VA Handoff

Time: Arrive 7:30–7:45 AM. First case starts 8:15 AM. Huddle around 7:45–8:00 AM in patient’s room (like a time-out) before patient rolls to OR.

• •Once a month: surgery residents meeting with Dr. Lagoo at 7 AM — we should be going to show representation within the surgery department. Surgery conference room: through Surgical Services door, walk through office spaces to the back left corner. Outlook calendar invite for this.

Wear: VA Scrubs (need a special VA Scrub card; scrub machines in the locker room). If you don’t have a scrub card, email LawShon. A few pairs of extra scrubs in rotation between residents.

Where:

• •ORs on the 4th floor. Find Blue elevators on 1st floor, take to 4. Pre-op area in 4B (right out of elevators).
• •ORs are down C hall.
• •Locker rooms: Blue elevators to 5th floor. Left out of elevator. Find door on the left that says “Surgical Services” — use keypad. Once through, immediately a door on right to locker rooms (also keypad). To find our locker, go through the door that looks like bathroom. Our locker says “GYN” on the lower panel.
• •Scrub machine in locker room. Return machine right outside locker room.

Access:

• •Key pads around ORs and locker rooms: 6940*
• •GYN Locker combination: 13 - 35 - 13

Lachiewicz and Thomason will generally do everything except the op note. With Moss or Wilson, they’ll have you do everything.

• •Brief Op Note: SURGERY-BRIEF OP NOTE before you leave the OR. Make sure you are listed as Primary surgeon (circulating RN can update).
• •SURGERY-DISCHARGE NOTE: serves as “AVS” for patients. Check box for “GYN major” and “GYN minor” auto-populates patient instructions.
• •Post-op orders: Admissions/transfers → Gen Surg orders → Orders for postoperative 4B. Walks you through nursing vitals, diet. Click “quit” for return to clinic pop-up.
• •Word processing orders: free text orders nurses see. To discharge, put in word processing order: “Please discharge to home when 4B discharge criteria are met.” Put another word processing order with your name and pager number or phone number.
• •Prescriptions: review and prescribe (to window) if not given at pre-op visit.
• •Op note: surgery tab → click on surgery in left hand → operative note → right click to edit. Note is empty — generally copy/paste from brief op note as start. Dr. Lachiewicz has dot phrases through CPRS booster (ask him).
• •If patient is being admitted: write delayed orders. NEW WARD ADMIT GEN SURG ORDERS → GSU OBS → Admit to 4b observation for 23-hr obs. For longer admission use GSU WARD. Under the orders tab, “Write Delayed Orders” and put in admission orders (vitals, diet, meds). Upon discharge, need discharge note. If >24 hr, also need discharge summary (see tab next to surgery tab).

Time: First patient 8:30 AM; last clinic slot usually 3:30 PM. Wear: scrubs, business casual, whatever.

• •General GYN visits (annuals, contraception, AUB, etc.) + pelvic pain patients.
• •Usually a medical student (PIONEER). For general GYN patients, the medical student staffs with the resident and you’re included as needed. For pain patients, he makes the decisions :)
• •Medical students generally write the notes. Helpful if you don’t have VA access!
• •VA clinic door code: 2244

See 1J clinic conventions in the broader Outpatient handoff.

Time: First patient 12:30 PM; last clinic slot usually 3:30 PM. Wear: scrubs or business casual.

• •Dr. Thomason staffs this clinic. She also has her own clinic going concurrently and Katie Leidecker usually helps see people in her clinic. If pre/post-op clinic is slow, she also might ask the resident to see some patients on her schedule.
• •Mix of pre-op and post-op appointments.

Pre-op to-do list:

• •GYN H&P note: template that pops up; go through item by item with patient. Once filled, populates into a note you can free-text into.
• •Consent: tools → iMed consents. Search procedures you want to consent for. Go through consent form with patient. Sign using the electronic signature pad in all clinic rooms.
• •Post-op pain medications: send if you have access to send narcotics (hard to get this clearance at VA — if you don’t, ask Thomason to send the pain medications).
• •Return to clinic order for post-op visit. Face-to-face appointment, click specific date (Wednesday of whatever week you want them to come back).
• •For hysterectomies: Thomason likes to see them at 2 weeks and 6 weeks.
• •For all other procedures: 4 weeks.

Other things to know:

• •Make sure the patient has been contacted by anesthesia for pre-anesthesia appointment. Typically tells the patient not to eat after midnight, then drink a small amount of clears in the morning.
• •They do not have Clear Fast drinks like we do in 1J.
• •Anesthesia typically gives them the sponges to clean off the abdomen before surgery.

Post-ops:

• •Normal post-op things.
• •If it’s a 2-week post-op hyst visit, don’t need to do a cuff check unless they’re having concerns. Save it for the 6-week visit.

Time: First patient varies (8–9 AM, check ahead); last clinic slot usually 3:30 PM. Wear: scrubs, business casual, whatever.

• •CPRS Clinic Name: DUR Gen Surg Brst C Md
• •Attending: Dr. Chiba — great and awesome teacher! Some residents have scrubbed into her cases. If interested, let her know.
• •Breast Clinic NP: Grace Ayala — amazing! Will answer any and all dumb questions about breasts.
• •Mix of post-ops, cancer surveillance, consults (dense breasts, family history of breast cancer, etc.), or new cancer consults.
• •At beginning of day, Dr. Chiba sometimes picks the ones she wants you to see. Generally they want you to see the most educational (not surveillance).
• •You don’t need to put any orders in — Grace will put in all the orders.
• •Almost all patients need breast exams — have them undress when you leave the room. Gown opens in the front.

Note Templates:

• •New: WHC Consult
• •Return: WHC-Breast Clinic

Time: First patient varies (8–9:30 AM, definitely check ahead). This is only an AM clinic.

• •Dr. Moss staffs this clinic. Sarah Collins is the NP who helps out.
• •Generally they’ll have you see most of the patients and Sarah will help if needed.
• •Dr. Moss also takes telehealth consults for patients at VAs around the country. If there are any consults, you’ll do them with her at the end of the clinic day.

If someone pages, staff with the attending of the day (indicated in red on the VA monthly calendar).

• •Pager Number: 919-970-0207
• •If patient is stable and needs follow-up, get them scheduled in WHC clinic.
• •If patient needs admission, can admit to medicine with GYN as a consultant and round on patient.
• •When you have inpatients, FYI the Benign GYN team in case anyone needs to know about the patient overnight/weekend.

Two VA documents shared with you:

• •Monthly Clinic Schedule (name highlighted in red = who is on call that day).
• •GYN OR Schedule (cases highlighted in red are cancelled).

Email the schedule to:

• •Every Week: Wilson, Lachiewicz, Thomason, Katie Leidecker (kathryn.leidecker@va.gov), Grace Ayala (grace.ayala@va.gov)
• •Breast Clinic Week: Chiba (akiko.chiba@duke.edu)
• •Onc Clinic Week: Moss, Sarah Collins (Sarah.Collins3@va.gov)