County Consult Month

By Vickram Reehal 

County Hospital Consult Month

Rotation Format
-You will be working with 2 Attendings, one from LAC/USC, and one visiting attending.
It’s nice to have a different viewpoint on certain cases, but each attending may have differing management plans, which can sometimes make it tricky
-You will have 3-4 interns/residents, and possibly a couple of medical students.  They should see all of the consults, present them to you, and then you come up with a plan, which is presented to the attending.
-Make sure to divide up home call and weekends for the residents.
-Make sure to note down resident clinic days.(and either you or a resident will present the patients of the residents who are in clinic)
-The fellows on ambulatory will cover two weekends for you, but you must cover the rest of the weekends.
Consult Details
-Consults are now officially done via affinity. An initial consult should be typed upon seeing the patient, and then an addendum should be added to affinity when the patient is discharged to briefly describe the hospital course.
-Once the consult is put into affinity, print a copy to place in the chart in the progress notes section (easier for the primary team to locate).  Make sure the resident leaves their pager as well.
-The resident, fellow, and the attending should sign the note.
-It may seem cumbersome at first putting the consults into affinity and editing them later, but it will make it much easier to understand what happened when you see the patient in clinic weeks later.
-Upon discharge, fill out a follow up form and give it to Martha or Magdalena next door.
At first, you may not know how soon you should see them in clinic, so ask your attending.  With time you will realize how soon you need to see them, and what is possible.
Fellows Office (room 8012)
-The office is spacious with 3 computers, a microscope, a few desks, and a screen for power point presentations.  This is where you will usually meet to round.
-Update the list on the computers in the fellow’s room.  Either you should do it, or have the residents update the list.
-Make sure you don’t have consult notes and such laying around in the open.  There is a shredder where you can dispose of these things, and trash cans.  This is HIPPA law, and you might as well get used to it 
-Make sure to use the microscope to review all cases of suspected gout and CPPD disease.  Ask a senior fellow or attending for help when doing it for the first time.
-Consult mail box- Use this number to find out about new consults.
323-226-1800, Then upon the prompt dial 266-7858, Then upon the next prompt dial 226-7889.
-Phone number to the fellows’ office is 323-226-7873 or 7874. The fax is 323-226-2432.
You will receive urgent consults by pager.  Assign the consults to the residents, and have them write the patient info in the book.

-Every Monday at noon is grand rounds.  All members of the team are expected to attend.
-Monday at 1 PM is Journal Club, and only the fellows and faculty attend.
-Every Wednesday Dr. Quismorio will give a lecture to all of the members of the consult service. Make sure everyone is on time and get the computer and projector from Martha or Magdalena.
-Once a month there will be a lecture on Friday.  The time, date, and location will be emailed to you.
-Radiology rounds are with Dr. Forrester.  Set up a time and date with her (contact info?).
Usually it is the last Friday of the month at 8:00 am, but the date is really arbitrary.
Collect cases during the rotation.  I suggest starting a word file which gives the name, PF#, and 1-2 lines of clinical history.  Print the page and give it to her.  It will make things easier for her.  Have everyone show up on time; remember that she does not have to do this for us.
-Each team member will do a 5-10 minute presentation on a topic.  Assign the dates and let the attending know.

Problems or Questions
-Ask the senior fellows.  They are always available for help or advice.
-For especially interesting or difficult cases, consider running them by Dr. Quismorio.  He likes hearing about the difficult or rare cases, and always has excellent advice.  Often times the attending will even tell you to run the case by him.  These cases are often good for Grand Rounds as well.