2007 2008 Pediatrics at MSKCC Overview n GME

2007 -2008 Pediatrics at MSKCC

Overview n GME folders and beepers n Organization of the clinical services n Expectations of residents, fellows, NPs n Daily schedules n Administrative Procedures n Computer information

First day at MSKCC n On your first day, please go to M 9 first at 7 AM n No need to stop by the GME office anymore n Once on M 9, you will first receive sign-out from the post -call resident, and then you will be given a brief orientation

GME folder and beeper n n GME office = M 2101 Please sign all paper work including: n n n Confidentiality agreement DEA acknowledgment HIPAA security form “White card” with general phone numbers, your institutional DEA number, and all computer passwords Blue prescription card ID slip (security office, basement Memorial Hospital), scrubs/lab coat requisition (general stores, basement Memorial Hospital) MUST obtain these after rounds on first day

Organization of clinical services n n M 9 – Inpatient, Pediatric Observation Unit (POU), and Pediatric Day Hospital (PDH) Two teams on M 9 Inpatient – two medical teams (“green”, “blue”) POU – step-down unit for peds PICU at NYPH PDH = outpatient clinic: n Primary teams include attendings, NPs, social work: n n n leukemia (Drs. P. Steinherz, Yurasov) lymphoma (Dr. Trippett) sarcoma (Drs. Meyers, Wexler, Merola, Merchant, Chou) neuro-oncology (Drs. Dunkel, Khakoo, Lyden) neuroblastoma (Drs. Cheung, Kramer, Kushner, Modak) surgery (Drs. La. Quaglia, Kayton) long-term follow-up/endocrine (Drs. Sklar, Oeffinger) Cardiology (Dr. L. Steinherz) BMT (Drs. O’Reilly, Boulad, Kernan, Small, Prockop, Scaradavou) Open M-F from 7: 30 am until 7: 30 pm Sees approximately 120 - 150 patients/day

Meet the Staff n n n n n Primary teams include attendings, NPs, social work: Leukemia (Drs. P. Steinherz, Yurasov) Lymphoma (Dr. Trippett) sarcoma (Drs. Meyers, Wexler, Merola, Merchant, Chou) Neuro-oncology (Drs. Dunkel, Khakoo, Lyden, Gillheeney) Neuroblastoma (Drs. Cheung, Kramer, Kushner, Modak) Surgery (Drs. La. Quaglia, Kayton) Long-term follow-up/endocrine (Drs. Sklar, Oeffinger) Cardiology (Dr. L. Steinherz) BMT (Drs. O’Reilly, Boulad, Kernan, Small, Prockop, Scaradavou)

Meet the Staff

M 9 Inpatient Service n GREEN Team – general oncology n n n n Attending Fellow PGY-3 senior resident from Downstate 3 -4 PGY 1/PGY 2 from Cornell, St. Barnabas, Harlem, Lincoln 2 -3 NPs (Courtney, Rebecca, Angela) Case manager (Megan Behringer) BLUE Team – BMT n n n Attending Fellow PGY-3 senior resident from Downstate 3 -4 residents from Cornell, Downstate , Metropolitan NP (Heidi) Case manager (Megan Behringer)

The Nurses

Role of the Nurse Practitioners on M 9 n n Provides continuity of care for patients NPs fulfill several roles on the inpatient unit n n n Patient care Work-flow facilitator Education Administration NPs do not work on weekends and thus their patients are covered by housestaff on weekends Surgical NPs (Carol, Courtney, and Rebecca) take primarily post-op surgical patients. If there are not many, they will then assume responsibility for general oncology patients

Role of the Fellow n Mentor, supervisor, educator n There is ALWAYS a fellow available n Fellows are notified about all admissions to the floor n Fellows are responsible for writing all of the chemotherapy orders for all patients

Housestaff at MSKCC n n n n 6 residencies throughout NYC: Cornell, Downstate, Lincoln, Harlem, Metropolitan, St. Barnabas Without you, MSKCC cannot function!! Primary caretaker when patients are admitted to M 9 Typical census = 5 -6 patients/resident Responsible for all orders (medications, IVF, diagnostic tests [labs, radiology], admission orders, discharge orders) except chemotherapy Prescriptions upon patient discharge Admission notes, daily progress notes, acceptance notes, discharge notes, off-service notes

Role of the PGY-3 Senior Resident n n n n n Works closely with the Pediatric Chief Resident, Pediatric Fellow on -service, and the Pediatric Attending Serves as a knowledgeable resource of general pediatrics to PGY 1 / PGY-2 residents, nursing staff, and NPs Supervises PGY-1 and PGY-2 residents on the rotation Responsible for knowing all of the patients on their team Takes on patients and/ or does admissions/ discharges of their own when necessary Aids in the distribution of admissions Takes in-house, overnight call 4 -5 times a month Attends own continuity clinic at their home institution Attends Tuesday and Friday Morning Report in addition to all resident conferences (core lectures, tumor boards, grand rounds)

Role of the Chief Resident n n n n Assists with new resident orientation Maintains communication among the resident staff and pediatric hematology/oncology fellows. A liaison to the pediatric administration, nursing, and all ancillary services to improve work relationships on the inpatient unit Identify issues and work on solutions to improve resident well being and patient care Make the schedule of rotating residents, provide residents with feed back on progress, complete resident evaluations, communicate with Outside Chief Residents Organize daily noon conferences, give didactic lectures on topics of interest in general pediatrics and pediatric hematology/oncology Be informed of all “sick” patients on M-9, provide advice to Attendings/ Fellows/ Residents regarding patient care

Admissions n n n Fellows are notified of all admissions to the floor Patients being admitted will be posted on the patient board on M 9 Typically, admissions from 9 am-5 pm come from the PDH after being assessed by the primary team n n n Once a patient’s name has been posted on the admission board, you do not have to wait until the patient physically comes onto the floor before evaluating them. You can go to the PDH to start the admission process. After 5 pm, they usually come from UCC after being assessed by the fellow on-call Many patients come with typed admission notes BUT this does not mean you don’t take a full H & P on all admitted patients.

Discharges n Anticipate discharges so you can get prescriptions filled and follow-up appointments set-up early on. n Communicate with the case manager, Megan (b. 4547, x 2331) for setting up home-care, getting supplies, etc. requires advance planning n Discharge orders and instructions are computerized in HIS n Please write a discharge note summarizing the hospital course/admission

Consults n Main MSKCC page operator = 7900 or 2000 n Contact main MSKCC page operator to obtain numbers to call (telephone and/or pager) for most consults

Medication Reconciliation n Accurately and completely reconcile medications across the continuum of care. n n n Definition n n Implement a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization with the involvement of the patient. This process includes a comparison of the medications the organization provides at admission, transfer, and discharge to the medications on the list. A process for obtaining a complete and accurate list of the patients’ current home medications , including OTC’s and herbals, and comparing the practitioner’s admission, transfer, and/or discharge orders to that list. Instructions found in Resident Manual

A “typical” day n 7 am: sign-out/sign-in (weekdays/weekends) n n n n Pre-round on your patients, obtain vital signs, I/Os, PCA doses/ attempts RENEW ORDERS for IVF and narcotics 9 am: Start of attending work rounds 11 am: Radiology rounds in PDH classroom (M-F) 1 pm: Core conference and lunch (M-F) 2 pm – 5 pm: Admissions, Discharges, etc. 5 pm: sign-out (weekdays/ weekends (buddy system)) n Enter AM lab orders for next day

Weekday call n n n n On weekdays, call starts at 5 pm You will never be asked to cross-cover other team On-call resident is responsible for all admissions to the floor after 5 pm There is always one fellow supervising. On-call fellow is responsible for both teams on M 9 as well as the Urgent Care Center Responsible for making sure all AM labs are appropriate Midnight rounds with on-call fellow A call room on the floor is provided; meal cards for dinner are provided

Weekend calls n n n n n Sign-out starts at 7 am Attending rounds start at 9 am On-call resident responsible for daily progress notes on all patients on the service (may be typed or written) On-call resident responsible for all admissions, discharges, and transfers from the POU Will be supervised by one fellow per team (unlike weekdays) Cafeteria closes at 7 pm on weekends Midnight rounds with on-call fellow Gets AM vitals and I/Os of all patients A call room on the floor is provided; meal cards for dinner are provided

Call schedules n Adheres to ACGME rules (<80 hours/ week) n Call schedules are made monthly by the Pediatric Chief Resident n Can be found on-line in Pediatrics shared drive n Please let the Pediatric Chief Resident know if there any conflicts, emergencies, illness as early as you can n n Tawana Winkfield-Royster: winkfiet@mskcc. org Long range pager 917 -205 -4091, In-house pager #2244, Office x 8398

HIPAA Training n Currently MSKCC requires that all of its rotating residents complete its on-line HIPAA training course (takes at most 40 min) n n n START Reference Manuals & Tutorials Computer Based Training HIPAA CBT Sign in with your MSKCC employee ID# found on your ID tag Choose “All Users” under ‘Job Function’ Choose the curriculum labeled “All Other MSKCC Users” Then make sure to complete the required courses (HIPAA Awareness and HIPAA Security) PLEASE complete this as soon as you can…and give me the certificates when you are done

Computer Information n n Passwords found on back of “white card” Healthcare Information System – central hub for all clinical information at MSKCC; integrates order entry, labs, medical records, radiology, pathology, on-line databases (Up. To. Date, Lexi-Comp), on-line calculators n n On-line tutorial = http: //mskcbt. mskcc. org Username: “pedteam” / Password: “pedteam” sign-on for all computer workstations Start Programs Accessories Windows Explorer Peds Shared Drive = H: -drive

On-line HIS Tutorial n Can be accessed from within MSKCC or at home n http: //mskcbt. mskcc. org Log in using "New User“ Then take course called "Clinical Systems"

Peds Shared Drive (“H: -drive”) n Must log-in to computer station using “pedteam/pedteam” n Contains notes, schedules, resident resources n Start Programs Accessories Windows Explorer n For inpatient admission/progress notes: n n n For monthly call schedule n n H: notes_M 9M 9_GREENTEAM_ONC H: notes_M 9M 9_BLUE TEAM_BMTBlue Team_Progress_Notes H: Pediatric On-Call SchedulesFellows SchedulesOn Call Schedule H: Residents you will find orientation materials, lecture slides, review articles, handy databases, etc.

Housekeeping n n n Every morning, please renew all IVF and PCAs/narcotics after checking AM labs and obtaining vital signs Please also renew all medication orders promptly Blue meal cards are provided for meals on-call only: $5. 50/meal Please return all beepers to “beeper drawer” at end of each day M 9 Hallway Bathroom code = 27368 Important phone numbers: n n Chief Resident: Tawana x 2923 Wendy Werner: x 5966 Alexander Chou, MD: 6057, beeper 917 -205 -1757, e-mail: choua@mskcc. org When in doubt, please ask

Don’t worry, you’ll be just fine!!