Benign Handoff

• •Duke North (DNOR Main)
• •ASC
• •DRH (unlikely as the intern, but depending on your chief and your service you may operate there)
• •Get parking access added to your parking permit at the Parking Office (next to the bookstore — you can also call the parking office and have it added). It’s PG III.

Team will have a daily group text to decide who will round. Generally round on whoever you operate on.

• •Takes longer to round — includes night-team admits.
• •Get there based on rounding needs: 6:00 / 6:30 AM, 20–30 min per person total (read, see, write note).
• •Patients will be all over the hospital, so factor this in when planning what time to arrive.
• •You’ll receive sign out from the night resident about your patients, usually around 6:30. Call them and get overnight updates. In the beginning your chief will join that conversation; over time the team will trust you to take it solo.
• •Once you pre-round on your patients, you and your upper level call the attending and sign out. You’ll round with the attending later in the day — but if you’re in the OR, the attending will usually round with Maria Domingo (APP) and you can get updates from her later.
• •Notes need to be to the attending by 8 AM. If you’re going to be in the OR that morning (first case usually 7:30), plan to have them earlier.

Usually operate with an upper level, so experience is variable.

• •Works directly with attendings.
• •Sees consults while we are in ORs.
• •When you’re on the floor, she will see consults with you and progressively give you independence to see consults on your own. She’s a great source of information and learning — utilize her when you can.
• •On Wednesdays when you’re at didactics, start an Epic chat to update her on what was discussed on the AM attending call — she doesn’t get in until 8:30 AM.

• •Send out a Zoom link Wednesday AM beforehand to those attendings (see who in the email the intern before you included you on), then host the conference on Wednesday at noon. You should have the link via a calendar invite that an administrative team member sends out at the beginning of the academic year.
• •You generally do pre-op conference for the cases happening the following week. (So for this coming week, we did pre-op last week.) I generally worked on the sheet on Friday or Saturday, or during downtime on the floor.
• •If you end up having a sub-I, you can teach them to do it — e.g., you do the first two weeks and they do the rest/last two weeks.
• •Pre-op Conference is only for Community Health attendings (1J), NOT DWHAs.
• •Configure Snap Board to save ORs (ASC, DRHOR, DNOR).
• •Configure “Benign Gyn Pre-op” lists for all attendings you could possibly operate with.
• •See instructions below.
• •Only attending not on the below images is Dr. Megan Huchko — be sure to add her to your schedule.

[Original Epic configuration screenshots from the source document inserted here in the full version.]

• •For cases, I generally read the pre-op visit to know their history. Looked at recent labs and any imaging, including uterus size.
• •See below — some tips my chief sent me prior to starting that I found very helpful.
• •I generally prepped for new cases by first watching a video on TVAS if they had it (or on YouTube), then reading about it on Williams (we get access to the online textbook through Duke), and then reading the op note. You of course don’t have to do this, but I learn best through reading, and Williams was an easy read — especially after watching a video first.
• •For op notes I would search for Chelsea Fledderman and Alex Sunderman, or even your chief, and add yourself to op notes for TLH, TAH, TVH, BTL, hysteroscopy, BS/BSO, and any other procedures you might have. Other people you can also search: Jenny Wu, Jessie Li-Barton, Jennifer Talbott.
• •Practice, practice, practice suturing at home. If you don’t have a kit, ask Caroline.

[Verbatim chief-to-chief tips from the source document inserted here in the full version.]

Common consults: PID, pregnancy of unknown location / ectopic, vaginal bleeding and pregnant, heavy vaginal bleeding, ovarian torsion.

• •Consulting team needs to be called back within 15–30 min; urgent consults (heavy bleeding, seizures, scary ED stuff, torsion) within 15 min.
• •Consults seen and evaluated within 1 hour; note completed in 2 hours.
• •No consults or notes should be pending by signout (it stresses out the night team!!).
• •Consults after 5:45 PM will be seen by night team; consults after 6:45 AM will be seen by day team.
• •PGY-1/2 run consult by upper year immediately after calling back team to discuss plan, see patient and finalize plan, then run by attending (call upper year or call into OR).

• •Call night float around 6:45 AM for sign out.
• •Sign onto first call after sign out, and sign onto the benign pager and/or consult pager (0700).
• •Progress notes for inpatients need to be signed by 8 AM to the attending of the day.
• •PGY-1/2 run progress note and plan by upper year or attending.
• •Anytime you see a patient (i.e., PM check-in) needs a brief progress note — a few lines is okay.
• •Call/text attending in the morning after seeing patient to discuss plan of the day.
• •Handoffs started on admission, updated daily with to-dos and events of the day (this is what keeps patients safe at night).
• •Always work toward discharge — what is keeping the patient in the hospital?
• •Discharge summaries signed within 24 hours.
• •Sign out to night team: one-liner, events of the day, any to-dos, plus anticipatory guidance (if x then y).

• •Must prioritize these H&Ps — include VTE algorithm (.gynvte).
• •Call and discuss plan with attending.
• •Sign consents.
• •Orders and post case.
• •Page attending number to anesthesia attending (sometimes need to page resident anesthesia pager).
• •Call OR front desk to tell them about the case (can ask them any other specifics needed, including special instruments).
• •Need consent to roll with patient.

After case:

• ◦Post-op orders placed.
• ◦Brief op note before patient leaves OR.
• ◦Op note must be done before day ends by the surgeon who did the majority of the case.
• ◦Post-op follow-up internal communication and post-op patient instructions.
• ◦Update handoff if they are staying.
• ◦Log case!!

• •Meet patients beforehand; sign consents if needed.

After case:

• ◦Post-op orders placed.
• ◦Brief op note if not going to write op note in the next 30 minutes.
• ◦Op note must be done before day ends by the surgeon who did the majority of the case.
• ◦Post-op follow-up internal communication and post-op patient instructions.
• ◦Update handoff if they are staying.
• ◦Log case!!