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--- resident:va [2023/08/21 13:18] – [VA Phone Numbers] haley.d
+++ resident:va [2026/08/20 12:00] (current) – ariel
@@ Line 2: / Line 2: @@
 ==== VA Faculty ====
-[[resident:michael_gordon|Dr. Michael Gordon]]\\
-[[resident:david_mathes|Dr. David Mathes]]\\
+[[resident:david_mathes|Dr. David Mathes]]\\
+[[resident:david_mathes|Dr. Seth Tebockhorst]]\\
 ==== Generic Monthly Schedule ====
 Subject to change! Melissa Munkwitz can update you on any changes, particularly with OR time. \\
-Hand fellow usually covers Weds hands cases--check weekly with fellow or Melissa. \\
+General Schedule
 ^ ^ Tuesday ^ Wednesday ^ Thursday ^
-|Week 1 - Dr. Mathes |Gordon 8 AM Plastic Clinic (door code is 3-2-4), PM Gordon Hand Clinic | AM Gordon Hand OR (Fellow covers), AM/PM Hand Clinic (located in E1: door code is 1-5-4)| Mathes Plastic OR - 7:45AM Start|
+|Dr. Mathes |AM/PM Tebockhorst +/- Mathes Plastics/Hand Clinic in E1 | Tebockhorst MPR | OR - 7:45AM Start|
-|Week 2 - Dr. Gordon| Mathes 8 AM Plastic Clinic, PM Gordon Hand Clinic | AM Gordon Hand OR (fellow), AM/PM Hand Clinic | Gordon Plastic OR - 7:45AM Start |
-|Week 3 - Dr. Mathes | Gordon 8 AM Plastic Clinic, PM Gordon Hand Clinic | AM Gordon Hand OR (fellow), AM/PM Hand Clinic | Mathes Plastic OR - 7:45AM Start|
-|Week 4 - Dr. Gordon | Mathes 8 AM Plastic Clinic, PM Gordon Hand Clinic | AM/PM Gordon Hand Clinic | Gordon Plastic OR - 7:45AM Start |
-|Week 5 - Dr. Mathes | Gordon 8 AM Plastic Clinic, PM Gordon Hand Clinic| AM Gordon Hand OR (fellow), AM/PM Hand Clinic | Mathes Plastic OR - 7:45AM Start |
 ==== VA Templates ====
@@ Line 24: / Line 20: @@
 ^ Phone Numbers ^ Role ^ ^
-| Vocera | Calling system, return pages | 303 299 8020 |
+| Vocera | 15239 | 720-857-5239 |
 | IT | 14681 | 8556734357 |
 | ED | 16298 |
 | DJ | Plastics RN | 303 803 5199 |
-| Mary | Plastics Scheduler | 720-857-2710 |
+| Zeina Omisola | Plastics RN Coordinator | 720-989-5327 |
 | Jenn Hutton | SCI Wound Care RN | 720 469 8217 |
 | Melissa Munkwitz | Hand/PRS PA | 414 587 8491 |
@@ Line 34: / Line 30: @@
 VA Prefixes: 720-857-xxxx or 720-723-xxxx. Use this last number to call back pages. ie. 1-2345, call 720 723 2345 skipping the 1.\\
-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.)\\
+Vocera:  720-857-5239 or 1-5239 (in-house), then say the name of the person you want to call (example: Pre-op charge nurse, K3 [room number] nurse/provider/resident, wound care, OR 1 nurse, radiology, outpatient pharmacy, etc.)\\
+==== VA APP'S ====
+The VA now has APP's that help manage inpatient needs and consults. There are sometimes gaps in coverage. If you admit a patient, please sign out to them so that they know the plan in case they get called (this limits phone calls to you!)
+{{:resident:screenshot_2025-12-19_at_3.31.31 pm.png|}}
+{{:resident:screenshot_2025-12-19_at_3.31.04 pm.png|}}
 ==== VA Remote Access ====
-Get Card reader either from VA (will loan, but may lock you up if you lose it) or Amazon. Make sure MAC compatible if user\\
+Get Card reader either from VA IT (as of June 2024 they don't write down your info and don't care about getting it back) or Amazon. Make sure MAC compatible if user\\
-https://www.amazon.com/dp/B0177O5XNA?psc=1&ref=ppx_yo2ov_dt_b_product_details (MAC friendly)\\
+https://www.amazon.com/dp/B002N3MM6W?psc=1&ref=ppx_yo2ov_dt_b_product_details (MAC friendly)\\
-https://www.amazon.com/Reader-Saicoo-Military-Compatible-Windows/dp/B071NT53M7 (for USB-C users)\\
+https://www.amazon.com/Identiv-SCR3310v2-0-Smart-Card-Reader/dp/B07VVSY96H/ref=sr_1_6?keywords=IDENTIV&qid=1699290763&sr=8-6&th=1 (for USB-C users)\\
 Make sure you have received Welcome Letter in email giving remote access. IF you have not, email Ashley.Herrera@va.gov \\
@@ Line 62: / Line 64: @@
 ==== General Information & Onboarding ====
-Welcome to the VA. The senior resident has good autonomy at this location and you are expected to run the service. We no longer have a PA or interns on service (including night coverage). Mary Maddox is the plastics scheduler. For cases at the VA, it is VERY important to make sure you have everything ordered beforehand. They won't have anything like Integra or implants on consignment.\\
+Welcome to the VA. The senior resident has good autonomy at this location and you are expected to run the service. We no longer have a PA or interns on service (including night coverage). For cases at the VA, it is VERY important to make sure you have everything ordered beforehand. They won't have anything like Integra or implants on consignment.\\
 Signing up for the VA can be a huge hassle. Please start the process as early as possible. You will need the following processes to get started with onboarding\\
@@ Line 69: / Line 71: @@
     *Complete VHA Mandatory Training for Trainees-Refresher (if done before), VHA Mandatory Training for Trainees (if not done)\\
     *If you need help with your TMS Account when you log in please contact 1(855) 673-4357 or email VHAECHTMSHelpDesk@va.gov\\
-    *Please email Selena both of your TMS certificates to add to your file.\\
+    *Please email PRS Program Coordinator both of your TMS certificates to add to your file.\\
     *Review VA Policies and then sign the VA Local Policies Acknowledgement Form and return it to Selena.\\
     *{{ :resident:va_fingerprint_request_form.pdf |}}\\
@@ Line 77: / Line 79: @@
     *Recommended: Email VHAECHAcademicAffiliations@va.gov or Kayla.Lewis3@va.gov to schedule an appointment at the Aurora VA for fingerprints. the resident will need to bring 2 forms of ID - see PIV Acceptable Forms of ID. See RMR map for office location and directions for where to park for this visit.\\
 *VA WOC Letter\\
-    *Selena must send you Without Compensation (WOC) Packet and you must sign it via DocuSign\\
+    *Program coordinator must send you Without Compensation (WOC) Packet and you must sign it via DocuSign\\
     *If completed and held up at this stage Please reach out to VHAECHSurgeryPSA@va.gov .Michael T. Kilmer is the director who signs the letters\\
 *VA Badging (after completion of fingerprints)\\
@@ Line 100: / Line 102: @@
 |Men's Locker #59 | 8008 |
 |Woman's Locker #90 | ? |
+====Expired Badges====
+    * OH NO I HAVEN'T SCANNED MY BADGE >90 days SO NOW IT'S EXPIRED\\
+    * EMERGENT: Call Police Dispatch 720-723-5800 and request reactivation for emergent purposes. This gets recorded in Facility Access Section for follow-up and verification with the supervisor/service. \\
+    * NON-EMERGENT: Email VHAECHfacilityaccessrequest@va.gov to request badge re-activation in advance of your rotation.
+    * If you are already on campus when you realize this, use intercom button at entrance of staff garage marked "POLICE" and you will be granted entrance after answering few questions. You must then visit Facility Access Section in A2-104 during normal business hours for re-activation. REQUIRED: WOC letter with non-digital signature (can get from HR on 1st floor in A building\\
 ==== Meals ====
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 ==== Clinic ====
-Plastics 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 VSE now to show when patients arrive. Once the vital signs are taken, you call for the patient yourself and bring them to your room. The attendings have been using the 3rd room (room 228) from the main door as his office. You (and medical student, if there) select your own rooms and camp out there throughout clinic. 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. Disinfect the rooms ourselves between patients.
+Hand clinic and Plastics Clinic:
+st floor, building E. Code 251 enter. On Tuesdays it is you, Mathes, Dr. Tebockhorst and Melissa the PA or some combination of those people. Everyone sits in the "Care Team Center" E1-223. You will sit in the main team room and the nurse will room patients and write on the schedule when people arrive and when she roomed them; you will write initials next to one you see. These clinics are more organized. So you should only have to look at 1 schedule. Melissa will print out list of all patients for clinic and leave in team room. Make sure if scheduling patient for follow-up via RTC in orders, you select the correct follow-up clinic. Ask Melissa\\
-Hand clinic:
-st floor, building E. Code 154 enter. On Tuesdays it is you, Dr. Gordon and Melissa the PA. You will each have a room and will call patients similar to plastics clinic. On Wednesdays, you will sit in the main room and the nurse will room patients and write on the schedule when people arrive and when she roomed them; you will write initials next to one you see. Wednesday mornings are you, Melissa, and the attending. In the afternoon, the ortho residents should be joining after their didactics.\\
 Clinic names on CPRS: \\
 Plastics: Rmr Surg Plastc (MD MPR, MD Oper, MD/PA, MD/PA postop, Md/PA preop, MD/Res Eval) (VVC is video)\\
 Hand: Rmr Surg Hand (MD, MPR, OPer, Md/PA urgent, Pa post, pa screen)\\
-Make sure if scheduling patient for follow-up via RTC in orders, you select the correct follow-up clinic\\
-For pre-ops, patients need: an H&P ("Surgical Preop-Op 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).\\
+Note Formats on CPRS:\\
+I recommend you creating templates for new patients vs. post-ops etc. Go to templates in lower left corner of CPRS, right click "My templates" and create new template. When filling out notes, you can drag these to empty note page and will copy over. \\
+When you click "new note" it will pop up with progress note title:\\
+Plastics: PLASTIC SURGERY RESIDENT/FELLOW CLINIC NOTE\\
+Hand: Type in Hand --> will pop up options, select HAND RESIDENT CLINIC NOTE\\
+Sign notes by right clicking and selecting "sign note now"\\
+It will show a prompt saying "are you the primary for this encounter"--select yes.\\
+You have to select encounter type, complexity, add Dr. Gordon, and diagnosis for encounter, then sign\\
+For pre-ops patients, patients need: an H&P (select "SURGICAL PRE-OP H&P" as progress note title), 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).\\
+For pre-op labs: Women <55 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), pre-procedure (NPO/IV/Iodine/CHG/Hair), and CBC/coags if indicated. I recommend placing/confirming these orders in clinic or the night before cases or you will be woken up to a page at 6am.\\
-For pre-op labs: Women <50 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), BINAX (under labs- POC), pre-procedure (NPO/IV/Iodine/CHG/Hair), and CBC/coags if indicated. I recommend placing/confirming these orders in clinic or the night before cases or you will be woken up to a page at 6am.\\
+If ordering studies/labs that require follow-up or change management - please make sure to add to "tasks to follow up on" spreadsheet in Excel. Melissa and next resident will then be able to follow-up after you change rotation. \\
-==== PACS ====
+==== IMAGING ====
-PACS is IMAGING PAC (IMPAX) here. Click the icon on the desktop and search by using the last #4 of patient's SSN ("*1234").
+PACS is IMAGING PACS (XERO Viewer) here.
-You can also access by opening CPRS:
+Access by opening CPRS:
 . Tools
 . Imaging Apps
@@ Line 128: / Line 144: @@
 . Type in patient's last initial and *#### (last 4 of SSN)
-==== Clinic Notes ====
-Make sure you always set up an encounter by right clicking note, select edit encounter and select yourself as a primary provider. Also select billing level of complexity, whether condition is service related, and a diagnosis for 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.  When you sign the notes - you are the "Primary" signer. Once you sign, right click and add co-signers. Add relevant attending.\\
-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\\
 ==== Surgery ====
+Find surgery schedule by selecting clinic schedule RMR SURG PLASTC MD OPER. All Gordon hand cases are now under this schedule as well\\
+\\
+\\
 The plastic surgery operating room day is Thursday. The first case is supposed to roll into the room before 08:00 AM to not be deemed "late." Start time is supposed to be 07:45 AM. The operating room is on the 3rd floor of the D building. There are locker rooms in the back of the resident call room.
@@ Line 148: / Line 159: @@
 Prior to procedure, patients need orders, a pre-op H&P (by attending) and a consent. You do not need to write note on day of surgery. It's good practice to double check the charts beforehand to make sure that was all done. You should mark every patient. Dr. Mathes likes you to text him all patient names/last 4 of SSN at the beginning of each OR day so that he can write all his notes in the AM.\\
-==== Admitting Patients ====
+Ordering Tumescent: Go to surgery main menu, order tumescent\\
+==== Outpatient Surgery and Inpatient Tasks  ====
+All the things you need are in the tabs at the bottom of the screen \\
+Right click with the mouse to sign orders/notes/etc. \\
+I pre wrote all my instructions and op not in an email to myself to make copy and pasting easier, you’ll see why below. \\
+Outpatient Surgery Discharge. \\
+. Go to Notes, click New Note, Brief op note\\
+	- Fill in the form \\
+	- Sign after it populates as a note\\
+. Go to Orders tab \\
+	- Click “ Pre/Post Procedure Order Sets”\\
+	- Click “POST PROCEDURE ORDERS (click here)”\\
+	- Under “outpatient discharge orders” there is a 1,2 and 3 click thru each one and fill in what you need 	\\
+	- easiest to have some generic dc instructions in you email or something that you can just copy and paste in there \\
+. Outpatient meds I could never order, so I would ask Melissa or ask for a surgery APP to help me \\
+	- Melissa is there tues - thurs and can help you \\
+	- Tebock does his own meds or can for you \\
+. Op note \\
+	- Go to “Surgery” tab \\
+	- Find the surgery date and name you just did in the left hand column \\
+	- Open that *date*, OPERATION REPORT\\
+	- Right click to edit, and then you can type your op report in there. \\
+	- once you SIGN it you cannot edit, it disappears so make sure you are happy. Some people write the notes on their own comp or in word then copy and paste, then sign. \\
+	- I never got the phone call dictation to work, this works just as well. \\
+\\
+Admitting at the VA \\
+HIGHLY recommend doing this in the resident bowl so a surgical APP can help you. \\
+. Complete brief op note, can do op note too if you want, or do it later. \\
+. Go to “Orders” tab \\
+	- Open “Surgery Main Menu”\\
+	- Under surgical speciality menus there is “General Surgery Menu” click that \\
+	- <<Click Here>> General Sx Admission Order Set, let that go through all its things. \\
+	- Can also just click all the orders you want here in the “general surgery menu”\\
+	- don’t forget no ice or heat to breast, surgical bra or binder, drain care can write those as nurse free text orders. \\
+. Restarting Home Meds: In the Meds tab \\
+	- under “Outpatient Meds” you can hold Shift and highlight all meds you want to be continued. \\
+	- At the top of the CPRS screen there is “Action” click this and in the drop down menu select “transfer to inpatient”\\
+. You must complete a “Life-sustaining Treatment” note, you’ll need their family contact phone number before hand!!!\\
+	- Go to Notes tab, select New Note, Search “Life sustaining “\\
+	- fill in the form\\
+	- sign after it populates as a note\\
+\\{{ :resident:va_inpatient_orders.jpg?nolink&400 |}}
+\\
+I have an APP check this before I leave \\
+\\
+How to discharge at the VA \\
+. Check meds on the “Meds” tab and make sure outpatient meds are what you want, if needed order whatever post op meds you want (Residents usually can’t order meds so you have to ask a PA to order them for you - like Melissa or one of the surgery APPs) \\
+. Go to Notes and “New Note” and chose the “Provider discharge instructions” \\
+	- fill out the form, easy if you have some instructions already written you can copy and paste, if not just free hand it \\
+	- sign after it populates in a note \\
+. Home oxygen, if needed \\
+	- Click Consults tab \\
+	- click “New Consult” from the left hand column \\
+	- On the far right column in that pop up window it says “PULMONARY…”, click that\\	- Under “Home Oxygen” there is a “New Home O2 Order” click that to get a home O2 order and get O2 delivered to bed \\
+	- In your dc order (under step 4) you can write in the “special instructions”, “do not dc until home O2 delivered.” \\
+. Go to orders \\
+	- in the left column click, Discharge pathway, follow the instructions in order\\
+	- Pharmacy Discharge Consult, fill the pre filled form, you’ve already checked the outpatient meds, sweet \\
+	- you’ve already done the provider dc instructions, yay 	\\
+	- “Click here to order Discharge Order”\\
+. Go to D/C summary and click “new summary”\\
+	- chose any template that says “dc summary” or some version of that, it doesn’t matter which\\
+	- fill out the form\\
+	- sign when complete \\
+. Do the PDMP Query \\
+	- top right hand corner just clinic and follow steps and sign \\
+\\
+If your unsure surgical APPs are very nice and helpful I would have them check my work before I left \\
+All BLUE orders need to be signed, you can hold shift and select them all and sign at once \\
-Under orders, "Write Delayed Orders"
-"Admit to Plastic Surgery", relay orders immediately
-Surgery Main Menu - can use general surgery
-Go through each tab
-==== Discharging Patients ====
-Admitted patients will go to the Building K - 3rd floor.\\
-Prior to discharge INPATIENTS, the patients will need:\\
-  - Discharge order\\
-  - Discharge Instructions (under Notes-discharge instructions)\\
-  - Pharmacy Consult\\
-  - Pain medication\\
-  - Operative Note must be dictated the same day\\
-  - Discharge summary (under D/C Summ tab)\\
-(Clicking discharge menu under orders will walk you through this)\\
-Prior to discharge OUTPATIENTS, select:\\
-   - Pre/post procedure order sets\\
-   - Post\\
-   - Outpatient discharge orders 1,2,3\\
-For narcotic prescribing, email vhaechepcshelp@va.gov to get your pharmacy ID\\
 ==== Dictations/Op Reports ====
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 .	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.\\
 .	Enter your USER ID, followed by the # key. \\
@@ Line 237: / Line 300: @@
 SCI - This is the inpatient spinal cord unit (first floor of H). This unit is run by PMNR doctors and wound care.
   * There are no longer MDC meetings
+  * See Plastic Surgery TEAMS spreadsheet for pending SCI consults. You keep this up to date
   * Whoever you are in clinic or OR that day is who I tend to staff the patient with.
   * Our criteria is that their co-morbidities are relatively well-controlled, osteo has been addressed, and their albumin is 3 or above.
@@ Line 248: / Line 312: @@
 ==== End of rotation Tasks ====
-Set up a Surrogate: In CPRS - under “Tools” —> select “Options” —> select Surrogates —> select “Add Surrogate” put in name of next resident coming onto rotation and select start date as your last Friday on rotation (just make sure you clear your inbox your last day of rotation)
+Set up a Surrogate: In CPRS - under “Tools” —> select “Options” —> select Surrogates —> select “Add Surrogate” put in name of next resident coming onto rotation and select start date as your last Friday on rotation (just make sure you clear your inbox your last day of rotation)\\
+Make sure TEAMS spreadsheets for SCI consults & Tasks to follow up are updated.\\