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Santa Monica Wards

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General Information

 

Santa Monica wards is a mixture of community patients, post-operative orthopedic patients, patients admitted for scheduled chemotherapy or vEEG, and patients with chronic medical problems who do not currently require tertiary care.

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The SM Hospitalist and the team will be rounding on patients who are admitted from UCLA ER, SM ER, or PCC. Sometimes UCLA PICU downgrades will transfer to the SM SDU. Sometimes NICU graduates will transfer from UCLA/SM NICU to us as well.

 

We also admit patients directly from private community PMDs - please take a brief signout from the PMD but also direct them to the SM hospitalist for attending-to-attending signout and bed request purposes. Private community PMDs who have privileges and admit to SM will round on their own patients with the team or the intern/senior that is following their patient and make clinical decisions directing the patient’s care.  

 

The pediatric residents are first call for SM ER consults and admissions (as compared to Pediatric Hospitalist first call at UCLA ER). 

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​Team Structure:

There are 4 interns (generally 2 Peds, 2 FM) and 2 seniors (1 rounding, 1 teaching) on the wards at Santa Monica. The team is structured such that each intern, on average, covers approximately 1 week of nights (1 block of 5 nights, and 2 other night/month) in a month long experience.

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Rounding Schedule: 

All residents and students are expected to attend all rounds.

 

Weekday Rounding Schedule:

  • Pre-rounding: arrive by 6AM to get signout and pre-round on all your patients (completed by 7:30) 

  • 8AM-11AM: Ward rounds (teaching senior can touch base with private PMDs if they are present)

  • 11:15AM: Ward Interdiscliplinary Rounds AKA IDR (rounding senior only)

  • 12 noon: Noon Conference

    • Usual location: Conference Room 4 (Across from security desk and east elevators on Ground Floor)​

    • Location subject to change; the chiefs will notify you if another group will be using the room during noon conference time

 

Nighttime Rounding Schedule: 

  • Night rounds will be at 23:00 every night. If the team is unable to make this time due to patient obligations, please communicate with charge RN. 

  • Please meet at the front nursing station. 

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Weekend/Holiday Rounding Schedule:

  • Pre-rounding: arrive at 6AM to get signout and pre-round (should be completed by 7:30) 

  • Ward rounds: Start time to be clarified by attending/team. Typically start 9am or before.

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Shifts:

Weekdays: 

  • SM Day Senior: 6AM to 6PM

  • SM Day Intern: arrive 6AM to 6PM*

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  • SM Teaching Senior: usually 7AM to 4PM

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  • SM Night Senior:  6PM to 6AM

  • SM Night Intern: 6PM to 6AM

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*Mon-Fri if you are not scheduled to SM Admitting Intern, it is a regular day. Arrive at 6AM to get sign-out and pre-round. Leave/sign-out when the day is done, only admitting intern stays to 6pm. Sign out for FM interns with clinic is 12 PM.

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**On weekends for 24hours coverage, please help out your colleagues (seniors and interns) by preparing a FULL signout, which should be completed the day prior to their coverage shift.

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Weekends:

  • Friday/Saturday SM Senior: 6AM to next day 6AM***

  • Sunday SM Senior: 6AM to 6PM

  • Sunday Night Denior: 6 PM to 6AM

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  • Sat/Sun SM Interns: 6AM to 6PM

  • Sat/Sun SM Night Intern: 6 PM to 6AM

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Patient Caps:

  • Patient cap = 9 patients per intern/resident

    • Weekday overflow patients

      • Days with 3 interns, can potentially round on 24-27 patients, however the SM hospitalists is capped at 18 patients.

        • At the discretion of the nursery and wards hospitalist, patients 19 and above may be rounded on with the nursery hospitalist and teaching senior alone so these rounds can happen simultaneously with the wards team rounds.

      • Days with 2 interns, patient 19 and above go to teaching senior

        • At the discretion of the nursery and wards hospitalist, patients 19 and above may be rounded on with the nursery hospitalist and teaching senior alone so these rounds can happen simultaneously with the wards team rounds.

    • Weekend since there is only 1 senior and 2 interns, the admitting senior resident should round on patients 19 and above. Use discretion based on census/complexity -- night senior can help post-call round if needed (post-call resident must leave by 10am). 

  • Overflow guidelines:

    • The night hospitalist should help the night team determine which patients go to the overflow (nursery hospitalist/teaching senior) team. Priority for quick discharges including EEG patients.

    • Teaching senior should signout to the rounding senior and nursery hospitalist before leaving for the day, to ensure patient care is appropriately covered

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Medical Students:

  • MS3 may co-follow any patient with an intern/resident (Ward, SDU, consult)

  • MS3 may follow up to 4 patients each

  • Sub-Interns function independently and report to senior directly and do not need to co-follow with an intern

  • Sub-Interns may round up to 8 patients each, but generally for teaching purposes, soft cap at 6 patients

 

Admitting Patients:

  • Patients may be admitted to an intern on non-call days.  This is at the discretion of the senior resident. 

  • Sometimes, you may be called for a direct admission from PMD/Subspecialist. Please take a brief signout but also direct the conversation to the attending physician so that the attending-attending signout can take place and additionally admission process is appropriately started.

    • FYI for direct admissions​

      • ​Regular Business Hours: 310-319-4780​

      • Nights and Weekends: 310-825-0909

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Didactics: 

SM Noon Conference is independent of UCLA Noon Conference. The link to the calendar with conference assignments will be sent out in the monthly email to all residents on the rotation. Topics/presenters include hospitalists, senior residents, medical students, EBM (Dr. Kamzan), mock code (Grace Sund and Dr. James Lin), and Chief talks. Teaching seniors, please utilize Conference Room #4 and treat your assigned presentations with the level of formality expected for a dedicated noon conference hour. 

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Staffing Workflow:​

Hospital Admissions (hospital transfers, ED admissions, etc):

  • Day shift: staff new admissions with the daytime attending 

  • Night shift - prior to midnight: staff new admissions with the overnight attending

  • Night shift - after midnight:

    • No requirement to staff new admissions

    • Please FYI and staff the following patients with overnight attending:

      • Sick (ie “watcher”) patients

      • All respiratory admissions

      • Step-down unit patients

    • Please continue to call attending for RRTs, code white/blue, and stat overnight consults by other teams (ex: ortho) 

    • If a question ever comes up about any patient, please do not hesitate to ask the overnight attending

  • Please inform Charge RN of ALL admissions (regardless of staffing) as this helps plan nurse staffing and resources - see communication workflow below

 

Overnight ED Consults:

  • For all patients you feel are medically stable for discharge from ED, discuss with ED attending that the patient may be discharged from ED. Then page overnight peds attending to staff and discuss discharge. Consults from ED that are planned for discharge must be seen by pediatric attending prior to patient leaving.

  • Close loop with ED attending after staffing

  • Please inform Charge RN of ALL consults throughout the night as this helps plan nurse staffing and resources - see communication workflow below

  • If plan is for admission to SM, see above for admissions workflow

 

Overnight MSP Admissions:

  • Please FYI email Adolescent Medicine Team for new MSP admits so they know who to round on in the AM. No need for recs, continue to follow MSP order set and protocol

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Santa Monica Wards Senior Resident / Nursing Communication Workflow:

  1. Establish a secure Epic chat with charge RN, resource RN, senior, intern (charge RN will initiate this)

  2. Senior to let charge RN know when going to see any ED consults

  3. Senior to let charge RN know as soon as there is a plan to admit a patient

  4. Charge RN to determine RN staffing needs (this is independent of senior +/- attending determining need for admission)

  • Note: Please always feel empowered to include your attendings in any of these discussions or decisions!

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Golden Hour Workflow: 

Please see the following workflow for admissions that occur during Golden Hour: 

​Golden Hour Workflow

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Consults:​

  • Any service may request a pediatric consultation (such as Orthopedic surgery).

  • Initial consultations require a full history and physical.

  • Ongoing consultations (co-follows) must be requested and are not automatic.

  • The pediatric team must verbally communicate with the consulting team daily.

  • Please see SM-How to Call Consults

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Rapid Responses:

  • A hospitalist attending should be present for all rapid responses given we do not have a PICU at Santa Monica.

 

Back Up Call:

  • A pediatric resident requiring back-up call should contact the pediatric chief resident on-call.  A pediatric resident on back-up call will be utilized if a pediatric resident can not fulfill their duties.

  • A family practice resident requiring back-up call should contact the family practice chief resident or family practice program director.  A family practice resident on back-up call will be utilized if a family practice resident cannot fulfill their duties.

  • Pediatric residents on back-up call should not cover FP residents and vice versa for emergent back-up needs unless special circumstances or previously arranged coverage.

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Other Responsibilities:

  • Sign up for your patients (with name and pager number) on CareConnect​

    • Primary resident​ or

    • Primary intern

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Discharges:​

  • Discharge summaries should ideally be completed within 1-2 days of discharge to ensure optimal patient care and communication with PMDs and consultants.

    • Discharge summaries must be completed within one week of discharge.  A discharge summary not completed within one week is considered delinquent.  Delinquent discharge summaries may result in the suspension of an attending’s privileges. 

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Totally Kids:

  • Please follow the listed procedures for patients who are to be discharged to Totally Kids specialty health care facility

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Transfers:

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Neuro Patient ADMISSIONS: 

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Please see detailed [SM PHM and Neurology Communication], below is a abbreviated version:

Usually, neurology patients are admitted to Santa Monica for overnight video EEG monitoring. The neurology team is not physically at Santa Monica, and their schedule is dynamic, so please keep the following in mind:

  • The pediatric epilepsy fellows read the EEG studies at Westwood along with the Reagan studies. The fellows will then review the studies with the EEG attending starting 9 am, and then round with the Westwood inpatient neurology team when they arrive around 10am. Afterwards, the EEG attending will call Santa Monica and communicate with the inpatient team there and with the families via Zoom. If there are events to discuss or questions the epilepsy fellows have about events overnight, they will call the residents earlier to clarify.

  • Contact information for all SMH admissions including scheduled EEG, urgent EEG, patients requiring neurology consult are as below:

    • ​Weekday 8 am- 4 pm: Contact Kristina Murata, neuro NP, available on pager/SPOK

    • Weekday after 4 pm: Contact RR neuro attending, see who's on call on Mednet intranet paging system

    • Weekend 8am - 4 pm: Contact EEG attending based on the attached pdf schedule

    • Weekend after 4 pm: Contact RR neuro attending, see who's on call on Mednet intranet paging system

    • Neurology fellow/residents are not at SM.

  • Additionally, the Neurology schedule and Neurology NP contact information are available in the resident workroom

  • The EEG techs at Santa Monica should clarify and confirm with the pediatric inpatient team prior to EEG lead removal in case overnight events necessitate continuation of the study.

  • Please make sure a neurology consult and EEG order are in for each patient.

  • Please click here for status epilepticus algorithm

  • Please click here for ketogenic diet guide

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Pediatric Resident Expectations with vEEG admissions:

  • Complete med rec within an hour

  • Do not assess neuro patients while vEEG leads are being placed!! 

  • Keep communication with charge nurse of all upcoming admissions during the day and night

  • Complete discharge med rec. Neurologists will send meds to the pharmacy. Ensure correct list in AVS prior to discharge order

  • Update nurse of patients plan on admission and discharge

  • Staff patient with hospitalist attending

  • If there are any questions about the admission (eg medications, eeg details, discharge plan) check notes first, then ask the hospitalist attending who will be direct contact with Neurology team. 

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Care Taker (Parent) Calls

Intern Expectations

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Daily Responsibilities

  • Discuss any urgent patient issues (i.e. worrisome labs, vitals, fever, bleeding, pain, etc) with the senior prior to rounds to ensure that issues are addressed promptly.

  • Review the MAR and all orders written overnight for your patients prior to rounds.

  • See all patients prior to rounds.

  • SIGNUP for Your Patients in CareConnect as "Primary Intern”

    • Admitting intern, please add name and pager number to the dry erase board on the door of workroom

  • Arrive at noon conference on time every day.

  • Be prepared to start rounds at 8 am everyday 

  • Present succinct presentations during rounds which contain pertinent history for patients new to the service, a brief summary of overnight events, vital signs including weight (specify gain/loss, %), total I/O, PO volume (in mL/kg if <1 y/o), stool output, pertinent negative/positive PE findings, pertinent lab data, and an organized assessment and daily plan of care (by systems if complex patient).  Please be able to identify outliers in recorded vital signs. 

  • All Pediatric Team patients to be rounded on during Patient Family Centered Rounds, including Private MD patients (Hospitalist to listen, but all care decisions to be made by attending of record).

  • Call consults prior to noon (please inform attending by 1:00pm regarding any service that has not been contacted or has not returned a page).

  • Update parents (daily if in-house, q 2-3 days via telephone per parental discretion).

  • Complete all notes prior to evening sign-out with the goal of going home immediately after evening sign-out. Ask senior resident for help with note writing if having difficulty accomplishing this goal.  Every patient needs a separate note for each date of hospitalization; an addendum to the H&P is only acceptable if admission occurs after midnight (confirm on facesheet date of admission). 

  • Please only use the .PEDSRES smart phrases for all notes. This includes a History and Physical, Progress Note, Discharge Summary, Consult H&P, Consult Progress Note, Transfer Summary, and Transfer Accept template.

  • Night team can help prep skeleton admission orders for next day's Heme/Onc + Neuro admissions to minimize interruptions during morning rounds.

  • Special note for rotating FM residents. Please see our residency essentials section for our expectations for every resident. Specifically:

    • Hospital Courses​ - We need you to prep hospital courses whenever rotating as an inpatient resident on our services. Before you leave from your shifts, especially if there is any potential for DC/Transfer before you return, prep a hospital course on your patients. The pathway we expect is for you to start a hospital course ASAP to effectively communicate patient management. Not doing so is detrimental to co-residents at times of discharge, especially with the constant variation of schedule on this rotation.

    • Sign-Out - This is expected to be verbal (face-to-face or via phone) between two rotations. If both parties agree to email, that is OK as long as there is ample and prompt opportunity for questions. You must also provide sign-out (verbal) to a provider before you leave for the day. You are expected to signout your patients if you are off the next day or if you have to leave for clinic.

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Caretaker (Parent) Calls: 

While at Santa Monica, the pediatric residents are the doctors on call for PCC patients and parents when PCC is closed. You may get pages from the page operator directing you to call a parent who has a question about their child.   Please return these calls as soon as possible and see the "PCC” section for advice on some common Parent Call topics. Pediatric interns should run the assessment and plan with the senior.

 

Please use the following workflow regarding staffing/questions (UPDATED 12/2023):

1. For a patient coming to the ED for evaluation or possible admission, please run any questions by your senior or the hospitalist on call

2. For all other URGENT questions, page the following PCC attending:

- for medical home patients, please page Dr. Lerner. If no answer after 10 minutes, page Dr. Dudovitz

- for all other patients, page Dr. Masood. If no answer after 10 minutes, page Dr. Dudovitz

3. For non-urgent questions, contact any PCC attending the following work day

4. Send all telephone encounters and orders to a PCC attending for co-sign (ideally the last attending to see the patient in clinic)​

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Parent Call schedule:

Monday through Friday 6pm-6am: Santa Monica Intern or Senior (Senior if intern is family medicine)

Saturday and Sunday 6am - 6am: Santa Monica Intern or Senior (Senior if intern is family medicine)​

 

You are only responsible for caretaker calls for PCC patients ONLY. For patients calling from CPN clinics (NOT PCC) who may be mistakenly directed to the resident line, please provide them the following numbers so they can access the appropriate after-hours help line: 

  • West LA: 310-231-9150

  • Marina Del Rey: 310-301-6310

  • Santa Monica: 888-899-4227

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Discharge Planning

  • Update PCP within 1-2 days of admission then per PCP requested frequency and before d/c. (discuss who will be doing this with senior/attending)

  • Begin discharge planning on the day of admission (start prescription forms, d/c instructions, home health needs, etc.).

  • Begin parent teaching and/or ensure teaching is given to parents when discharge is anticipated.

  • Contact case manager/discharge planner regarding home health needs as soon as possible.

  • Notify all involved subspecialty services about discharge plans at least 1-2 days prior to discharge.

  • Set-up all necessary subspecialty follow-up appointments by the day prior to discharge - for some patients this may involve calling and making the appointment for the family rather than giving the family the appointment number to call. This will be specified by the attending.

  • Complete discharge paperwork (home health orders, Rx forms, school notes, etc.) by the day prior to discharge. Discharge orders should be done and pended on all discharges prior to AM rounds, including Rx's (must be reviewed by attending prior to giving to family/RN). Attending should be made "second sign” for all discharge Rxs.

  • Please confirm receipt of discharge medication Rx to all non-UCLA pharmacies, as there have been issues with medication availability which has held up discharge, or resulted in readmissions.

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Last modified: Jan 2023

Rounding Senior Expectations

 

Handoffs

  • Arrive on time and be prepared for evening and morning sign-out.

  • Obtain sign-out from the Night Team on all patients admitted to the wards and patients boarding in the ED

  • Update sign-out by 4 pm daily and make certain the information is accurate.

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Emergency Department Admissions

  • The senior resident takes the initial (and only) call/page from the emergency department for admits/consults.  The attending does not get a call/page, so it is the senior's responsibility to triage.

  • If an ED attending wants to admit a patient, we should honor that and not "block"the admission

  • If you feel an admission isn't warranted, please discuss it with the ED attending and the hospitalist attending, NOT THE PATIENT

  • Once admitted, the patient is under your care, however please notify the ED attending if you plan to cancel any orders (e.g. antibiotics) if the patient is still physically in the ED

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Daily Responsibilities

  • Examine new, sick and anticipated discharge patients prior to rounds. Ideally examine all patients prior to AM rounds.

  • Review daily plan of care with interns prior to rounds to help them streamline their presentations.

  • Arrive on-time for noon teaching activities M-F

  • Be prepared to begin AM rounds at 8 am daily. Senior resident is to call RN to bedside to participate in rounds

  • Assign yourself on CareConnect as "Primary Resident” for all team patients.

  • Encourage 1 teaching point during rounds daily.

  • Remind interns to update PCP and parents as noted above.

  • Review the MAR for all patients daily.

  • Assist interns with floor work (i.e. calling consults, writing orders, completing paperwork, etc.) to help ensure they arrive at noon conference and clinic on time.

  • Assist interns with handling any crises or emergencies involving patients on the service and support them until the issue has been completely resolved.

  • Briefly review the patients with the interns prior to noon conference, assessing work that still needs to be done and assisting the intern in prioritizing their afternoon.

  • Ensure that consults are called prior to noon (please inform attending by 1:00 pm regarding any service that has not been contacted or has not returned a page).

  • Volunteer to help interns with floor work and/or note writing to make certain they are able to leave the hospital immediately after evening sign out. 

 

Discharge Planning

  • Assist the interns with completing discharge paperwork and scheduling follow-up appointments 24-48 hours prior to discharge.

  • Work with the intern and case manager/discharge planner to set-up all home health needs at least 24-48 hours prior to discharge.

  • Update PCP within 1-2 days of admission then per PCP requested frequency and before d/c. (discuss who will be doing this with senior/attending)

  • Senior should be second sign for all Rx's, but Rx's must be reviewed by attending prior to giving to RN/family.

  • Attend IDR meetings at 11:15 AM in the nursing break room on weekdays.  

  • Charge nurse should be updated at any time with new expected discharges so that the "discharge board" can be updated before 8am daily for hospital administration meetings (held at 9am).

  • The SM 16th street pharmacy does "meds to beds"

  • The dotphrase ".addapt" which is a request for follow-up appointments also works at SM

 

Education

  • Hold intern pagers during educational times so they can focus on learning.

  • Prepare at least one 10-15 minute talk for the interns during your block. The talk may consist of a case presentation, review of a new pediatric guideline, or a topic of your choice.

 

 

Last modified: Sept 2021

 

 

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TEACHING Senior Expectations

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Handoffs

  • Discuss with rounding senior when to arrive in morning

    • On busy days - suggest arrive at 6am for signout​

    • On busy discharge days - suggest arrive at 7am for discharge preparation

    • On low census days - suggest arriving at 730am for rounding preparation

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Daily Responsibilities

  • Review daily plan of care with interns prior to rounds to help them streamline their presentations.

  • If a high census, will need to pick up "overflow” patients and pre-round/round on these patients with the nursery hospitalist.

    • Please see flowsheet above for overflow plan.​  Depending on patient complexity and team needs, teaching senior can round on more patients as 'primary resident'. 

  • Be prepared to begin AM rounds at 8:00 am daily.

  • Assist with rounding efficiency:

    • ​Prepare ​a rounding list for the charge nurse every morning to help families and RNs anticipate when the team will be coming to round.  Suggested order of patients would be most acute patient --> discharges --> room order. 

    • Help keep the team focused during rounds. Ideally rounds should be completed before 11 AM.

  • If there are admissions during rounds, admit patient (with or without intern/medical students depending on rounds) for the team, at least admission orders and possibly H&P note; touching base with subspecialty teams (ortho, surgery, hem/onc, etc) if needed.

  • If there are ED consults during rounds, see patient (with or without intern/medical students depending on rounds), and staff with hospitalist. 

  • Assist interns with floor work (i.e. calling consults, writing orders, completing paperwork, etc.) to help ensure they arrive at morning report and clinic on time.

  • Assist interns with handling any crises or emergencies involving patients on the service and support them until the issue has been completely resolved.

  • Ensure that consults are called prior to noon (please inform attending by 1:00 pm regarding any service that has not been contacted or has not returned a page).

  • Help orient new members of the team (medical students, interns, FM) on the first day of rotation. 

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Teaching Responsibilities

  • Give brief teaching points during rounds if time permits

    • If busy rounds, please identify teaching points to be reviewed with individual students/residents or as a group after rounds are finished

  • Look at the noon conference calendar (sent out in monthly email) to see when you will be presenting noon conference. On these days it’s expected that you stay until after you have presented. Please utilize conference room #4 for your presentations to help foster a formal learning environment. 

  • Help medical students prepare a talk to give on Fridays

    • Assist with topic selection, identification of resources, etc. ​

  • Help coordinate residents' attendance to noon conferences

    • Locations and topics will be available on the noon conference calendar on the home page or on the printed calendar in the work room​

 

Discharge Planning

  • Assist the interns with completing discharge paperwork and scheduling follow-up appointments 24-48 hours prior to discharge.

  • Work with the intern and case manager/discharge planner to set-up all home health needs at least 24-48 hours prior to discharge.

  • Update PCP within 1-2 days of admission then per PCP requested frequency and before d/c. (discuss who will be doing this with resident/attending)

  • Discharge orders should be done and pended on all discharges prior to AM rounds, including Rx's (must be reviewed by an attending prior to giving to family/RN).

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Last modified: October 2021

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