J10

Welcome to J10!

Arrive 6am for sign out

Get a phone, pre round and start your notes. Get ready for rounds
8am rounds - grab one of the computers on wheels to help with orders while on rds
Patients you'll see: Asthma, bronchiolitis, seizures, gastroenteritis, failure to thrive, infections (pneumonia, abscesses, sinusitis, osteomyelitis, cellulitis)
It’s a BUSY floor with many admissions throughout the day – try to stay on top of things and ask for help if needed.
These are “bread and butter” peds cases and many are kids with chronic conditions
Make yourself a template for the common stuff ie. Plan for bronchiolitis , asthma
For asthma, include their PAS score in your note. For age 2yr +, put them on the asthma protocol which is ordered as albuterol q1H PRN – respiratory therapist checks on them every hr. Treatment for an asthma exacerbation is albuterol PRN, oral steroids (Orapred or Dex) and a controller med (start Flovent if the pt was not previously on it)

Hospital Medicine Files/Protocols

Use the Resident Checklist below when evaluating the Medical Students!

[ ] Pediatric History and Physical Exam (including general framework of growth, developmental milestones)

[ ] Inpatient focused FEN/GI

[ ] Fever in an infant: General approach, intro to Procalcitonin use (cases developed by

Dipalma/ED/Shamim)

[ ] Signing out (students to stay until evening Sign-out 1 day during 1st week, and to sign-out their patients our to floor intern/resident when they leave the floor everyday

[ ] Newborn Exam (reflexes; signs of concern, such as dehydration, lethargy; etc.)\

[ ] Dermatological exam: How to describe on rounds/in notes (not diagnoses per se)

[ ] Pulmonary exam: general description; also Pediatrics focused signs of distress

Floor Intern Responsibilities:

Interns arrive on the floor at 6:00 am for pre-rounding
Should receive an overnight report from the overnight intern or senior
Overnight intern (or senior on Wednesday and Thursday) should write the progress notes for the patients admitted overnight whose admission note was written prior to midnight
Must have their notes completed by 1:00 pm
Interns present their patients on rounds; Full H&P for new patients, SOAP style for preexisting patients
Interns should propose a plan before the senior or attending
Overnight intern will present the patients admitted overnight (with the assistance of the senior)
Interns write all admission notes and discharge summaries on the floor. Seniors write all aforementioned notes in the absence of interns or in situations where patient care will be compromised by not assisting the interns.

Floor Senior Responsibilities:

Role is to oversee the management of all the patients on the inpatient team.
Ensure interns are primary contact for all questions and concerns regarding their own patients
- Hypercare communication between attendings, senior, and intern
- Intern's ASCOM written in room
Should ensure all orders are correct, medication doses are accurate, notes are completed
Communicate with nurses, discharge planning, attendings and other staff to ensure efficient care and patient management
Organization and flow of rounds is the responsibility of the senior resident
Final plans for patients should be the responsibility of the senior resident, and should work closely with the attendings to become strong autonomous pediatricians.
Must be available to interns and nurses throughout the day, and always carry senior pager and ASCOM.
Overnight seniors are responsible for writing admission notes and pre-midnight progress notes on Wednesday and Thursday nights or any other time there are no interns overnight or if the interns have too many notes to write.

PHM/Pulm Virtual Rounds - Monday afternoons at 1PM

On Zoom: https://buffalo.zoom.us/j/99904759092?pwd=bnNVT3h1RkZja0xoZ2EyUm4yNlVyQT09
- Link as of 1/1/2025
- Discuss chronic lung kids (trach/vent), asthma admissions, etc with PHM and Pulm teams
- Seniors presents one liner and any updates

Pediatric Hospitalist Service AM Rounding

Rounds with night team to focus on education by making the following changes:

Do NOT routinely round on:

o Patients another senior admitted (ie: J11 team did an admission to help J10 team; J10 team reads off their work in current model)

o Basic cases (gastro, bronchiolitis, cellulitis, constipation, etc)

§ Exception for “sick” kids!

o Psych cases w/out medical aspect (or straight-forward aspect)

· DO round on:

o Interesting/complex cases

o “Sick” kids

§ Whether or not they are new! Eg: if an existing patient had the night shift busy with management all night, they should be included on O/N rounds.

o We feel that interns need to have some interaction with attendings. Therefore, we prefer when an intern is on nights that at least 1-2 patients are chosen for presentation (not zero).

o The residency program has indicated that the night team does not have to pick up new admits after 7:45am. Therefore, you may leave after AM/overnight rounds (if your work is otherwise done) and as always- by 9am at the latest to stay in work hour compliance.

Determination of Overnight (8am) Rounding list:

· Day or Night senior cortext on-call hospitalist attending at 7:45 AM with the rounding list, based on the above considerations.

· **Alternative: indicate in Free text column of Provider handoff tool. This is proving useful as we learn how to use this tool together. Attendings and residents have been indicating “AM rounds” and “AM discharge” in this column on J10. It allows anyone to edit and be on the same page, and allows communication with whichever attending has the patient**

· Attendings-of-record can add to the list if they’ve identified someone else they’d like to round with nights on.

Things that aren’t changing:

· Night seniors still identify patients ready for early/pre-rounds discharge and report this list to the on-call attending at AM check-in. (and/or free text column in provider handoff)

· AM check-in is still a check-in for quick/timely questions and discussions. This is not to replace AM rounds. Ie: if a full presentation & full discussion is necessary then this patient should be added to the 8am list.

o Timely discussions can also be had at any time overnight. Seniors never NEED to wait for AM check-in or AM rounds. Attendings are always on call.

· Day interns must have picked up ALL patients and have reviewed their charts, and examined all the kids before rounds. Progress notes need to be in before rounds on any kids admitted before midnight.

o For O/N admits that night team does not present, reading off the “full H&P” isn’t necessary. Can give a 1-liner and go into SOAP format.

MS-3 clerkship Inpatient (J10 and J11) documentation

3rd year medical students are encouraged to write 1 progress note/day in their first week and 2/day in their second week.

· The notes are to be written under the students’ own names (not under a resident name).

· No H&Ps to be done by MS-3. (these are done & submitted separately according to their clerkship requirements)

· Discharge summaries may also be done by MS-3’s.

· The intern does NOT also write a separate note but they DO have to fully examine and take ownership of the patient.

They should submit the note to the intern also assigned to the same patient so the intern can review & addend if needed. Also choose the attending of record to submit the note to.

Attending Commitment to Thursday afternoon Resident Education

Between the hours of 12:30pm-4pm on Thursdays, PHM attendings are committed to the following duties (as it pertains to patients on PHS service), in order to allow the residents to focus on their education:

· Carry the J10 Senior ASCOM

· Field & address RN calls

o Place orders when needed

o Speak with families as needed

o See/assess patients with acute medical concerns

· Place admission orders for new ED admits including med rec completion

· Accept PICU and/or NICU transfers

o Assess patient on arrival to the floor, if before 4pm.

· Put in discharge orders for patients meeting discharge criteria

Attending expectations from Floor residents on Thursdays

In turn, we expect the following from residents:

· Have anticipated discharges prepared (including med rec)

· Sign-out to us before leaving for lecture if there are pertinent updates since rounds

o This includes any AM admissions or transfers that were accepted

o Let us know if consults still need to be called

· See and evaluate any new admission who arrived while you were gone

o Attendings are not expected to write H&Ps.

§ Time-permitting, an attending my opt to write one to help relieve the residents’ return workload

Thursday Afternoon 12:30 - 4PM - Nurses to contact on call attending & not resident ASCOM

· Residents are gone to lecture & should not be contacted

· Issues do NOT have to wait for their return!

· RN check “attending physician” column on Powerchart for appropriate physician to contact

· Call Attending Physician to address concerns

Those with Cortext are also welcome to use this as method of contact

Sheri Wagner 716-380-0530 - also try as back-up if unable to reach on-call MD

Samara Appelstein 917-734-3747

Jessica Donhauser 716-713-2329

Laura Easton 585-298-7913

Kendria Hall 601-209-1362

Anna Hays 716-861-1213

Meghan Jacobs 716-531-1174

Kara Oliver 716-316-2472

Steve Turkovich 716-390-6032

Larry Gersz 585-314-9457

Matthew Swatski 610-256-0189

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