DRH Handoff

Park in employee lot off of Olympic and use the staff entrance by outpatient services entrance. Scrub machine on 3rd floor; can return on L+D (across from workroom).

Resident workroom: 4th floor L+D (across / slightly to the left coming out of staff elevators).

• •Postpartum / Antepartum / Gyn patients down the hall on unit 4-3.
• •AM Sign out 7 AM, PM Sign out 6 PM.
• •Navy blue scrubs (3rd floor) for main ORs.
• •Two physical pagers: OB emergency, and regular OBGYN resident pager.

Context: DRH IP OB Virtual

Snapboards:

• •DRH OR (3rd floor)
• •DRH OB ORs

Patient Lists — DRH OB:

• •All C-sections you do (excluding Chapel Hill OB / Durham Women’s Clinic).
• •Gyn post-ops.
• •DCHD / Duke Perinatal / no prenatal care or non-private practice patients.
• •All antepartum patients (including Durham OB and Harris & Smith).
• •Triage patients won’t auto-populate onto the DRH OB list — usually the nurse will let you know if you have someone, but always good to keep an eye on the L+D greaseboard. You’ll see triage pts with no PNC, health dept, UNC, DPC, DWHA.

DRH Consults:

• •Patients should automatically pop up on the DRH OB list — add manually if they don’t.
• •Call to respond to page/consult within 30 minutes.
• •Ask if the patient is established with a group. If it’s CHOB or DWC, those providers should be contacted by ED to see the patient.

*Other: sometimes we get patients from Cone Health, Granville CHD, out of state, etc.

C-section / general:

• •.CSDECISION
• •.KNHDRHCSTODO — CS to-do checklist
• •.KNHTRIAGESCHEDULEDCS — Scheduled CS plan for H+P

Consults / discharge:

• •.GYNCONSULTHP
• •.GYNCONSULTBETA — PUL consult note
• •.GYNDCSUM
• •.ACSCONSULTACUTEVB
• •.TXAUB — options for AUB management
• •.LEVELEDCASE

Op notes:

• •.ABOPNOTEECV — ECV op note
• •.HCKOPCSECTION
• •.KNHOPPPBS — postpartum salpingectomies
• •.KNHOPSUCTIONDC — suction D+C for missed AB
• •.KNHOPECTOPICSALP — ectopic with salpingectomy
• •.KNHOPDXLAP

Contact / PP instructions:

• •.DRHCONTACT
• •.PPDRHINSTRUCTIONS

Blood pressure cuff for patients with hypertensive disorder of pregnancy:

• •Order blood pressure cuff prior to discharge.
• •See blood pressure flowsheet for process and who patient should see for BP check.

Follow-up appointments:

• •Send internal communications for every practice except county health department patients (Person County, Durham County, Wake County, etc.).
• •Dot phrase: .internalcommunication

Summaries:

• •Make sure they’re done between you and the team (I created my own personal D/C summary list because people come off the list pretty quickly).
• •Same-day surgery going home → NO D/C Summaries.

• •Try to prep H+P and put pre-op orders in the night before (order set; make sure labs are ordered if they need them).
• •Scan patient in triage for presentation when you see them / consent.
• •Use the iPads for consents (at back corner of nurse station).
• •For op notes there’s a list of what sutures attendings use for each stage of closure in the workroom.
• •Always do a brief op-note.
• •Write specifics that deviate from your op note template on a Yellow Sticky Note in patient chart when you don’t have time to write the op note right away. Every attending does things a little differently.
• •CS checklist: .KNHDRHCSTODO

• •1J clinic day: Thursday afternoon clinic (after January).
• •Medical student practice pages: Wednesday evening on 2nd and 3rd weeks of MS2 rotation.

• •Early pregnancy loss
• •Tubal ectopic pregnancy
• •Evaluation and management of adnexal mass
• •Management of acute AUB
• •Management of labor

• •1. Call back consults within 30 min. If you’re in the OR, you can have the nurse call back the ED and let them know you’ll call back, or simply wait. Some attendings will want to call back in the OR; some feel like it can wait because if they’re unstable, then the ED needs to stabilize them first anyway.
• •2. Try to see consults as soon as possible. Even if all you do is get the history. Don’t wait — it can pile up. You can ask the attending to do the first few exams with you. Some will volunteer to see patients with you.
• •3. Ask for help! From attendings, from uppers, from the midwife, etc. Get the attending of the day’s number after sign out and ask them if they want to see every consult with you or want you to see them then come tell them about it.