ACADEMIC ASSOCIATE CHEAT SHEET
last updated: 5/20/08
Rapid HIV Study
Background / Study Aim
Approximately one out of four New Yorkers who are HIV positive are unaware of their status. Central to this
problem is a lack of accessible testing. HIV testing, however, is beginning to change.
For the last two decades, HIV testing has been kept separate from other routine disease screenings, such as
those for Hepatitis and Tuberculosis. As the disease becomes less stigmatized and better understood, health care
professionals anticipate that HIV screening will soon become incorporated into regular check-ups. As this happens,
many believe that HIV testing counselors and clinics will be fazed out of existence.
To prepare for the gradual disappearance of HIV testing counselors and clinics—and further reach out to the
approximately 100,000 New Yorkers who are unaware they are HIV positive—the Center for Comprehensive Care
(CCC), the St. Luke’s/Roosevelt HIV care program, recently launched a free Rapid HIV testing program for patients
admitted to St Luke’s–Roosevelt Hospitals Emergency Departments (SLR ED). This study aims to assess patient
attitudes towards, and frequency of enrollment in, the new free Rapid HIV testing program.
Inclusion Criteria
All patients 18 years or older who receive care in the SLRH ED and whose ultimate disposition (admission to
the hospital, discharge home, etc.) is determined and entered into the EMSTAT system (under column “Dis”) by their
physician during the hours of 9am-10am, 1pm-2pm, 5pm-6pm and 9pm-10pm.
Exclusion Criteria
-Patients < 18 years old.
-Patients who cannot read and write English or Spanish.
-Patients who have altered mental status (confused, unconscious, intoxicated, etc.) or in extremis
(extreme pain and /or very ill).
-Prisoners.
AA Role:
1)
Watch for patients whose disposition time appears in the “Dis” column in EmStat during the hours of
9am-10am, 1pm-2pm, 5pm-6pm, and 9pm-10pm.
2)
Identify patients who are eligible for the survey and approach them.
3)
Smile and introduce yourself. Ask if the patient is willing to answer some questions for our survey. Read the
script on the survey (“We are evaluating our new, free testing...”).
4)
If the patient agrees, hand them a survey and pen and let them know you will be back soon in case there are
any questions. Note: Patients must read and fill out the survey themselves.
5)
Enter patient name, “HIV survey,” “Y,” and survey # in Excel Patient Screened Spreadsheet.
6)
Enter survey data into the HIV_Survey Access Database.
7)
Enter appropriate data into the Enrollment Tracking Access Database.
8)
Deposit the form into the locked, blue research box. Thanks!!
ACADEMIC ASSOCIATE CHEAT SHEET
Intubation/Bougie Study
Very sick patients sometimes have difficulty breathing on their own. In this event, we often assist their
breathing by placing a tube in their trachea (“intubation”) and placing them on a ventilator. Endotracheal intubation is
not a simple procedure. Sometimes it can be difficult/impossible to see the vocal cords (which are at the top of the
trachea and between which we want to place the tube) and therefore difficult to know where to direct the tube. There
are many “rescue techniques” that can be used in the event of a very difficult intubation. We often change the patient’s
head position, change the laryngoscope blade/tube we are using, or have someone else more experienced attempt the
intubation. There is also a tool called a “bougie” that may be used.
Dr. Shah wants to study what techniques physicians are using in the event of a difficult airway and the
resulting complications of that difficult airway. Then he wants to see if emergency physicians can successfully use the
bougie rescue technique and reduce the number of complications.
Inclusion Criteria:
Any doctor who attempts an intubation on an adult (>18 y/o) patient should fill out a form
Exclusion Criteria:
None
AA Role:
1) Watch for any intubation occurring in the ED (there is usually quite a bit of commotion around one patient for 15-20
minutes) or any patient on a ventilator. Find out which physician intubated the patient and ask them to complete the
study form.
2) Note that the inclusion criteria means EVERY doctor who attempts to intubate should fill out a data form. If one
doctor can’t get the tube in and one can, they both fill out sheets. If three try and one of them gets it in, three sheets get
filled out. Force them at gunpoint.
3) If you are present for the intubation, you may want to pay attention to how many times the physician had to look in
the mouth and if different physicians attempted the procedure (in order to help them if they ask questions while filling
out the form). Feel free to ask the physicians what the difficulty was and make sure they document it on the second
page of the study form. Any person who attempts and does not succeed even once (regardless of whether they
eventually succeed), should be filling out pages 1 AND 2.
4) MAKE SURE A DATE AND TIME ARE WRITTEN ON THE FORM!!!
rd
5) If a bougie is used make sure the 3 page is completed.
6) Once the form is completed, place it in the blue research box on the wall in the adult ED.
If there are any problems/concerns/questions, please call Dr. Shah at 646-369-2747.
ACADEMIC ASSOCIATE CHEAT SHEET
LP-Ultrasound Study
A lumbar puncture (LP) is generally performed in order to obtain cerebrospinal fluid. Analysis of this fluid can
tell us if a patient has encephalitis (infection of the brain), meningitis (infection of the linings of the brain), or
subarachnoid hemorrhage (bleeding around the brain). Although frequently easy, this can be a difficult procedure.
From a previous study we know that the procedure is more difficult when you cannot see the bumps of the spine with
the naked eye. The technique requires passing a needle between the spinous processes (“the bumps”) into the
subarachnoid space.
We hope that the ultrasound machine can help us to visualize these bones. Some patients will be ultrasounded
and some will not (we will randomly select this). The goal is to see if using the ultrasound does any of the following:
reduce the number of needle sticks, reduces the number of red blood cells caused by accidental trauma, reduces the
time necessary for the procedure, or reduces the pain.
Inclusion Criteria:
-Any adult patient (≥18) undergoing lumbar puncture in whom the spine is not visible to the naked eye
Exclusion Criteria:
-Age < 18
-Prisoners
-Anyone in whom the spine is visible to the naked eye
-Altered mental status, e.g. unconsciousness or confusion (therefore unable to consent)
AA Role:
1) Watch for any patient requiring a lumbar puncture. Common ED complaints that result in LP include headache,
headache and fever, stiff neck, and others. Approach the physician caring for the patient and ask if the patient is
eligible by REMINDING THE PHYSICIAN OF THE INCLUSION CRITERIA.
2) Have the physician consent the patient. Only physicians can consent patients for this study. The first two pages of
the packet should be signed by the patient, the physician (investigator), and you (witness). Pages 6-13 should be
given to the patient.
3) If the patient consents, open the lowest numbered “LP-U/S” envelope in the cabinet (or filing box at Roosevelt).
-If the number is even, the ultrasound should be used to facilitate the procedure.
-If the number is odd, the ultrasound should not be used. Tell the physician.
4) Remind the physician to use 5cc of lidocaine. If more is necessary, ask them to document it on the data form.
5) Use the stopwatch to time the duration of the procedure. Start the timer when then physician enters the room ready
to start the procedure (include the time for ultrasound; do not include time to gather materials). Stop the timer after
the CSF is collected and the needle is removed from the patient’s back.
6) Once the data form is completed enter the data into the database, then place the form in the box.
If there are problems/questions, call Dr. Shah at 646-369-2747 or Dr. Newman at 917-453-8865.
ACADEMIC ASSOCIATE CHEAT SHEET
Pregnant Patient Study
Pregnant women frequently come to the emergency department because of vaginal bleeding. When
there is bleeding during pregnancy one of the concerns is that the blood of the fetus and the blood of the mom
might contact each other, which could result in the mom generating immune system antibodies to the fetal
tissue. These antibodies wouldn’t be dangerous to the fetus immediately, but could be dangerous to a fetus
during a subsequent pregnancy. Usually, we check these women’s blood type to determine if they could
potentially generate these antibodies (only women with “negative” blood types can generate these antibodies).
If they have the “negative” blood type we give them Rhogam, a medicine to reduce the chances of the mother
generating the antibiodies.
Our goal is to study pregnant patients. We want to know how reliable they are in their knowledge of
their blood type. If they’re generally right about their blood type then we may be able to skip the blood type
tests that we usually do. We will compare their survey responses to the lab test results we obtain.
Inclusion Criteria:
Any adult patient (age 18 or older) with a positive pregnancy test who is having blood sent for a type and
screen (T & S).
Exclusion Criteria:
Age less than 18 years Prisoners Unable to consent (Altered mental status, confusion, language barrier, etc.)
AA Role:
1. Watch for any female patient with a positive pregnancy test.
2. Ask the physician if the patient is having a type and screen sent and if they may be consented for this
study.
3. MAKE SURE THE DOCTOR HAS TOLD THE PATIENT THAT SHE IS PREGNANT
BEFORE YOU CONSENT FOR THE SURVEY.
4. Consent the patient. Tell the patient that this is simply a survey to determine how often patients know
their blood type. Feel free to tell the patient their blood type AFTER they have completed the survey.
5. Complete the top part of the survey (labeled “academic associates”) after the patient has completed the
survey. Also, please ensure that the patient has filled out all parts of the survey.
6. Place the complete form in the blue Research Box. There is no database yet.
If there are any problems/issues, please contact Dr. Kaushal Shah (646-369-2747) or Dr. Jessica Paisley
(347-387-5230).
ACADEMIC ASSOCIATE CHEAT SHEET
Syncope Study
Purpose:
Syncope is defined as a sudden transient loss of consciousness with a complete recovery. It has been estimated
that approximately one in four people will experience syncope during their lifetime and that syncope patients make up
1% to 2% of all ED visits and hospital admissions There is a ‘Decision Rule’ called the San Francisco Syncope Rule
(SFSR) that aims to determine the likelihood that a person will experience a major health problem or death soon after
being seen in an emergency department for syncope. Knowing this would help us to decide who should be admitted to
the hospital for further testing even when everything initially seems fine, and who can safely go home from the
emergency department after a syncopal episode.
The 5 criteria of the SFSR are: BP <90 mmHg, shortness of breath (SOB), a history of congestive heart failure
(CHF), a hematocrit (% red blood cells) <30, and an abnormal ECG. According to the results of the SFSR study,
patients with any of these criteria are considerably more likely to experience a serious outcome within 7 days, and
should be admitted to the hospital. The SFSR has only been proven to be safe and effective by the group who created it,
and only in their hospital. We would like to know a) if it works in NYC, and b) if not, whether we can build a better
rule.
Inclusion Criteria:
syncope or near-syncope (transient lightheadedness so
severe that the patient felt they might lose consciousness).
Exclusion Criteria:
1. Patients younger than age 18.
2. Patients who do not speak/read the language of the consent form
3. Prisoners
4. Patients who do not consent to participate in the study.
5. Patients with altered mental status (confused, unconscious, intoxicated, etc.).
AA Role & Duties:
the ER with syncope or near-syncope. You may see their chief complaint as
“syncope”, “fainted”, “near-syncope”, “lost consciousness”, “nearly fainted” or variations of fainting or almost
fainting.
ermine whether they match any of the exclusion criteria by
looking in EMSTAT or asking the physician.
Make sure you assure them that their
medical care will NOT be altered as a result of participation in the study and that you are asking for permission
to review their medical records and call them back 3 times in the span of one year to check up on their
condition.
ex, chief complaint) and drop the form in the blue box
after writing across the top: ‘DID NOT CONSENT’
If they consent, fill out the GREY AREAS! You might have to wait a while until you can completely fill out the
form. ECG cardiac parameters (rate, PT interval, QRS interval, and QT/QTC) can be found on the ECG printout in the
patient’s chart. Ask the physician to see a patient’s chart before taking it. (Do not wander off to the AA desk with any
charts).
ACADEMIC ASSOCIATE CHEAT SHEET
Force the physician to fill out ALL POSSIBLE white areas on BOTH pages of the study form. (There may be
areas they don’t have answers for.) Even if you have yet to complete the grey area of the form, be sure to get it to the
physician ASAP. Only physicians listed in the ‘Phys’ column of EMSTAT should fill out forms, not physicians
listed in the ‘Res’ column. You should also make sure they return it to you, completely filled out, in a timely manner.
 Once all parts of the form are filled out (usually once the patient is discharged) enter the data into the computer and
drop the form in the blue box. If you have to leave and the form is incomplete, make a note for the next AA on the
excel spreadsheet or, if you are the last shift of the day, enter the form in the database with a diagnosis of “CHECK
DIAGNOSIS” and drop the form in the blue box. Make sure you write the form number provided by the database at the
top of the study form.
CBCDIFF
Hemoglobin
WBC
Platelets
Hematocrit
ACADEMIC ASSOCIATE CHEAT SHEET
Renal Colic Decision Rule Study
‘Renal colic’ is the name that we use for the pain that occurs as a result of kidney stones. In the ED when
physicians are considering kidney stones as a potential diagnosis for the pain that a patient is having, one of the primary
questions that they must ask is whether or not it is necessary or useful to obtain a CAT (computed tomography) scan of
the abdomen. CAT scans see kidney stones very well, and perhaps more importantly they also identify other lifethreatening problems that can cause similar pain. Therefore it can be very useful to have a CAT scan.
However since most kidney stones will pass on their own with time and will not require anything besides pain
medicine it would be useful to be able to identify those patients in whom we could safely forego imaging. In this case
we would simply relieve the pain and arrange follow-up with a urologist, the kidney stone specialists. CAT scans are
also expensive and often take hours to perform and read, therefore developing a rule that would allow us to avoid CAT
scans would be helpful. This study is designed to identify factors that may be combined in an easy-to-remember and
easy-to-apply way that could allow us to safely avoid CAT scans in many of these patients.
Inclusion Criteria:
1) Any adult (>17) patient in whom renal colic is “suspected”. (This is intentionally vague, see your scripted question
below)
Exclusion Criteria:
1) Prisoners
2) Patients presenting with a blood pressure <90 systolic (the top number in the BP)
3) Pregnancy
4) Anyone in whom AAA (aortic aneurysm) is considered to be in the top 2 possibilities
AA role:
1) The great majority of the patients in whom renal colic is being treated or considered will arrive with complaints of
back, flank, groin, or abdominal pain. Sometimes it will be ‘kidney stone’, but rarely. Look for all of these chief
complaints on EMSTAT.
2) When you find these complaints, which should be often, wait until the patient has been in the ED for one half to one
hour or so, and then approach the doctor who is listed in the ‘Phys’ column (this person is listed as the ‘Emergency
Physician’ when you double-click on the ‘Phys’ column for that patient, and will be an attending or senior resident).
Then ask the following: “Dr. X will you be treating or imaging this patient for potential renal colic?” Sometimes they
may not have seen the patient yet. If so, try again in 15 minutes.
3) If their answer to the above question is ‘yes’, then ask: “Is aortic aneurysm one of the top 2 diagnoses in this
patient?” If the answer is ‘no’ then enroll. If the answer is ‘yes’ then the patient meets exclusion criteria #4 above and
should not be included. (Most will be ‘no’.)

If the pt is having imaging (a CT scan) that is partly designed to detect renal colic (but not an aneurysm), or if
the pt is being presumptively treated for renal colic without any imaging, then yes.
st
4) If the patient is being enrolled, complete the top of page ‘3’, which is actually the 1 page of the actual dataform, and
GET 3 CONTACT POINTS!! Then give it to the physician so that they can fill it out.
5) Next, fill out the top of the second dataform on page 4.
ACADEMIC ASSOCIATE CHEAT SHEET
6) Find the patient and consent them. If they say no, throw away the consent and page ‘4’ and write on the top of the dataform
“Refused” in large letters, cross out the name and MR#, and drop this in the blue box. Do not enter these into the database.
7) Now go back and hassle the physician about completing the form. It should be quick and easy for them to circle all of the
answers on the form. Once the physician hands you the completed form double check that they have answered ALL of the
questions on it.
8) If page 3 and the top of page 4 are completed and the patient has signed, make sure the patient has copies of the consent and
authorization paperwork and enter it into the database (if there is one). Well done.
If you have major questions or feel that you may miss an enrollment because you are unable to figure out a problem,
feel free to call Dr. Kilian, this study’s principal investigator at 917327-1516 any time, or email us urgently at
chiefs@angel.net.
ACADEMIC ASSOCIATE CHEAT SHEET
ACS Communication Study
ACS, or Acute Coronary Syndrome, is the term we use to describe an entire spectrum of heart disease. This
spectrum ranges from unstable angina on one end, to heart attacks, or MI's, on the other end. All of these represent
some degree of cardiac ischemia and they can all be difficult to detect. This requires us to admit many ACS patients
and those who might have ACS. What this study aims to accomplish is to evaluate patient and doctor perceptions of
disease management and outcome in possible ACS admissions; and to evaluate the discrepancy between doctor and
patient perceptions. Secondarily, the study also will try to determine the relationship, if any, between perceptual
discrepancies and patient demographics.
Inclusion Criteria
• Anyone being admitted to the hospital primarily for chest pain and possible ACS
Exclusion Criteria
• Under 18 y/o
• Prisoners
• Non-English speakers
• Patients not fully aware of their surroundings (sleeping notwithstanding) or in acute distress
AA Role:
1) Search for complaints related to ACS that are being admitted to the hospital. These complaints may be related to
chest pain such as “cp”, “chest tightness”, and “chest pressure”; or they may be related to shortness of breath such as
“sob”, “doe”, “dyspnea”. Because these latter symptoms can be related to many different disease processes, be sure to
check with their doctor to see if the patient is being admitted primarily for possible ACS.
2) In the main EMSTAT screen if there is a number in the final column (“Dis”) then the patient should be screened
because they have either been discharged or admitted. If they are being admitted this will be apparent in their EMSTAT
chart on the “DISCHARGE” tab. If there are multiple orders that start with “Admit-”, the person is being admitted to
the hospital.
3) When you find a patient that meets the criteria, fill out the top of the study form on both Physician and Patient
Questionnaires. Separate the forms so that neither party accidentally sees the other's answers.
4) Present the patient with the Survey explanation and Patient Questionnaire forms. Be sure that they understand that
this is anonymous (their doctor will not see their answers), unrelated to their treatment, and voluntary. Make sure that
they fill out both sides of the survey.
5) Present that patient's physician with the Physician Questionnaire form. The doctor filling this out should be the
person under the “PHYS” column of EMSTAT. The senior red team resident should be the only resident to fill out this
survey—all others should be attendings.
6) Enter the data into the database, staple the forms together, and drop them in the blue box .
If you have any questions or issues, especially if it may cause you to miss an enrollment, please contact
us at chiefs@angel.net, call Dr. Newman 917-453-8865, or Brian Ackerman 845-323-8720.
ACADEMIC ASSOCIATE CHEAT SHEET
Last Updated: 11/10/2007
Gestational Age Study
The evaluation of pregnant females is a common occurrence in the Emergency Department (ED), where we
check if the woman is indeed pregnant, attempt to confirm that the pregnancy is in the uterus, and whether the fetus is
viable. The Emergency Department is often where the first evaluation of a pregnancy takes place.
We often ask a woman for her last menstrual period (LMP) to approximate the age of the fetus. However,
because women cannot always provide accurate information about their LMP and, can have irregular cycles, dates
calculated by LMP are often inaccurate. Ultrasound, which has proven to be the most accurate method of determining
fetal age, can also be used.
We would like to determine if there is a correlation between fetal age based on reported LMP and that
calculated by ultrasound, and we would like to know how accurately emergency physicians can use ultrasound for this
purpose.
Inclusion Criteria:
• Any adult pregnant patient (age >17) with an HCG blood test done, in the first trimester of pregnancy
Exclusion Criteria:
• Anyone under 18
• Prisoners
• Unable to consent (altered mental status, confusion, etc)
AA Role:
1. Watch for any female patient who has an ‘HCG’ ordered in Emstat.
2. Check if the patient is pregnant. Urine pregnancy tests are routinely done in the ED and will usually appear under the
“tests” section of EMSTAT. If no urine pregnancy test was done, you can wait for the results of the HCG – if it is >5,
the patient is pregnant.
3. Once you confirm pregnancy, ask the physician if the patient is in the first trimester immediately. Some pregnant
patients may have ultrasounds quickly, so rapid identification is critical.
4. If the patient is eligible, obtain informed consent . The only change in patient care is the addition of an attempt to
estimate the gestational age by ultrasound. Do not do the study if the patient’s physician does not know how to do GA
or use US for IV (just document this on the excel spreadsheet).
5. If the patient refuses, write “Did Not Consent” on the dataform and drop it in the Blue box
6. If the patient consents, stamp the dataform using the addressograph (at the team’s station), fill out what you can (e.g.
ethnicity, test results), and remind the physician to do a gestational age.
7. Make sure the dataform is completed, collect the physician’s ultrasound, and staple them together.
8. Drop the completed dataform in the bluebox and you are done. You do not need to enter this information into a
database (there isn’t one yet).
If you have any major questions or issues, especially if it may cause you to miss an enrollment, please contact us
at chiefs@angel.net, call Dr. Newman at 917-453-8865, or Dr. Saul at 212-523-3981.
ACADEMIC ASSOCIATE CHEAT SHEET
Last Updated: 11/10/2007
Ultrasound-Guided Peripheral IV Study
Patients who present to the emergency department often require IV access as part of their treatment. A common
problem in the ED is difficult IV access, which can be especially marked in those with complex medical problems and
pediatric patients. IV placement in these groups may occupy the time of many ED personnel, and failure may
necessitate alternative routes, such as central venous line placement, that involve a risk of complications, increased
patient discomfort, and are more time consuming.
Ultrasound has been studied extensively, and shown to facilitate central venous access in adult populations.
Some studies have also applied ultrasound-guided peripheral IV placement to adult patient populations with difficult IV
access and demonstrated that ultrasound-guided peripheral IV placement may be more successful than traditional
techniques, requiring less time and fewer attempts.
Bedside ultrasound may help difficult IV placement in patients of all ages and decrease the necessity for more
invasive forms of vascular access with their increased time, cost, and risks of complications. This would facilitate care
in our ED and improve the overall quality of care in our patients. We would like to see if this can apply to our ED
patient population, both pediatric and adult. This study is designed to examine bedside ultrasound-guided IV
placement with regard to the number of attempts and needle redirections required, and time for placement.
Inclusion Criteria:

All adult and pediatric ED patients who require IV access and have had 2 unsuccessful IV placement attempts
Exclusion Criteria:

Prisoners

Unstable patients

Unable or unwilling to consent (altered mental status, confusion, etc)
AA Role:
1) At the beginning of every AA shift, let all teams in the adult and pediatric ED know that you're available to
help out with the peripheral IV study, and they should come get you whenever they find a patient with difficult
IV access. For this study, you will not be screening for patients. Rather, you need to remind the ED teams to
screen patients for you.
2) Whenever you are told about a patient with difficult IV access, get a dataform with the informed consent sheets
for the physician, and a watch to record time. The physician must obtain informed consent for this study.
3) If the patient refuses to consent to an ultrasound, write “Did Not Consent” on the dataform and drop it in the
Blue box
4) If the patient consents, stamp the dataform using the addressograph (should be located at the team’s station),
fill out what you can (e.g. gender, age, skin color, etc.).
5) Record the time that the tourniquet is placed on the patient as the start time, and record the time of successful
IV placement as the end time. The IV is considered successfully placed when the phsyician is able to inject
saline into the vein.
6) Make sure to find out how satisfied the patient or parent is for the final question on the dataform, and have the
physician complete the study for you.
7) Drop the completed dataform in the bluebox and you are done. You do not need to enter this information into
a database.
If you have any major questions or issues, especially if it may cause you to miss an enrollment, please contact us
at chiefs@angel.net, call Dr. Newman at 917-453-8865, or Dr. Doniger at ________.