The UCSD Medical Center Hillcrest Hospital is located on the north side of downtown San Diego on the Hillcrest neighborhood campus. This rotation includes a busy infectious disease inpatient consult service, emergency department consults, and the weekly I.D. outpatient clinic held in the adjacent Ambulatory Care Center on the Hillcrest campus. The I.D. Consult Service receives on average 1-4 new consult requests per day from all inpatient services at Hillcrest. The hospital houses an urban trauma center, the regional burn center, a busy emergency department that receives walk-ins and transports from all over San Diego County, medical, surgical, and neurosurgical intensive care units, a coronary care unit/step down unit, and obstetrical delivery suites, in addition to general medical, surgical, and inpatient psychiatric wards. The UCSD MC Hillcrest also houses the solid organ transplant programs including renal, liver, pancreas, heart and lung transplants. This service provides the fellows with a broad experience with infections related to medical, surgical, and other acute illnesses, viral, bacterial, mycobacterial, fungal, and parasitic infections. The hospital serves an urban patient population from the immediate area, as well as the surrounding metropolitan area of southern, central, and eastern San Diego County and the border with Mexico. Its geographic location near the Mexico border also provides access to patients who seek care for infectious diseases that are endemic to tropical and subtropical regions of Mexico and Central America. The third party payer mix includes individuals with private insurance, managed care coverage, medicare and Medi-Cal, and self-pay.
The UCSD Medical Center Thornton Hospital is located on the La Jolla campus of UCSD, 8 miles north of the Hillcrest campus. Thornton is a general medical hospital located adjacent to the UCSD Moores Comprehensive Cancer Center, and also serves as the primary inpatient facility for patients hospitalized with malignancies or for bone marrow transplantation. This service sees on average 1-3 new consultations per day. The service provides the fellows with experience in the care of infections in immunocompromised hosts undergoing cancer chemotherapy or treatment, infections in bone marrow transplant recipients, and general infectious diseases similar to those previously described, referred from clinicians staffing the adjacent Perlman Outpatient Center and surrounding communities. The hospital serves a more suburban patient population from the immediate area, as well as the surrounding north and coastal San Diego County region, although tertiary and quaternary referrals from the southern California area are also seen. In addition, the outpatient travel clinic, staffed by the Infectious Disease faculty at the Perlman Outpatient Center also attracts inpatient consultations for travel-related infectious diseases.
The VAMC is located on the UCSD La Jolla campus approximately 1.5 miles from the UCSD MC Thornton Hospital and immediately adjacent to the UCSD School of Medicine campus. This rotation includes consult services for inpatients at the VAMC and the weekly outpatient I.D. Clinic. The VAMC is a general medical hospital without obstetrics or pediatrics. The I.D. Consult Service receives on average 1-4 new consult requests per day from all inpatient services at the VAMC. The hospital houses a busy emergency department that receives walk-ins and transports eligible for VAMC care from the San Diego metropolitan area. The VAMC houses medical and surgical intensive care units, and a coronary care unit/step down unit, and obstetrical delivery suites, in addition to general medical, surgical, and inpatient psychiatric wards. This service provides the fellows with a broad experience with infections related to medical, surgical, and other acute illnesses, viral, bacterial, mycobacterial, fungal, and parasitic infections occurring in a primarily male veteran population. The I.D. Consult Service participates in the care of all HIV-infected patients who are admitted to the medical or surgical services, controls the utilization of certain restricted antibiotics, and consults on all patients with medically important bacteremias. All HIV-infected inpatients are primarily managed by the housestaff teams in consultation with the I.D. service. The VAMC also houses a large spinal cord injury service and a hemodialysis service for which infectious disease consultations are frequently sought for management of difficult infectious complications.
The Owen Clinic is UCSD’s primary program responsible for care of HIV-infected persons. Although administratively housed within the Division of General Internal Medicine, the Owen clinic is closely intertwined with the Division of Infectious Diseases. Several Owen Clinic faculty members are jointly appointed in the Division of Infectious Diseases, and several members of the I.D. Division actively participate in clinical programs of the Owen Clinic. Members of the Owen Clinic faculty participate both as attending physicians on the I.D. Inpatient Consult service and in the Infectious Disease clinical and research conferences held weekly alternating at Hillcrest and the VAMC as well as weekly HIV/AIDS Clinical Rounds held at the Antiviral Research Center (AVRC). The Owen Clinic and I.D. Division maintain a joint journal club that meets on the second Thursday of each month at the Ambulatory Care Center as described below. First year I.D. fellows will rotate on the inpatient Owen Clinic HIV Service, and will be responsible for providing inpatient consultative and primary service care for all HIV/AIDS inpatients hospitalized on the Owen Clinic Service in conjunction with the Owen Clinic faculty member attending on the service. Although the bulk of the activities during this rotation will be focused on inpatient care, at least one-half day per week the fellow will attend Owen Clinic Outpatient Practice activities. The Owen Clinic is an extremely active Ryan White Care Act-funded comprehensive care program that provides primary and specialty medical care to over 2,000 HIV-infected persons. The clinic is fully staffed with internists, infectious disease specialists, psychiatrists and other mental health workers, a hepatologist, an oncologist, an obstetrician-gynecologist, pharmacists, nurse practitioners, social workers, and other staff critical to the multidisciplinary care required of HIV-infected individuals.