1. Comer Children’s Hospital Pediatric Emergency Department
Resident Orientation

2. Prior to arrival… View entire resident orientation slideshow
Access chief resident’s webpage
Review all the clinical guidelines prior to starting work in the PED – our faculty expectation is residents must be familiar with these guidelines prior to working in our PED
Contact Gail Armstrong to ensure all paperwork completed ( )

3. Pediatric Chiefs Page via the Intranet
Link via “UCMC Intranet for Physicians”
Select “Pediatric Chiefs”

4. Pediatric Chiefs’ Page
Scroll down and select “Emergency Medicine”
Multiple resources including
clinical guidelines
important numbers
additional resident orientation resources

5. Comer Emergency Department Lay Out
22 exam rooms
Orthopedic procedure room
Trauma room
2 beds
Flex up to 4 beds if needed
Infant warmer for deliveries
Two isolation rooms with anterooms
Negative pressure
Positive pressure
One OB/Gyn room with attached bathroom

6. Lay Out Central Hub – physician and nurse workspace 5 main pods
Pod 1- Rms #1-3
Pod 2- Rms #4-7
Pod 3- Rms #8-12
Pod 4- Rms #13-15
Pod 5- Rms #17-20
Rm 16 - OB/Gyn room

7. When You Arrive… Sign-in on the white grease board
Find a cordless phone for the duration of your shift
Sign into Epic
Remember to log-off and sign-out when changing computers and at the end of your shift

8. Signing up for Patients
Choose next patient based on acuity – higher acuity before lower acuity regardless of length of time in the ED
Within the same acuity level, choose next patient based on length of time in ED – longest first
Or use the “Next to See” button in EPIC
Please do not “cherry pick” – your fellow residents will notice!
Please sign up for patients when you are ready to see them, not several at a time

9. Epic Charting “Share” your note prior to presenting to the attending
Do not have to “accept” note if plan not determined
Facilitates care as attending can view prelim note
“Accept” note after plan created
Reassessments can be done as “ED note”
Accept ALL notes prior to discharge and if signing out at the end of a shift
Prescriptions will print out and will need to signed and place in blue folder prior to discharge
Select “Discharge” after staffed with attending and patient ready to be discharged

10. PER Order Sets Select ORDER SET Search “PER” in order set field
Select from list of “PER: IP” order set listed

11. Epic Observation Status
Select “ED OBS only”
Use order set “912 or “PER:IP OBSERVATION”
Document updates of patient using ED notes including patient’s status at time of final disposition:
home vs. admit vs. transfer

12. I want to follow up on my patient from my last shift – how do I do this?
Use “My Reports” to track patients seen
Select “My Reports”

13. Select “UCMC COMER”
Select “Monthly, My Patients, My Patients Last 24 Hours and “My Patients Last 7 Days” and select “Add to Favorites”

14. Select blue “My Reports” Select desired report and select “run” 1 2 3
Select blue “My Reports”
Select desired report and select “run”
Select “view” after report is “ready to view”

15. Oops! I have pended charts – how do I find them?
Use the same “My reports” procedure
Open chart to
Sign orders
Accept any pended notes

16. Paging Directory Access text paging system as illustrated
Page by pager number or last name
Page to your cordless phone
If the call bounces to main ED number listen for coordinator to announce call
Page by phone system
Dial 188 then follow prompts

17. How to use paging system
2 systems
Text paging via intranet
Phone paging via phone or intranet
Important numbers
Main ED number:
ED attending phone:
Prefixes (internal vs. external calls)
2-xxxx = xxxx
4-xxxx = xxxx
5-xxxx = xxxx

18. Admissions RFA: Request For Admission 7AM-7PM 7PM-7AM
Locate name of floor attending physician on intranet:
“Ped General On Call”
7AM-7PM
Maroon: Gen Peds, Cards, ID, Rheum, Pulm
188-PEDS (7337)
Silver: Neuro, GI, Nephro
Gold: Hem/Onc
188-HONK (4665)
7PM-7AM
Call Night Float Senior for ALL admits (188-PEDS)
No Pediatric admits from 5-7AM
Neurology resident on consults will NOT be the floor resident caring for the patient

19. Prescriptions Pitfalls
Reasonable doses based on concentration
8 tsp twice a day?
Start and end date
Please add total number of days in the comments section. Pharmacies call to clarify in spite of the start and end written on prescription
Use Harriet Lane for pediatric drug dosages
Remember to sign the prescription and then place in patient’s blue folder prior to discharge
Pharmacy phone calls get directed to the trauma senior for clarification

20. Social Services We have 2 social workers dedicated to the Comer ED
Involved in:
Trauma patients – called automatically to all traumas
Physical abuse cases
Sexual abuse and assault cases
Neglect cases
Children at risk for child abuse or neglect
Social service needs of the child or family
Availability:
7 days a week for 10 hours/day
Available overnight for phone consultation only
Pager #8887

21. Child Life Services in Comer Pediatric Emergency Room
Child Life specialists are trained professionals who help children cope with the stress and uncertainty of illness, injury, disability, and hospitalization. We promote effective coping through play, self-expression activities, and age-appropriate medical preparation and education. Child Life Specialists are child development experts who have earned a master degree and are nationally certified.
Top reasons to call Child Life
A patient of any age is exhibiting signs of fear & anxiety
Procedural Preparation and Support
IV placement
Blood draw
Medical exam
MRI, CT, x-ray, ultrasound
Sutures, Derma Bond
Asthma treatment
Catheterization
Injections
Sedation
Casting
Developmental education for caregivers
Age appropriate diagnosis information
Emotional support
Preparation for inpatient admission
Sibling Support
Trauma / Bereavement
Interested in learning more about supporting children and families during medical experiences?
View the Child Life clinical guidelines
Availability
Child life services are available full time Monday-Thursday 12pm-8:30pm & Friday 9-5:30pm
Child Life services are available by page Monday-Friday mornings beginning at 7:30 a.m.
For Child Life services and referrals please page #9308
For more information or questions

22. Disposition Resources Urgent Care
Limited urgent care appointments available at Friend Family Health Center Monday-Saturday
HMO patients cannot be seen
New non-HMO patients can be scheduled
Asthma clinic on Monday afternoons for non-HMO patients

23. Disposition Resources General Pediatrics
Pamphlets available for primary care and general pediatrics clinic

24. Disposition Resources Subspeciality referrals
Advise family a patient advocate will call regarding follow-up with a subspecialist
Fill out paper form and place in blue patient folder
Nurse will copy paper form and leave for the patient advocate
Family to be contacted regarding subspecialty follow-up

25. Welcome to Comer Pediatric Emergency Room We look forward to working with you. We hope you enjoy your rotation with us.

26. Questions? Contact Lisa McQueen MD, rotation director
Pager 4933
Gail Armstrong, section administrator