Plastics

Important phone numbers:
Peggy Walsh: 713-320-9063
Maureen Andrews: 303-929-7929
Amy Circle: 970-310-7745
OR charge: 64890
ED: 76888
One call: 73999

How to see who's on call: either call One Call or go to children's webpage, click on quick links, then amcom.

Important rooms: There's a surgeons lounge on the 1st floor right when you walk in from the parking garage with food and drinks. There's a faculty respite room in the hallway leading up to the outpatient building on the 1st floor that has comfortable seats and 6 computers/phones and a printer.

Expectations: OR takes precedence over clinic. However, if you are not in cases, you are expected to attend clinic. If simultaneous cases, I would cover cases in order of seniority (Dr. French's cases covered first, then Khechoyan, then Domeshek). Of course, if one of the more junior attendings is doing a really cool case, I'd talk to French about covering those instead.

Consenting: Children's is all electronic consents. In order to make a consent, you click on the pre-op consult tab in Epic and then click consents. To make a consent - you click on procedure #1 (or 2 or 3 if it's a combo case) consent (or something like that) and fill in the correct information in the boxes on the right. .momsname or .dadsname in the first box and then whatever parent (or patient) is signing for the kid. This has to be accurate and only have one parent's name, they will hold a case indefinitely if this is done incorrectly. You can add extra procedures and whatnot in those boxes on the side. And then fill in your name as the person obtaining the consent. Often the procedure and stuff will already pre-populate. If you're consulted for a spine closure or something, you'll have to type in all the stuff yourself. After you did all that, you can either have the parents sign on the computer, or on the patient's ipad. To log into the ipad you put in the patient's DOB (mmddyy). Click submit after you and the patient have signed the consent. The attending can sign the consent when they're back in the OR.

Rounding: I ended up seeing everyone myself in the morning and writing everyone's notes. In the past, it sounds like the fellows have left the notes to Peggy and Maureen, but ever since that meeting we had a couple of months ago, it's clear that the attendings don't like that. - After rounding - I would text both the attending covering the patient and Peggy for general plastics kids or Maureen for the craniofacial cleft kids.

Craniofacial kids: ● Maureen is an awesome resource. She ends up seeing everyone herself too, and will write her own little note. She'll also check in with people postop. I would text her whenever we finished a craniofacial or cleft case so she would know how it went. She provides teaching to all the families while in house, and is their main point of contact after they get discharged. If she's ever not there, you can get the teaching handouts for patients on discharge on the children's webpage - resources - patient hand outs. ● If you put in distractors, French usually likes to teach the parents pretty quickly on how to turn the distractors themselves. However, for the first day or two, you and Maureen are responsible for distractions. Typically, I'd let her do the morning distraction with the parents and I did the PM distraction. ● All of the craniofacial kids are neurosurgery primaries postop. They are responsible for drains and everything. The only thing we are responsible managing are distractions. ● Consents - these cases are always booked under the neurosurgery attendings. The neuro fellows are usually slammed in the mornings, so I would be the one doing the consents there. All the kids need a regular procedural consent as well as a transfusion consent. The plastics attendings are typically not on the consents. We've established this is okay because they're co-surgeons on the same procedure. If they were doing different procedures, plastics would need their own consent.

Cleft cases: ● Maureen helps to manage these too. ● They typically stay in house only one night. If you type in “plastics” in the post op order sets, there're pre-populated ordersets for each type of cleft case. ● For Dr. Khechoyan - if they are a syndromic kid who is getting a palate repair, they go to the PICU postop (French's kids all typically go to the floor). Khechoyan will also do a tongue stitch and sometimes a nasal trumpet sutured in that you have to remove the next morning. This is super fun.

Orthognathic cases: ● Khechoyan has a big postop pathway, see separate document.

Clinic: ● The clinics are on the second floor of the outpatient side of the hospital. Hallway B tends to be where all the general plastics patients are, there's a work room in the back hall that we share with gyn and ID. Multi-D clinics are behind these. Sometimes you're in the clinics at one end of the hallway, sometimes you're in clinics on the other end of the hallway. ● There are several multidisciplinary clinics that we attend: craniofacial, cleft, brachial plexus, vascular malformations. These are kind of weird clinics where you just stand in the background and observe. I didn't pre-see patients or write notes in these clinics. They're educational, but you don't do much. side note: Khechoyan showing up to his multi-d clinics, at least for me, has been hit or miss. If he wasn't there, I wouldn't stay. ● Plastics clinic- you're expected to see the patients yourself and then staff them like we usually do. We also write the notes, like we usually do. ● Amy Circle is the go-to person for outpatient plastics stuff. She'll also help you with wound care stuff on the floor if you ask her. ● Sometimes you'll get called by Amy to help with the odd clinic patient (usually for tissue expander fills, steroid injections, vac changes, etc.)

Consults: ● We are now first call for all consults (face, gen plastics, wound). If you're slammed, Peggy is happy to help with these too. I've asked her to take care of wound care consults in the past, since she's the one who does the outpatient wound care anyway. ● Wound care consults: you'll sometimes get weird consults from wound care to establish care prior to a patient's discharge. Typically I just go see them then say continue whatever wound care recs the inpatient wound team has recommended and then set them up to see Amy and Peggy as an outpatient. It's totally reasonable to have Peggy see these too, since she'll be the one seeing them as an outpatient.

Admitting complex patients to medicine: This is a new thing for me. If there's a complex medical patient coming in (read: Maxwell Harmon) or if you want to have a patient stay overnight from the ED (I've done this for lip hematomas and stuff that we may or may not operate on), you can have medicine admit them. They usually don't put up much of a fight. You call the One Call people and then select admissions/transfers and they'll connect you to the admitting attending and senior resident to discuss the admission.