Rotation Directors:
Name: Danny Hsia (pulmonology) and Chris Ronai (cardiology)
Emails: hsia@ohsu.edu, ronai@ohsu.edu
Office: Danny Hsia: CDRC 2234, Chris Ronai: CDRC 3241
Phone: Danny Hsia 8-4955, Chris Ronai: 4-5135
Pager: Danny Hsia: 16971, Chris Ronai: 12809
Overview:
This is an inpatient rotation where residents will directly care for patients admitted for primary cardiac or pulmonary reasons. The team is made up of one 3rd year senior resident and one intern.
Rotation goals and objectives:
Demonstrate an understanding to standard clinical approach to many common disease processes in pediatric pulmonology such as cystic fibrosis, asthma, and other chronic lung diseases
Demonstrate an understanding to standard clinical approach to many common disease processes in pediatric cardiology including pre-operative and post-operative management of congenital heart disease, arrhythmias including tachyarrhythmia syndromes, myocarditis and pericarditis, and other chronic heart diseases
Demonstrate effective communication skills with patients, families, and colleagues
Prior to the start of the rotation:
Receive signout from preceding resident
Be ready to hear sign-out your first day by 7am
Update your pager status (in hospital, available)
First day of the rotation:
Interns:
The SSA workroom is located in DCH 9S next to the surgery workroom. It is called “the batcave” and has this as a sign on the front door.
Pre-round on all of your patients. The goal is to examine all of your patients prior to the start of rounds. It is okay to let the stable cystic fibrosis patients rest in the morning and not examine them but please discuss with your senior. Please note that active patients and patients with other primary pulmonology issues still need to be seen
Attend morning report at 8:30am and grand rounds at 8am on Thursdays
Be ready to bedside round at 9am, starting with the pulmonology patients (see schedule below). The attending will meet the resident team at 9am in the workroom. Please note, there will not be computers during rounds except in patient rooms
Read the “ideal rounding state” document regarding cardiology rounds found in box
Seniors:
Review the patient census. Please see below for full details regarding patient census management during the weekday.
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 if the intern will be in continuity clinic and goals for sign-out to get them to clinic on time. If the senior is in clinic, they should discuss with other seniors (SSB, coast, hood) to determine who will cross cover
Read the “ideal rounding state” document regarding cardiology rounds found in box
Resident Expectations:
Interns:
See above for pre-rounding and read the “ideal rounding state” document regarding cardiology rounds.
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 medical student). Residents should 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
Please note that the NP will finish and sign the discharge summary for cardiology patients
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
Seniors:
See above for pre-rounding and read the “ideal rounding state” document regarding cardiology rounds.
In person evaluation of sick children as well as new admits prior to team rounding
Take charge of running efficient family-centered bedside rounds. This includes ensuring orders are written in patient room, coaching/facilitating intern and medical student presentations, and finding teaching points and giving feedback
Take active bedside involvement in patient care in the afternoon – i.e. participating in new admissions, assisting interns in creating care plans for children with active developing issues, etc.
Run the list w/ the attending (and/or NP) 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:
Lead daily 5 min informal teaching sessions if possible
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
For cardiology patients transferring out of the PICU to SSA, the resident team (along with the NP) is expected to go to the PICU to receive signout in person.
General Schedule:
See below
For further details on cardiology rounding, please see box “ideal rounding state” document.
Signout schedule:
See below
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:
Census
Patient census on weekdays:
Interns should cap at 10 patients, though this number might need to be lower if it is early in the year or depending on acuity. Seniors are expected to take remaining patients as primary.
If there are more than 13 total patients:
If pulmonology patients exceed 8: Please call the chief on call as soon as possible. Options the chief is likely to recommend are an intern float, pulmonology consult resident, SSB. These options must be discussed with the chief on call prior to any other resident team being contacted. Please note that the primary SSA team will be responsible for giving sign-out to the night team on any “overflow” patients.
If the cardiology patients exceed 5: Discuss with the nurse practitioner present. The nurse practitioner will be responsible for being first call on the “overflow” patients. Please note that the senior should still be aware of these patients throughout the day and must receive sign-out from the NP prior to the end of the day. The resident team is responsible for giving sign-out to the night team.
Please note: These numbers refer to morning census only. Residents will still be responsible for admissions past 13 patients in the afternoon, but can discuss the following morning plan with the respective teams.
Examples:
There are 12 total SSA patients, 9 of which are pulmonology patients. The senior takes 3 pulmonology patients that morning, leaving the remaining 9 patients for the intern. As the total census is still lower than 13, all pulmonology patients are kept on SSA (no “overflow” as above).
2 patients are scheduled to be admitted to SSA. The resident team does both admissions but discusses with cardiology or the chiefs that afternoon to strategize for the AM as this will put the total census at 14.
There are 14 total SSA patients in the morning. There are 8 pulmonology patients and 6 cardiology patients. The senior discusses this with the nurse practitioner who takes 1 cardiology patient.
There are 14 total SSA patients in the morning. There are 12 pulmonology patients and 2 cardiology patients. The senior discusses with the chief on call, who identifies that coast only has 2 patients. The coast intern floats to SSA for the day and helps take pulmonology patients.
Signout Schedule:
General Schedule