Division of Infectious Diseases

Thornton Hospital

Thornton Hospital Website

Topics
- Roles and Responsibilities of the I.D. Fellow and Consult Team at Thornton Hospital
- 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
- On Call Responsibilities
- Weekend Coverage
- Required Conferences
- I.D. Outpatient Clinic

 

Roles and Responsibilities of the I.D. Fellow and Consult Team at Thornton Hospital:

The I.D. Consult team at Thornton is comprised of an I.D. faculty member/attending physician, a clinical I.D. fellow, and on occasion when scheduling permits 1 medical resident. The attending physician is responsible for the activities of the members 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, initial new consult workups by the I.D. fellow, resident or student, and for bone marrow transplant rounds (see below). The I.D. fellow is responsible for following all active I.D. consults 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.

An integral part of I.D. consult rounds at Thornton is participation in rounds with the bone marrow transplant service 3 days per week. Bone marrow transplant rounds generally take place from 9:00 a.m. to approximately 11:30 a.m. 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 weekend coverage 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^

Required Conferences:

While based at Thornton Hospital, fellows participate in the Hillcrest and VAMC clinical and research conferences each week as described in I.B. below as well as the medical service Morbidity and Mortality (M&M) conference each week. Top^

I.D. Outpatient Clinic:

The I.D. Outpatient Clinic at Thornton is located in the Perlman Outpatient Center adjacent to Thornton Hospital. The clinic meets on Wednesday mornings and is staffed by one or two I.D. faculty members; this clinic experience also includes a travel clinic that provides consultative care regarding immunizations and prophylactic antimicrobial therapy to prevent tropical or other endemic diseases for travelers outside the U.S., and referral care for infections acquired during travel outside the U.S. I.D. fellows rotating at Thornton are expected to participate in I.D. outpatient clinic at Perlman. Top^