Welcome to Inpatient Peds

Welcome to your first month on Inpatient Peds at CCHMC. This should be a fantastic month for you! You will have the opportunity to work with very strong pediatric residents and learn from some of the giants in education and pediatrics. CCHMC is a pretty incredible institution! The focus of the rotation is to gain experience in caring for acutely hospitalized general pediatric patients. Although CCHMC is the home of zebras, the goal is to cover the bread and butter during the month and perhaps be exposed to a zebra, but not be the area of focus. 

If you have not received information from CCHMC (check both your personal email and TCH email) within 3 weeks before your start date, please let Dr. Putnam and Holly Hargraves know.

There are a couple of things you need to do to have a successful rotation:

• Badging

  • You must obtain your badge before you start work. Try to get it the week before you start work.

  • The cost of the badge is $15 (cash, credit, or check)

  • You may pick up your badge at The Protective Services Office in the South Garage

    • Bring payment and a drivers license or state ID

    • You will be photographed and fingerprinted as part of the process

    • Office hours: Monday - Friday, 8am-4pm

• EPIC Training

  • You must attend an in-person or online EPIC training session through Cincinnati Children’s within 5 days prior to starting your rotation or you will NOT be granted EPIC access.

  • You will be assigned a virtual training session. If you’d prefer to attend the training session in person, contact Mark Brasington at mark.brasington@cchmc.org

  • An EPIC trainer will contact you by email with training information.  If you cannot attend training on this date, then you must contact the EPIC trainer to schedule another date.  Rescheduling must be done in advance of your rotation.

  • For IT help at any time, contact the Helpdesk at 513-636-4100

  • Please contact Dr. Putnam or Judy if you have not heard anything about the EPIC training

• Record encounters

  • You must keep a record of how many encounters you have each day.

    • (1 encounter = 1 note/day; if you write 3 notes for a patient over the admission, you have 3 encounters)

    • Just tally how many notes you write each day. This is you number of encounters

  • Please print the encounter tracker as emailed to you and give to Holly completed at the end of the rotation. Fill it out each day!

• Dr. Rosenthal provides care for the pediatric patients from our office over at CCHMC. If a patient from our office is admitted, please request to have the patient assigned to you in order to provide additional continuity. 

Have fun and enjoy the rotation!

Faculty lead: Dr. Putnam

General info: 

• If you want to get CCHMC Epic off site at all you’ll need to set up multi factor authentication at Children’s - the easiest way to do this is just to call their IT support at 636-4100. They have 24 hour support and will walk you through finding the MFA site, setting up multifactor authentication, and getting into Epic. Please do this after your EPIC IT orientation as they may address this then.

• You will follow the same schedule as a peds intern

• You will be on a color team (Blue, Purple, Red, or Orange)

• Each team consists of senior residents, interns, and usually AIs

• Resident work rooms are on A6 (Blue-Purple is A6. 110, Red-Orange is A6. 115)

  • On the first day, the inpatient work rooms are all on the 6th floor in the A building at Children’s. You should get there a few minutes before 6a on your first day.

• Admitting shifts last 6 AM-7:30 PM, typically alternate admissions with your peds intern buddy and after 5 PM you will cross cover for your sister team

• You will work 5-6 nights from 7 PM-9AM, night team must be done by 9AM. The night team will present as many admits as they can in the AM, but you may have to present on the fly if you pick up a patient that they don't get to. They never present psych overflow (pts who are boarding until a bed opens up in the psych facility).

Mandatory Activities and Rounds:

• Please check with your senior first day on rotation or the recent TCH/UC resident who did this most recently if anything has changed:

  • Morning report starts every day at 7:30 AM (except Grand Rounds and FIRMS days) in the resident conference room on A8, rounds typically start after this at 8 AM

  • Grand Rounds is every Tuesday at 8 AM in auditorium, rounds start at 7:30 AM, break for Grand Rounds then resume at 9 AM

  • FIRMS (case conference) every other Thursday at 7:30 AM in auditorium

  • Noon conference, at noon (obviously) in resident conference room

  • Rounds are family-centered, except psych overflow- discussed outside the room

Notes:

• If you admit the patient, you write the H&P

• If admitted overnight and you are taking over care for the day:

  • Admitted before midnight: you write progress note

  • Admitted after midnight: no progress note needed that day

• To make somebody a "Watcher" (someone who is unstable/team should be worried about, needs reassessment every few hours) must write a watcher note (.saconcern)

• Admitting psych overflow, notes are typically pretty brief, don't need to do a super thorough history, just need to know generally what they are being admitted for and that they are medically stable- sorry FMPs!

Useful templates and dot phrases

• In general, talk to the CCHMC senior or co-intern for smart phrases. The following could still apply:

• In the "Insert Smart text" box type the following (and save as a favorite to make your life easier!)

  • ip hospmed general admit - for general H&P template

  • ip hospmed general asthma admit - for asthma H&P template

  • ip hospmed progress note - for daily progress note template

• Psych overflow:

  • borrow smart phrase note from CCHMC intern/senior

• Watcher note:

  • .saconcern

• Letters:

  • Go to letters tab

  • For work/school excuses use: amb: letter school excuse- take out outpatient heading and change phone number to 513-636-0000, may have to alter parts of note to reflect hospital rather than outpatient visit

  • School note to allow medication: neu: letter school auth med admin (this is a neuro note but has all the info you need, take out all neuro info and give general phone number 513-636-0000)

Accessing Epic externally:

• Extranet.cchmc.org

• Use your login info, go to Citrix applications or Centerlink

Clinical Resources:

• Community Practice Support Tools: A great CCHMC resource with succinct information items on common diagnoses

  • https://www.cincinnatichildrens.org/professional/resources/community-practice-support-tools

• CenterLink (centerlink.cchmc.org)

  • Isolation Guidelines:

    • Go to Residents tab

    • Patient care links --> Clinical Resources --> infection control policies and resources"

    • Choose "Transmission-Based Isolation Precautions for Selected Agents, Diseases or Syndromes & Appendicies" and look up specific condition or organism

  • Evidence Based Guidelines:

    • Go to Residents tab

    • Patient care links --> Clinical Resources --> CCHMC Evidence Based Guidelines

    • They have very specific protocol and discharge criteria for bronchiolitis, asthma, and neonatal fever (links below), so definitely look here for those conditions, other conditions you can try to look here too.

      • AFP Articles

        1. GER

        2. ALTE (note: new guideline has changed name from ALTE to Brief Resolved Unexplained
           Events)

        3. Febrile Infant

      • CCHMC Guidelines (click here to review available resources and read topics below)

        1. Fever of Unknown Source

        2. Management of Acute Exacerbation of Asthma