DigESTIVE Health (DHS)

Expectations: 

• DHS fellow serves as an educational resource, supervisor and educator for the inpatient DHS between 7:00AM-5PM.

• DHS fellow should be present for inpatient rounds with the DHS team and throughout the day to be available for the housestaff and teaching (see below for teaching expectations).

• DHS fellow is responsible for all TPN and PEG consults, pager (p9160). Sign into TPN/Nutrition consult list.

• DHS fellow is required to post endoscopy cases for DHS patients (see GI Inpatient Consult section for more info about posting) and to obtain endoscopy consent from the POA in patients who lack capacity.

• Contact the on-call fellow (usually a page or call) everyday at 5PM to sign out unstable patients.

• DHS Fellow is responsible for requesting all GI and Hepatology followup appointments (NOT THE RESIDENTS/INTERNS). See how to schedule on the "Requesting Follow Up" page.

Patient Census: 

Current cap for inpatient DHS admission is 15 patients (10 hepatology + 5 GI). 

• • Admissions are decided by the MAA, but collegial discussion with the fellow about patient appropriateness for DHS is encouraged.  

  • If there is a patient being admitted from clinic, endoscopy, OSH and you think they should go to DHS, it is your duty to notify the MAA that the patient should come to DHS when a bed is available.

  • Ensure residents denote "luminal" or "hepatology" in their admission orders for the MAA to review for admitting purposes. 

Patients for the DHS service: 

• • Patients considered appropriate: Acute flare of inflammatory bowel disease, primary decompensation of cirrhosis, complicated pancreatitis, cholangitis, acute hepatitis, GI bleeding (overt symptoms, not chronic anemia with +fecal occult), high risk post-procedure care (bleeding post ERCP), patients needing advanced endoscopic procedures, any post liver transplant patient with nonsurgical pathology. Typically post-transplant patients are managed by the transplant surgery team if the transplant has occurred within 1 year. 

• • Patients for whom DHS may (at discretion of covering fellow/attending) admit over cap: 

    • Direct admissions from GI and Hepatology Clinics

    • Post-liver transplant patients with suspected transplant related complications (acute rejection, abnormal liver chemistries)

Education/'Hepatology Happy Hour':

• Weekly teaching session starting at 1pm. Dr. Matherly will do a hepatology topic and DHS fellows with a GI topic

• GI Fellow topics (be mindful residents rotate every 2 weeks, be cognizant of the topics they may have already had):

  • Week 1: Inpatient GI bleeding 

  • Week 2: Inpatient IBD

  • Week 3: Pancreatitis and its complications (i.e pseudocyst)

  • Week 4: Stones (cholecystitis, choledocholithiasis, cholangitis)

PEG consults: 

• DHS fellow sees all PEG tube placement or GI placed PEG management consults (we do not manage IR or Surgery placed tubes). 

• The DHS fellow does not see consults about bleeding PEG or GI symptoms in PEG patients (vomiting, diarrhea, etc) as these are seen by GI Consult Fellow. 

• Any bedside ICU PEG placements are performed by the DHS fellow. Staff these patients with the GI-DHS attending, and if appropriate for endoscopy, post the PEG procedure (see GI Inpatient Consult section). 

  • DHS fellow is encouraged to participate in the PEG procedure but is not required to do so. 

TPN consults: 

• DHS fellow sees all GI Nutrition (TPN) inpatient consults that are staffed with the GI-DHS attending. These consults are essentially a "Yes/No" for TPN approval. 

• Try to see these consults as early as you can and discuss with attending ASAP. Once decision is made (and if patient has central access) page the TPN Pharmacy (p9310) before 1PM to give the TPN approval - send patient name & MRN, "TPN approved by Dr Attending Name. Call if questions, Your Name & Phone #

• TPN pharmacists and dietitian will set up dosing and follow-up. 

Transfer Calls: 

• See notes on transfer and outside hospital phone consult calls on the VCU GI Consults page.