VA Urology Rotation Schedule
Monday - S. McCallum.
Book biggest case first unless patient travel/preop studies preclude.
8:00 AM Indications Conference. Get Films and histories for Tuesday - Monday cases. Diane will present ESWL's and get those films. You get all others. Submit list on prior Friday to film library. Print out and copy OR schedules (about 12 copies) for handouts. First Monday of month will be followed by M&M.
9:00 AM OR - book three to four cases. The fourth case may get bumped.
Tuesday - H. Gill ESWL. S. McCallum academic day.
8:00 AM - 12:00 PM - One to two cases here, Diane will schedule.
1:00 PM GU Oncology Clinic
4:30 PM Pathology Conference and Attending rounds. The third Tuesday of the month will be Tumor board instead (starting at 4pm). Marie and Jason submit these lists. E-mail them if there is something you want to review. Srinivas will present patients in Tumor Board
***Enter a note in the computer under "Urol-Treatment Planning" after this conference if any decisions regarding further studies, treatment, etc. were made.***
Wednesday - R. Anderson OR (BPH cases).
8:00 AM - 1:00 PM - OR. Three to four cases.
Book the big case you want to do as first case.
9:00 AM - 12:00 PM - PNB clinic. Send PGY2 if available.
1:00 PM - S. McCallum clinic.
PGY6 should leave OR to cover clinic if possible.
**Send e-mail today for Friday GU/SCI radiology conference list to g.gu/rad conf **
Thursday - R. Kessler OR (prosthesis, stones, other)
8:00 AM - Three to four cases.
1:00 PM - 4:00 PM - overflow clinic. Residents not required to cover but appreciated. Also minor procedures such as vasectomies sometimes performed during this time.
Friday - No OR S. McCallum at Stanford.
8:00 AM - GU radiology conference. Get histories for non-spinal cord pts.
***You have to enter a note in the computer after this conference if any decisions regarding further studies, treatment, etc were made. Do this through GUI under "Urol-Treatment planning." This helps the people in clinic. ****
9:00 AM - R. Anderson clinic.
Friday afternoon - prepare for conferences. Cystos or vasectomies sometimes booked in the afternoon slots. Enter the upcoming weeks OR schedule. Recommend entering from upcoming Tuesday through the following Monday (see OR scheduling).
4:30 PM - Stanford conference
Bowel Prep Rules
Note: Bowel Prep Orders start at least 2 days earlier on an inpatient basis for any spinal cord injured patientsVA RADICAL CYSTOPROSTATECTOMIES
- Clear liquids 2 days prior to ARRIVAL
- Admit the day before, and DON'T FORGET TO GET THE STOMA MARKED BY NINA BELLATORRE
- 2 dulcolax tabs orally on arrival
- 1 bottle of magnesium citrate on arrival
- Erythromycin base 1 g and neomycin 1 g given at noon, 6 pm, and midnight the day before surgery
- Soap suds enemas until clear
- After clear, neomycin retention enema (500 ml)
- Hibiclens shower after that
- Ampicillin 1g, gentamicin 80 mg, and flagyl 500 mg IV given at 6pm and on call to OR
VA RADICAL PROSTATECTOMIES
- Admit to observation bed (ward 4A) one day prior to surgery unless patient is very responsible and lives locally
- Clear liquids
- Fleets enema x 1
- Hibiclens shower after enema
- Ampicillin 1g, gentamicin 80 mg, flagyl 500 mg given at midnight and on call to OR
- Day of surgery in AM, give neomycin retention enema 500 ml x 1
ESWL
Bowel prep usually unnecessary unless patient is spinal cord injured or if the case is a re-treatment and bowel gas was a problem during the prior session.
Mechanical bowel prep only with Ducolax tabs x2 and a Fleets enema on the day prior.
OR Scheduling
See the instructions below for entering cases into Surgical Scheduling. Shortcut: after the blood prompt, just hit "Enter" several times until the request is done.
For three day weekends, a request for the following Tuesday (i.e. post MLK holiday) must be in by 9AM on the prior Friday.
If a case gets bumped, you can change the request date to something in the distant future so it is saved. When you need it, just change the date back.
The OR goes down to two rooms at 2:30 to 3:00. Forget what the official policy is. If you finish your third case at 3:00, you will be on the first available list.
Prior to leaving the rotation or before going on vacation, enter in the upcoming week's cases as a courtesy to your colleagues that will be taking over from you.
M&M
Monthly presentation at Monday Indications conference. Do the prior month's cases only.
E-mail or provide a copy of the M&M information to Dr. McCallum after conference. Destroy all other copies
Make about 12 copies of the M&M packet for handouts
Use template in the "Chief Resident Stuff" folder
Complete your stats and M&M cases before you leave at the end of your rotation
Call Schedule
Maryann will have you prepare it for the upcoming month.
Contact PGY 5 at the Valley to work out coverage issues. Contact lab residents if they are covering any weekend call.
Misc
Most RRPs are admitted to an observation bed on the day before for bowel prep. VERY responsible, local patients can do the prep as an outpatient.
Reserve ICU bed if you even think someone is going to go there. Easier to cancel than to try to arrange later.
For cystectomy pts, may be easier to admit two days in advance if they come from a distance. This ensures the bowel prep will be started on time and avoid last-minute problems.
The Mailman system in DHCP is used extensively for communicating with faculty and staff and is especially good for contacting non-urology people. It is an efficient way to triage patient related issues and gets questions answered. CHECK YOUR E-MAIL daily.
Important e-mail addresses:
mccallum@stanford.edu
marie_macy@yahoo.com (Marie)
catpurple5@yahoo.com (Maryann)
bite11@hotmail.com (Jason)
jfanddidi@hotmail.com (Diane)
How to Schedule O.R. Cases
**Please note: All O.R. cases must be entered by no later than 9 a.m. on the nearest workday before the O.R. In other words, if it is a Monday a.m. case, it must be entered in the computer by 9 a.m. the Friday before. The computer will lock you out if it is even a few seconds late. After that point, you need to "pink sheet" (i.e., add on) the case for the O.R. It doesn't matter if it is 9:05 a.m. on Friday, it still needs to be pink-sheeted. Most often, that also means it goes on the add-on list on the corresponding O.R. day. Not good. Do what you can to avoid this situation.
- Log into DHCP, not CPRS-GUI
- At the first menu, where the numerical choices are offered, instead of typing in a number, just type in "SURG"
- There will then be an intro screen, hit
- At the next prompt, type in "R"
- Likewise, at the next, type in "R"
- At the next prompt, enter the patient's first initial of his last name and the last four of the social security number (e.g., L3994)
- " " " ", enter date of surgery (e.g., 7/5/00)
- " " " ", enter the attending surgeon's name (e.g., McCallum, S)
- " " " ", enter "Urology"
- The next prompt will read: Principal operative procedure:". You should enter the full, typed out name of the procedure (no abbreviations)
- Hospital Admission Status: enter a choice of outpatient vs. inpatient (like on those patients admitted already for bowel prep)
- CPT code: refer to the blue book of CPT codes (generally kept under the computer in the residents office)
- Modifier: ignore this and hit
- Principal pre-op diagnosis: enter the appropriate text, e.g., urethral stricture
- Requested Post-op Care:
Here you have a choice: o for outpatient, ob for surgical observation bed (the 23 hour unit= ward 4A), w for ward, I for iicu, 7sci for spinal cord, s for sicu - Attending: enter the attending's name again (Why? I don't know!)
- Case schedule order: i.e., is this the first case, second case, etc.,
- First assist: that would be you
- Case length: just enter the corresponding time as hours:minutes i.e., 3:00
- ICD9: painfully, yes. Also kept under the computer is the basic billing sheet from the downstairs Urology clinic. This conveniently has a list of relevant ICD9 codes. There is also a gray book in the residents' office with the complete ICD9 codes
- Related to Service Connection (enter N)
- Intraop X-Rays: obviously yes for any fluoro/ESWL cases, no for most others
- Indications: you MUST enter yes and then write a sentence blurb about the indication for the surgery: e.g., patient with symptomatic kidney stone. Patient with renal tumor. Blah, blah, blah. To get out of this function, you must push the "Num Lock" and "E" keys at the same time
- " " " ", hit
Other procedure: go ahead and list anything else you would like to do, e.g., cystoscopy, stent for patients already booked for ESWL - " " " ", hit
- " " " ", hit "N"
- Blood available: enter "Y" for big, open cases. Then type in "PRBC". You can later indicate how many units you need. Please note: putting this in the computer doesn't always mean it makes it to the O.R., and you certainly still need to do the Type and Cross stuff with the patient pre-op
- For the next three prompts, hit
- At this next prompt, hit "Y"
- At the following prompt, type in "EL" for elective
- Hit x 5 through the next prompts
- Surgical position: enter supine, lithotomy, prone, or whatever
- Requested anaesthesia: enter "C" for choice, "G" for general, and so on. For the full list of options, type in a "?". This will let you know what the codes are for each anaesthesia type
- Frozen section: I usually say "N"
- Pre-op XR requested: I usually say "Y"
- " " " ", hit
- Medical media: I'm not sure what this is, really, but I usually hit "N"
- Clean/contaminated: I think this is a ridiculous question, so I always say "clean"
- Hit through the next 6 prompts, and you are done!
*** If you cannot access the "surg" function when you start the rotation, contact the department secretary***
