Regional

Rotation Leadership

Rotation Director: Cynthia Khoo, cynthiak@stanford.edu

Rotation Coordinator: Brenda Macedo,  bmacedo@stanford.edu

Location

Your rotation will take place at Stanford Hospital (500P, 300P, and ASC) and the Redwood City Outpatient Surgery Center (OSC). You will rotate between Stanford and OSC on a weekly basis, and this schedule may vary depending on the number of residents on service. At Stanford, you'll be exposed to a wide variety of peripheral nerve blocks, nerve catheters, and neuraxial procedures, and at the OSC you'll learn how to manage "bread and butter" extremity blocks while balancing the daily procedure schedule.

Daily Schedule / Call

Stanford:

Arrival time for residents is usually between 5:30 and 5:45, depending on how many first case blocks. Plan to have "needle on skin" by 6:00 AM for first-case blocks! On Mondays, instead of Grand Rounds, please plan to arrive for blocks between 6:30 and 6:45 AM. The Regional Rotation Handbook below goes through the daily workflow, but to provide a brief overview, your daily work will include: blocks, block follow-up phone calls, and inpatient consults. Regional is a team sport, so work with your fellows and attendings to figure out where you can be most helpful! The regional fellow will help to orient you on your first day.

OSC:

At OSC, the residents make the schedule. This gives you an opportunity to make decisions about which blocks to do for each case, rather than just doing the blocks you are told to do. You will work with the assigned OSC regional attending to determine appropriate blocks for the following day's cases. Make sure you have an updated list of surgeon's preferences! We will try to keep an updated list on this website, but these things may change. The OSC is located on the 3rd floor of the Stanford Medicine Outpatient Center in Redwood City (Pavilion A, 450 Broadway 94063). Review the Handout for parking, free food, and scrub access.

Regional Pager Call: The block pager is covered by NPs during the weekdays 7a-2p, Stanford resident in the afternoons 2p-6p, OSC residents cover on Saturday and Sunday 7a-5p (1-2 weekends per month), and Acute Pain Service at night 6p-7a. The residents cover the pager if the NP is unavailable. To ensure complete coverage, do not set an end time for your coverage. This is a major point of professionalism on our service to not miss patient calls or consults. 

On the weekend, the Regional Pager is home call - you may have to respond to consults for urgent blocks over the weekend or outpatient calls regarding nerve catheter questions! The Regional attending of the day can be found in your Ether app. Of note, the Acute Pain team covers the Regional Pager overnight, so you will not be expected to cover emergent blocks overnight. 

In addition, Stanford is now trialling elective work at the weekend with Saturday morning cases. These cases might require blocks, which the call regional attending for the day is going to come in and do. When you are holding the block pager on these Saturday mornings, you are welcome to join the attendings and do those blocks for additional numbers if you wish - just notify the regional attending of the day that you'd like to help do the blocks. You can tell if there are cases booked by looking at the 500P statusboard for Saturday. Coordinating times/location will be up to the regional attending and OR attending but your contact person would be the regional attending.

If your patient has a *syringe icon* on the EPIC Statusboard or if you are considering the placement of an epidural for your patient, please adhere to the following protocol:

• Patient is a first case start: Primary OR anesthesia team to staff and place epidural

• Patient is not a first case start: Regional anesthesia team to staff and place epidural, unless primary OR team requests otherwise

Epidural Documentation:

Within the Stanford system, the team that places the epidural is responsible for the following:

• Write an epidural procedure note

• Click YES to the "consult to pain" button on Epic

• Write epidural orders (contact the regional team if you have any questions about surgeon preferences)

• Sign out to the Acute Pain service (2-PAIN pager)

• Sign out to PACU nurse and PACU resident if available

• If on cardiac and placing an epidural before the day of surgery, please remember to sign out the plan of when to start running the epidural to the acute pain service and the CVICU team (if applicable)

Thank you for your attention and efforts to ensure epidural safety.