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--- medical_student:denver_health [2023/08/22 22:34] – [CONSULTS] haley.d
+++ medical_student:denver_health [2026/08/18 15:54] (current) – ariel
@@ Line 4: / Line 4: @@
 [[resident:corrine_wong|Dr. Corrine Wong]]\\
 [[resident:stephanie_malliaris|Dr. Stephanie Malliaris]]\\
+[[resident: haley_desjardins | Dr. Haley Desjardins ]]\\
 ==== Contact Information ====
 PRS NP: Rosa DiPrima. 256-558-3028\\
-PRS Clinic RN: Aimee Harmon. 719-661-1555\\
+PRS Clinic RN: Aimee Harmon. 719-661-1555 (MESSAGE FOR FU)\\
 Attendings:\\
 Stephanie Malliaris: 617 970 7590\\
 Corrine Wong: 972 322 2078\\
+Haley Desjardins: 207 838 1957\\
-==== Replant/Fellow Hand call ====
+Surgery Schedulers:\\
-There is a google calendar that is shared that has the schedule of fellow call. It is shared amongst the two ortho hand fellows and the senior plastic surgery resident. Add yourself to 4 weekdays and 1 full weekend for the month you are on. Can be any dates of your choosing (ie multiple weekdays in a week) but first come first serve as far as dates. You will only be called for operative interventions. For the weekdays, this mostly means replants as other cases get pushed to the next day. For the weekends, means replants, nerve repairs,pus/washouts. All attendings take 1 week at a time starting at 5pm Friday\\
+Ortho: Jacob Geesling\\
+Plastics: Christine Archuleta
+==== Haiku Setup ====
+{{ :medical_student:dh_haiku.pdf |}}\\
+{{:medical_student:initial_patient_activity.png?400|}}
 \\
-All hand patients admitted while Malliaris or a PRS attending are on call get admitted to PRS team but are managed in ED by ortho hand team.\\
+==== Replant/Fellow Hand call ====
+There is a google calendar that is shared that has the schedule of fellow call. Reach out to the 6s to get added to the calendar. It is shared amongst the three ortho hand fellows and the senior plastic surgery resident. Please reach out to the fellows directly and let them know that you put in your dates and to contact you if there are issues. More communication is better to have a good working relationship with them. Add yourself to 1 weekday per week and 1 full weekend for the month you are on. Can be any dates of your choosing. If you have a vacation you have to make up that week day in another week. Weekend call starts Friday at 5 pm to Monday 6 am. \\ You will only be called for operative interventions. For the weekdays, this mostly means replants as other cases get pushed to the next day. For the weekends, means replants, nerve repairs, pus/washouts. All attendings take 1 week at a time starting at 5pm Friday\\
+\\
+All hand patients admitted while Malliaris or a PRS attending are on call get admitted to PRS team after the initial ortho consult.\\
+{{ :resident:hand_fellow_excused_days.png?nolink |}}
 \\
@@ Line 118: / Line 131: @@
 === Pressure Ulcers ===
-Pressure ulcers come in waves at DH. PMR wants to see patient before surgery at a pre-operative appointment. Physical therapy, occupational therapy and PMR should be consulted on day 1 regardless of activity restrictions.
-For any wound consult, make sure you know nutritional status, if the wound is infected, reason for admission, overall prognosis of the patient, and an assessment of resources for wound care after surgery.
+MOST PRESSURE SORES ARE NON-OPERATIVE.\\
+Pressure ulcers come in waves at DH. PMR wants to see patient before surgery at a pre-operative appointment. Physical therapy, occupational therapy and PMR should be consulted on day 1 regardless of activity restrictions.\\
+For any wound consult, make sure you know nutritional status, if the wound is infected, reason for admission, overall prognosis of the patient, and an assessment of resources for wound care after surgery. Below can be copied into the PRS consult note for all pressure sores and contains all required criteria to be optimized prior to surgical intervention. \\
+Surgical closure of pressure sores has a high rate of failure. To maximizing the patient's chance for success, the following criteria must be met prior to consideration of soft tissue closure or reconstruction for chronic pressure ulcers: \\
+- Wound:\\
+The patient must have source control. Staged reconstruction can be considered for a clean wound after adequate debridement and antibiotic therapy optimization.\\
+Debridements should be performed by the patient's primary surgical service or by the general surgery service. \\
+If evaluation for osteomyelitis or bone biopsy is desired, the orthopedic service should be consulted. Often an MRI is necessary.\\
+The infectious disease service should be involved for antibiotic recommendations. \\
+The clean wound should be managed with a wound vac whenever possible until ready for soft tissue closure. There should be evidence of the ability to form healthy granulation tissue in the wound. If wound care recommendations are needed in the interim, please consult the wound care team.\\
+- Nutrition:\\
+Albumin > 3.0 gm/dl\\
+Prealbumin >16 mg/dl. \\
+In general, patients with osteomyelitis and inflammatory processes do not have a normal prealbumin (negative acute phase reactant). However, if they can show consistent elevation in prealbumin over 3 weeks, they can be considered candidates for reconstruction. A nutrition consult should be ordered if these goals are not being met.\\
+- Medical comorbidities: \\
+Medical comorbidities, such as diabetes, must be well controlled.\\
+Control of any spasms or release of fixed contractures that may impair flap mobilization should be obtained prior to soft tissue closure.\\
+A bowel regimen must be well established and urinary control must be obtained. If necessary, stool diversion must be arranged prior to soft tissue closure. \\
+- Postoperative disposition: \\
+Pressure relieving surfaces should be used during hospitalization and should be obtained for outpatient use prior to closure (e.g. mattress, wheelchair). \\
+Outpatient wound care, if needed, should be arranged.\\
+Medical management follow up and rehabilitation plan should be set up. \\
+Physical therapy, occupation therapy, and social work should be involved with the disposition process.\\
+Once these parameters have been met, the patient can follow up with Dr. *** in outpatient plastic surgery clinic for evaluation. \\
 ==== Replant Protocol ====
@@ Line 153: / Line 197: @@
   *If following pathway, typically discharge POD 4 or 5
+\\
+\\
+==== Discharge Summary ====
+Discharge summaries need to include a complete list of every diagnosis or medical issue that impacted your patient’s care during their hospitalization in the discharge summary. The discharge summary is the first documentation that coders review. If the diagnosis is not present in the DC summary, even though it was treated during the hospital course, payers use this discrepancy to deny payment.
+Ways to phrase things: Apparently there is  widespread use of the words “in the setting of” to possibly link conditions together.  For coders to link conditions together, the physicians and APPs need to use linking verbiage like “due to”, “secondary to”, or “with”.  Do not use “iso” or “in the setting of”.