Ambulatory Updates: May 27, 2022

Monkeypox

The Maryland Department of Health urges Maryland clinicians to follow the “Identify, Isolate and Inform” paradigm for possible monkeypox: 

Identify - Monkeypox should be considered in the differential for patients presenting with skin lesions, even in the absence of known travel. Symptoms may include fever, headache, muscle aches, lymphadenopathy, and a rash that may concentrate on the face, hands, and feet. This disease presentation may resemble chickenpox, measles, and syphilis. Several of the most recent cases have first presented for care in STI clinics. 

Isolate - Monkeypox is a zoonotic disease and may be transmitted from species of rodents to humans, but may also be transmitted from person to person. Person-to-person transmission is primarily through large respiratory droplets, but also through direct contact with body fluids or 2 

skin lesions, including scabs. Indirect contact, such as exposure to contaminated linens and surfaces, has also been reported. It can be spread between people through direct contact with skin lesions or body fluids, or contaminated materials such as clothing or linens. Patients suspected of having monkeypox should be isolated in a negative air pressure room as soon as possible. If a negative air pressure room is unavailable, place patients in a private examination room. If neither option is feasible, then precautions should be taken to minimize exposure to surrounding persons. These precautions may include placing a surgical mask over the patient’s nose and mouth—if tolerable to the patient—and covering any of the patient’s exposed skin lesions with a sheet or gown. 

Inform - The risk of transmission of monkeypox to the general public remains very low; however clinicians should remain alert to the clinical signs and symptoms in populations without travel. If you should suspect a case of monkeypox, please call the Maryland Department of Health immediately at 410-767-6700 (business hours) or 410-795-7345 (after hours) to arrange for follow-up, including testing.

Read the full letter from the deputy secretary of public health services of the Maryland Department of Health here.

Printing Lab and Imaging Requisitions from MyChart

Patients can print lab and imaging requisitions from MyChart. If patients require assistance in figuring out how to print the requisitions, see the steps on the tip sheet here. For more information on which requisitions will appear, see the “Good to Know” section at the bottom of the tip sheet.

Urgent Endoscopy

The GI division will be launching a new plan to streamline and accommodate patients that need an urgent endoscopy (esophagogastroduodenoscopy andor colonoscopy). We are revamping the procedure order in EPIC to include a new option for "urgent" procedures. When an urgent order is placed, our direct access nurses will review cases to determine timing and location for any urgent endoscopy. As a bridge to this new order (which is not yet live), we have established a temporary, urgent endoscopy email urgentdaendo@jhmi.edu. This can be used in the interim as we wait for final implementation of new order.

Providers can email us directly urgentdaendo@jhmi.edu. Please refer to this criteria for guidance.