Important Clinical Links
Soarian (on campus or on VPN only - for off campus use App Store above)
Columbia Library (for access to journal articles off campus)
Latest News from AIM
Welcome to our new patient care director!
We are excited to welcome Robyn Vaughan MS, BSN, RN as our new PCD (patient care director). Robyn comes to us after spending 5 years as a Nurse Manager at NYU Center for Women’s Health. She also has staff RN experience in interventional radiology, med/surg, BMT/oncology and cardiac stepdown. She has extensive experience in leadership and quality improvement, and we’re really excited to have her as part of our team!
Forms clinic pilot
You may have heard that we recently started an NP staffed forms clinic. The pilot has been successful thus far and we are brainstorming how to scale this service to meet the needs of our practice. While this is not a clinic that doctors can refer directly to, I would like to share some details so that you are aware of what has been happening behind the scenes.
-Goal: To complete patient forms in a timely manner & decrease one time visits to housestaff for form completion
-Who: Patients who walk-in or call the practice needing a form completed are scheduled by a PFA or supervisor
-When & Where: Meets Tuesday and Friday afternoons, Module 201
-Eligible forms: The majority of forms requiring completion have been M11q and CDPAS re-certifications; the only exclusions are disability, pre-op, commercial driver’s license, and citizenship forms
-A big thanks to: Carlos and Florence who have been completing lots of forms!
Patient verification reminder
Patient verification must be done on every patient at every visit, even in the ambulatory setting where we have long term relationships with our patients. We’ve recently had a few near misses that could have been prevented with proper patient verification.
-For patients with an ID band: verify name and MRN
-For patients without an ID band: verify name and date of birth
We are quickly approaching the 90 days to Go-Live mark; the website epictogetherny.org has lots of good information to help you prepare
-Saba e-learning videos: must be completed prior to your in-class training; once you have completed them you can get access to the Epic playground (You should have gotten 2 emails regarding Epic Training this week)
-Intentional redesign tab: here you will find connect2change videos highlighting important Epic tools
Ambulatory Read of the Week
Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge
In this retrospective cohort study of 4056 patients 65+ with hypertension admitted to VA hospitals for non-cardiac conditions from 2011-2013, intensification of antihypertensive regimen at time of discharge was associated with increased 30 day readmission rates (HR 1.23, NNH 27) and serious adverse events (HR 1.41) and NO difference in systolic BP or CV events at one year (HR 1.18 trend towards INCREASED events with intensification) compared to propensity-matched controls. As with all VA studies, this is limited by the applicability of the population (97.7% male), and the fact that the intensification group didn't actually ACHIEVE better control doesn't rule out a benefit in cases that actually achieved better control (likely many outpatient docs pulled off the intensifications when they were seen in the office). Worth noting that over half the patients who received intensification had well controlled BPs prior to admission. A sensitivity analysis demonstrated that patients with poor control prior to admission did not experience the same increased readmissions and adverse events. However, it's a good lesson that changing chronic meds in an acute care setting is fraught with the possibility of adverse events, and should be done only with a very, very good reason and coordination with the outpatient PMD. Or, as the authors say, "Shifting practice from intensifying antihypertensive regimens during hospitalization to communicating concerns about patients’ long-term BP control to outpatient practitioners for close follow-up may provide a safer treatment path for patients."