Pediatric Emergency Medicine Children s Hospital at Montefiore / Albert Einstein College of Medicine

Transcription

1 Pediatric Emergency Medicine Children s Hospital at Montefiore / 111 East 210 th Street Bronx, NY Telephone (718) Fax (718) June 2005 Dear Applicant: Thank you for expressing interest in the Pediatric Emergency Medicine Fellowship Program at The Children s Hospital at Montefiore and The. Attached, as pdf files, are a brochure and other information about our program. Our fellowship is fully accredited by the Residency Review Committee for Pediatrics; we recently completed a site visit by the RRC and were accredited without citations. This year, our fellowship will be using ERAS for the application. Please see our brochure for the required documents and other information This has been a very exciting time for our service. We continue to experience growth in our service and are currently one of the busiest Pediatric Emergency Departments in our region with an annual census of over 51,000. Please review the enclosed material. If there are any questions, please feel free to contact our administrative supervisor, Irma Gonzalez ( , Irgonzal@montefiore.org) or myself ( , or to JRAvner@montefiore.org. Sincerely, JRAvner Jeffrey R. Avner, M.D. Director, Children s Emergency Service

2 Pediatric Emergency Service (2005) Children s Hospital at Montefiore Jeffrey R. Avner, M.D. Division Chief, Pediatric Emergency Medicine Fellowship Director Professor of Clinical Pediatrics Fellowship training: Children's Hospital of Philadelphia Interests: febrile infants, occult bacteremia, fever, minor trauma Paul Chambers, M.D. Associate Director (Administrative Service) Quality Assurance Coordinator Risk Management Coordinator Interests: asthma, quality assurance Maureen Cook, P.N.P. Pediatric Nurse Practitioner Follow-up Program Interests: oncology Michele Fagan, M.D. Fellowship Training: Children s Hospital at Montefiore/ Interests: diabetes, education Michael Gombos, M.D. Fellowship training: Schneider's Children's Hospital/ Long Island Jewish Medical Center/ Interests: otitis media, occult bacteremia, RSI Waseem Hafeez, M.D. APLS, PALS Course Coordinator Associate Professor of Clinical Pediatrics Interests: mock codes, RSI

3 Marianne Hughes, P.N.P. Pediatric Nurse Practitioner Follow-up Program Interests: sedation, minor trauma, wound care Hnin Khine, M.D. Associate Professor of Clinical Pediatrics Assistant Fellowship Director Fellowship Training: Children's Hospital of Pittsburgh Interests: trauma, evidence-based medicine, pain management Diana King, M.D. Fellowship training: Montefiore Medical Center critical care Interests: education, ethics, critical care issues Theresa Maldonado, M.D. Fellowship Training: Children s Hospital at Montefiore/ Interests: asthma, triage protocols, education Ruby Rivera, M.D. Assistant Fellowship Director Fellowship Training: Montefiore Medical Center/ Interests: asthma, psychiatric issues, toxicology, education Kathleen Ronca, P.N.P. Pediatric Nurse Practitioner Follow-up Program Lorraine Ronca, D.O. Fellowship Training: Jacobi Medical Center/ Interests: trauma, injury prevention

4 Victoria Shulman, M.D. Pediatric ED Residency Coordinator Assistant Clinical Professor of Pediatrics Interests: resident education, infectious diseases Cathi Sellinger, M.D. Associate Director (Clinical Service) Interests: education, diabetes, dermatology Cary Siegel, M.D. Interests: adolescent medicine, observation unit Young Jin Sue, M.D. Associate Clinical Professor of Pediatrics Fellowship Training: Children's Hospital, Boston Interests: toxicology, RSI, sedation Joy Tun, M.D. Housestaff Education Coordinator (Ambulatory Care) Fellowship Training: Bronx Municipal Hospital Center/ Interests: trauma, toxicology Larry Williams, M.D. Assistant Clinical Professor of Pediatrics Sarah Barrett Wren, P.N.P. Pediatric Nurse Practitioner Follow-up Program Interests: adolescent care, gynecology

5 Pediatric Emergency Medicine Fellows (2004): 3 rd Year: Henry Clinton Pollack, M.D. Residency: Children s Hospital of Oakland, California 2 nd Year: Ee Tay, M.D. Residency: Children s Hospital at Montefiore/Albert Einstein, New York 1 st Year: Christine Rizkalla, M.D. Residency: Children s Hospital at Montefiore/Albert Einstein, New York

6 Conference Schedule: PEDIATRIC EMERGENCY SERVICE Children s Hospital at Montefiore Resident Conference Grand Rounds PED Fellows Conference Morbidity / Mortality Conference Fellow Research Seminar. Professor s Rounds Monday, Tuesdays & Thursdays 8:00am 9:00am Wednesday 8:30 9:30 am Wednesday 9:30 12 noon every 3 rd Wednesday Noon 1 pm Biweekly conference Tuesdays 7:45 8:45am Friday 8:30 9:30 am In addition, there is a Department of Pediatrics fellows research retreat in August and a weekend course at The on basic research design & statistics.

7 PEDIATRIC EMERGENCY SERVICE Children s Hospital at Montefiore Sample Fellow Conference Topics All fellows conferences begin with a 30 minute case conference presented by a fellow Research updates are given monthly Journal writing seminars How to publish a paper How a paper is peer reviewed Computer basics Epi Info primer Designing a study Confidence intervals Didactic lectures on PEM topics How to study for the subspecialty exam Journal Clubs Controversial areas in PEM Looking for a job Toxicology Cases ECG interpretation How to write a CV Interviewing Skills Rapid Sequence Intubations Preparing slides Preparing a lecture Writing an abstract Radiology Cases How the ED bills Child Health Issues State of Health of NY s Children Economic Efficiency in the delivery of health care services Micro-teaching techniques Mini-workshops Evaluating the residents Case Conferences

8 SECTION ON PEDIATRC EMERGENCY MEDICINE Department of Pediatrics Children s Hospital at Montefiore Annual Report

9 The Children s Emergency Service is responsible for over 51,000 visits per year of patients under the age of 21 years. As the hub of the primary tertiary care center in the Bronx, the Service cares for children with high acuity illness, and is responsible for most of the admissions to the inpatient units. Patient care is provided by members of the pediatric and emergency medicine house staff under the supervision of the primarily full-time Pediatric Emergency Medicine faculty. This is one of the largest groups of fellowshiptrained and Pediatric Emergency Medicine sub-board certified physicians on the East Coast. FACULTY Jeffrey R. Avner, MD Professor of Clinical Pediatrics Chief, Section of Pediatric Emergency Medicine Fellowship Director Paul Chambers, MD Associate Director (Administrative Service) Quality Assurance Coordinator Risk Management Coordinator Michele Fagan, M.D. Michael Gombos, MD Waseem Hafeez, MD Associate Professor of Clinical Pediatrics APLS, PALS Course Coordinator Hnin Khine, MD Associate Professor of Clinical Pediatrics Assistant Fellowship Director Diana King, MD Theresa Maldonado, MD Ruby Rivera, MD Assistant Fellowship Director Lorraine Ronca, DO Victoria Shulman, MD Assistant Clinical Professor of Pediatrics Pediatric Emergency Department Residency Coordinator Cathi Sellinger, MD Associate Director (Clinical Service) Cary Siegel, MD Young Jin Sue, MD Associate Clinical Professor of Pediatrics Joy Tun, MD House Staff Education Coordinator (Ambulatory Care) Larry Williams, MD Assistant Clinical Professor of Pediatrics POST-DOCTORAL FELLOWS Chris Kelly, MD Henry Clinton Pollack, MD Ee Tay, MD

10 CLINICAL ACTIVITIES The Children s Emergency Service remains one of the largest providers of emergency care to children in the Northeast. In 2003, the Emergency Service continued its growth in the following ways: registration census increased by 7.4% to 51,446, admissions from the PED increased by 10.6% to 4,467, and ambulance transports increased by 5.3% to 5,140. Emergency Medicine faculty also provided three months of inpatient rounding. In addition to the region s largest faculty of Pediatric Emergency Medicine specialists, the staff also includes three fellows and two pediatric nurse practitioners, Marianne Hughes and Sarah Barrett Wren. TEACHING ACTIVITIES In addition to our clinical service, the Section of Pediatric Emergency Medicine is involved in a variety of teaching activities within the department and the AECOM community including: precepting of residents & students in the Department; didactic teaching conferences (including mock codes) weekly for the residents; didactic conferences for fourth year ambulatory students; direct clinical observation of third year students; mentorship for residents and students; development of the Department s orientation manual, and coordinating PALS & APLS courses for the community practitioners, residents, and nurses. The PEM Fellowship Program continues to be a sought after fellowship. Fellow selection data for 2003 showed nearly 45 applications and 16 interviews for one first-year position. This past year fellowship activities included: development and implementation of fellowship competency standards, completion of the ACGME Residency Review Committee evaluation of the fellowship program, development of PEM Fellowship Directors handbook, participation in an Evidence Based Medicine workshop and compilation of selected readings in Pediatric Emergency Medicine. RESEARCH ACTIVITIES Investigators: Jeffrey R. Avner, MD; Michele Fagan, MD; Hnin Khine, MD Fluid Resuscitation for DKA: How Dry Are They? The objectives of this research are to determine the actual percent loss of body weight in patients with DKA and to determine whether clinical and laboratory parameters are predictors of the percent loss of body weight in DKA. Investigators: Jeffrey R. Avner, MD; Amy Fox, MD; David Goldman MD; Hnin Khine, MD; Marguerite Mayers Association Between Bell s Palsy and Herpes Simplex Virus Infection in Pediatric Patients. The objectives of this research are to determine how frequently HSV-1 infection occurs in association with Bell s palsy and to characterize the nature of the infection (e.g. primary versus reactivation) in affected children. Investigators: Jeffrey R. Avner, MD; Hnin Khine, MD; Theresa Maldonado, MD Incidence of Lyme Disease in Patients with Bell s Palsy in the Northern Bronx. The objectives of this research are to determine the incidence of Lyme Disease in patients with Bell s Palsy in the Northern Bronx. Investigators: Jeffrey R. Avner, MD; Vicki Shulman, MD Parental Perception of the Passage of Time During a Stressful Event. The objectives of this research are to determine whether stress affects the ability of a parent or caretaker in relaying information.

11 Investigators: Ruby Rivera, MD; Hnin Khine, MD; Michal Fagan, MD Fluid Resuscitation of Pediatric DKA Patients: Are We All in Agreement? The objectives of this research are to determine practice patterns of emergency physicians in their initial fluid management of pediatric patients who present in DKA. Investigators: Jeffrey R. Avner, MD; John McKitrick, MD; Joshua Needleman, MD; Ee Tay, MD Bacterial Colonization in the Oropharynx of Asthmatic Children During Acute Exacerbations The objectives of this research is to identify the incidence and type of bacteria that colonizes the oropharynx of asthmatic children during acute asthma exacerbations and to determine if a relationship exists between the type of bacteria identified in the oropharynx of asthmatic children during an acute exacerbation and the severity of the exacerbation. Investigators: Cathi Sellinger, MD; Joshua Rocker, MD, Nora Estabon, MD The Epidemiology of Bacterial Conjunctivitis The objective of this research is to identify the incidence and type of bacteria in bacterial conjunctivitis. Investigators: Chris Kelly, MD, Jeffrey R. Avner, MD, Sue Coupey, MD A Comparison of the Diagnosis and Management of Pelvic Inflammatory Disease in Adolescent Females between General and Pediatric Emergency Physicians The objective of this research is to evaluate and compare diagnostic and treatment practices of adolescent females with PID by different groups of emergency physicians. MAJOR GOALS & PLANS FOR FUTURE DEVELOPMENT 1. Introduction of a patient tracking system that will allow real time data on patient flow and location. The tracking system, in combination with the Lynx charting system, will increase the efficiency of emergency care, provide easier means for follow-up care and allow for quick generation of a variety of databases used for quality improvement and research. 2. Continuing development of disaster and bioterrorism training: The Section is continuing to develop training, protocols and management guidelines in the event of a major disaster and/or bioterrorism event. We are developing disaster protocols and bioterrorism response plans as well as acquiring the necessary child-specific equipment and medications for emergency management. 4. Development of an integrated referral system to primary care and a direct referral system to the primary care clinics to capture children in need of a primary care provider. 5. Pediatric Emergency Department brochure: A new informational brochure about health care delivery in the Service was recently developed for our patients and families. 6. Future development of the Section is focused in the following areas: increased involvement in regional EMS-C system planning; community outreach (schools/parent groups); developing an integrated referral system to primary care; developing a PED newsletter for community practitioners, and improved research activity and funding.

12 AWARDS, HONORS, AND MAJOR PRESENTATIONS Jeffrey R. Avner, MD Delivered the Weech Memorial Lecture at The Cincinnati Children s Medical Center on Occult Bacteremia. Waseem Hafeez, MD Winner of the Lewis M. Fraad Award for excellence in teaching pediatric housestaff. Diana King, MD Inducted into the Leo Davidoff Society of The for outstanding achievement in the teaching of medical students. Robert Olympia, MD, Hnin Khine, MD & Jeffrey R. Avner, MD The Effectiveness of Oral Dexamethasone in the Treatment of Moderate to Severe Pharyngitis in Children and Young Adults. Presented at the National Scientific Meeting of the Ambulatory Pediatric Association National Meeting, Seattle, WA, 2003, and at the Society for Academic Emergency Medicine Annual Meeting, Boston, MA, Fagan M, Avner JR, Khine H: Initial Fluid Resuscitation for Patients With Diabetic Ketoacidosis: How Dry Are They? Presented at the National Scientific Meeting of the Ambulatory Pediatric Association National Meeting, San Francisco, CA, Shulman V, Kelly C, Cleary K, Avner JR: Parental perception of the passage of time during a stressful event. Accepted for presentation at the National Scientific Meeting of the Ambulatory Pediatric Association, Washington, DC, Pollack HC, Khine H, Avner JR: Changing pattern of patients requiring psychiatric evaluation in the pediatric emergency department. Accepted for presentation at the National Scientific Meeting of the Ambulatory Pediatric Association, Washington, DC, GRANT SUPPORT Hnin Khine, MD Association Between Bell s Palsy and Herpes Simplex Virus Infection in Pediatric Patients. Departmental Trans-Divisional Grant. (Principal Investigator). $7,500/year for 2 years ( ). Andy Racine, MD and Jeffrey R. Avner, MD Linking Pediatric Emergency Departments to Primary Care. Commonwealth Fund of New York State. $125,000 for 2 years ( ).

13 PUBLICATIONS Avner JR, Sharieff GQ. Medical Emergencies. In Advanced Pediatric Life Support (APLS): The Pediatric Emergency Medicine Resource 4 th Edition, Fuchs S, Gausche-Hill M, Yamamoto L (eds), American Academy of Pediatrics & American College of Emergency Physicians, Avner JR, Sue YJ: Trauma and Ingestions. In Pediatrics for Medical Students (2 nd edition); Bernstein D, Shelov SP (eds), William & Wilkens, Avner JR. Occult bacteremia in children. Audio Digest - Emergency Medicine. 21(6), March 21, Avner JR: Abdominal distention. In Textbook of Pediatric Emergency Medicine - 5 th Edition; Fleisher G, Ludwig S (eds), Williams & Wilkins, (in press). Avner JR: Evaluation of the Cervical Spine. In The Clinical Practice of Emergency Medicine, fourth edition; Ann Harwood-Nuss, et al (eds). Lippincott, Williams & Wilkins, (in press) Cimpello LB, Khine H, Avner JR: Practice patterns of pediatric versus general emergency physicians for pain management of fracture reduction in pediatric patients. Pediatr Emerg Care. 20(4): , Fagan M, Khine H: Pediatric Neurologic Potpourri: Case to Remember Clin Ped Emerg Med. 4: , King D, Avner JR: Altered Mental Status. Clin Ped Emerg Med. 4: , Maldonado TE, Avner JR: Triage of the pediatric patient in the emergency department: Are we all in agreement? Pediatrics. 114: , 2004 Olympia R, Khine H, Avner JR: The effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children and young adults. (In press, Arch Disease Child & Adolescents) Olympia R, Khine H, Avner JR. The use of evidenced based medicine in the management of acutely ill children. (Accepted for publication, Pediatric Emergency Care)