Division of Infectious Diseases

Hillcrest Hospital

Hillcrest Hospital Website

Topics
- Roles and Responsibilities of the I.D. Fellow and the Consult Team at UCSD MC Hillcrest
- I.D. Consult Rounds
- All new consults must be dictated into the electronic medical record either by the fellow or the resident assigned to the patient
- Microbiology Rounds
- On Call Responsibilities
- Weekend Coverage
- I.D. Outpatient Clinic
- Specific subject matter that will be addressed in the UCSD MC Hillcrest I.D. Outpatient Clinic includes

 

Roles and Responsibilities of the I.D. Fellow and the Consult Team at UCSD MC Hillcrest:

The I.D. Consult team at Hillcrest is comprised of an I.D. faculty member/attending physician, a clinical I.D. fellow, 1-2 medical residents when scheduling permits, 1-2 fourth year medical students, an I.D. pharmacist, 1-2 pharmacy residents, and on occasion other visiting medical trainees. The attending physician is responsible for all consultative activities of the consult team and directly supervises the work of the I.D. fellow. The I.D. fellow is responsible for supervising any residents or students assigned to the service, at the direction of the attending physician.

All consults must be seen by the I.D. fellow, although the fellow may delegate the responsibility for the consultative history, physical examination, chart review, and review of pertinent diagnostic tests to the residents and students. If the consultation is delegated to a resident or student, the fellow must review the work of the resident or student.

The I.D. consultations will include a history and physical examination, a review of the chart and all pertinent radiographs, microbiology, serology, and pathology. All new consults are presented by the team (usually by the team member who performed the initial consultation visit and review) to the attending physician, who is then responsible for seeing the patients and discussing the diagnostic and therapeutic recommendations, as well as instruction and education for the team about the infectious disease that is the focus of the consultation. The diagnostic and therapeutic recommendations must be conveyed to the primary care team by the fellow or the resident immediately after the consultation, either in person, by phone or electronically as appropriate. Top^

I.D. Consult Rounds:

The I.D. Consult team makes daily rounds 6 days/week. The attending physician is responsible for the medical care provided by the consult team 7 days/week throughout the rotation. Rounds generally take place at a prearranged time daily, in consultation with the attending physician and the I.D. fellow. In general, the morning is set aside for followup of existing consult patients and initial new consult workups by the I.D. fellow, resident or student. The I.D. fellow is responsible for following all active patients on the service, and if followup is delegated to a resident or student, the fellow is responsible for reviewing each case briefly with the resident or fellow prior to attending rounds. In general, the I.D. attending physician on service will meet with the team in the early afternoon to review active cases and new consults. Rounds continue until all patients requiring consultation or followup have been seen and notes written as appropriate. After each new case is seen, the I.D. fellow is expected to review the pertinent literature regarding the case. This may be done after during free time before rounds or after rounds are completed. Top^

All new consults must be dictated into the electronic medical record either by the fellow or the resident assigned to the patient:

Instructions for dictations are provided as an appendix to this document. If the resident is unable to or does not dictate the initial consult note, the I.D. fellow is responsible for doing so. Medical students may not dictate consult notes in the medical record. If a medical student is assigned to perform the initial consultation encounter, the I.D. fellow must review the case and is responsible for the dictation for that patient. Daily progress notes may be written in the chart by the fellow, resident, medical student, or attending physician. If written by a resident or student, these notes must be reviewed by the I.D. fellow and countersigned by the fellow. If written by the I.D. fellow, these notes should be reviewed by the attending physician and countersigned as appropriate. The attending physician will be responsible for reviewing dictated or written consultation notes, making appropriate edits or additions, and either writing an additional attending physician note or tying into the fellow’s note and countersigning the note either electronically or in the hospital chart.

When the consult team deems the I.D. care of the inpatient completed, or the patient is sufficiently stable that care can continue under the supervision of the primary care team, the I.D. fellow can "sign off" the case. When an active consult patient is to be discharged, the team will make the determination whether or not post-hospitalization outpatient followup is required, and if so, will refer the patient to the I.D. Outpatient Clinic, and provide the patient with appropriate instructions for outpatient care and for making an appointment in the I.D. Outpatient Clinic (see below). A discharge note should be dictated into the electronic medical record either by the fellow or the resident responsible for the followup of the patient. The discharge note should be brief and state the I.D. diagnoses established at the time of discharge, the pertinent I.D. discharge medications including all antibiotics and doses, the duration of antimicrobial therapy planned, and the instructions for outpatient followup. A "discharge note" should be dictated into the electronic medical record even if the team is only "signing off" the case and the patient is expected to remain in the hospital for other chronic care or followup. This serves to inform the outpatient providers about the I.D. care and recommendations the patient received when a written record may not be available at the time a patient is seen in followup. Top^

Microbiology Rounds:

An integral part of I.D. consult rounds at Hillcrest is daily rounds in the Microbiology laboratory with the Microbiology Laboratory Director and/or I.D. attending physician. Microbiology rounds are generally held daily from 11:00 a.m. – 12N. During Micro rounds, the laboratory director will review new positive blood cultures, interesting or rare isolates identified in the lab, microbiology results from patients on the consult service, and other critical results with the consult team. The purpose of this component of daily rounds is to provide clinical-microbiological correlations and to teach fellows how to use the information from the microbiology laboratory to improve patient care. Although some critical results may be communicated to the responsible primary care team during this time, the I.D. fellow is not responsible for providing consultative care for patients reviewed during Microbiology rounds unless formally consulted by the primary care team. Top^

On Call Responsibilities:

I.D. fellows will take after hours and emergency calls from home. If an emergency consult or followup visit is required, the fellow will return to the hospital as necessary. Fellows will contact the attending physician to present the case immediately after the consult is seen. The fellow on call is responsible for answering all pages and must be reachable by pager or prearranged phone number at all times when on call. The attending physician on service must be available by pager or prearranged phone number at all times as a back up for the I.D. fellow. Top^

Weekend Coverage:

I.D. fellows rotating at Hillcrest and Thornton Hospitals will cross-cover both hospitals on weekends. This will allow a weekend off every other weekend for fellows, and allow the training program to meet the requirement of an average of one day off per week. The fellow on each service is responsible for signing out important clinical information to the fellow on call to assure continuity of care over the weekend. The schedule for days off and which weekend days will be covered will be arranged with the attending physician on service at the beginning of each rotation. The attending physicians on service at Hillcrest and Thornton Hospitals will also cross-cover both institutions with the fellow on weekends, and will serve as on call back up for the fellows. Top^

I.D. Outpatient Clinic:

The I.D. Outpatient Clinic at Hillcrest is co-located within the Owen Clinic on the 3rd floor of the Ambulatory Care Center across the street to the south of UCSD MC Hillcrest Hospital. The clinic meets every Tuesday afternoon from 1:00 p.m. to 5:00 p.m. Inpatient consultation cases that require outpatient I.D. care after hospital discharge are referred to the I.D. Outpatient Clinic at the time of discharge. The clinic also sees patients with outpatient I.D. consultation needs by referral from UCSD physicians. The I.D. fellow rotating on the Hillcrest consult service is responsible for attending I.D. Outpatient Clinic each Tuesday afternoon during their rotation. The clinic is staffed by I.D. faculty/attending physicians, who will supervise the activities of the fellow and assign outpatient cases to the fellow each week. Top^

Specific subject matter that will be addressed in the UCSD MC Hillcrest I.D. Outpatient Clinic includes:

  1. Antibiotic administration at home via central catheters
  2. Coordination of care with home care agencies
  3. Diagnosis and management of STDs
  4. Pleuropulmonary and bronchial infections
  5. Urinary tract infections
  6. Cardiovascular infections
  7. Central nervous system infections
  8. Skin and soft tissue infections
  9. Infections in geriatric patients
  10. Gastrointestinal infections
  11. Bone and joint infections, including chronic osteomyelitis
  12. HIV and AIDS
  13. Tuberculosis
  14. Infections in solid organ transplant recipients
  15. Infections in drug users
  16. Mechanisms of action of and adverse reactions to antimicrobial agents
  17. The appropriate use antibiotics in ambulatory patients
  18. Principles of immunoprophylaxis

Top^