HOME BASE: 4th floor call room
TEAM: One attending, 1 senior, 1 junior, 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. 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. At night, you are also responsible for cross-cover for all surgery patients. There is a separate SICU resident on for ICU issues. When the other teams sign out they'll give you their list. You carry the intern phone (30120). Will usually need to change the batteries in the phone (batteries at nurses’ stations) Senior phone: 69333.
Make sure to update team lists with new admits and consults (med students can help).
See all consults and admits, fill out H&P (can leave A/P empty until after presenting to senior).
Respond to all Level A and B 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; initial log-on to the computer is user name: pacs, password: pacs; go to image icon; get user name/password from GME office (different than cerner)
- 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
CALL ROOM: Most call rooms at RCRMC are on fourth floor in hallway. The surgery call room is the one on the very end closest to the A/C side- E4014. The code is 3127*.
DAYS OFF: Work it out with other interns and your senior. You will have 2 weekends off over the month. Hopefully you can get to have every other weekend off. 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.
- 5:00-5:30ish: See pts and write notes. You will need to print a new list from any computer. 6:30ish (ask senior each day, time will vary): Round with senior.
- After rounds: Do floor work and see new patients/traumas.
- Template. 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.
- 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)
- H&P: You have to do a paper H&P for the traumas and give to the senior to dictate. You do gen surg H&P/consults on the computer.
- Consults: On computer
- Patients going to OR: Need consent for surgery (English/Spanish) and YELLOW FORM for OR scheduling (#1 priority-see next)
- OR add on form: This is a yellow form which gets filled out to schedule a case, and turned in to OR desk. Get this in ASAP because cases are first come, first serve. Make sure and punch it at the time machine near the OR board, then turn it in. If it’s after noon, you need to have anesthesia attending sign the form to add on a case. Before noon, you can just turn it in to scheduler.
- Discharges: There is a discharge summary form. You have to dictate them all. Be very brief when writing and more thorough in the dictation. You have to write down the dictation number or the patient will not leave. DO NOT leave any space blank. You need to write “N/A”, otherwise the chart will come back to you to finish.
- Dictation: There's a dictation card which tells you all of the numbers to push and the order to dictate the info. It's easy.
SURGERY PRE-OP, POST-OP:
- 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, only dictate if you actually did the surgery (rare)
- Tues. 7am: M&M (lecture halls by GME office)
- Tues. noon: Tumor boards (lecture halls by GME office)
- Wed. am: LLUMC surgery conferences (normally you don’t have to go, so don’t round until 8am with your sr)
- 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 they will let you do small cases like hernias, cyst removals, etc, so read up and practice your knot-tying.
- 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. 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 (2D). 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 will likely have medical/PA students who can help write notes and do d/c summaries. Use them!
- 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. Be proactive about them, and you should do well.
- 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. You will end up doing lots of scut work.
- Most discharge plans which fall apart do so because of SW/CM issues. 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.