Plastics

VA Faculty
Dr. Michael Gordon
Dr. David Mathes

Important numbers:
Krysta: 720-737-4532 (office 720-857-5817)
VA Prefixes: 720-857-xxxx or 720-723-xxxx.
Vocera: 720-723-7997 or 1-7997 (in-house), then say the name of the person you want to call (example: Pre-op charge nurse, K3 [room number] nurse, OR 1 nurse, radiology, outpatient pharmacy, etc.)
Jenn Hutton, wound care nurse in the SCI: 720-469-8217

We usually have an intern, but they've been trying to skimp on us lately. If this becomes an issue, let Dr. Mathes know, because the service really is starting to get busier. We also have a PA, Krysta Bearish, who is awesome, but she is also part of the Breast service. She can see ED consults and patients, and helps out in the OR. We don’t have a scheduler right now, so she’s wearing both hats. She works Tuesday - Friday.

Clinic - Tuesday AM 8-11:30. We are in Maroon Peak clinic. 3rd floor specialties clinic in Building E, in rooms 224 - 228. 3-2-4 “enter” is the code to the door to get back into the clinic from the waiting room. They're using this VetLink program now to show when patients arrive. Once the vital signs are taken, you call for the patient yourself and bring them to your room. You can edit the memo to say you are seeing the patient by adding your name/initials or adding “done” in the memo if the patient has been seen so everyone else is on the same page. The attendings have been using the 3rd room (room 228) from the main door as his office. Since we only have 3 assigned rooms, Krysta will often use one of the Thoracic rooms if an intern is helping in the clinic. Krysta will typically see the pre-ops, and the fellow/resident will see the new patients, and the intern will see everyone else. Obviously, if things fall behind, you see anyone. I also encourage you to at least peek in on your post-ops, as you are afforded quite a bit of independence in the OR and it’s a good way to learn from your mistakes. Because of COVID, we are disinfecting the rooms ourselves between patients).

If you have a case to schedule, the patient should be provided a business card with the contact information for the office (Krysta has those available). Sometimes we can offer them an OR date same day, but most of the time she will call them later in the week to get them onto the schedule.

For pre-ops, patients need: an H&P, pre-op labs (under pre-procedure labs), signed consents (consents are electronic: under “Tools” → iMed Consents → Plastic Reconstructive Surgery → Consents Basics → then select appropriate consent and follow prompts).

Make sure you always set up an encounter, a primary provider, and a diagnosis (The first 2 tabs when you set up the encounter). Then write the note - there are specific plastic surgery headings to select. You can create your own template or use a pre-populated one. Before I made my own templates, I often used the Urology clinic note template). When you sign the notes - add the attending and Krysta as co-signers. Also order clinic follow up appoints (RTC - specialty clinic - plastics).
If you are seeing a NEW patient consult: “Plastic Resident/Fellow Consult Note”
If you are seeing a patient for follow-up, post-op: “Plastic Resident/Fellow Clinic Note”
If you are seeing a pre-op: “Surgical pre-op H&P” then follow the prompts and check all the boxes

On Thursdays. Usually in OR 1. 3rd floor of building D. You have a locker, I don’t know what the male locker is, but the women’s is #90. Please be aware that they have a tendency to take our lockers away, so let Krysta know if this happens. She can talk to Dr. Robinson about it. The code to get into the locker rooms and the break room is 145 enter. Our scrub card doesn't work anymore. I just used old scrubs that I had on hand (the children’s blue scrubs), but I think you can talk to some guy named Hugo (?) in the basement to have your card activated.

If you want to put in pre-surg orders so you don't get paged at 5:30 am on Thursdays, you put them in under the RMR OR Plastics MD visit encounter. Have one of the interns show you how to do it. (Note: Krysta has been taking care of this for us as she mostly sees the preops in clinic)

If you admit patients, they usually go to the 3rd floor of building K.

The attendings expect us to dictate all of the operative reports. Attached below are the dictation instructions. Your dictation code is 45 followed by your pharmacy ID.

SCI - this place is going to make our service busier each month. It is located one the first floor of building H. This unit is run by PMNR doctors and wound care. Once a month, there is a meeting before clinic (7:15 am), where we go over patients at a multidisciplinary meeting. I’ve found that they typically call Krysta with patients who need decubitus ulcer coverage. Our criteria is that their co-morbidities are relatively well-controlled, osteo has been addressed, and their albumin is 3 or above. The unit can be very eager about getting these patients to the OR, so be on your toes to ensure nothing is missed in optimizing the patients. Intraoperatively, Dr. Mathes typically does V-Y advancements, and Dr. Gordon does rotational flaps. Postoperatively, Dr. Mathes typically likes to keep the patients on antibiotics until the bone biopsies result. The SCI has a whole protocol for postoperative management. Typically sutures stay in 4-5 weeks (sometimes longer for Dr. Gordon’s patients), the drains stay in until dust comes out of them (typically 4-5 weeks). Gordon likes to keep his dressings on until they get soiled underneath. I’ve left them on for about 4 weeks once. Mathes has his dressings removed in 24-48 hours. After the 6th week, the SCI starts with their stretching protocol, and this is typically the time I stop seeing the patients. The wound care team here is amazing, always helping to turn and prep the patients, and manages dressings per our instructions. We will typically round on any current inpatient SCI patients on Tuesday afternoon, after clinic. The intern can round with the team, and Krysta is also willing to help with this for continuity.

Instructions for installing a card reader can be found at Military CAC. There is a section for buying a card reader and installing the required certificates.

See Aline's guide here: plastics_va_.docx