Week In Review 5-29-15

Hi Residents,

The changing of the guard has begun: you will see your new chiefs starting Monday, your new interns arrive for orientation on the 8th and begin in the 24th, and your newly minted senior and junior residents start on July 1st. With all this change lets get to a weekly constant – your week in review:

  • Graduation and Grand Rounds: Wednesday June 4th will be special grand rounds where we will be honoring our graduating class for their accomplishments. These grand rounds will be held at 1145 AM in the SMC building instead of shock trauma. In addition morning report will be canceled on Wednesday to allow for everyone to complete his or her work in time to join us for graduation.
  • Waffle Day: Your new chiefs will be breaking in their new year with waffles on Monday for morning report so make sure to come hungry.
  • Senior Retreat Coverage: Our senior retreat will be on June 11th. Please see attached for the coverage schedule. For those of you receiving coverage please make sure to contact your coverage person a few days before hand to confirm and arrange a sign out. Senior Retreat Coverage 6-11
  • At the VA
    1. Outside Transfers: Starting now all outside hospital transfers must be discussed with your attending/on-call attending prior to giving full approval for transfer. For people straight forward this will be easy and quick but when you have that difficult patient transfer question your attending will be there to help you with their wealth of experience in the best possible disposition for the patient.
    2. Joint Commission Pre Survey: Next week (The week of the 8th) you will see surveyors at the VA. They will be focusing on discharge planning, consents and length of stay
    3. VA BLUE Team Fellow Pager: The VA cards fellow can now be reached on the BEEP system at 8061.
    4. Legionella surveillance: The VA nationally is trying to monitor the burden of pneumonia secondary to legionella. Please see the following message from Dr. Morgan: Legionella pneumophilia is an important cause of pneumonia. Although we have had no cases of healthcare-associated Legionella, we wish to remain vigilant to this possibility. The only way to know if we have a problem is to test for Legionella. Typical sputum culture will not detect Legionella. If Legionella Pneumonia is suspected (e.g. healthcare associated or severe pneumonia), order a Legionella antigen from a urine specimen. Legionella PCR is available on BAL fluid.
  • At University
    1. NACR Sheets: Please make sure to complete the NACR sheets daily and leave them in the Med ID Gold team room alongside the consult document. Lynette from the hospitalist group will be collecting them daily and the data will be used for discussions of bed flow with the ER (so it is critical).
    2. CM-SW Consulting Group: Thank you to anyone who participated with the consulting group here last week. I hope your comments and the findings of this group will help improve the system and subsequently patient care delivery.
  • PSQI Place: This month’s PSQI project focused on lab draws cancelled by phlebotomy at the VA on 3A/3B without notification. The group found out two very interesting facts that may help: 1) Phlebotomy will not draw labs on anyone who has a mediport- must be nurse collect, and 2) there is a phlebotomy collection sheet at both the 3A and 3B nurses stations that the phlebotomists use to record missed lab draws. Theoretically the nurses should notify you of uncollected labs (for whatever reason) but if you wanted to find out yourself, go to the 3A and 3B nursing stations and save yourself hours before you find out labs were not drawn!
  • ACLS/BLS Renewal: For anyone who got their ACLS/BLS in June of 2013 (almost all pgy2s and pgy4s) your certifications are about to expire. The hospital provides free renewal to all residents but you need to plan ahead. Please refer to the website for more details. These dates go fast so if you have not signed up yet, do so NOW.
  • Moonlighting: Many moonlighting spots remain for the month of June. Make sure to sign up on the doodle calendar. June: http://doodle.com/cqtdvwfk5f4zxuxz Supplemental Moonlighting: http://doodle.com/kupweaciqqvs4v36
  • Social Events: Your new chiefs have started a private Facebook provocatively named “Maryland Backwards” to advertise and share social events. To be part of this group you will need an invite so email or Facebook friend one of the rising chiefs in order to get in on the ground floor.
  • Resident Accomplishments: If you have published anything or presented an abstract we want to know. Please make sure to send Debbie Trust this information in Pub Med format (and don’t forget to keep that CV up to date).
  • Article of the Week: For my last week in review I have chosen to discuss a problem we likely have all treated mores o than any other… back pain. How many times have you seen or prescribed steroids for patients with acute sciatica. Every time I came across this issue I was underwhelmed by the data. This time perhaps there is some more. In this article published in JAMA the authors randomized over two hundred patients, with back pain <3 months and MRI evidence of a herniated disk, to a 15 day course of tapered steroids vs placebo. The steroids group had no improvement in pain or need for surgery at 1 year. There was however a small statistically significant improvement in a functional score however its clinical significance is unclear and debated. Now you may argue that all these patients had positive MRI herniation and this is not the patient population we are initially managing. However, I would argue that this population was probably the most likely to benefit from an anti-inflammatory modality and if the benefit here was modest at best it will only be watered down in the group of all comers with acute back pain. Food for thought.
  • Farewell: I think I can speak for all of us and say that this has been a wonderful year. Thank you for giving us the opportunity to grow as educators this year as well as allowing us to aid you in your journey to become ever better physicians. It was a true honor and we look forward to seeing you all at graduation.

Sent on Behalf of Bethany, Rory, Mike and Peter

About Sunny

Inpatient Chief Medical Resident 2014-2015

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