ED EDITION

Introduction Schedules FirstNet Where things are When things happen Charts

Orders Consults Admissions Discharges Procedures

The pediatric emergency room department is located on the 4th floor of the new wing. Even though tons of people will show you where it is, you will still get lost for the first week. It’s okay. We understand.

Dress code is scrubs ± white coat. As it stands right now, pediatric residents work in

the ED during 1 of 3 shifts: Daily: 10am – 10pm or 2pm to 2am Wednesdays: 12pm – 10pm (plus above mentioned

night shift) Be prepared to see at least 10 – 12 patients in a

10-hour shift, more during the winter months. You will hopefully learn the finer details of time-management, triage and emergency management of pediatric patients.

For every 14 days of ED, you will work 7 12-hour shifts.

Continuity clinic will be once per week and full days.

You will be post-call on days after you’ve worked 2pm to 2am, but you can work multiple night shifts in a row. If you are post-call on a

Wednesday, you do not need to attend lectures.

If possible, chiefs will schedule shifts so that you will have two entire weekends off for every month you work.

FirstNet is our electronic ED board. For access, please email Peter Vecere, ideally 2-3 weeks before the start of your ED rotation.

Take an hour or two just to surf around FirstNet and see how things work. The first thing you should do is set yourself up as a provider: Hit the “provider” tab Pick a nice nickname for yourself and a representative

color Select “mid-level provider” as provider role.

For more information regarding FirstNet, please refer to your previous CPOE orientation/training.

Charts When you walk into the ED, chart racks will be in front

of the nurse’s station and will house, in order from the first chart you see to the last: Patients waiting to be discharged Charts in process Charts that need orders picked up New charts

Carts Green (in each room)

Blood/IV/Urine supplies Diapers, pedialyte

Yellow – ED wear (gloves, masks, gowns, etc) Blue – Casting supplies

Board Our new electronic board is projected in HD to your left

as you walk in.

The ED is pretty straightforward in that you come in when your shift starts, see patients, and sign-out when your shift ends. If your shift ends at 10pm, you should sign out

to another resident seeing pediatric patients. If your shift ends at 2am and patients are still

under your care, two things must happen before you can go home: The ER* resident must take sign-out from you Attending-to-attending sign-out must take place…

though this is obviously not under your control. As a failsafe measure, please log your

ED duty hours on new innovations @ https://rms1.newinnov.com.

On the green triage form, you will find:Level of acuity (assigned by nurse in triage)

Level of acuity will determine how quickly the patient is seen. If ten patients who are a level three are waiting to be seen, but a level two walks in the door, the level two jumps to the front of the line.

Always see the higher acuity patients first.Age of patientChief complaint and 1-sentence HPIWhatever vitals were done in triage

Take all vitals with a grain of salt and, if concerned, make sure to repeat them.

Brief HPI, PMH and physical exam.

Tip: Note the PMD somewhere on your H&P form.

Sign, date and time at the bottom.

ED, like all of medicine, is all about documentation.

You will document any change in patient status, reaction to medication, conversation with a PMD or consulting physician, etc.

Document anything that you would want to know if you were a consulting physician looking at the chart for the first time.

When a patient leaves the ED – whether it is to home, to the OR, to 11N, or to somewhere else – a disposition form must be filled out.

Fill out everything except for diagnosis and billing – the attending will take care of those – and sign at the bottom.

This will be reiterated multiple times, but if you are discharging a patient from the ED, tell their nurse.

All order writing is now done electronically through our CPOE system. CPOE is accessed via FirstNet by double-clicking a patient’s chart.

As with all orders, you should notify the patient’s nurse of any new orders, especially if the order is written as STAT.

Lexi-Comp online (http://online.lexi.com/crlonline) is our hospital approved reference for medication.

In the ED, all orders are usually STAT and x1 in frequency. The STAT designation is extremely important, especially

when you are ordering labs and scans. Don’t forget the STAT!

Chem-8s must be ordered using the “ED Whole Panel” option or the STAT lab won’t run them.

When arranging for a consult, put a physician consult order in the computer. The clerk will then page the appropriate person. Just so you are aware: If there are no ophthalmology residents seeing pediatrics

patients, consults are attending-to-attending. ENT consults are always attending-to-attending. Cardiology and child pysch consults are arranged via their main

offices. To consult either one of these services, have the operator connect you to their main office. Tip: Before calling a cardiology consult, you should obtain an EKG and

4-limb blood pressure. They are always helpful!

Fill out the top part of the consult form and clip it to the chart.

Never call a consult without attending approval. Never initiate a plan proposed by a consultant without

attending approval.

If a patient needs to be admitted, you first must determine who the admitting physician will be. A patient with a private attending who admits to the

hospital will be admitted under that attending A patient with no PMD or a PMD without admitting

privileges will be admitted under the hospitalist service.

A patient going to a subspecialty/surgical service will get admitted under their on-call attending.

You must then talk to the admitting physician and outline a plan for the patient once they are admitted.

Call their destination and talk to: The charge nurse The on-call resident who will be accepting the

admission Note on the disposition form who you spoke to

and when.

Patient Information and Follow Up To start the depart process, single-click

your patient on the tracking list and then select the notepad (the second-to-last icon) on the toolbar.

Complete the “patient education” and “follow-up” forms. Follow-up is generally with their PMD in 1-2

days. Also instruct them to return to the ED within 1

week if necessary for whichever symptoms you would deem appropriate.

Check the box that states that the patient verbalizes an understanding of these instructions.

Print.

Disposition Form As with admissions, fill out the entire form except diagnosis and billing. Make sure to fill out the bottom thoroughly, including if you want your patient to

be taking Tylenol and Motrin. Double check doses! Because you’ve already printed out information and follow-up instructions, you

can write “please see attached” in the area of the disposition form that asks for that information.

You will get to try your hand at numerous procedures in the ED from the fairly simple rapid strep swab to the slightly more involved lumbar puncture.

All procedures must be logged in New Innovations. Sign in my procedure log enter a procedure When you choose a procedure (for instance, lumbar

puncture), the program will tell you Your credential target Logs counted toward that target

Take one day to look through all of the procedures that require credentialing and how many you need to do. Keep those numbers in mind!

You should do all of the procedures possible during your rotation. Practice makes perfect.