Infectious Disease

Pediatric Infectious Disease Elective and Site Director: Dr. Aaron S. Miller

• Cell: 203-675-3366. Feel free to text or call. If no response in 3-4 minutes, page

• Pager: 314-908-9471

• Office phone: 314-678-2170 Office room #: 3722

• Email: aaron.s.miller@health.slu.edu (note: there is another Dr. Aaron Miller at SLU Hospital)

• Faculty

  • Dr. Aaron Miller

  • Dr. Wail Hayajneh

• Nurse Practitioner: Caryn Yeager PNP

  • caryn.e.mcdonald@ssmhealth.com

  • Mondays and Fridays

  • Pharmacist: Jeanine Cain PharmD: Ascom 7470

• Nurse Navigator: Patty Werner RN

  • Helps with anything clinical for outpatient coordination pertaining to follow up call, lab/ imaging ordering and tracking results, appointment scheduling/referral management, PICC management, paperwork for lab send outs and is the staff nurse for ID clinic.

  • Schedule: Monday through Friday 7 am 3:30 pm

  • Office x3446

  • Email: patricia.werner@ssmhealth.com

• Infection control nurses: Michelle Engle RN/Rashaad Adams RN

  • Submits all reportable diseases to the State Health Department (IL or MO)

  • Ascom 7347, Office 1506

• Administrative assistant: Theresa Forsythe

  • Help with return clinic visits and/or tracking down records and labs for new clinic patients

  • Schedule: Monday through Friday 7:30am-4pm

  • Office Phone: 314-577-5644

  • Fax: 314-268-2712

  • Email: theresa.forsythe@health.slu.edu

• +/- Residents (pediatric, family medicine, internal medicine) and/or fourth year medical student on elective (2-4w)

+/- Third year clerkship or career exploration student (1w)

Personalize your experience

• • Update your facesheet. (We share these with course and site directors, supervising physicians, and team)

  • Contact attending on service at least a week before starting to discuss your rotation goals, objectives, strategies, as well as any schedule requests. ID activities include inpatient consult service as well as ID clinic.

    • The expectation for all mini electives is a full work week in clinic potentially with a caveat that on half days a clinic is not held, you may be assigned to other tasks etc at the discretion of the site director.

  • Review EPIC for the “clinical landscape” during your time on a given service.

    • Clinics. CG ACC Inf Dis. ID clinic schedule-Monday PM, Friday AM, other days as needed

    • Inpatient/consult service

      • EPIC Systems lists

      • =CG Resident Treatment Teams

      • CG ID

  • Review the Learners on Pediatrics Spreadsheet/ID tab.

    • Consider touching base with any outgoing learners and/or those scheduled with you.

    • Use the "insert comment" feature to designate weekend work days as well as any schedule requests. ID is a potential site for one of the two required weekend work days for clerkship students. Weekends are optional for elective students.

    • At times multiple options: consult service, clinics, intern academic half day (for M4s) are available. We will go through to finalize.

    • Review EPIC again to

      • Confirm patients are scheduled. At times clinics get cancelled (Eg. faculty vacation, conference, inpatient service) or added.

      • Confirm start time. While typically AM clinic starts at 8AM and PM clinic starts at 1PM, both times can vary

      • Read about patients you will be seeing

• Contact an established team member (M4, resident, Caryn) or Dr. Miller the afternoon/evening before starting to:

  • Identify potential patients you might follow the following day. Reading about them the evening before will make your morning a lot smoother!

  • Clarify day 1 meeting time, typically (varies based on day and patient census/acuity). Typically Dr. Miller's office (3rd floor of Glennon Hall above Danis) at 8 am, except on Grand Rounds day (Wed) when we start at 9 am.

• Individual Study

  • Infectious disease individual study resources. Please review Dr. Miller’s antibiotics presentation and handout prior to starting

  • Inpatient Skills

Dress code. White coat optional

• Fever in child / unknown etiology

• Tick-borne diseases (especially ones endemic to midwest: Ehrlichia)

• MIS-C

• Pediatric rashes (tick-borne vs viral vs bacterial)

• Best Pharmacology practices for gram positives, gram negatives, anaerobes

• Know which labs are most important for monitoring ~ CRP, Antibody panels,UAs, blood/urine cultures

*Priority diagnoses you are likely to see in each clinic session in bold

Clerkship Students

• Observed patient encounter: problem based encounter possible if working with a resident

• Document required clerkship encounters (OASIS)

  • Problem based complaints

Qualtrics self-assessment and formative feedback. Possible since working closely with the ID attending

The team follows patients at Cardinal Glennon Hospital. Students are expected to write consult notes as well as daily progress notes for patients followed by the service.

EPIC Systems lists > CG Resident Treatment Teams > CG ID

Pre-rounding (Before 8:30-9AM)

• See “inpatient skills” for more detailed information regarding pre-rounding

• Identify team patients for each learner on the team to follow primarily. New patient consults are a great great opportunity to take a history and do a thorough physical exam.

Grand Rounds or Professional Development Wed (8-9AM) currently via zoom

• All team members expected to attend.

• When in person held in Danis Auditorium. Breakfast provided

Rounds (starting 8:30-9:30 am; varies based on day)

• Meet in Dr. Miller's office (3rd floor of Glennon Hall above Danis)

• Learners are expected to have prerounded on their patients prior to rounds

• See “inpatient skills” for more detailed information regarding rounds and presenting hospitalized patients

+/- ID Clinic

After Rounds: work (~11AM-afternoon)

• Clinical Work. Make sure someone from the ID team updates the primary team after each consult on daily basis

• See new consults

• Afternoon team check-in/”running the list”

• Team teaching

• See “inpatient skills” for more detailed information

Resident Noon Conference (12:15-1PM via zoom)

• All team members encouraged to attend

• When in person. Resident noon conference: 12:15-1, Ries. Lunch provided

Student Academic Half Day (Wed or Friday 1:30-4:30PM)

• Clerkship students expected to attend

• All other learners invited

Resident Academic Half Day (Every other Thursday 1-4PM)

• Interns and seniors are scheduled for alternating weeks.

• Fourth years strongly encouraged to attend intern academic half day

Infectious Disease Clinic

• Cardinal Glennon Ambulatory Care Center (ACC) Ground Floor (AM clinic) or 1st floor (PM clinic); ; work room is in the front corner of the orange hall

• Sometimes the medical records will be in EPIC, sometimes they are faxed to Theresa Forsythe (ID administrators). If they are faxed to Theresa, she usually drops them off at Dr. Miller’s office 1-2 days prior to the visit.

• Usually Mondays and Fridays; sometimes on Wednesdays (check EPIC)

• After actively observing 1-2 patient visits, you may see a patient independently.

Medical Documentation

• Document a consult (initial or follow up) or clinic note for each encounter

  • Route all notes to the ID attending

  • Start notes with “Pediatric Infectious Diseases Consult Note”

  • Include all major systems of history (HPI, ROS, Meds, All, Imm, SH, FH)

  • Note exposure history (travel, animal, insect, sexual, freshwater, food, sick contacts, TB)

  • End each note with: “Discussed with Dr. X (ID attending)” so the team knows that they can act on plan.

Support your recommendations citing primary literature, review article, or a textbook.

Smartphrases:

• Initial consult note: .PEDSIDCONSULT

• Progress note for neonates: .PEDINFPROGRESSNOTENEONATES

• Progress note for young children: .PEDINFPROGRESSNOTECHILDREN

• Progress note for adolescents: .PEDINFPROGRESSNOTEADOLESCENT

Thursday Case Conference

• Students should discuss with attending and residents about possible cases to present