Benign (Chief) Handoff

You are the Chief of this service and considered the “Fellow”. You are responsible for making the weekly scheduling, knowing the entire service, managing consults / emergent ORs, and leading the intern and medical students.

Friday at 10 PM — send coverage requests via Google Form for Admin Chiefs.

On Sunday, when the Admin Chief releases schedule — go through EVERY DAY of coverage email:

• •Take note of ORs/clinics being covered by Benign and other services for Benign.
• •Note people on your team who are pulled.

Qgenda for ED/Rounding Attending, PM Call Attending, 1J Attending.

• •1J: PGY-3 on Mondays, PGY-4 on Tuesdays.
• •ORs take priority. If Monday or Tuesday ORs, Benign resident covers and you get coverage for 1J or Emergent ORs.
• •Maria’s Cervix Clinic on Mondays — need to request coverage from 12 PM until PGY-3 done with 1J for Consults/Floor and Emergent OR.

Every day, Benign Consults/Floor and Emergent ORs need coverage 0700–1800:

• •Maria usually covers Consults/Floor 0830–1630 Tuesday–Friday. At the beginning of the block, ask her for her PTO / meetings / appointments so you can request coverage in her absence.
• •The PGY-3 or PGY-4 can serve as both Consult/Floor and Emergent OR backup, or split roles. Emergent OR backup can be from home / not in the GYN work room if you have meetings.
• •Request coverage when not possible for the PGY-3/4 to cover schedule needs.
• •Rarely ORs on Mondays. Usually ORs Thursday. ASC ORs on Fridays.
• •Sample coverage needs: 0700–0830, 0830–1630, 1630–1800.

• •All DUH/ASC Benign GYN and DWHA DUH/ASC/Arringdon ASC (AASC) ORs except for Family Planning Attendings (Gray, Swartz, Hagey).
• •Benign DOES cover Hagey ORs at the ASC only.
• •Sometimes cover PAG ORs (Streich-Tilles) when Monday or REI resident unavailable — see coverage email. Include Streich-Tilles ORs on weekly schedule if covering.
• •Do not cover GYN Attendings at DRH.
• •On Wednesdays, Benign PGY-3 and 4 have option of covering DRH majors. If covering, include on weekly schedule.

• •MS2 — alternate between Floor and ORs. Never send to clinic.
• •MS4:
• ◦Mondays: 1J AM / Cervix Clinic with Maria PM
• ◦Tuesdays: if Kerner operating at DRH, send to DRH OR
• ◦Rest of the week, Floor or OR
• •If they have special interests, can coordinate with Irene for ultrasound template or Carleen for EPAC.

• •Backup for OR, consults, rounding as needed.
• •Have Senior assigned every day to be on the phone when night team gives sign out to Intern (usually between 6 AM – 7 AM, decide on time with night team), and to run list every morning before Intern calls Attending to staff.
• •If list is complex or sick, have Senior on phone during Intern sign out with Attending.
• •In general, reach out to Attending of the day by 7:30 AM at the latest to staff.
• •Technically Emergent OR can be from home unless needed for Intern to staff consults with — then it is in person.

• •Have notes and rounding done before cases — by 7:00 AM those days; if no cases, have done by 7:15 AM.
• •Wednesdays: round / run list before didactics.
• •Should be on the Consult and Benign pagers at 7 AM.
• •Fridays (ASC days): always make an Intern OR day; don’t have Intern round.

Occurs at 6 PM in 4200 work room.

• •Intern signs out every day with a Senior assigned.
• •Towards end of block, can clear Intern to sign out independently.

• •Intern sends reminder via weekly email that it is Wednesdays at noon with Zoom link they make + link to Pre-op Excel spreadsheet.
• •Go through it with Intern the first week and make it together.
• •After the first week, Intern does pre-op conference independently. Sub-I to split list with them; if no Sub-I, consider splitting list with them so not too much work on one person.
• •Talk with PGY-4 about whether they want to do learning points / teaching for the cases.
• •After Conference, clean up doc and send to Attendings.
• •Only Pre-op Benign GYN attendings at DUH/DRH/ASC (excludes Hagey DUH/DRH, Gray, Swartz, DWHA).
• •If Gray with a CKC/LEEP, ask if FP pre-op’ing or not.

Recommend making separate EPIC Pre-op Benign GYN Attending list:

• •Hagey ASC only
• •Hernandez Calderon (exclude DRH)
• •Kerner
• •Lachiewicz
• •Pleasant
• •Wilson

• •Level 1 or 2 → don’t need H&P or Consult note signed before OR. Attending does not need to see patient before Level 1 (may see for Level 2). Can roll to the OR yourself for level 1 (e.g., ruptured ectopic with unstable vitals).

Leveling Process:

• •Call Attending.
• •Case request → fill out for Duke North OR. Diagnostic lap (torsion, ectopic, etc.).
• •Call OR front desk. Talk to circulating staff: “Posted a Level # for X… I need X.” Let them know special requests or change order of leveled cases. If have scheduling needs, call OR Scheduling. Pull up snapboard and reference while talking.
• •Paging Anesthesia: page Anesthesia Attending to GYN Attending’s phone number: 970-9111. “Level X for X, Attending Name #Phone.” Nights/Weekend → page Anesthesia Resident to OB Chief.
• •Consent patient.

• •If need a Wednesday add-on for Family Planning cases (D&C, D&E), know that Wednesdays in the afternoon FP attending on L&D usually has afternoon off. Call them first before posting to see if they have availability (they may have meetings scheduled).
• •If you note that GYN OR (including Onc) has early end, can request unscheduled inpatient cases or leveled cases to follow.