Hood
Rotation Director:
Name: Megan Aylor, MD
Email: aylorm@ohsu.edu
Office: CDRC 3203
Phone: 8-8232
Pager: 13539
Overview:
This is an inpatient rotation where residents will provide direct clinical care for general pediatrics patients and adolescent patients.
Rotation goals and objectives:
Evaluate and manage, with consultation if indicated, patients with signs and symptoms that commonly present to the inpatient unit
Examples: Fever, BRUE, respiratory distress, stridor, wheeze, dehydration, vomiting, arthritis/arthralgia, limp, seizure, suicide attempt
Recognize and manage, with consultation as indicated, patients with conditions that commonly present to the inpatient unit.
Examples: failure to thrive, fever without a source, anaphylaxis, pneumonia, Kawasaki disease, acute gastroenteritis, electrolyte and acid-base disturbances, pyelonephritis, iron deficiency anemia, cellulitis, cervical adenitis, encephalitis, meningitis, croup, status asthmaticus, bronchiolitis, central line infection, sepsis/bacteremia, drug overdose, status epilepticus, inpatient management of children with special healthcare needs
Provide family-centered patient care that is developmentally and age appropriate, compassionate, and effective for the treatment of health problems and the promotion of health
Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients and their families.
Demonstrate interpersonal and communication skills that result in effective collaboration with other health care providers.
Prior to the start of the rotation:
Obtain sign-out from preceding resident
Be ready to hear sign-out your first day by 7am
First day of the rotation:
Interns:
The hood workroom is located in DCH 9N. The daytime team will receive sign-out from the night team at 7a (in the workroom). Residents are encouraged to arrive earlier than 7a to ensure enough pre-rounding time and help divide patients among the resident team.
Pre-round and examine all your patients (see below for expectations prior to AM rounds)
Attend morning report at 8:30am and grand rounds at 8am on Thursdays
Be ready to bedside round at 9am. The attending will meet the resident team at 9a in the workroom. Please note, there will not be computers during rounds
Seniors:
Help divide the new patients among interns prior to 7am sign-out
Meet with case management between 8am-8:30am to review patients including expected discharge and any anticipated case management/home needs
Help ensure interns attend morning report on time
Review who is going to be in continuity clinic and how sign-out will take place to get them to clinic on time. If the senior is in clinic, they should discuss with other seniors (SSB, coast, SSA) to determine who will cross cover
Resident Expectations:
Intern Expectations:
Prior to bedside morning rounds:
See and examine their patients
Review their patients’ notes (including consult notes), vitals, weight, labs, studies, and MAR daily prior to family centered rounds
Develop a care plan for the day
Attend teaching conferences including morning report, grand rounds, and noon conference
Prepare patients and families for family centered rounds. Residents will also serve as the primary communicator with family in room during rounds (unless followed by a third year medical student). Keep family informed of changes in their clinical status or in plan of care
Communicate key medical information to the nighttime team during handoffs and provide thorough sign-out to the incoming intern at the end of the rotation.
Admitting patients:
Residents should lead an admission huddle with the admitting RN for each new patient. This will review admission orders, plan of care, situational awareness, and contingency planning, and should be done shortly after patients are evaluated by the admitting team
Write a history & physical and problem based plan of therapy on each new admission
Discharging patients:
Residents should anticipate discharges by initiating discharge instructions and summaries and by providing prescriptions to parents as early as possible
Effective documentation:
Write a concise daily note on each patient, emphasizing the medical decision making and plan of care. These should be completed by 2pm
Discharge summaries should be completed within 24 hours of discharge, unless this note is being used as the daily progress note in which case it needs to be finished prior to the end of that day
Senior expectations:
Seniors are expected to provide leadership and organization to the inpatient teams:
Assign admission and consult patients to interns and students, promoting continuity of care
Provide clear expectations to learners
Lead time efficient, educational, multidisciplinary family centered rounds
This includes ensuring orders are written in patient room, coaching/facilitating intern and medical student presentations, and finding teaching points and giving feedback
Coordinate communication between subspecialty attendings and team
Maintain I-PASS sign-out list for call team and resident assignment list in EPIC
Organize day to prioritize attending conferences, getting post-call and clinic residents out in time, etc.
Bedside rounding on sick kids as well as new admits, if possible, prior to team rounding
Review plan of care and orders on all new admissions and consults with interns and students; encourage intern interaction with attending/fellows for new admissions and consults
Directly oversee all clinical care of the sub-intern, co-signing orders and notes. Please remember that H&Ps and discharge summaries cannot be signed by a medical student and will need a separate resident note.
Run the list w/ the attending in AM after sign-out and PM prior to sign-out to triage rounding for the day and review and solidify patient plans as needed
Teaching expectations:
Schedule teaching time for the team
Demonstrate physical examination findings and clinical pearls on family centered rounds
Delegate educational topics to students, interns, and faculty
Provide education and guidance for the medical students, giving them direct and constructive feedback, a safe learning environment, input on notes and presentations, and access to information on their patient
General Schedule:
The daytime team will receive sign-out from the night team at 7am in the Hood workroom
Evening Sign-out schedule:
Weekend schedule:
Morning sign-out is still at 7am in the hood workroom. Please note that all teams receive sign-out in this room on the weekend.
Evening signout starts at 5:30pm but happens in the hood workroom (not resident lounge!). There are only two residents on the weekend nights that split the 4 teams. There is no set order of team sign-out, it will be based on who is ready
Continuity clinic days: Each resident will have continuity clinic in the afternoon once a week. Please note this may differ from the usual continuity day to provide more even coverage on the wards. Residents are expected to provide sign-out to the senior and remaining intern prior to noon conference. The goal is to have daily notes completed prior to leaving for clinic. The remaining intern is expected to become first call for the continuity resident (the senior may help divide patients depending on census and acuity)
Ward 2:
For a portion of the year, there are two hospitalist attendings on service, allowing for a “ward 1” and “ward 2” service. The primary purpose of running two teams is to improve morning efficiency by rounding in parallel. Some tips to ensure smooth functioning of the two teams:
The senior resident is the leader of the teams. Though they will not round with ward 2, they are still the leader in charge of the entirety of the Hood service (much as they function with adolescent patients). The senior and ward 2 attending should touch base prior to rounds, if necessary, and should always run through the patient plans after rounds, prior to noon.
Ward 2 is comprised of one pediatric intern and one MS-3. Ward 1 is comprised of 1 pediatric intern +/- a subintern and family medicine intern. The interns should split their month as evenly as possible between the ward 1 and ward 2 teams. Students should spend one week at a time. The student is paired with the ward 2 intern for the week and will follow ward 2 patients (ie students shouldn’t bounce around between 2 teams during rounds).
The Senior resident is in charge of assigning patients to interns/sub-interns. The attendings will follow patients assigned by the resident to their respective team. The senior is welcome to consult with the ward attendings about workload on the respective teams if they desire. Ideally, ratio is kept approximately 2/3 of patients on Ward 1 and 1/3 of patients on ward 2.
If you are going to be absent for all or part of a day:
Please contact (page or text) chief on call as soon as possible to arrange coverage. A verbal exchange must happen with the chief on call because you may need to contact other individuals.
Any resident missing more than 2 days (or 4 half days) may be required to make up the difference at a future date at the discretion of the rotation director and program leadership.
Resident Resources, Helpful Tips, and Further Readings:
Box Folder (algorithms, protocols, dot phrases, papers, etc.)