Gyn Onc Handoff

Unit: Duke North 6300

6300 HUC fax: (919) 681-8182 (for OSH results to be faxed)

Printer password: HUCS (4827)

If you have a lot of people to round on, you can get sign out earlier — just text. Print long lists closer to round time so labs are back (great sub-I task).

• •PGY-1 on the floor and sometimes in the OR.
• •PGY-3/4 in clinic 1 day/week.
• •PGY-3/4 in the OR.
• •2 fellows, 3 resident team members, 1 MS2, 1–2 sub-Is.

Use top sheet for yourself for to-dos — check boxes for every task because all of them are up to YOU.

Handoff

• •Refresh handoff for each patient individually before printing the list.
• •Generally 6–12 patients on service.
• •Keep handoff updated throughout the day:
• ◦Summary/Course
• ◦.GYNONCHANDOFFNOTES
• ◦Day Team Notes (free hand text) — update with major events/updates day to day
• ◦X-cover Anticipatory Guidance / To Dos — things for the overnight team
• ◦Recent labs → steal dot phrases from Jasmine Arrington: .CMP8, .CBC8, .Mag8

Rounding Notes

• •.GYNONCROUNDINGMEDICAL
• •.GYNONCROUNDINGPOSTOP
• •.GYNONCROUNDINGCHEMO

If rounding notes are already written on a patient, copy forward and update info prior to signing.

• •Know overnight events.
• •Check labs, imaging, path / cytology results.
• •Check for new notes from consulting services / event notes.
• •See patients who need to be seen — generally people who have issues / active and post-ops. Don’t prioritize patients there for case management / awaiting placement if stable.

Types of patients: post-op, medical admits, chemo admits (inpatient chemo).

Walking or table rounds with fellows — see all patients as a team. Should see everyone and introduce yourself because you are their point person.

Presentation format:

• •Subjective
• •Objective
• •UOP — report in mL/kg/hr if recorded amounts are available
• •Assessment
• •Plan

Take good notes:

• •Case manager conversations, consults, labs to follow up on.
• •Go through each patient on the list and confirm you’ve seen their labs; note abnormalities.
• •You are responsible for calling consults for these patients.

• •Place any consults on the list — you want to be at the top of their list, so do early/first.
• •Consult PT for most patients (exclude young patients) to confirm patients safe to go home vs. discharge needs.
• •Medically urgent: repleting electrolytes (don’t need to recheck lab unless it was a critical value), transfusing blood.
• •Get rounding notes in for patients by 8 AM (we’ve been aiming to get them in before rounds). Med student / sub-I may see your patient and write the note — send to fellows for co-sign.
• •Follow up on consult notes.

Communicate via Gyn Onc Team Epic Chat. Georgia is on the floor with you and accessible by text/call — all patients belong to both of you.

Mondays 7:30 AM — Tumor Board

• •Hectic rounding day — only 1 hour to get through patients.
• •Conference room is in GynOnc clinic.
• •You’ll be on your computer placing consults / orders while there.
• •Excuse yourself to talk to consults as needed.

Wednesdays — Didactics

• •Georgia covers pager while you’re at didactics.
• •Still round and get sign out from Georgia when you return.

Sundays (AM) — Discharge Update

• •Update all discharge info in the DC spreadsheet.
• •Send email out to everyone in the department: name, date, procedure, D/C summary complete, follow-up appointments listed.
• •Whenever someone is discharged to a service, add them to the Gyn Onc Discharge patient list in EPIC.
• •Remove them from the EPIC Gyn Onc Discharge patient list when their discharge summary is done and documented in Excel.

• •Usually round after first case with the fellow.
• •If you’re in the middle of something, that’s okay — but should go.
• •“Speak when spoken to” situation, not pimped.
• •Fellow may lean on you, so be prepared.

• •IR — nerve blocks, uterine artery embolization (bleeding), G tubes
• •Palliative care — pain control, PCAs (managed by them), goals of care conversations
• •Gen Med Procedures — thoracentesis, paracentesis
• •ID — antibiotic management for infections
• •GI — occasionally
• •PT — everyone gets (except young people)

• •PGY-3/4 should add the patient to the list. May add summary / course.
• •Want to know:
• ◦Name, procedure (usu. TAH/BSO, bowel resection + ostomy)
• ◦Diagnosis
• ◦EBL
• ◦Major medical comorbidities (DM, CV, CKD)
• ◦When need to void and how much
• ◦Discharge orders, D/C summary, AVS done by upper level
• •You get sign out because you are first call on these patients too.

• •Upper level will tell you when to do post-op check.
• •Write a note for the post-op check: .GYNONCPOSTOPCHECKNOTE

Post-Operative Checks (generally not for all post-ops who stay — anyone with intraop complications, significant EBL, etc.):

• •Incisions
• •Lines (what do they have?)
• •Dressings
• •Lots of I/Os during presentation
• •PCN (percutaneous nephrostomy)
• •Post-op milestones
• •Pain

Overview — MD tab in patient chart shows what lines they have + I/Os.

• •Check Cr — if OK:
• ◦Ibuprofen 600 mg q6h
• ◦Tylenol 975 mg q6h
• ◦Oxy — sliding scale: 5 mg (mild), 10 mg (severe)
• •Everyone on bowel regimen post-op.
• •ERAS protocol
• ◦POD1 → foley out
• ◦POD2 → pause trial of epidural (hold heparin) — info in intern handbook

You update the discharge summary along the way and are responsible for all of these (your upper levels should also help).

• •Have med student / sub-I help with this.
• •Should be completed within 72 hours of discharge.
• •Make sure anyone writing these hits the SHARE button so they can be completed by different authors if needed.

• •If you want to go to the OR, put forth an effort — or it will not happen.
• •You are the point person for RRTs on patients on service (with Georgia when she’s there). Know people’s anticoagulation status and especially code status. Always ask consults about this if they are getting admitted.
• •Use Duke Custom ID.

Calculator for how many Oxycodones surgical patients go home with: Go-Pop — https://duke-som.shinyapps.io/painmeds-app/

• •Reference pre-op H&P for preoperative questions.
• •Look at surgery details for duration of surgery (need length of time in minutes).