A. Inpatient Rotations
The 1st year Fellow will spend the first 8 months of the year on the inpatient service. During the inpatient rotation, the Fellow will have 1 outpatient follow-up clinic weekly. The inpatient team will consist of the Fellow, the supervising Attending, a pediatric gastroenterology nurse practitioner, and a second-year pediatric resident to whom GI inpatients are assigned. Every year, there will also be a month when a senior GI Fellow, with the GI Attending as back-up, will be primarily responsible for the supervision of patient care by the 1st year GI Fellow and pediatric resident. The second-year Fellow will have 3 months of inpatient responsibilities, as well as weeknights and weekends that the 2nd year Fellow is on call.
Rounds: Work rounds with residents and the GI Attending will be conducted daily at approximately 10 a.m. It would be helpful for the Fellow to pre-round on the patients since the pediatric resident is not always able to do so. The Fellow should strive to see the sickest patients before work rounds. An attempt should be made to have all notes written on each patient by the end of the morning. If there are films that need to be reviewed at rounds, the fellow should attempt to obtain these films.
Charting: Standard admission, SOAP and problem-oriented formats are used in documenting patient contact. All inpatient notes should have dates and times on them. Admission notes must have a clear statement as to why the patient is being admitted, and a plan outlining a specific course of action. It is also important to discuss the plan with the residents to give them the opportunity to ask questions and clarify intended intervention. The residents are not always able to read our admission notes promptly and they depend on us to communicate with them any urgent management plans.
Consultations: Consults must be done within 24 hours of notification. It is again important to communicate with the team of residents or the attending in charge of the patient our recommendations, so that implementation can be carried out promptly. It is necessary to officially “sign-off” by a note in the chart on any patients that are no longer followed by GI. Inpatient GI consult patients that were seen initially by the fellow and need follow-up after discharge are to be scheduled for follow-up with the fellow to ensure continuity. The fellow is responsible for logging all consults in an Excel spreadsheet established by the division for tracking consultation data.
Radiology/Pathology: All imaging studies must be viewed. It is not sufficient to review just the report. Studies may be viewed electronically through the iSite Stentor site. If biopsies taken from inpatients are available for viewing, these must be viewed and the results added to inpatient charting. Viewing of biopsies can be arranged for by calling pathology and speaking with either the secretary or the pathologist directly.
Discharge Summary: The Fellow is responsible for dictating a discharge summary on any patient on the GI service who gets discharged when the fellow is on service.
Evening/Morning Check-Out: When the inpatient Fellow is not the On-call Fellow for a particular evening or weekend, the inpatient Fellow is responsible for signing out any unstable patients or anticipated admissions to the On-call Fellow or Attending. Fellows are responsible for providing a complete list of patients to the Attending.
The on-call Fellow must relay any significant changes that occurred on patients being followed by GI to the inpatient Fellow the following morning. Overnight admissions arranged for by the on-call Fellow and Attending will be seen by the inpatient fellow.
