OVMC INTern Guide

General Information

Olive View is a county facility that serves mostly immigrant patients, many of whom are Spanish speaking only. There are a few different clinical settings that interns rotate through:

Pediatric Urgent Care: same day appointments and sick visits which take place in the pediatric clinic on the second floor
Pediatric Subspeciality Clinics: scheduled appointments for subspecialty patients - including Allergy, Allergy/Asthma (ie pulmonology), Cardiology, Cardiology-Hypertension, Dermatology, Endocrinology, GI, Nephrology, Neurology, Rheumatology. These appointments are in the same clinic as urgent care and occur simultaneously.

*Note: You are not responsible for seeing Pediatric Surgery, NICU High-Risk Infants, or Pediatric Ortho.

Emergency Room: After clinic closes, the day senior resident and swing resident will continue seeing pediatric patients in the ER. This is a great time for you to learn emergency pediatrics and some basic procedures.

While seeing patients in clinic (and sometimes in the ER), you will also be responsible for helping/teaching 2 to 3 medical students.

Logistics/Schedule

Typical weekday schedule for swing intern (1400-Midnight)

0800 Do not need to join teaching sessions in the morning
1400 Swing intern/resident arrives in clinic. Will generally help with clinic but if ED census high may be pulled to ED by Day Senior
1530 Last patient is allowed to check in and physically on 4C to be roomed
1630 Start transitioning care of patients who can not be discharged by 1700 to the ER
1700 Day senior resident and swing resident receive sign out for UC patients that need to go to ER to resume/continue care
1700-Midnight See ED patients
2100 Night senior resident arrives
2300 Stop picking up new patients, wrap up notes/orders. If high acuity patients arrive, please work with admitting resident for someone to see patient
Midnight: Sign out to nighttime resident

Typical weekend (or Holiday) schedule for swing intern (10am-10pm)

1000 Swing intern/resident arrives, see ED patients
1000-2200 See ED patients
2000 Night senior resident arrives
2100 Stop picking up new patients, wrap up notes/orders
2200 Sign out to nighttime resident

Typical weekday schedule for clinic intern (8am-5pm)

0800 Morning teaching on 4C Pediatrics for all residents
0900 Morning teaching ends, residents go to clinic to huddle, and then start seeing patients
0900-1700 Residents see patients (urgent care and subspecialty).
- Note: on Mondays/Fridays with noon conference, please stop picking up new patients by 11:30 and finish presenting to attending by 11:45am, so that you may grab lunch and head to NC
- Note: on all other weekdays, there is no designated lunch time - work together to ensure everyone takes time off for lunch
1530 Last patient is allowed to check in and physically on 4C to be roomed
1630 Start transitioning care of patients who can not be discharged by 1700 to the ER
1700 Sign out to Day senior resident and swing intern/resident for UC patients that need to go to ER to resume/continue care

Intern Roles/responsibilities

During the weekdays when the clinic is open, if you have no shift listed in amion, you’re working a regular day in the clinic until the last patient has been seen. Please speak with a chief resident if you’re confused about your schedule; there have been a lot of changes in the past few years.

Regular OV Urgent Care and Subspecialty Clinic:

When on a regular OV shift during the weekday, your duties are from 8 am to 5 pm (as outlined in the above schedule). Your clinical responsibilities are all in the 4th floor pediatric clinic (4C).

See the patients as they are roomed, regardless of their type. Once you see a patient, present urgent care/same day patients to any available General Pediatrics OV attending. Present subspecialty patients to the assigned subspecialist (in the corner office).

Notes are completed on Orchid - PowerChart (purple icon). Note template is “Ambulatory >Peds Outpatient”.

Swing Intern/Resident:

Your duties are from 2pm to 12midnight on weekdays or 10am to 10pm on weekends (as there is no clinic on weekends).

Report to clinic at 2pm on weekdays to help with clinic. If the ED is busy, the Day Senior may pull you from clinic to go down to the ED. Once clinic closes, you receive continue working in the ED until 12midnight. On weekends, report to 4C workroom to Day Senior to see patients in the ED.

When in the ED, you and your senior will see all patients 18 yo and younger. Always talk with your senior or the OV Ward attending on call if you have questions or concerns; the senior is there to help you. You present the patients you see to the ED attendings. Stop picking up new patients 1 hour prior to end of shift so that you can wrap up notes, orders, and other clinical care prior to sign-out. However, if a high acuity patient arrives, please help admitting resident in ensuring patient is seen.

If there is need for an admission of an ED patient, your senior should help you through the process.

Notes in the ED must be completed with the Red EMR (FirstNet) icon.

Other roles:

Teaching of medical students:

OV is a big medical student teaching site. There are typically 2-4 rotating medical students at any given time. If it is the start of the student’s OV rotation, try to see 1-2 patients with the student, have the student practice his/her presentation with you, and discuss teaching points/plans with the student before having them present to the attending. As the med students become more comfortable, they can work more autonomously, but you should always check in with them to go over questions and plans if needed. The med student will be responsible for writing notes for the patients that they see, and if you see the patient with the student, you should review the notes as well.

In the ED, med students should present to and work with the senior resident. When the student presents to the ED attending, the senior resident should also be present.

FYI's and Tips

In Clinic

Visits in general: Think of every visit as a chance to vaccinate. Check and clearly document immunization status. Pay attention to the requirements for children 12 years and older, including TdaP, MCV4, and HPV. Nurses should have access to the CAIR system.
Translation services: Many of the patients are Spanish-speaking only. If you need a translator, we have 1) in-person Spanish only 2) certified RNs Spanish only 3)video on iPad translator for any language 4)phone translators for any language.
Float book: If you have a lab/image study, a telephone check, or a clinic return visit that you want someone to keep track of, fill out a float book page. Make sure to get the patient’s name, MRN, date of birth, working telephone number, and primary language spoken. Try to put as much relevant information with if/then statements about what you want followed-up and done. Let the day senior or night senior know after you’ve put the form into the float book, especially if it is an urgent matter. Float book is only for following up on results. It’s not intended for general check-ins like seeing if a patient is feeling better, confirming appointments, or making sure they have insurance.
In general follow up and referrals should be done by PMDs.
All teaching patients on 4C should be seen by residents in the order they arrived, regardless of which clinic/specialty the patient is assigned to. This means no cherry-picking just same-day/urgent care patients.

In the ED

Decision-making: All patients must be staffed with the ER attending. But if you have ANY questions or concerns about the plan, you can discuss with the pediatric attending on call. All patients that are being admitted should be discussed with the on-call attending also, even if the patient is being transferred to an outside hospital.
Available subspecialists at OV: For pediatrics, we do not have vascular surgery, neurosurgery, cardiac surgery, emergent orthopedic surgery, or PICU. Patients needing these must be transferred. Sometimes patients >14 yo can go to the MICU.
Radiology: Afterhours, there may be a moonlighting radiologist in the ED reading room (by US and Xray). Always look at images first and knock on the room door to get help with reviewing images. If no one is moonlighting, US ROC provides radiology service. Reads are quickly loaded into synapse and the ROC website. Use the posted login in the ED to access the ROC reads. If no read is up, call US ROC to get the read.

*Note: If you have ANY questions when you are on at night PLEASE call the pediatric attending!

Resources/How-To

Clear a Psych patient
- If patient is cleared from a medical standpoint, page psychiatry to evaluate your patient
Decide what to do about a broken bone…
- Podiatry—sees all foot complaints, any age
- Plastics/Hand—sees all hand complaints, older than 15 yo if they are on campus, otherwise send to USC
- Steps to successful LAC-USC ortho referral:

1. Make sure patient has elbow fracture or growth plate fracture and cannot be seen by at OV by hand, adult ortho, podiatry, or pediatrics (see flowsheet)

2. COMPLETELY fill out LAC+USC Medical center Expedite Referral Request (sheets in float book) for acute pediatric injuries.

3. Give family:

a. CD with images (ask XRay tech to make this)

b. Map to LAC-USC

c. Copy of referral form

d. Copy of demographic and insurance information (ie the patient’s Facesheet)

4. Fax the following to 323-409-3703

a. Referral form

b. Copy of demographic and insurance information (ie Facesheet)

5. Call to confirm fax went through at 323-441-8072

6. Leave referral form and COPY OF NOTE in front of float book, and ensure that an attending gets it the next day to enter in referral processing system

**Patient will not get phone call confirmation of appointment and should just go to appointment.

LAB USER GUIDE It’s a quick and easy way to look up details for any lab test you’re ordering, including the type of tube needed, how the sample should be collected, and any special instructions.

Admits:
- Who is admitted to peds?
  - Age <21 years. Ages 18-21 years need medicine co-follow.
  - Co-follow all pediatric surgery, ENT, plastic surgery patients (you can put in orders but discuss with surgical teams before writing if non-emergent. We also have to agree on discharge of patient)
  - All others are peds primary with subspecialists consulting
- When admitting…
  - Notify pediatric attending on call
  - Notify pediatric floor nurses at x4831

Transfers: When a patient must be transferred (for insurance or medical needs) call the Medical Alert Center (MAC), which is the county’s transferring system.

1. Call MAC at 323-869-0587

2. Have all paperwork with you before you call. They will ask everything from story to labs, latest vitals, and demographic info.

3. Write down the name and MAC ID number of the person helping you

4. After talking to the MAC operator, they will connect you with a possible accepting physician. Present the patient to this physician as you would to your attending.

5. The physician will accept or not and MAC will help you through the process. They will arrange transport for you and update you on pick up time and where the patient is being taken.

6. Before the patient is transferred, you must fill out 2 forms: a consent for transfer that must also be signed by parents, and a checklist for documents going with the patient. Give these to the nurse caring for the patient.

7. Keep the nursing staff updated on expected time of transfer so they can sign out the patient and prepare all needed documents. When you know the accepting physician name and patient room number at accepting hospital, document these things and the MAC case number in a SOAP note in the patient’s chart.

Setting up follow-up from the Emergency Room
- How to find out if the patient can be seen at Olive View:
  - Go to “Utilization Review” tab under the left sided “Menu” tab of their chart:
  - Look at “Insurance Information”: if any of the below are listed under “Primary” they can follow up with pediatrics at Olive View:
  - MEDI-CAL RESTRICTED BENEFITS 402 aka Emergency Medi-Cal
  - MEDI-CAL RESTRICTED BENEFITS 406 aka Emergency Medi-Cal
  - MEDI-CAL MANAGED CARE LA CARE (DHS) 615 aka Olive View Medi-Cal
  - MEDI-CAL MANAGED CARE LA CARE (DHS) 644 aka Olive View Medi-Cal
  - SELF PAY OUTPATIENT 000 aka self-pay
  - Any questions about insurance, call Utilization Review at extension 4890.
- If they have one of these insurances you can message the peds clinic to set up an appointment:
  - Go to the “Communicate” tab on the top middle of the chart window.
  - Send the new message to “OVM Pediatrics ED/UC Urgent Care Follow Up”, press enter.
  - You may have to look for this contact by clicking the “Pool” button, then add the contact.
  - Send a quick message about when you want them to follow up, the clinic will do the rest. Click the “Patient Needs Appointment” box bottom left before you send the message.
- Don't have one of these insurances but want/need to follow up at Olive View Pediatrics? Here is how the parents can change their Medi-Cal Insurance:
  - Give them a "pink sheets", available in clinic and in ED, to call to change insurance.
  - Have parents call the Olive View Patient Service Center at (818) 364-3800 or they can come in person to the office.

Last modified: September 2021

Logistics/Schedule

Roles/Responsibilities

Tips

Specialty clinic schedule

How-To