DRH Handoff

Your primary role is to operate, and help with the floor/consults as time allows. Check in with Intern in between cases.

This applies when there are no FM Attendings on call:

• •FM Antepartum patients — these become staff patients and the OBGYN resident should be 1st call and manage.
• •At the start of the night shift, FM residents on call may present to L&D and introduce themselves to the on-call OB-GYN resident. Nurses know to page them if patients in triage arrive.
• •Any FM OB pages that will result in a L&D triage must be communicated directly to both the charge nurse and the OB resident on call.
• •The FM resident triages the FM OB patient with the 3rd or 4th year OB resident. The OB resident acts as the supervising resident similar to when training an OB intern. If a 2nd year OB resident is on call, the FM resident will not be involved.
• •After triage, the FM resident notifies the OB resident if they can commit to staying on L+D 100% of the time to co-manage. If not, the OB resident assumes care. If yes, they co-manage with the OB resident acting as supervisor (similar to training an intern). The OB resident should communicate with the OB attending as usual.
• •If the FM resident is not able to commit 100% to L+D, the nurses will notify the FM resident when the patient begins pushing and if at that time they are able to commit 100% to L+D they can be involved in the delivery supervised by the OB resident and the OB attending on call.
• •C-section follow-up should be scheduled with either Harris & Smith or Durham OB depending on which group performed the surgery.

• •Durham OB patients, DRH unassigned, and resident patients (Duke MFM, no prenatal care, surrounding OBGYN offices) supervised by DOB attendings → Durham OBGYN RN triage for PP follow-up.
• •H&S patients, DRH unassigned, and resident patients (Duke MFM, no prenatal care, surrounding OBGYN offices) supervised by H&S attendings → H&S OBGYN RN triage for PP follow-up.
• •H&S and DOB groups: routine follow-up for c-section / SVD w/o other reasons for follow-up should be seen at 6 weeks postpartum, not 4 weeks. We do not perform routine “incision” checks.
• •DCHD and surrounding health department patients can be seen at the respective health departments.

ED Pelvic Exams:

• •The OBGYN provider can use the SANE room with the pelvic exam bed for pelvic exams in the ED. Just need to ask the ED charge nurse to get the patient moved into the room.
• •When a patient is transferred from the ED to L+D, the OB provider must place the “Assign as Inpatient” or “Assign as Outpatient” order prior to the patient leaving the ED so that the L&D team can see the patient in the depot.

The schedule is created by the DRH Chief. However, if your Chief is on vacation, you make the schedule.

• •Mondays — Single DRH 1J template (can be any level, but account for someone on the floor).
• •Include FP and MIGS ORs.
• •Have senior scheduled for each sign out with Intern every day.
• •Put med students in ORs vs Floor (not in MIGS ORs).
• •Weekly schedule email includes people working weekend shifts.

In EPIC under ‘Schedule’, your DRH OR list should include:

• •Hernandez Calderon
• •Manvelyan
• •DASC ORs
• •Family Planning providers
• •MIGS providers

Simulator at Duke Regional Hospital in OR 11.