Women & Infants Hospital
Psychiatry Consultation/Liaison Rotation Guide
C/L Rotation Guide pages 2-3
Rotation Goals & Objectives page 4
Psychiatry Call Manual pages 5-9
Day Hospital Rotation Guide page 10
WBH Clinical Services pages 11-12
WIH Phone Numbers page 13
Cerner EMR Guide page 14
Psychiatry Note Templates pages 15-17
Common Abbreviations page 18
Resources for Medications & Referral Options pages 19
Rotation Guide for Women & Infants Psychiatry Consult Service
Welcome to your PGY-2 psychiatry consultation-liaison rotation at Women & Infants Hospital! We are excited to have you join us, and hope you will enjoy learning about women’s mental health during your time with us. The manual provides a lot of valuable information about your experience here, so please be sure to review it prior to the start of your rotation.
Before the Rotation:
1-2 weeks before rotation, call 274-1122 x41925 OR e-mail , to contact Fran Niang for the necessary documentation for your rotation and to get a computer log-on and Cerner access. You will get a welcome email several weeks prior to the start of your rotation reminding you of this. Please also be sure to read this guide in its entirety prior to your first day of the rotation.
General Info
Computer: Cerner is the electronic medical record. See Cerner guide below for more details. There are templates for the consult note and follow up note if you choose to use them.
Food: ABP on the ground floor, and cafeteria in the basement. ABP and RIH cafeteria through the tunnels. 2 Dudley Street also has a café on the first floor.
Locations: Consult office located in the Department of Medicine Suite on the third floor of the main hospital. Code to enter office area is 1884* the DOM suite is down the corridor to the left.
WBH (outpatient) in 1st floor Coop building (2 Dudley Street) Day hospital 1st floor Coop building (2 Dudley Street)
Phone Numbers: see WIH phone numbers list on page 13
Codes:
Triage Entry Code: 0101
Social Work Office entry code: 4321 (consult office key kept next to printer) (make sure we still have access to this office)
3rd floor code: 1884*
Amion code for W&I: wihri (www.amion.com)
Consult Service Basics
Attendings:
Carmen Colomer, MD
Pager: 401-582-4581 Cell: 617-459-1210
Email:
Laura Hollar-Wilt MD
Pager: 401-582-4410 Cell: 717-903-6786
Email:
Neha Hudepohl MD
Pager: 401-582-9416 Cell: 513-659-8559
Email:
HT Kao MD
Pager: 401-582-7461
Women’s Mental Health Fellow:
Nina Gonzales, MD (2015-16)
Pager: 401-582-2157 Cell: 505-795-6263
Email:
C/L Social Worker:
Erin Hunt Capece, LICSW
Pager: 401-582-0312
Cell: 401-440-1277
Email:
Showtime: On your first day, 8AM @ Department of Medicine Suite on 3rd floor of main hospital. You will meet with Fran Niang initially to complete housekeeping requirements followed by a brief orientation and tour of the main hospital with the C/L Social Worker at 9am. Subsequently, your day will begin at 8am unless otherwise specified by the team.
What to expect: You will be expected to carry the consult pager and will most likely be the first point of contact for all consult calls. Expect to initially evaluate most consults either on your own or with the C/L SW as appropriate. It is important to talk with nursing staff/social work and obtain collateral information whenever indicated. You will write your initial consult evaluation (save but do not sign without reviewing with attending.) You will present patients to your attending during “table rounds” and you and your attending will round on patients together during “bedside rounds”. You will also be expected to see follow ups whenever needed and to communicate psychiatry recommendations to the primary teams. Expect to be available to see consults until 5PM unless it is a didactics/clinic day. Also, please try to see all follow ups before 12:30PM.
Service Schedule: Plan to check in with the C/L team at 8am unless otherwise specified. You will spend your mornings seeing new and follow-up consults. If there are no new or pressing follow-ups , plan to spend your morning in the Day Hospital. Check in with the Day Hospital attending and let her know if there are pending consult follow-ups so you can best plan your time.
On your didactic/clinic days, you will check in with your attending at 11am prior to leaving. On your full days, plan to round with your team at 2pm unless otherwise specified. Generally, the daytime team will accept new consults until about 4pm, and later if there is an emergency. Consults called later than that will either be saved until the next day, or if absolutely necessary, seen by the on- call physician. This decision will be determined by the attending.
C/L Team Structure: The WIH C/L Team is comprised of an attending physician, resident, and psychiatric
social worker. The C/L Social Worker serves as an anchor for the team by triaging cases, assisting with coordination of behavioral treatment, and evaluating patients as needed. At times there may also be a women’s mental health fellow on the team.
Consult Rotation Goals & Objectives
· To demonstrate understanding of the unique needs of the perinatal population, including diagnostic assessment and treatment modalities.
· To develop a framework for approaching clinical decision making in the pregnant and breastfeeding patient.
· To develop an initial understanding of basic attachment patterns and disrupted attachment, as well as the implication of maternal mental illness on child development.
· To acquire expertise in liaison work in the setting of a specialty hospital.
· To expand knowledge on the application of non-pharmacologic evidence-based interventions for perinatal mental illness.
· To review details about perinatal mental illnesses, including postpartum depression, postpartum psychosis, perinatal-onset OCD, trauma-related illnesses, and psychiatric disorders in the gynecologic-oncology population.
Call Manual for Women & Infants Hospital
As the only psychiatry consultation service at a specialty women’s hospital, we provide a significant amount of expertise in dealing with psychiatrically ill patients at Women & Infants Hospital. Both our academic and community referral sources rely on our expertise in the care of their patients. To that end, we strive to be readily available both during the workday and after hours to help care for these patients.
General Information:
Weekday call: Begins Monday at 5PM and ends Friday at 8AM (weeknight call is 5pm-8am nightly during the week).
Weekend call: Begins Friday at 5PM and ends Monday at 8AM.
During your PGY-2 rotation, you will take 1 week of call (usually Monday at 5pm – Monday at 8am).
Prior to coming on call you must be sure that your Cerner password is active. Please check with the chief resident for WIH (Brian Theyel MD) regarding your Cerner login/password. Most of you should already have this access from your C/L rotation in the past. If you had access in the past but need to update your password, contact Butler computer support at 921-1000 or the WIH Helpdesk at 274-1122 ext. 48777. You should check your Cerner access while at Butler Hospital (under the CNErgy Cerner icon) in advance of your call. You are expected to refresh or familiarize yourself with this system prior to being on call. You must be free of other call responsibilities including other moonlighting and jeopardy call.
While you are on call you will be supervised by an attending. You will receive a call schedule distributed in advance by the chief resident as well as an email reminder at the start of your call. You can also check AMION (www.amion.com password = wihri) for the backup attending information. It is your responsibility to know when you are on call and who your backup attending is.
You will be emailed any relevant consult sign-out to your Brown email accounts, but will be sent via encrypted email with “PHI” in the subject line.Please be sure to provide relevant information regarding the consult service in sign out to the primary team via secure email.
Weeknight and Weekend Call:
Consult requests can be reviewed with your backup attending prior to coming into the hospital, unless it is a clear emergency. Many, but not all, consults may be seen or evaluated by a social worker prior to you being called, unless it is a psychiatric emergency.
Due to the untimed nature of obstetrics, patients may not come to the attention of either SW or psychiatry until over the weekend. Because these patients are likely to be discharged home over the weekend it is our policy to evaluate consults called in on the weekends. Often social work will have seen these patients first, but sometimes the primary team will call the psychiatry team directly especially if there is a question related to medications or safety. As a general rule, all consults must be seen and completed within 24 hours of consultation request.
If you are called on a consult that can be pushed until the primary team returns (the following morning), please email or page the psychiatry resident or attending covering consults for the next morning by 8:00AM with the information including patient name, room number, DOB, and any other pertinent information
Consultation Requests:
There are important psychiatric emergencies that necessitate having to come in. When in doubt, we err on the side of coming in to evaluate patients. The following list constitutes what our service generally considers to be emergent:
· Acute onset of delirium in patients who are not responsive to the initiation of the Delirium Care Plan
· Acutely agitated, behaviorally dysregulated, or actively suicidal/homicidal patients on the medical or obstetrical floors
· Patients where there is a high index of suspicion for post-partum psychosis. These patients must be evaluated rapidly!
· Substance abuse patients in active withdrawal that cannot be managed by current protocols at WIH
· Capacity assessments where there is a high degree of risk for death or injury to patient or fetus, or a significant change in care or assessment due to refusal of recommended care, or desire to leave AMA.
· Patients in Triage
Any other patient for which the primary team is requesting an urgent consult.
Transfer Protocols for Women & Infants:
Calls for other reasons:
The backup attending covers any calls from outpatient attendings on weeknights and weekends. If you are called on an outpatient in Women’s Behavioral Health, have the answering service call your backup attending.
If you are called about an active Day Hospital patient or a Project Link patient, then refer the caller to the therapist on call for these respective programs (can be found in AMION). The answering service should also have a list of who is on call for these programs.
Emergency Slots:
One emergency slot is available for patients over the weekends that need immediate follow-up evaluation and/or care. This slot is primarily available to pregnant or postpartum women. The slots are scheduled on Mondays at 8:30AM (Or Tuesdays at 8:30AM if there is a holiday on Monday). These are 60-90 minute slots with a psychiatric clinician who will have backup from a psychiatrist if it is clinically warranted. The patient should be directed to Women’s Behavioral Health at 2 Dudley Street, First floor and given the number (401) 453-7955.
As the on-call psychiatry resident, you will be responsible for managing the use of this emergency appointment. Remember, there is only 1 slot and once filled, it is no longer available. The social workers should contact you if they have a patient they would like to refer to that slot, but it is ultimately your decision how that slot is utilized.
Please notify the following individuals about a patient booked in an emergency slot. Please provide the patient’s name, DOB, contact phone number as well as a brief description of the clinical circumstances.
Margaret Howard ()
Judy Randall ()
Erin Hunt Capece ()
Please use a secure email address to send this information.
Consult Documentation:
Women and Infants Hospital has an electronic medical records system (Cerner) and all consult notes are to be written in Cerner. Prior to coming on call you must be sure you have your Cerner access active. Please check with the WIH Chief Resident Brian Theyel MD regarding your Cerner login/password if you are uncertain of it.
Consultation notes are within the “Clinical Notes” section and should be documented in the same fashion as a standard psychiatric consultation note or H&P. Please see the Consult Note Templates below for further details. Please contact either the WIH Chief Resident or your supervising attending if you have any questions about documenting in Cerner. We encourage you not to wait until the start date of call to do this. Please add any new consults seen/called to the “WIH BH Consults” list in Cerner (see Cerner guide for more details).
Attending Contact Information:
Carmen Colomer, MD
Pager: 401-582-4581 Cell: 617-459-1210
Email:
Thamara Davis, MD
Pager: 401-582-0144 Cell: 401-663-5590
Email: or
Laura Hollar-Wilt, MD
Pager: 401-582-4410 Cell: 717-903-6786
Email:
Margaret Howard, PhD
Pager: 401-582-4618 Cell: 401-368-2180
Email-
Neha Hudepohl, MD
Pager: 401-582-9416 Cell: 513-659-8559
Email:
HT Kao, MD
Pager: 401-582-7461
Jessica Pineda, MD
Pager: TBD Cell: 513-532-4889
Email:
Lawrence Price, MD
Home: 401-245-9246 Cell: 401-523-4315
Email:
On Call Telephone Tree:
Call your listed backup attending
I
I
(If unavailable after 15 minutes, try backup attending again – consider alternate number)
After 2 tries or 30 minutes
I
V
Call Neha Hudepohl MD, Medical Director, Women’s Behavioral Health
AND/OR
Margaret Howard PhD, Division Director, Women’s Behavioral Health
I
(If unavailable after 2 tries or 30 minutes)
I
I
V
Call Lawrence Price MD
Chief of Psychiatry, Women & Infants Hospital
Rotation Guide for Women & Infants Day Hospital
While you are on service at Women & Infants, the psychiatry consultation/liaison service is your primary clinical responsibility; however, you will often have free time during the mornings and can participate in clinical care at the Day Hospital. This is a unique experience and will help expose you to women’s mental health and perinatal psychiatry in a partial hospital setting using the concept of a mother-baby unit. While participating in the Day Hospital, you will attend groups, rounds and participate in individual patient care. Residents have found this to be a very valuable experience and a great introduction to the care of pregnant and postpartum women.