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
7pm - sign out to the night team. Update the E doc list before sign out. I.e. Remove any patients that were discharged and add new admissions, update meds, actions
You cover patients for the sub specialty services including G.I., pulmonology, endocrine
You also cover the patients in the CDU (maybe....one day)
On rounds, present your plan to the senior. After rounds, you always have to confirm with the primary team ie GI, neuro, endo
For PHS patients, you will present the overnight admissions with them, and complete family-centered rounds with their patients
The primary subspecialty or private attending should also see the patient that day! Notify the chiefs if the attendings are not physically seeing their patients!
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
[ ] 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
CORTEXT 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.
Neurology Patients Resident Responsibilities
This applies to all patients who have a Neurologist as the attending
Peds Residents:
-H&P
-Admission orders
-Peds Interns expected to round with Neurology team on the patient
-Residents should be in regular communication with Neurology service & residents about the patient
-All other subsequent orders
-Depart
Neurology Residents:
-Initial consult note
-Will be in regular communication with the Pediatric residents
-Daily progress notes
-Discharge summary
-Will complete any prior authorizations
-Will send controlled substance scripts as needed for discharging patients
Adolescent: No long has a private service as of Spring 2024. Admit known eating disorders to PHS with Adolescent consult.
A/I:
FPIES challenges
Endocrine:
Diabetes, panhypopituitarism, hypocalcemia
**when above problem is the primary reason for admission
GI:
WNY GI (Gelfond/Hashmi/Nugent group) admits their patients for exacerbations of their known GI disorders
UBMD GI patients go to PHS
Hem/Onc:
New-onset or known leukemia/lymphoma, new solid mass, known cancer, working diagnosis of malignancy
Sickle Cell, Hemophilia, Thalassemia Major, severe anemia, hemolytic anemia, severe pancytopenia
DVT/PE
ID:
Known HIV positive -- discuss with attending
Tropical Infectious diseases on case-by-case basis
Nephro:
Nephrotic syndrome
Dialysis patients
Neuro: No longer has a private service as of Spring 2024. All neuro are admitted to PHS with neuro consult.
Previously: Exacerbation of known seizure disorder, age > 12 months
No comorbid infectious disease or other significant underlying medical problem (eg: trach)
DENT patients will typically go to PHS
Pulm:
CF
Rheum:
Exacerbation of known Rheum disorder
Private Subspecialists Contact Numbers:
GI:
Dr. Hashmi cell: 716-803-5576
Dr. Gelfond cell: 917-783-1709
GI @ Rochester: 1-800-499-9298
Fax face sheet: 585-256-3156
Med Peds:
Dr. Gosine cell: 443-615-3553
Dr Abeles cell: 716-908-1106
Jericho Road:
Dr Glick: 716- 435-1440
Dr Harding: 917-664-9174
Dr Milazzo: 716-480-2438
Dr Raleigh: 716-364-1626
Dr Stoltzfus: 484-667-7678
Holiday Pediatrics
Dr. Dejneka: (716) 698-6978
Psychiatry:
On-call answering service: 716-608-1065