OVMC NIGHT SENIOR GUIDE

General Duties

See the ED patients, take care of the floor patients, eat a burrito.

Logistics/Schedule

8:55pm: Arrival. Traffic on the way there typically takes about 30-40 minutes from Westwood.
9pm: Meet OV-Late Senior for signout in the Peds Resident Workroom. ***Remember to grab both pagers!*** They will sign out the floor patients and the remaining ED patients. Next go over to the ED Resident Workroom and ask the ED resident on call how they want to split the patients.
12pm-1am try to run the list with the nurses upstairs. Send a list of the patients you have seen throughout the night to the Chief via email or text so they can prepare teaching for the next day.
7-7:30 am: Print out signout for incoming wards resident, give verbal signout. ***Give the resident the “wards pager”
7:30am-8am: Grab a burrito.
8am: signout to OV-Float Resident on any leftover ED patients ***Give the resident the “ED Pager”
8am-9-930am: Teaching with Chief Resident, Grand Rounds, and/or Radiology Rounds
9:30am: Go home!

Roles/responsibilities

Delegating Patients

In the ED, theoretically Peds/EM are supposed to split the patients. It doesn’t usually work out perfectly, but it is best facilitated if you touch base with them at the beginning of your shift. GO In the “List of important numbers” section there is a calendar there with “P” next to the ED resident who is supposed to see peds patients that day. There also is a picture page with their faces if you don’t know them. Ask the resident who is on how they want to split responsibilities. They don’t really check the peds list too frequently, so jot down the number of the workroom (3907) so if there are a bunch of patients you can have them see someone.

Seeing patients

See attached “Orchid Tips” for suggestions. Sign up for patients as they come into the ED. Prioritize patients based on the numeric scale, 5 less serious, 1 very serious. (Recommended to read the triage note/look at vitals in addition to reading the numeric scale as it has been known to be inaccurate at time: i.e. a febrile, tachycardic, neutropenic kid was rated as a 4 recently). After seeing the patients, put in preliminary orders and go present to the attending. Follow up on labs. Prepare the depart summary. Make clinic appointments. Write prescriptions. Send them home. Write your note.

Notes: For the remaining ED patients that were signed out to you, the OV-N person will sign a note. You create an addendum note for any interventions/labs/etc. that come back and then go through the disposition process.

Tips and tricks

If you disagree with management plan with ED attending: Explain reasoning, fight for the important stuff (like antibiotics), and if needed, call the attending on call. They are very receptive.
Orchid issues: Ask one of the ED residents. A few of them are “Orchid Super-users” and are very helpful
My prescription just printed out on regular paper: Go to an Rx Printer, take out one sheet, put it in one of the trays put it face up, select that tray on the copier, and copy the paper onto the Rx paper. Get the ED doc to sign it
I need to discharge a floor patient at night: send the Rx to the attending on call, then call the attending to log onto orchid from home to sign the Rx. After that, you can print it and it should have an E-signature. If not, you can at that point re-route it to a pharmacy.
Orthopaedic injury medical stuff: look up the fracture type and manage appropriately. Call Ortho if needed. There is an ortho cart to help you out.
Orthopaedic injury dispo stuff: Look in the floatbook. There’s a flowsheet on what to do with each injury. There is another sheet that tells you what insurances are accepted at olive view. If you are confused (because sometimes ones that say they are accepted actually aren’t, call the on-call attending. Olive View does not actually have Pediatric Orthopaedics. Basically:
1. if they’re an emergency, you’re going to have to transfer them to another center. If they have county insurance or no insurance, you have to transfer them to LAC-USC. If they have an HMO or Kaiser, etc. you have to transfer them to that facility.
2. If it is not an emergency, and they have our insurance or no insurance, splint them, put in a referral for ortho at LAC-USC. If they have an HMO or Kaiser, etc. they have to call their PMD urgently to get an urgent referral to an orthopaedist in their own system.
I&D: grab the Surgical cart.
Admitting? Have the name of the admitting attending ready (sometimes it is the peds-surgery attending).
Chronic kids? Looking for our records? Log into Clinical workstation, it’s all still there. It will likely be your old password, not your new one for Orchid.

Pre-Rotation Assignments/To-Dos

Figure out how to log into orchid - Plan to arrive early to first shift or speak with OV-N person who is currently on

Helpful Contacts: In the resident float-book, the numbers are there for all the OV-N attendings.

Key rotation topics to know/review: Pretty much everything

Abdominal Pain
Head injuries
URI’s
Gastroenteritis
Feeding issues - infants
Child with Limp
Child Abuse
Depression/Suicidality
Testicular Torsion

Great websites:

Uptodate: Duh
Pediatric Advisor
Orthobullets.com
EM WIki

Orchid Tips:

Access from home (you need a PC). Go to internet explorer, https://sslvpn.lacounty.gov/dhs
1. Follow the prompts, update citrix, click Orchid Production
2. Firstnet -ED
3. PowerChart - Floor Patients
Firstnet Tips:
1. How to see your patients, go to Olive view all beds - provider, Filter Peds <18
2. Person button to sign up: Change display name and color first time
3. Right click adding provider
4. Hover over and it tells you attending
5. Events -M means need Medical Screening Exam (MSE)
  1. MSE: Go to MSE button definitive treatment provider, please see chart for details
  2. For float you are screening provider. For Nights you are the primary provider
6. Note Writing:
  1. Highlight chart, hit the play button
  2. Provider notes, power note, search - click binoculars
  3. Sections to fill in:
    1. Basic Info
    2. HPI: Recommend Free-text
    3. ROS
    4. Histories
    5. PE - Remember to input vitals, physical exam
    6. Medical Decision Making: Recommend free-text, Put your thoughts here, the labs/tests you’re going to order
    7. Reevaluation: recommend free-text, put results here, reexaminations, counseling, etc.
    8. Impression/Plan:
      1. Must input a diagnosis, click on it, click add, click binoculars. First time? Click the … and make it “Physician friendly Term” then put whatever into the search box. OK. Click ADD! then close
    9. Must do: Prescriptions, Education, follow up
    10. Sign/Submit, select Attending. If you forgot your attending, first press save, then go back to the floor menu, hover over the attending name, that’s the name.
7. Discharge:
  1. open patient chart, go through depart (sometimes called admit/discharge tab). Fill in all the yellow sections
  2. Do they need subspecialty referral? Go through float book for this, usually need to go through the “communications” tab. Or you can go to message center, communicate, type patient name, callback, look at addresses on cabinets for the to column "ovm peds"
  3. Discharge medications (Rx) - press add new order, change from “inpatient” to “prescriptions” filll it out, sign it to your ED attending. Then you walk over to the ED attending, tell them it’s in their inbox. They push it through, usually it prints. If it isn’t in their message center, tell them to push refresh. It must be on Rx Paper. See Tips above on how to get it on Rx paper if there are issues. They sign it. Give it to the nurse or the patient.
  4. Patient education:
    1. If you already gave the diagnosis, it should autopopulate
    2. you can change the language to spanish
    3. If you don’t like those, click “all” and select one that’s good
    4. if not good,
    5. School excuses: click custom, scroll to right, click, fill out. If they need it separately, sign it, print with right click
  5. Follow up: free text, hit add
  6. Discharge order itself: go to place orders, “Discharge patient”
8. Admit:
  1. As soon as you think you need to admit, need to have financial services check their insurances: Right click events, click interqual request, under events it will come back as "met" if it is ok
  2. Have the service attending ready, go to order panel, Request for admit - bed request
  3. Admission orders: type “Ped Gen Admit” and fill out the form
    1. Sometimes you input tiimes for orders then it changes the times after you initiate them. Double check the times of orders after you sign them
    2. The default is to consult social work in the panel. It’s not always necessary.
Power chart tips
1. Responsibilities: signouts, notes, orders, billing
2. List: pediatric ward, 4C (have someone help get this for you when you first start
3. Sign out: use the little arrow
  1. Write one liner
  2. Actions: to do list
  3. Print, detailed

Last modified: Wednesday, January 13, 2016, 1:32 PM