to provide this always!
  • Clean your hands often with soap and water or an alcohol-based hand sanitizer, especially after touching shared objects
  • Avoid touching your face without clean hands
  • We remind all staff and faculty that PPE should be preserved for appropriate use
  • Encourage sick colleagues to go home or stay home, if possible
  • 3. Providing you with the best education possible to prepare you for anything that may come next!

https://acgme.org/Newsroom/Newsroom-Details/ArticleID/9962/ACGME-Guidance-Statement-on-Coronavirus-COVID-19-and-Resident-Fellow-Education-and-Training-in-the-United-States

  • During this time of unusual need, when many may be out due to symptoms or quarantine, we may have cross-cover needs that exceed those of our current bench of residents on VIQ, XC14, XC60; we will exercise our best judgment but may need to ask you to help cover for critical duties, even if you are not on a cross-cover rotation (will possibly need to pull from consults or outpatient rotations, for ICU and ward coverage); if this happens, please be the awesome members of our UCSD family who I know you are and pull together to cover for our family members.

For more information, you may refer to this UCSD website:

https://pulse.ucsd.edu/Pages/coronavirus.aspx

And this CDC website:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

And this powerpoint!

COVID-19_Inservice_v5 2-27-20_fm

I realize this is a difficult time for all, and you may be worried about the well-being of your loved ones, our patients, and yourselves. We are here to support you. If you have any questions or concerns, please do not hesitate to reach out to me directly or to any member of the leadership team—PD or CMR.

love you and I will miss hugging you until this is all over! 😉

Sincerely,

simerjot (on behalf of UCSD IM Residency Program Leadership)

VIQ: Procalcitonin: Does It Really Change Management at UCSD?

Procalcitonin: Does It Really Change Management at UCSD
Our stellar residents and interns on VIQ questioned the practical use of procalcitonin in our hospitals. Great job Nagambika Munaganuru, Bianca Palushaj, Alexander Tong, Alexandra Sykes, Jacob Kaiser, W. Kenneth Winter, Nandi Shah, Lester Tsai, Cynthia Hsu, Katarina Vasiljevic, Yan Xing, Praneet Mylavarapu, and Janna Raphelson!!

Procalcitonin is an emerging biomarker that can be used to predict the likelihood of bacterial infection. Multiple studies have looked at its role in guiding abx therapy with patients admitted for respiratory tract infections, as well as those admitted with sepsis to the ICU. Typically, for PCL < 0.1 mcg/L, antibiotics strongly discouraged; if it is >0.25 mcg/L, antibiotics are recommended.  

Our study was to determine whether PCL levels resulted in fewer days of antibiotic therapy for patients with uncomplicated pneumonia. Charts for 57 patients hospitalized at UCSD with a diagnosis of CAP between 2/2019-8/2019 were reviewed. We found no clinically significant difference in average antibiotic duration between patients with elevated PCL vs normal PCL’s (5.1 vs 5.7 days, respectively).   

Even in cases when RPNA was positive for virus and PCL was low, the median antibiotic duration was 7 days, suggesting that we do not rely on results from either diagnostic test for clinical decision making. This raises the question of why we order these tests at all.  

There are several reasons that may explain this. There may be a discordance between a patient’s clinical presentation and their PCL level. Since many PCL’s are ordered by the ED, they may be accidentally or deliberately ignored by the primary team. Except for rare cases, it does not appear that PCL was trended (it should be to determine response to antibiotic treatment). Lastly, given that it is a relatively new biomarker, clinicians may not yet feel comfortable using it as part of their routine practice.  

We conclude that there remain opportunities to improve our use of diagnostic testing by either reducing the use of irrelevant testing or increasing the extent to which we incorporate the test results in our antibiotic decision making.

Checking off boxes

When I was a resident, I kept track of every patient encounter by writing information in a little book kept in my white coat pocket next to a stethoscope, a Sanford guide to antibiotics, an empty 10 ml syringe to practice aspirating/advancing when bored, and my pager. I listed each patient, the diagnosis, and any lab tests or studies I ordered and followed it by including little check boxes.  Every so often, I would flip through the book and follow up on my patients – calling them back and checking off the boxes (very satisfying!).  This also helped me remember interesting cases (which I highlighted in yellow!) for morning reports or to compare with current admissions.  While a book full of patient information is not advisable any more, it’s still important to think of a system that allows you to ensure your patients are safely cared for and improve your own clinical practice by reviewing your patient interactions after time passes.  Did you know EPIC allows you to create

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