OCHSNER ED
Dr.______,
You are assigned to Ochsner Clinic Foundation the month of ______.
Director of ED: Dr. Joseph Guarisco is the Director (842-4433).
ED Rotation Director: Rebecca Hutchings, MD
Orientation: Report for 7:00 a.m. on the first day of the month to the Emergency department. Prior to beginning your first rotation at Ochsner, contact Esther Catalanotto f the Ochsner GME Department (842-4937) to schedule a time to get your ID and parking cards. You will be required to give a $10 refundable deposit for the cards. Detailed information concerning orientation and the rotation are in the Ochsner resident handbook you have been given.
Schedule: All residents will work 15-16 shifts per month; half of the scheduled residents will work 16 in months with 31 days. PGY1, 3, 4 & 5 residents will be assigned to the Main ED. Schedules for will be set by Dr. Hutchings; if you have specific requests for your schedule, please contact Dr. Hutchings at least 1 month prior to starting, otherwise contact them one week prior to starting the rotation to obtain your schedule.
Directions: 1514 Jefferson Highway New Orleans, Louisiana 70121
Conference: You are required to attend conference and journal club.
Extras: All procedures must be recorded in New Innovations.
Supervision: Board Certified EM physicians provide Supervision.
Evaluations: Compiled and pooled from evaluations by the staff physicians and submitted at the end of the year.
LSU Emergency Medicine Residency Program
Ochsner Clinic Foundation Hospital
Emergency Department Rotation
GOALS and OBJECTIVES
What follows are the goals and objectives for the Ochsner ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the Ochsner ED. The year of training may include PGY 1-5.
The educational goals and objectives for the Ochsner ED rotation are to provide residents with an opportunity to experience and learn about the initial evaluation and management of emergency patients in the community, health maintenance organization setting, including the following:
1) Perform basic assessment of patients with a variety of moderate and major traumatic conditions.
2) Formulate a differential diagnosis for patients with various kinds of traumatic conditions and mechanisms of injury.
3) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma patients.
4) Competently perform minor procedures such as suturing of lacerations, incision and drainage of the abscesses, insertion of nasogastric tubes and urinary catheters, venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of fractures and sprains, spinal immobilization.
5) Demonstrate basic understanding of the principles of ACLS, PALS and ATLS resuscitation as applied to persons in cardio-respiratory arrest.
6) Achieve ability to perform an adequate history and physical exam, prioritize conditions, and form a differential diagnosis in adults with acute and chronic medical problems of varying severity presenting to the ED for care.
7) Learn proper methods for stabilization of patients with life threatening conditions such as sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose.
8) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract infections, pneumonias, and other respiratory illness.
9) Learn to evaluate and appropriately manage a variety of patient complaints such as chest pain, abdominal pain, dizziness, headache, syncope, etc.
10) Learn to perform an adequate history and physical exam in female patients with gynecologic problems or problems related to early pregnancy including abdominal bleeding, infection, threatened abortion, and ectopic pregnancy.
11) Learn to evaluate the pediatric patient in the emergency department, including fever of unknown origin and other common pediatric presenting complaints.
12) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations.
13) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s.
14) Perform the following procedures with basic competency and to know indications and contraindications: venipuncture, starting an IV or heparin lock, arterial puncture, insertion of a Foley catheter, placement of a central venous line, thoracentesis, paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal secretions.
15) Become familiar with common medico-legal problems which present in emergency medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or adult abuse or neglect.
16) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions.
17) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning.
18) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients.
19) Learn about billing as it pertains to ED patients.
20) Learn about transplant patients.
21) Learn about geriatric presenting complaints.
The clinical and didactic experiences used to meet those objectives included daily patient care in the Ochsner ED, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, also including PALS/ACLS/ATLS provider and instructor certification and weekly didactics (part of the overall didactic curriculum).
The feedback mechanisms and methods used to evaluate the performance of the resident include an end of rotation global evaluation. Immediate feedback may also be given to the resident, and any significant problems will be discussed during the rotation with the LSU EM administration.
The resources and facilities in the institution that will be available to each resident include computer access to Up To Date and the LSU Library services, including current texts in emergency medicine. The residents will have access to the resources of the hospital including medical texts, medical records, doctor’s lounge and cafeteria.
The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Emergency Medicine team in a community hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include trauma, psychiatric, obgyn, pediatric and general medical patients.
The relationship that will exist between emergency medicine residents and faculty on the service: The overall goals of resident education and patient care will govern the relationship between faculty and residents. Residents will receive 24 hour supervision while on the rotation. All patient care and medical charts will be reviewed and signed by the ED faculty prior to patient discharge.
Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7 days off.
This rotation summary has been reviewed and agreed to by the service director and LSU Program Director.
Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: PGY1-4
1. While in the community ED, the resident will demonstrate skill in “Data Gathering” that includes but not limited to:
a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR)
b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP)
c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP)
d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical date in difficult situations. (* PC, IPC & PR)
2. While in the community ED, the resident will demonstrate skill in “Problem Solving” that includes but not limited to:
a. PGY1: Generate an appropriate and complete differential diagnosis for an undifferentiated patient (* PC, MK)
b. PGY2: Appropriate organization of data collection in relation to patient management decisions (* PC, MK, PBL)
c. PGY3: Generate an expanded differential diagnosis including possible atypical presentations (* PC, MK, PBL)
d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (* PC, MK, PBL)
3. While in the community ED, the resident will demonstrate skill in “Patient Management” that includes but not limited to:
a. PGY1: Development of a basic treatment plan (* PC, MK, SBP)
b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable patient (*PC, MK, SBP)
c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS, PR, SBP)
d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK, ICS, SBP)
4. While in the community ED, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that includes but not limited to:
a. PGY1: Demonstrates a basic fund of medical knowledge (*MK)
b. PGY2: Understands the scientific basis for their decisions (*MK, PBL)
c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK)
d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using problem-based learning techniques. (*MK, PBL)
5. While in the community ED, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes but not limited to:
a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC)
b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma resuscitation (*PC)
c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation (*PC)
d. PGY4: As above, but also skilled in teaching procedures to lower level residents.
6. While in the community ED, the resident will demonstrate skill in “Efficiency” of care that includes but not limited to:
a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP)
b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP)
c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed, with a goal of 2 patients per hour (*PC, MK, SBP)
d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed, with a goal of >2 patients per hour (*PC, MK, SBP
7. While in the community ED, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes but not limited to:
a. PGY1: Demonstrates effective information exchange with patients, their families, and professional associates (*ICS, PR)
b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR)
c. PGY3: Works effectively with others as a leader (*ICS, PR)
d. PGY4: Models and teaches leadership skills to lower level residents. (*ICS, PR)
8. While in the community ED, the resident will demonstrate appropriate “Professionalism” that includes but not limited to:
a. PGY1: Introduces self to patient and/or family (*PR)
b. PGY2: Respectful of patient’s privacy and confidentiality (*PR)
c. PGY3: Demonstrates respect, compassion, and integrity, even under stressful situations (*PR)
d. PGY4: Models and teaches professionalism skills to lower level residents. (*PR)
9. While in the community ED, the resident will demonstrates skills in proper “Documentation” that includes but not limited to:
a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC, ICS)
b. PGY2: Appropriately documents medical decision making (*PC, ICS)
c. PGY3: Documents ED course including re-evaluation of patient if applicable (*PC, ICS)
d. PGY4: Models and teaches verbal and written documentation skills to lower level residents. (*PC, ICS)
10. While in the community ED, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes but not limited to:
a. PGY1: Understands basic resources available for care of the emergency department patient in the community setting. (*SBP)
b. PGY2: Utilizes the consultation process appropriately (*SBP, PC)
c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC)
d. PGY4 Models and teaches system-based practice skills to lower level residents. (*SBP)
11. While in the community ED, the resident will demonstrate skills in “Practice Based Learning and Improvement” that includes but not limited to:
a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC)
b. PGY2: Applies knowledge of scientific studies to patient care decisions (* PBL, PC)
c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
d. PGY4: Models and teaches practice based learning and self-improvement skills to lower level residents. (*PBL)