WELCOME

Who Can Help Me?

Peds Hospitalist                        Phone        503-216-1101

Site Directors

Dr. Roy Jan      
Dr. Yolanda Domond                  Office        503-216-2906

Course Director

Dr. Tracy Bumsted                    Office        503-494-5982 

Student Coordinator                             

Trevor Monteith                        Office        503-494-3195   

 

Helpful Items

• Stethoscope
• Calculator – some on the floor
• Harriet Lane Handbook – also on the floor

Dress Code

• ID badge
• Professional dress – tie, optional
• Scrubs – on call or post-call only

Pediatrics

The Pediatrics Unit on 4 East Tower has 12 beds for medical and surgical patients.  Medical admissions can be covered by the Pediatric Hospitalist service or the patient's own pediatrician.  A Board-certified Pediatrician is in-house 24 hours/day, 7 days/week.  The daytime pediatrician usually stays until 7:00pm, when the nighttime pediatrician comes in, 7:00pm-7:00am.

The Nursery is located on the 3^rd floor.  Newborns without a selected pediatrician are usually seen by the Pediatric Hospitalist Service; otherwise, they are seen by their pediatrician within 24 hours of birth.

Orientation Day

• First half of day begins at OHSU.

• The second half begins at St Vincent's @ 1pm on the Pediatrics Inpatient Unit (4 East Tower).

• You will meet with the site director, who will orient you thereafter.

Schedules

Daily

07:00-08:00a    Pre-round

08:00-12:00p      Rounds – with Hospitalist- remainder of time alotted to self-study

12:00-01:00p      Lunch

01:00-05:00p      Off-unit sessions – with subspecialist or ancillary services

May go home as early as 3pm on days without off-unit or sessions or when student is not on call.

Call

• Every 5^th night until 11pm (No overnight call).

• Meet the night shift pediatric hospitalist at 7 pm in the Hospitalist Office.

• 07:30p-08:30p - See newborns with the hospitalist
  

• 08:30p - Night rounds on floor patients with hospitalist
  

• 09:00p - Lecture

You will admit any new patient with the hospitalist until 11 pm.

Post-Call, you will work the usual workday (unless it falls on a weekend day)

Days Off

• Off on weekend days that you are not 'On Call' (This includes post-call days that fall on a Saturday or Sunday).

• Off the entire weekend following the Pediatrics Exam.

• No holidays off – if we work, you work (similar to OHSU & Emanuel policies).

Learning opportunities with Faculty

• Daily work rounds and bedside teaching.

• Didactics with peds subspecialists and ancillary services in the afternoons.

• Formal talk to be given by night shift hospitalist when you are On Call.

• Pediatric Interdepartmental Inservice Conference                                 
  
•   (see monthly schedule provided at orientation).

Recommended learning on your own time

• Keep up with CLIPP cases – do them early.
• Watch the OHSU Core Lecture series online.

• Optional:  attend any interesting Neonatal Grand rounds or Pediatric Grand Rounds (see monthly schedule provided at orientation).

Evaluations

• Mid-block evaluation and feedback will be provided by the site director.

• Final evaluation will be determined by consensus from all hospitalists who had contact with you.

• 'Off unit' educators will provide a pass/fail grade, based on attendance and participation. Failure to pass may affect the 'Professionalism' component to your overall evaluation.

• We will also be collecting feedback from you about your experience here with us at St Vincent's.

EXPECTATIONS

Everyone

• Be a team player.
• Ask questions.
• Read everyday.

Pediatric Attending/Hospitalist

• Covers general pediatric patients that are not covered by a community pediatrician.

• Notified of all admissions to the pediatric unit.

• Will be present at all pediatric Code 99's.

• Teaches during rounds.

Medical Student

• Follows 2-4 patients per day.

• May admit patients daily, as long as total cap of 4 patients is maintained (you may drop an old patient to pick up a new patient).

• Know your patients – you are major part of the medical team.

• Pre-round on your patients starting with the sicker patients first.
• • Check vitals, ins and outs, medications, frequency of respiratory treatments.
  • Check labs, imaging.
  • Check the orders in the past 24 hours.
  • Check with the nurse on overnight events.

• Accompany your patients to any procedures.

• For anticipated discharges, help fill out the Discharge Orders sheet.

 

THE CLINICAL STUFF

Admission Tips

• Evaluate patients as soon as possible.

• Provide parents with our team structure:

Attending -----------Consultant (if applicable)
I
MS3

 

• Write your name and title on the patient room dry erase board.

• Perform the H&P.  If this is your first time, ask the attending if you can just shadow them once or twice before doing one on you own.

• Then write your H&P.  Don't be afraid to ask your attending to review your first few.  It takes several years to get good at these!

• Help out by filling out the Medicine Reconciliation Form.

• Towards the end of the block, practice writing Admission Orders.  Pediatric Hospitalist Admit Order Sets can be found on the Intranet: Intranet -> Physicians -> PSVMC Preprinted Order Sets -> Unit: pediatric.       

Tips on Writing Orders

• Don't attempt until you have your H&P skills down.
• Write legibly – Sign and print name, followed by "MS3."
• Your attending should be present to sign them. 

Medications abbreviations:

Do Not Use                                 Write Out
U                                              Unit
IU                                             Unit
QD                                            Daily
QOD                                          Every other day
Trailing zero (5.0mg)                     5 mg
Lack of leading zero (.1mg)            0.1 mg
MS                                            Morphine
MSO4                                        Morphine
MgSO4                                       Magnesium sulfate
                                           mcg
X 3 D                                         X 3 days or X 3 doses
TIW                                          3 times weekly
Slash mark for decimal (0/25mg)    0.25mg
Superscript for schedule (10²)      10 mg BID

Include dose per kg, e.g. Acetaminophen 150mg PO q 6 hours (15mg/kg/dose).

After co-signed, pull up red flag.

 

Tips on Discharging Patients

• Help complete discharge orders during pre-rounds for potential discharges

• Help call the Acute Care Manager for ordering home-going equipment

 

Pediatric Code 99

• Attend any Pediatric Code 99's heard on the overhead paging system.
• Your hospitalist should arrive on the scene to either run or co-run the code.
• You are there simply to observe.

LOGISTICS

 

The Computer

Paging               Providence Intranet Home Page -> AMCOM text paging.

Portal (EMR)       Portal icon or Intranet -> Physicians -> Portal.

Staff Directory    Intranet -> Physicians -> Staff Directory.

 

References

 

Library

Lower level of the hospital.

Online references – UpToDate, MD Consult, etc.

Intranet -> Clinicians

Pediatric books – Harriet Lane, Red Book, etc.                

Far left cupboard in "Computer Alley" - Code 5214

Personal Space / Belongings

Use the far left cupboard, computers, and bulletin board of "Computer Alley" in the Pediatrics Inpatient Unit – Code 5214

Food

Cafeteria – 2^nd floor

Café West – 1^st floor, West Pavilion

Vinnie's – 1^st floor, East Pavilion

 

Phone Numbers

Acute Care Manager    6-6292, usually

Computer Help Desk    6-2800

Lab                           6-7829

Peds Hospitalist           6-1101

Pediatric Unit              6-4400

Radiology MD              6-2181

NEW ADMISSION AND DAILY ORAL PRESENTATION GUIDELINES

 

New Admissions

Chief Complaint                   

• one line in parents'/patient's on words.
  

History of Present Illness     

• age, sex, pertinent pre-existing conditions.  
• duration,associated symptoms.
• pain qualifiers –location, quality, relieving and worsening factors, severity, timing.
• remedies tried.
• chronologic summary of PCP/ED visit-diagnoses, studies, treatments.
• ED/clinic course.

Review of Systems

• pertinent positives and negatives.

Past Medical History            

• birth history –if young or pertinent, chronic illnesses.

Past Surgical History   

PCP/Clinic Name

Immunization Status

Developmental History

Diet

Medications

Allergies

Social History                      

• who patient lives with, day care, tobacco exposure, pets.

Family History

Physical Exam                    

• plot growth chart.

Studies

Assessment and Plan

 

Daily Presentation

Identification                      

• name, age, working diagnosis

Subjective                          

• include events overnight, current complaints.

Objective                           

• vitals, I/O's, pertinent PE positives, negatives labs/studies.

Assessment Plan

• Diagnosis? differential diagnosis? Include clinical status include further workup, treatment, disposition

 

Editor:  Cindy Chan-Lazzara, MD
with various contributions from the PSVMC Hospitalists
Last updated 6/7/2008