ORIENTATION Pediatric Community rotation at St. Catharines hospital for PGY-1 Dear New Learners, Welcome to the Niagara Health System, we hope you have a wonderful experience on the pediatric CTU. Important Contacts Pediatrics REL/CTU director: o Dr. Rocio Monroy, monroyr@mcmaster.ca Pediatric Regional Chief, Chair of Pediatrics o Dr. Madan Roy, roym@mcmaster.ca Administrative Assistant: o Caroline Abeidat, Abeidat@niagarahealth.on.ca, and o Sarah Litke, Sarah.Litke@niagarahealth.on.ca Elective Coordinator: o Sara Pool, sapoole@mcmaster.ca Pediatric community office placement: o Tammy Keeler, keeler@mcmaster.ca Pediatric Nurse Coordinator: o Carol Munro, Carol.Munro@niagarahealth.on.ca Nurse Practitioner in SCN o Amanda Symington, Amanda.Symington@niagarahealth.on.ca Hospital Location: 1200 Fourth Ave, St. Catharines, Ontatrio L2S 0A9 Directions once inside the hospital to Peds CTU: From the main entrance of the hospital, walk straight ahead past the Tim Horton s to the main set of elevators. Then take the elevator to the 4th floor. Turn left when getting off the elevator. There will be two sets of doors. Go through the set on the left hand side. It should be labeled Children s Health. Walk straight through the hallway until you see a sign on the right hand side, which says On-Call Rooms and Conference Rooms. This sign will be next to a door. Enter the door and find the conference room in this area. This is where they met each morning before rounds. 1
Pediatrics CTU Location: Pediatric Floor located at the 4 th floor Paediatric Ward (4B children s health unit) CDU (clinical decision Unit) Conference room for teaching Special care nursery (SCN) Labour and delivery (Women & Babies) O.R suits for C/Sections, adjunct neonatal resuscitation room Post partum area P-RAC Bili Clinic 4 th floor MAP 1-4A Medical Respirology Unit 2-4B Children's Health Unit 3 - Special Care Nursery & Antenatal/Postnatal Unit 4 - Women & Babies 5 -Outpatient Clinics, including Pediatric Rapid Assessment Clinic (PRAC) 6 - Gift Shop 2
C-Sections are carried out in the OR off the Labor and delivery suite. Neonatal resuscitation from C-Sections is carried out in the resuscitation suite off the Special Care Nursery. When entering to resuscitation suit please get a gown and surgical hat outside in the room beside the Resuscitation room. St Catharines General Hospital phone number extensions Switch board dial #0 4B Children's Health Station A!43518 4B Children's Health Station B!41319 4B Children's Health Station C!41317 4B Children's Health Station D!41311 4DB Women and Babies!43283 4DB Special Care Nursery!42900/43200 ED Station A!45000 ED Station B!45120 ED RAZ!45400 ED Urgent Care!45100 OR Care Station!45560/45561 Academic and Education Centre!43867/43876 Laboratory!46371 Pharmacy!46379 Health Information Management!44772 ICT Service Desk!42850 Security Office!44309 Pediatricians: Al-Darazi, Youness Bhagirath, Chander Burger, Michael Dorah, Nick El Sayed, Manal Ashraf, Kaleem Ogunkeye, Alarape Brar, Parminder Monroy, Rocio Roy,Madan Shaikh, Omer Shakhatreh, Hala Asim, Shiba DrYouness.Al-darazi@niagarahealth.on.ca c.bhagirath@sympatico.ca michael.burger@sympatico.ca Nicholas.dorah@gmail.com manal.f.elsayed@gmail.com kaleem.ashraf@medportal.ca oalarape@gmail.com ParminderMD.Brar@niagarahealth.on.ca monroyr@mcmaster.ca MadanMohan.Roy@niagarahealth.on.ca Omer.Shaikh@niagarahealth.on.ca hshakhatreh_2000@yahoo.com shiba.asim@medportal.ca 3
EMR/Images: -Meditech -IMPAX Username and Passwords are provided by Sarah Litke, and will be emailed to the visiting elective learner prior to their arrival at Niagara Health. Vacation/no call requests Please ensure that all of your vacation or away or no call requests are submitted through the Medportal system so that this can incorporate this into your schedule. Please be sure to inform Niagara Regional Campus office (Sarah Litke) of any approved time off prior to starting the block. Every learner must fill out Mac-Care forms, which are sent to Niagara. This is imperative as no elective placement can occur without this happening. You can find the placement form here: http://maccare.mcmaster.ca/rotation-request-form.html Pediatric rotation is 4 weeks block divided as follow: One week in Special Care Nursery (SCN), level 2 One week in in-patient pediatric Clinical Teaching Unit (CTU) One week in pediatric consult service (PCS) One week in community pediatrician office CTU SCN PCS Community Hours 7am to 5pm 7am to 5pm 7am to 5pm 8am to 5pm Calls Calls Calls No calls No calls Evaluations Pediatrician on service Special Care Nursery (SCN): Pediatrician On service Learner will choose one pediatrician Preceptor SCN is a level 2 nursery with 12 active beds. Rotation hours from 7:00 am to 5:00 pm for one week SCN rounds are run in the morning with a dedicated pediatrician on weekly service for the mornings only. The pediatrician on call manages any pending issues or new concerns in the after noon. 4
In the afternoon learners are expected to review each patient for the next morning rounds including: o Caloric intake o Growth curves, including wt., length and HC o Feeds o Vitamins and mineral supplementations according to guidelines o ROP indications o HUS indications During the rotation learners are expected to review some basic CPS statements, including: o Risk GBS o Facilitating discharge of preterm infants o Safe discharge of the late preterm infant o Prevention and management of pain in the neonate o ROP screening o Screening guidelines for newborn at risk of low glucose. During this rotation learners are usually expose to feeds in prematures, GERD, meconium aspiration, and NAS, which are very common in our level 2. Furthermore, it is a good experience to get a sense when to call/transfer premature new borns to tertiary care center. This rotation is also a good opportunity to practice procedures including I.Vs, LPs and umbilical lines Amanda Symington, RN, our very experienced nurse practitioner is always eager to teach about I.V, L.P and umbilical lines in patients who are stable. Pediatrics in-patient Clinical teaching Unit (CTU) 16 acute beds, 4 reserved for children s psychiatry CTU hrs from 7:00 am to 5:00 pm for one week On arrival at 7:00 am, learners print the in-patient list from Meditech and subsequently meet at the conference room on the 4 th floor to divide patients. Rounds usually start at 8:00 am in the morning with the staff pediatrician on service for the week and rest of the learners. Most of our pediatricians do walking/bedside rounds. PGY-1 Expectations: o Divide patients among learners. - For Medical Clerks o The first week of rotation max 3 o Mid rotation 4 to 5 max o Take in account complexity of the patients as well 5
- If MF4/pre-clerks (Usually only during summer) o They usually shadow you at the beginning but depend on their comfort level they can take one patient. However is very important you review clinical notes in detail Complete daily progress notes on your patients Make sure face sheet is filed up properly when patients are discharged as well as appropriate follow up in the community - Once rounds and notes are finished in CTU, please call the pediatrician on call to join P-RAC (Pediatric Rapid Assessment clinic) Please follow up on pending issues left from morning rounds and report them to the pediatrician on call. Pediatrics Consult service (PCS) Rotation hrs: from 7:00 am to 5:00 pm for one week The resident will work with the pediatrician on call; this means will work with a different pediatrician every day. Please report via switchboard to the on-call pediatrician once you arrive at 7:00 am every morning. For this week is very important you pick up the pager from Sarah Litke in the Academic and Education Area. The pager for PEDS are on the white board behind Sarah s desk labelled PEDS Pager. You will receive text pagers to attend to high risk deliveries to assess high risk neonates that may require neonatal resuscitation. There usually 3 booked C/S on Mondays, Wednesday and Fridays. Calls for highrisk deliveries on the L&D can happen at any time PGY-1 Expectations: o Attendance to high-risk deliveries and C/S to practice NRP o PGY-1s are advice NOT to lead the resuscitation until the pediatrician arrives. o Usually pediatricians arrive very early within 5 min. If no pediatrician present, PGY-1 should let the R.T and nurse to lead the resuscitation until the pediatrician comes. o In the morning resident also can help with the discharge of the healthy newborns and bili clinic, this will be at discretion of the oncall pediatrician. The on-call pediatrician will assign consults to you through the day; the consults could be in E.R, Clinical Decision unit (CDU), P-RAC. Please make sure new consults are not assign to you after 4:00pm so you will leave on timely manner. 6
Community Pediatrician office We will assign the resident to a pediatrician office in advance. No calls would be allocated during this week. You will be exposed to a variety of pediatric cases, and primary care, including vaccines. On Call Policy We follow PARO rules. In total about 4 calls per block, Weekday night call (12 hrs. call) x 3/block. 7:00 pm to 7:00 am Weekend call (24 hrs. call) x 1/block. Call start at 7:00 am to 7:00am Post-call day as per PARO Calls are not allocated during the community week or during pediatric consult service week (PCS). Call room keys provided by Sarah Litke. Residents will be automatically assigned a key. Evaluations The first 3 weeks, evaluations are paper based. Please find the pdf evaluation form attached to the orientation package e-mail. Print 3 of them and ask the pediatrician at the end of each week to fill up the evaluation. The final evaluation is electronic trigger by you via One45. Please trigger the evaluation to the pediatrician in your 4 th week. If your last week you are on PCS, where you work with a different staff each day, then the final evaluation will be filled out by the pediatrician in your 3 rd week. During your week on PCS, you can choose one of the pediatricians to fill out one of the paper evaluations. Once you have identify who is your final evaluator, please e-mail that person your 3 paper evaluations. Teaching Formal teaching during in-hospital rotation as follow: -Tuesdays & Thursdays from 7:00 am to 8:00am at the conference room in the 4 th floor. -On Tuesday the teaching is presented by one learner a medical clerk or a resident. You will be notify in advance if you have to present, this lecture is supervise by the SCN on-service pediatrician. Thursdays are presented by the 7
SCN on service pediatrician. Teaching schedule will be sent with orientation package. If you are assigned to present, please prepare a presentation no longer than 45 min. The remainder of time is for discussion. The supervisor is the SCN Pediatrician please remind her/him of the presentation on Monday and let her/him know the topic you are presenting. If they are late they might have forgotten so call them. AHD on Wednesdays are mandatory please let Sarah Litke & Sandy know in advance about your preferences if you need V.C. Furthermore, remind the pediatrician early in the morning that you need to leave by noon. If you are commuting to Hamilton advocate for leaving earlier 11:30 am, so you have sufficient time to drive. For your LCC lectures at McMaster happening every 6 weeks, you are excused for the lecture period and expected to arrive late in the morning to St. Catharines, however, please remind the pediatrician on service and colleagues about it. If you have any concerns please contact us via e-mail. Looking forward to seeing you. 8