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. DJ is the scheduler but easy to go through Krysta for most things. 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

Thursdays, first case at 0800, typically in OR1. 3rd floor of building D. You have a locker: male locker is in the back corner, women’s is #90. (Tell Krysta if it gets taken away). The code to get into the locker rooms and the break room is 145 enter. Scrub cards can be obtained from the administrator down the hall from the computer room (ask Krysta).

Prior to procedure patients need orders, a pre-op H&P and a consent. Krysta typically handles all of this in her pre-op visit the tuesday before. If you had an intern for clinic they are typically also with you on your OR day.

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

All patients require a brief op note prior to dc.

You can either dictate (see below) or type your operative notes. However if you type, make sure it goes into the right encounter (it is often easier to simply dictate).

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.

DENVER VAMC Dictation Instructions

1. To access dictation system:

      From within the facility, dial x15075
      From outside the facility, dial 800-394-3845

When the call is answered, you will be greeted with a voice prompt which gives you instructions. 2. Enter your USER ID, followed by the # key. 3. When prompted, key in the patient’s full 9-digit SS number, followed by the # key. 4. When prompted, key in Work Type, followed by # key.

WORK TYPE REPORT TYPE 1 DISCHARGE SUMMARY 2 OPERATIVE REPORT 3 CONSULT & PROCEDURE 8 PROGRESS NOTE

At the sound of the tone, please begin your dictation.

* THE FOLLOWING MUST BE DICTATED DURING THE BEGINNING OF DICTATION* • IDENTIFY PATIENT NAME (SPELL THE LAST NAME AND FIRST NAME). • ENTER FULL SOCIAL SECURITY NUMBER • CLINIC SPECIALTY TITLE (i.e., ORTHOPEDIC, NEUROLOGY, PRIMARY CARE, ETC.) • DATE OF SCHEDULED APPOINTMENT • NAME OF CO-SIGNATURE (ATTENDING) IF APPROPRIATE.

3. If you wish to dictate multiple reports, press ‘8’ to end one and begin another. 4. To obtain a job number for the report you just dictated, press ## before hanging up. KEEP THIS NUMBER UNTIL THE DICTATION IS AVAILABLE FOR ELECTRONIC SIGNATURE. 5. To disconnect, simply hang up.

DICTATION KEYPAD FUNCTIONS PRESS 1 To pause dictation. 2 To resume dictating after pausing. 3 Rewind – rewinds approximately 3 seconds. Press ‘2’ to resume dictating. 8 To end current report & begin another ## To get job number of report just dictated before hanging up To disconnect, simply hang up.

‘LISTEN’ ACCESS 1. DIAL 800-394-3845 2. Press 333, followed by the # key. 3. Enter the patient’s full 9-digit SSN or Report number, followed by the # key. 4. The latest dictation or selected report will begin to play.

‘LISTEN’ KEY FUNCTIONS 1. PLAY 4. WILL GO TO END OF REPORT 2. PAUSE 6. NEW SEARCH 3. REWIND AND PLAY

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