LGH Trauma Surgery Scheduling not Basics

Transcription

1 LGH Trauma Surgery Be sure to contact your classmate who is on service before you about a week before you come on service. This will be your most updated resource. Scheduling Contact Eve Gorski, the Trauma Program Specialist, by phone: or by eve.gorski@advocatehealth.com one month prior to the start of your rotation to obtain the name of the Chief Resident that will make out your schedule. You may submit a limited list of requests and remind them of your need to attend Thursday morning conferences with the EM program. The call schedule will list your call nights (5p-9a, q4-6 nights) and your days off for the block. The Trauma Surgery interns (EM and General Surgery) should not be scheduled on back to back nights, thus allowing coverage of the service by one of the interns daily. Night call includes responding to all trauma code yellows in the ED and cross-covering all surgical patients in the hospital. Basics At LGH you will be the intern on the Trauma Team. As the intern, your responsibilities include: 1. Responding to all Code Yellows (Trauma Activations) - You respond whether or not you are on call. If it is during the day from 7a-5p, you are responsible for patient assessment and disposition. At 5p, the on call team takes over (maybe a little earlier if you work it right). 2. Caring for the floor and step down patients on the Trauma service. You round and write progress notes on all of these patients. 3. Attending Trauma Clinic Monday at 1pm and Friday at 11am. 4. Surgery/Trauma call approx 7 times in 28 days- When you are post-call or on a weekend and leaving early be sure to sign your pager out to the person on call for you via the operator prior to leaving. Also sign it out when you leave each night. Arrive between 6am and 7am to round on your floor patients. After completing floor rounds you should head straight to the SICU. The SICU is where most of the teaching will take place. These are the sickest patients with the greatest needs. You can learn how to manage ventilators, vasopressors, wound management, etc. Take advantage of this opportunity (you ARE expected to be there). This allows you to learn from the more acute and critical patients, and allows you the opportunity to get to know the patients who you will be taking care of prior to their transfer to the floor. You will have a different attending each day SICU rounds can be more or less educational depending upon the attending (for example, if you have a chance to attend rounds on a day Dr. Shah is rounding you will learn). When it is busy, you will barely have enough time to see each person on the floor and scribble a note before the attending is ready to round with you. Attendings generally start rounding in the SICU at 9am.

2 There is a daily surgery conference at 7:00 am at an ever changing location on the 10 th floor. You are not expected to attend, but they are educational, and if the workload isn t too heavy, it s strongly suggested you go. It will also make you look good to the seniors, who will then be more apt to give you procedures. You should attend the 7am conference on the second and third Tuesday of each month. Anything else is up to you and the residents/attendings that you work with. Procedures, such as chest tubes, lines, wound closures, OR time, etc., are all possible if you are available and express your interest to the other members of the team. Lots of lines are done in the SICU, so ask your intermediate if you can help put them in whenever someone is admitted. The SICU is on the 2 nd floor of the hospital in the South building. It can be a little tough to find, so don t be afraid to ask for directions. There is no senior on the floor it will be just you and another intern. You are expected to handle anything non-life threatening, and will round with the attending daily following ICU rounds. If you are uncertain, you can always page the intermediate or senior. The nurse coordinator for Trauma is Ken who rounds each day with the team. He keeps very good track of each patient s plan and needs for discharge. He is an excellent resource who you should constantly be trading information with. Become his friend and your life will be easier. Also, each unit has a nurse coordinator (assists with day to day issues) and a care coordinator (the angel that arranges placement/social work). These 2 individuals will be your best resource for discharging patients in a timely fashion (discharge = fewer notes = less work for you). Find them, know them, and constantly talk to them. They can make the rotation so much better. The trauma service has two APNs- Joan and Cari. Both are ED nurses and educators as well and can help with patient/family education, write orders, write notes, suture, change trachs, pull drains etc. They work from 2p-1030pm M, W, Th, F Sat. Their phone is Call them by 2pm and they will be happy to split any floor work you need help with. On call, they can babysit patients in CT and free you up some time. Trauma clinic is 1:00pm on Monday and 11:00am on Friday. It is basically an hour long and consists of follow-up appointments to check wounds and/or suture removal. The other members of the team will keep you updated. If you are post-call on a clinic day, make sure you let the attending know. If you have finished floor rounds prior to clinic, you will not be expected at clinic post-call. The attendings don t know the resident call schedule. Most of the time, the trauma attending needs to be called and will come see patients with issues that arise where you need their assistance. Rounding & Daily Duties We all know how to round in a general sense, but a few hints about what to know to be the most efficient trauma surgical intern. Start you morning by signing in your pager

3 (just dial 0 ). Page the intern who was on the night prior to get the super-short version of each new patient. Find a computer and print all the patient s physician summary reports (contains vitals, I&O, labs, meds, studies, and a place to write a brief SOAP). After you get your reports go see the patients (having the numbers and results beforehand will help you prioritize in case someone is really sick), and if labs are not showing up you can rectify it early. For the new admits, look at the trauma H&P from the night prior, you should be able to figure out what has been done over night and what is still pending. If you have any questions, feel free to page the intern who admitted the patient. Your notes should be short and should include a dispo plan. Always look over each chart when you see each patient to see what any consults have recommended (it s a private hospital so consults are made for EVERYTHING). They will never page you to tell you so the chart is the only way you can keep track of what other services are planning for your patient. As with most surgery services, trauma rounds are short and focused. If you are prepared with the facts your attending wants, you will be done rounding earlier and in less pain. Be prepared to address the following for every patient: 1) Know the injuries and radiology work up for every floor patient you have. 2) Know what consultants are on board and their current recs (know the attending name -- remember there are multiple orthopedic services) 3) Know every patient s DVT prophylaxis and last Doppler (if a patient is not on lovenox for a reason ex: spinal surgery, know the reason and when it will be okay to prophylax) 4) Know the activity level recommended by PT/OT or ortho for each person and, 5) the most important thing to know is what is keeping the patient from going home and what is your plan to move towards discharge. LE Dopplers to r/o DVT are typically done on the 2 nd day after admission and every 7 days thereafter unless the pt. is a very high risk or cannot receive anticoagulation. Check with the attending on these cases. Tube feedings have a protocol. Ask Joan/Cari the APNs or Ken for a copy and follow it. Computer The Trauma list is on the rainbow looking icon that says Orders and Documents. You will have your own password. Your default list should be the trauma list. Click on the patient s name on the list to get labs, vitals, and other reports. One hint: When searching lab values, reports, micro reports, or whatever that is a few days old, you need to change the date back to the date it was taken or earlier - Otherwise it will not show up. Also, change your results to table format which is much easier to read than the default display. It s not too difficult and Ken or your resident can show you how to do this if you can t figure it out. Consults This is a nebulous mess that you will never fully understand unless you are an attending for many years. You may have to contact their primary care doc to see who they want

4 to use. The best bet is to simply ask who would you like me to call? when an attending asks you to get a consult it saves a mess later. An ortho spine surgery on call consult list is available in the ED at Typically cervical spine injuries are managed by neurosurgery (resident available most days) and thoracic/lumbar by ortho spine (ortho resident or PA available 24/7). Every spine fracture needs both a neurosurgery and an ortho spine consult unless the trauma attending specifically states one is enough. Call Rooms These are on the 9 th floor on the East side near the library above the ER. The code to all surgery rooms is Talk to the other residents to see which room is for the intern. Try to get some sleep when you can. The bed is the most comfortable of all call beds and there s a computer in the room. There are showers and blow-dryers in the bathroom on this floor just make sure you can still hear your pager. Dictating This is SO IMPORTANT. KEEP IT BRIEF AND DO IT WHEN YOU DISCHARGE THE PATIENT. DON T WAIT FOR A LATER DATE. I cannot emphasize this enough; it will save you days and days in the future. These don t have to be novels. Be succinct including dates of admission/discharge, discharge diagnosis, procedures/operations, hospital course discharge instructions/meds/activity/diet and condition. Once you have done all this, simply state please see paper chart for more details. This covers your tail. When you are finished with your dictation, WRITE A BRIEF NOTE IN THE CHART STATING THAT PATIENT WILL BE DISCHARGED AND INCLUDE YOUR DICTATION NUMBER. This way when medical records calls you and states you did not dictate, number 1 you can tell them that if there is not a note in the chart with a dictation number then you did not discharge the patient and therefore it s someone else s responsibility to dictate, and number 2 if you did discharge the patient and for some reason they do not have it linked to a dictation, your dictation number is right there for them to link it. I CANNOT EMPHASIZE ENOUGH HOW IMPORTANT IT IS TO RECORD YOUR DICTATION NUMBERS, this will save you days and days of dictation! To dictate, dial , enter your code (0699 corresponding to your pager), and then the dictation report you want (likely discharge summary #3). Get a menu card from the 3 rd floor medical records to help navigate the system (they can fax it to you if you re near one of the fax machines at the nursing stations). Scrubs You can ask the surgery office about scrubs (call Eve Gorski), or you can simply use your own. The sea foam green LGH scrubs are the only ones that can go in the OR. Staff Lounge

5 This is in the South Building on the first floor and has breakfast at 7:00 am. Use your LGH ID to get in the room. At around 9:00 am on Tuesday and Thursday they bring in a hot breakfast. There is coffee and tea 24/7 and nice couches with big screen TVs. Take advantage everyone else does. Check out an ATLS textbook from the library (9 th floor) for the month. Reading this material will provide you with the basic knowledge needed for the rotation. If you have any concerns or questions please contact Dr. Shah (manoj.shah@advocatehealth.com) or Nikolich (sanja.nikolich@advocatehealth.com) on the trauma service or Dr. Olsen (jon.olsen@advocatehealth.com) at any time. Thanks for your service and we hope you have a great experience. JO/jh g:\luth_areas\emmed\winword\residents\trauma\lgh_trauma_surgery.doc 9/27/2011