Comer Children’s Hospital Pediatric Emergency Department

1. Comer Children’s HospitalPediatric Emergency Department Resident Orientation

2. Prior to arrival… • View entire resident orientation slideshow • Access chief resident’s webpage • http://pediatrics.uchicago.edu/chiefs/PER • Review all the clinical guidelines prior to starting work in the PED – our faculty expectation is residents must be familiar with these guidelines prior to working in our PED • Contact Gail Armstrong to ensure all paperwork completed (773-702-9087)

3. Pediatric Chiefs Page via the Intranet • Link via “UCMC Intranet for Physicians” • Select “Pediatric Chiefs”

4. Pediatric Chiefs’ Page • Scroll down and select “Emergency Medicine” • Multiple resources including • clinical guidelines • important numbers • additional resident orientation resources

5. Comer Emergency DepartmentLay Out • 22 exam rooms • Orthopedic procedure room • Trauma room • 2 beds • Flex up to 4 beds if needed • Infant warmer for deliveries • Two isolation rooms with anterooms • Negative pressure • Positive pressure • One OB/Gyn room with attached bathroom

6. Lay Out Central Hub – physician and nurse workspace • 5 main pods • Pod 1- Rms #1-3 • Pod 2- Rms #4-7 • Pod 3- Rms #8-12 • Pod 4- Rms #13-15 • Pod 5- Rms #17-20 • Rm 16 - OB/Gyn room

7. When You Arrive… • Sign-in on the white grease board • Find a cordless phone for the duration of your shift • Sign into Epic • Remember to log-off and sign-out when changing computers and at the end of your shift

8. Signing up for Patients • Choose next patient based on acuity – higher acuity before lower acuity regardless of length of time in the ED • Within the same acuity level, choose next patient based on length of time in ED – longest first • Or use the “Next to See” button in EPIC • Please do not “cherry pick” – your fellow residents will notice! • Please sign up for patients when you are ready to see them, not several at a time

9. Epic Charting • “Share” your note prior to presenting to the attending • Do not have to “accept” note if plan not determined • Facilitates care as attending can view prelim note • “Accept” note after plan created • Reassessments can be done as “ED note” • Accept ALL notes prior to discharge and if signing out at the end of a shift • Prescriptions will print out and will need to signed and place in blue folder prior to discharge • Select “Discharge” after staffed with attending and patient ready to be discharged

10. PER Order Sets • Select ORDER SET • Search “PER” in order set field • Select from list of “PER: IP” order set listed

11. Epic Observation Status • Select “ED OBS only” • Use order set “912 or “PER:IP OBSERVATION” • Document updates of patient using ED notes including patient’s status at time of final disposition: • home vs. admit vs. transfer

12. I want to follow up on my patient from my last shift – how do I do this? • Use “My Reports” to track patients seen • Select “My Reports”

13. Select “UCMC COMER” Select “Monthly, My Patients, My Patients Last 24 Hours and “My Patients Last 7 Days” and select “Add to Favorites”

14. 1 2 3 • Select blue “My Reports” • Select desired report and select “run” • Select “view” after report is “ready to view”

15. Oops! I have pended charts – how do I find them? • Use the same “My reports” procedure • Open chart to • Sign orders • Accept any pended notes

16. Paging Directory • Access text paging system as illustrated • Page by pager number or last name • Page to your cordless phone • If the call bounces to main ED number listen for coordinator to announce call • Page by phone system • Dial 188 then follow prompts

17. How to use paging system • 2 systems • Text paging via intranet • Phone paging via phone or intranet • Important numbers • Main ED number: 773-702-6249 • ED attending phone: 773-795-7696 • Prefixes (internal vs. external calls) • 2-xxxx = 773-702-xxxx • 4-xxxx = 773-834-xxxx • 5-xxxx = 773-795-xxxx

18. Admissions • RFA: Request For Admission • Locate name of floor attending physician on intranet: “Ped General On Call” • 7AM-7PM • Maroon: Gen Peds, Cards, ID, Rheum, Pulm • 188-PEDS (7337) • Silver: Neuro, GI, Nephro • 188-7587 • Gold: Hem/Onc • 188-HONK (4665) • 7PM-7AM • Call Night Float Senior for ALL admits (188-PEDS) • No Pediatric admits from 5-7AM • Neurology resident on consults will NOT be the floor resident caring for the patient

19. Prescriptions Pitfalls • Reasonable doses based on concentration • 8 tsp twice a day? • Start and end date • Please add total number of days in the comments section. Pharmacies call to clarify in spite of the start and end written on prescription • Use Harriet Lane for pediatric drug dosages • Remember to sign the prescription and then place in patient’s blue folder prior to discharge • Pharmacy phone calls get directed to the trauma senior for clarification

20. Social Services • We have 2 social workers dedicated to the Comer ED • Involved in: • Trauma patients – called automatically to all traumas • Physical abuse cases • Sexual abuse and assault cases • Neglect cases • Children at risk for child abuse or neglect • Social service needs of the child or family • Availability: • 7 days a week for 10 hours/day • Available overnight for phone consultation only • Pager #8887

21. Child Life Services in Comer Pediatric Emergency Room Child Life specialists are trained professionals who help children cope with the stress and uncertainty of illness, injury, disability, and hospitalization. We promote effective coping through play, self-expression activities, and age-appropriate medical preparation and education. Child Life Specialists are child development experts who have earned a master degree and are nationally certified. • Top reasons to call Child Life • A patient of any age is exhibiting signs of fear & anxiety • Procedural Preparation and Support • IV placement • Blood draw • Medical exam • MRI, CT, x-ray, ultrasound • Sutures, Derma Bond • Asthma treatment • Catheterization • Injections • Sedation • Casting • Developmental education for caregivers • Age appropriate diagnosis information • Emotional support • Preparation for inpatient admission • Sibling Support • Trauma / Bereavement Interested in learning more about supporting children and families during medical experiences? View the Child Life clinical guidelines • Availability • Child life services are available full time Monday-Thursday 12pm-8:30pm & Friday 9-5:30pm • Child Life services are available by page Monday-Friday mornings beginning at 7:30 a.m. For Child Life services and referrals please page #9308 For more information or questions e-mail chelsea.cress@uchospitals.edu

22. Disposition Resources Urgent Care • Limited urgent care appointments available at Friend Family Health Center Monday-Saturday • HMO patients cannot be seen • New non-HMO patients can be scheduled • Asthma clinic on Monday afternoons for non-HMO patients

23. Disposition ResourcesGeneral Pediatrics • Pamphlets available for primary care and general pediatrics clinic

24. Disposition ResourcesSubspeciality referrals • Advise family a patient advocate will call regarding follow-up with a subspecialist • Fill out paper form and place in blue patient folder • Nurse will copy paper form and leave for the patient advocate • Family to be contacted regarding subspecialty follow-up

25. Welcome to Comer Pediatric Emergency RoomWe look forward to working with you. We hope you enjoy your rotation with us.

26. Questions? Contact • Lisa McQueen MD, rotation director • Pager 4933 • lmcqueen@peds.bsd.uchicago.edu • Gail Armstrong, section administrator • 773-702-9087 • garmstrong@peds.bsd.uchicago.edu