HOME BASE: 4th floor call room
TEAM: One attending, 1 senior, 1 junior (sometimes), 1 or 2 interns (ER, FP, surgery). Your team covers for general, vascular, and trauma surgery. Blue team: Vascular. Green/Red/Purple: general surgery (green is somewhat colorectal).
CALL: You will split between being the ED person and the floor person OR you can split the work between the team members however you like. Your experience will vary greatly depending on whether you have a second intern or a 2nd year surgery resident, and the personality of your senior. Your call consists of taking care of all general surgery admits, floor consults, and you are also the trauma team for RCRMC. There is a separate SICU resident on for ICU issues. When the other teams sign out they'll give you their list. You will sign those lists out at 6:30pm to the night team. You carry the intern phone (18050). Will usually need to change the batteries in the phone (batteries available in the work room).
Make sure to update team lists (Word and Epic) with new admits and consults
See all consults and admits, fill out H&P (can leave A/P empty until after presenting to senior).
Respond to all traumas (responsible for ABCs and f/u of all tests/imaging). This is the fun part of the rotation! Go to all of them.
COMPUTER PROGRAMS: **Get your log-on codes/badge from GME before the start of the rotation**
- Cerner (labs): get user name and password from GME office
- PACS (imaging): computers at doctors’ stations on floors and in ED; click on folder that says "DBDOWN", then PACS. Log in info is the same as Epic.
- Surgery team lists (accessible from any computer): computer P: drive, then medicine folder, then surgery folder, then general surgery folder, will see different team lists. Under these folders are the patient consents as well.
CALL ROOM: Most call rooms at RCRMC are on fourth floor in hallway. Take the Cactus elevators to the 4th floor. Take a right after stepping off the elevator and the first door to your right is the surgery call room. The code is 3127*.
DAYS OFF: You will have 2 weekends off over the month (the schedule is assigned to you by the Surgery Residency coordinator). During the weekends you're on another intern is covering the new admits, floor consults, and traumas. You're just there to round on the purple patients. After you round on your patients, notes are written and floor work is done you can sign out to the Purple Team present during the weekend.
TYPICAL DAY:
- 6:30am: Get sign out from night team. Update the Purple team list. Get vitals/labs on your patients. Pre-round on your patients. Run the list with senior/pre-round with senior. Notes don't have to be written prior to rounds.
- After rounds: Write floor notes if you haven't. Do floor work, see new consults/traumas. Sign out is at 6:30pm.
PROGRESS NOTES:
- You can use all the smart phrases under .VW (trauma H&P, Tertiary Exam, Progress notes, Consult Notes)
- Computers are awful and go in and out. Try to finish the progress notes early before rounds so you don't have to worry about them later when it's busy.
- Sometimes it's helpful to take one of the mobile computers during rounds (some attendings want to look at imaging, labs, notes from consultants, etc)
SCRUBS:
- Must wear RCRMC scrubs in the OR
- Found on 2nd floor near OR: room F2014
- User ID: you should get your ID during the RCRMC orientation at the beginning of the year
- Password: ‘new’, it will then ask you to give a new password
- Can get up to 5 sets of scrubs (cannot mix sizes)
PAPERWORK:
- Patients going to OR: Need consent for surgery. Usually the senior makes the OR request and calls anesthesia to set it up.
- OR add on form: This is a yellow form which gets filled out to schedule a case, and turned in to OR desk. If it’s after noon, you need to have anesthesia attending sign the form to add on a case (done by OR staff). Before noon, you can just turn it in to scheduler.
- Discharges: There is a discharge summary form. If the patient is leaving that day, a discharge summary will be needed; a progress note is not needed that day. All of the trauma patients need to follow up in Surgery Clinic in 1 week. All of the patients with pneumothorax on hospital admission need a repeat CXR prior to clinic visit (place this order on discharge orders while doing the medication reconciliation)
SURGERY PRE-OP, POST-OP: (usually done by senior/surgery resident)
- Pre-op: go to holding area, find pts’ chart, put initials in the right column of white sheet for pre-op, sign your name, initials and date at the bottom; fill out top information of blue sheet for operative report; initial surgical site on the pt with your initials with a purple pen (ex. RW on L arm)
- Post-op: fill out d/c instructions if going home, give Rxs prn
CONFERENCES:
- Tues. 7am: M&M (lecture halls by GME office)
- Tues. noon: Tumor boards (lecture halls by GME office)
- Wed. am: EM conference (you're excused to attend conference)
- Thurs. am: Morning report (lecture halls by GME office)
STUFF TO REVIEW: Common surgical problems, such as cholecystitis, appendicitis, hernias, wound care, as well as reviewing ATLS and Standard post-op care. If you want to go to OR just let the attending know
PEARLS:
- The patient lists are kept on computer and need to be updated QDay.
- Sign out every night to overnight on-call team.
- You will admit patients for the other teams. Make sure all their admits/consults go on THEIR TEAM’S LIST (Word and Epic). In theory the purple team only takes non-operative trauma (you will get dumped on A LOT). It is your responsibility to update the lists. This is the only way they know these patients exist, so if you forget to add them on, no one sees them and people end up getting really mad. If an attending operates on a patient, it will go to the ATTENDING’s team (unless the attending dumps).
- You DO NOT need to write notes on or round on your team’s ICU patients. The ICU team does this. When they come out of ICU, they’ll come to your team and you’ll round on them. Try to be attentive though because some of them are complicated messes and the ICU sign outs can be pretty bad.
- You may have to give a 10 min presentation at one of the M&M conferences. The topic will be assigned to you. Talk to the attending you’re assigned to, as they will have evidence based articles and other ideas they want you to discuss during the lecture.
- Even though it’s not your official “trauma” rotation, it’s a good chance to log some trauma resuscitations and procedures.
- The trauma nurses can be very aggressive in the rooms. Review ATLS right before the rotation and take charge on your first day. Otherwise they'll push you out of the way.
- Be aggressive about getting procedures.
- Most discharge plans which fall apart because of SW/CM issues/PT/OT. Talk to these people very early in the day. It's county so people will sit in the hospital for 3-4 extra days because they haven't arranged for a wheelchair, etc. Your list will get huge so stay on top of this. Place SW/CM/PT/OT consults as soon as possible and communicate with them daily about discharge planning