Emergency Medicine
For more information about this rotation, please contact Dr. Sangeeta Chona at schona@stanford.edu
Welcome to your Peds ED experience for 2009-2010!
Each month we will send a new draft of this email to those of you rotating in the Peds ED the following month, so that the Peds Juniors can get going on the schedule and the EM Senior resident feels in the loop. Remember that Peds interns switch one week before Juniors/Seniors so that you will have 2 sets of interns to coordinate with. EM Senior residents only rotate for 3 weeks at a time. Peds Junior residents do either 2 week or 4 week rotations.
Here is the deal:
1. SCHEDULING (Guidelines in specific terms below):
Each month, the Junior ladies (or guys - but they are in short supply) designate a "spokes/scut" woman to make the schedule for the group. This goddess/wench (depending on how you feel about scheduling) submits a proposal to the peds Chiefs and Dr. Sangeeta Chona (Peds EM attending) for approval one week prior to the start of the rotation. Google Docs is lovely for this......if you needed a suggestion. NOTE: One of the attachments to the email here is the Junior Peds schedules -- look for who has ED during your block to get in touch and get the ball rolling!
2. ORIENTATION
Please see attached powerpoint by Dr. Chona for key tidbits (bathroom code, lay of the land, roles/responsibilities, etc.)**IMPORTANT: If you are new to the EPIC computer system (i.e. an INTERN), call 723-3333 to get an active EPIC Log-in and some help with the tutorial BEFORE your first shift *****
AND make sure you ask how to LOG patients in EPIC who need following -- it is an ACGME requirement that you demonstrate continuity of care (i.e. you are following up on cultures/X-ray reads, etc.). This list needs to be submitted to Mariko/Michelle for Peds residents.
3. ADULTS
For Peds residents, there is an Adult Binder (red cover - ask where it is) to document the age and chief complaint of adults you are asked to see. This was started this year to help the Peds Admins understand whether or not your role seeing adult patients from time to time when the ED is busy is an appropriate one. If it is a laceration in at 28y.o., that is a different thing than CHF exacerbation in a diabetic and hypertensive 78y.o. Please document CAREFULLY so that we may advocate for you and/or patients appropriately.
4. Peds PL2s and CAPE
You all are required to attend a CAPE session focused on ED cases. The schedule is attached with guidelines, as all sessions are Wed afternoons and some of you have Wed clinics (we are aware of this - please see the note in the document and let us know if you have concerns). There will also likely be SUTURING and SPLINTING workshops in the future - - stay tuned!
Scheduling Guidelines/Regulations:
1. Interns do not have to submit any requests to the juniors, as your schedule is different and does not impact theirs. You will discuss between the 2 of you which weekends you want off/on.
a) If you are on Well-Baby, your week-day duties are Monday from 4p-9p (tell the well-baby attending you MUST go -- they know this and expect the reminder from you - it is NOT rude to do this).
b) If you are in ACC (acute care), your week-day duties are Tuesday form 5p-10p (can't leave clinic until just before 5p, and your day starts later than the well-baby person who comes in at 7am, when you come in at 8am).
c) Weekend duties are Fridays 5p-10p, Sat 10a-9p, and Sun 10a-9p. Please divide evenly and let the Junior making the schedule know how you have divided it. If you are not sure who is doing the schedule, let us know - but ideally, you will all be involved in an email conversation denoting the lucky person well in advance. Please note that the MAX is 3 shifts in a row, so the person on WBN who has a shift on Monday should not do the Friday shift the weekend prior.
2. Juniors and Senior EM Resident:
a) Peds residents cover the ED from 7-7. This means day AND night duties (i.e. 7a-7p as well as 7p-7a) on FRIDAY, SATURDAY, SUNDAY, and MONDAY. If you have CLINIC on Friday or Monday, you can't work the day-shift that day, or the night shift on Thursday or Sunday, unless there are prior arrangements made. We will be combing the schedules to look for mistakes here, but please try to look for them yourselves as well.
b) On Tues, Wed, Thurs, Peds residents are in the ED only at night, 7p-7a. Most likely, you will have clinic in the day-time somewhere here, so think about that when making the schedule. Sadly, you will sometimes have to head to a 12-hour shift AFTER clinic - which is tough, but less than the 30-hour call. Technically, you should try to avoid this if possible, but more importantly, try to avoid the post-night-shift clinic if you can.
As for who covers the Peds ED in the day-time on Tues, Wed, Thurs, that is managed by the ED staff -- it is usually an attending and EM intern.
AGAIN: No more than 3 shifts in a row -- and pay attention to day/night reversals!
Please submit your schedule to Dr. Chona at schona@stanford.edu AND the Peds Chiefs at least one week prior to the start of the rotation (earlier is better, so we can trouble-shoot clinics and make sure all is fair or sort of kind of fair). We will also ask that the EM Senior resident forward this on to the EM Chiefs.