Green OR Schedule - Google Drive

Green OR Schedule


1	Week of: 4/5-4/9
2
3	Service:	Hepatibiliary								Skin/Soft Tissue/Breast
4	Residents:	Zhang / Caesar								***
5	Vacations:	None								***
6	Attending on call:	Fitzgerald
7
8	MONDAY	Attending	OR	Time	Case	Coverage	Attending	OR	Time	Case	Coverage
9					CONFERENCE 7AM
10		Mac	Clinic		AM Clinic	APP
11	APPs:	Royal	Clinic		PM Clinic	APP
12	Amy
13	Liz	Fitzgerald	12	740	Whipple	Zhang
14			12	1200	Right hepatic resection	Zhang
15			12	1630	Mediport	Zhang
16
17		Macgillivray	16	1230	Parathyroidectomy	Caesar
18				1420	Left thyroidectomy, ?total	Caesar
19				1640	Left thyroidectomy, ?total	Caesar
20
21
22
23
24	TUESDAY
25	7AM Tumor Board: Liver/ Rectal (4th Tues. of the month)	Fitz	Clinic		AM Clinic	APP
26
27		Macgillivray	16	730	Total thyroid w/ neck dissection	Caesar
28	APPs:		16	1010	Whipple	Zhang
29	Amy
30	Liz	Royal	SSC	1050	Diag lap / mediport	APP
31				1320	Left arm mass resection	APP
32				1510	Left leg melanoma	APP
33
34
35
36	WEDNESDAY
37	7AM Tumor Board: Liver (2nd Wed. of the month) Melanoma/Cutaneous (3rd Wed. of month)	Mac	Clinic		AM + PM Clinic	APP (x2)
38
39	APPs:	Royal	16	730	HIPEC / LAR	Zhang
40	Laura
41	Kristen
42
43
44
45
46
47
48	THURSDAY
49	7AM Tumor Board: Upper GI (1st Thurs. of the month) Rectal / Lower GI (2nd Thurs. of the month) Surg Onc Leadership Mtg (3rd Thurs.)				CONFERENCE 7-11AM
50		Royal	Clinic		AM + PM Clinic	APP
51	APPs:
52	Laura	Fitzgerald	9	930	Open chole, Hepato-J	APP / Zhang
53	Kristen			1400	Cervical node biopsy	Zhang
54	Donna			1530	lap chole	Casear
55
56		Macgillivray	19	1030	Parathyroid	APP
57				1300	Parathyroid	Casear
58				1450	Left thyroid, ?total	APP
59
60
61
62
63
64	FRIDAY
65	715AM Green Team Mtg (every 3rd Friday)	Fitz	Clinic		AM + PM Clinic	APP/Heidt (AM)
66
67	APPs:	Macgillivray	3	730	Right thyroid	Casear
68	Kristen			940	Parathyroid	Casear
69	Donna			1200	Parathyroid, ? R thyroid	Casear
70				1420	Left thyroid	Casear
71
72		Royal	SSC	1010	Right ankle melanoma	Uncovered?
73
74
75			3
76
77			3
78
79	SATURDAY/SUNDAY
80
81	Attending on call:
82	Saturday / Sunday APP:
83	Green Resident Days:
84	Green Resident Night:


1	Week of: 4/5-4/9
2
3	Service:	Hepatibiliary								Skin/Soft Tissue/Breast
4	Residents:	Zhang / Caesar								***
5	Vacations:	None								***
6	Attending on call:	MacGillivray
7
8	MONDAY	Attending	OR	Time	Case	Coverage	Attending	OR	Time	Case	Coverage
9					CONFERENCE 7AM
10		Mac	Clinic		AM Clinic	APP
11	APPs:	Royal	Clinic		PM Clinic	APP
12	Donna
13	Amy	Fitzgerald	15	900	distal vs subtotal gastrectomy	Zhang
14				1250	liver resection	Zhang
15
16		MacGillivray	16	1300	parathyroid	APP
17				1450	parathyroid	APP
18				1640	thyroidectomy	Caesar
19
20		Royal	16	730	Diag Lap	Caesar
21				1110	Left back mass excision	Caesar
22
23
24	TUESDAY
25	7AM Tumor Board: Liver/ Rectal (4th Tues. of the month)	Fitz	Clinic		AM Clinic	APP
26
27		Royal	SSC	740	Melanoma R ear	APP
28	APPs:			1020	Right buttock / leg lipomas	APP
29	Amy			1250	mediport	APP
30	Kristen			1420	scalp lesion	APP
31
32		MacGillivray	14	1110	Parathyroid, ?left thyroid	Caesar
33				1330	Right neck dissection	Zhang
34
35		Fitzgerald	16	1500	Diag lap, mediport	Caesar
36	WEDNESDAY
37	7AM Tumor Board: Liver (2nd Wed. of the month) Melanoma/Cutaneous (3rd Wed. of month)	Mac	Clinic		AM + PM Clinic	APP (x2)
38
39	APPs:	Royal	16	730	Ex lap, ventral hernia	Zhang
40	Amy			1140	Lap left adrenal	Zhang
41	Donna
42
43
44
45
46
47
48	THURSDAY
49	7AM Tumor Board: Upper GI (1st Thurs. of the month) Rectal / Lower GI (2nd Thurs. of the month) Surg Onc Leadership Mtg (3rd Thurs.)				CONFERENCE 7-11AM
50		Royal	Clinic		AM + PM Clinic	APP
51	APPs:
52	Laura	Fitzgerald	10	840	Open right liver resection	Zhang after conference
53	Kristen
54		Royal	9	1220	Liver, omentum, colon, pelvic turmor resection	Zhang
55
56		MacGillivray	MR	830	Melanoma left leg	Uncovered
57			19	920	Parathyroid	APP
58				1100	Parathyroid, left thyroid	Caesar
59				1330	Parathyroid	Caesar
60				1530	Parathyroid	Caesar
61
62
63
64	FRIDAY
65	715AM Green Team Mtg (every 3rd Friday)	Fitz	Clinic		AM + PM Clinic	APP
66
67	APPs:	MacGillivray	3	730	Whipple	Zhang
68	Laura			1220	Right thryoid	Caesar
69	Kristen			1440	Parathyroid	Caesar
70
71
72
73
74
75			3
76
77			3
78
79	SATURDAY/SUNDAY
80	APP: Laura


1	Week of: 3/29-4/2
2
3	Service:				Hepatibiliary					Skin/Soft Tissue/Breast
4	Residents:				Heidt/Elman					***
5	Vacations:				None					***
6	Attending on call:				Fitzgerald
7
8	MONDAY	Attending	OR	Time	Case	Coverage	Attending	OR	Time	Case	Coverage
9					CONFERENCE 7AM
10		Mac	Clinic		AM Clinic	APP
11	APPs:	Royal	Clinic		PM Clinic	APP
12	Liz
13	Laura	Fitz	15	740	Lap partial gastrectomy	Heidt
14			15	1010	Radial chole w/ node dissection	Heidt
15			15	1330	Diagnostic lap, mediport	Heidt vs Elman
16
17		Royal	16	730	Left upper chest melanoma WLE	Elman
18			16	950	Scalp fibroxanthoma WLE, possible STSG	Elman
19
20		Mac	16	1240	Total thyroid	Elman
21			16	1510	Lap left adrenal	Heidt vs Elman
22
23
24	TUESDAY
25	7AM Tumor Board: Liver/ Rectal (4th Tues. of the month)	Fitz	Clinic		AM Clinic	APP
26
27		Mac	14	730	R thyroid, possible total	Heidt
28	APPs:		14	940	Parathyroid	Heidt
29	Liz		14	1200	Parathyroid	APP vs Elman
30	Laura		14	1350	Total thyroid	APP vs Elman
31
32
33
34
35
36	WEDNESDAY
37	7AM Tumor Board: Liver (2nd Wed. of the month) Melanoma/Cutaneous (3rd Wed. of month)	Mac	Clinic		AM + PM Clinic	APP (x2)
38
39	APPs:	Royal	16	730	Left axillary LN dissection	Heidt
40	Donna		16	1050	Left medial knee resection	Heidt
41	Kristin		16	1350	R shin sarcoma resection	Heidt
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43
44
45
46
47
48	THURSDAY
49	7AM Tumor Board: Upper GI (1st Thurs. of the month) Rectal / Lower GI (2nd Thurs. of the month) Surg Onc Leadership Mtg (3rd Thurs.)				CONFERENCE 7-11AM
50		Royal	Clinic		AM + PM Clinic	APP
51	APPs:
52	Donna	Mac	MR	830	R neck mass resection	Uncovered
53	Kristin		19	930	Parathyroid	APP
54	Amy		19	1120	Parathyroid	APP
55			19	1310	Total thyroid	APP
56
57		Fitz	9	830	Open liver resection	APP/Heidt
58			9	1300	Diagnostic laparoscopy w/ mediport	Heidt
59			9	1530	Diagnostic laparoscopy w/ mediport	Heidt
60
61		Royal	SSC 10	830	R supraclavicular LN resection	APP vs uncovered
62
63
64	FRIDAY
65	715AM Green Team Mtg (every 3rd Friday)	Fitz	Clinic		AM + PM Clinic	APP/Heidt (AM)
66
67	APPs:	Mac	3	730	Parathyroid	APP
68	Donna		3	950	Parathyroid	APP
69	Kristin		MR	1110	Excision neck scar	APP vs uncovered
70	Amy		3	1140	Parathyroid	APP
71			3	1340	Lap ventral vs L femoral hernia	Heidt
72			3	1610	Left neck node excision	Heidt
73			in
74			3	3d	Neck
75			3
76
77			3
78
79	SATURDAY/SUNDAY
80
81	Attending on call:
82	Saturday / Sunday APP:
83	Green Resident Days:
84	Green Resident Night:


1	Week of: ***
2
3	Service:				Hepatibiliary					Skin/Soft Tissue/Breast
4	Residents:				***					***
5	Vacations:				***					***
6	Attending on call:				***
7
8	MONDAY	Attending	OR	Time	Case	Coverage	Attending	OR	Time	Case	Coverage
9					CONFERENCE 7AM
10		Mac	Clinic		AM Clinic	APP
11	APPs:	Royal	Clinic		PM Clinic	APP
12
13
14
15
16
17
18
19	TUESDAY
20	7AM Tumor Board: Liver/ Rectal (4th Tues. of the month)	Fitz	Clinic		AM Clinic	APP
21
22
23	APPs:
24
25
26
27
28
29
30
31	WEDNESDAY
32	7AM Tumor Board: Liver (2nd Wed. of the month) Melanoma/Cutaneous (3rd Wed. of month)	Mac	Clinic		AM + PM Clinic	APP
33
34	APPs:
35
36
37
38
39
40
41
42
43	THURSDAY
44	7AM Tumor Board: Upper GI (1st Thurs. of the month) Rectal / Lower GI (2nd Thurs. of the month) Surg Onc Leadership Mtg (3rd Thurs.)				CONFERENCE 7-11AM
45		Royal	Clinic		AM + PM Clinic	APP
46	APPs:
47
48
49
50
51
52
53
54
55	FRIDAY
56	715AM Green Team Mtg (every 3rd Friday)	Fitz	Clinic		AM + PM Clinic	APP
57
58	APPs:
59
60
61
62
63
64
65
66
67
68	SATURDAY/SUNDAY
69
70	Attending on call:
71	Saturday / Sunday APP:
72	Green Resident Days:
73	Green Resident Night:


1
2
3	Service:				Hepatobiliary					Breast
4	Residents:				Nikki Heidt/Meredith Elman
5	Vacations:
6	Attending on call:				Royal
7
8	MONDAY	Attending	OR	Time	Case	Coverage	Attending	OR	Time		Coverage
9	Liz				7 AM conference					monday conference 7-8 AM
10	Kristen	Fitz	15	740	Whipple w/ colectomy	Heidt
11			15	1300	Lap chole w/IOC	APP
12			15	1500	Diagnostic laparoscopy w/ mediport	Heidt
13
14		Mac	16	1230	Left vs total thyroid	Elman
15			16	1450	R thyroid	Elman
16			16	1710	Parathyroid	Elman
17
18		Royal	16	730	Laparoscopic HIPEC	Elman
19
20
21		Mac/Royal	-	8-430	Clinic (Mac AM/Royal PM)	APP
22
23	TUESDAY
24	Kristen
25	Donna	Fitz	-	9-4	Clinic	APP
26
27		Mac	16	730	Left supraclavicular node w/ ultrasound	APP vs Heidt
28			16	840	Total thyroidectomy	APP vs Heidt
29			16	1100	R thyroid	Heidt
30			16	1320	R shoulder melanoma WLE w/ SLNB, poss STSG	Heidt
31
32		Royal	-		Clinic PM	Elman
33
34
35
36
37
38	WEDNESDAY
39	Kristen
40	Laura	Fitz			-
41
42		Mac	-		Clinic	APP (x2)
43
44		Royal	16	730	Pelvic tumor resection w/ VRAM flap	Heidt
45
46
47
48	THURSDAY
49	Donna				Conference 7-11
50	Laura
51		Mac	19	840	Parathyroid	APP
52			19	1020	Parathyroid	APP
53			19	1020	R thyroid	APP
54			19	1240	Total thyroid	APP
55
56		Fitzgerald	9	1000	Lap splenectomy	Heidt
57			9	1245	Left supraclavicular LN biopsy	Heidt
58			9	1350	Diagnostic lap w/ mediport	Elman
59
60		Royal	-	10-5PM	Clinic	APP
61
62	FRIDAY
63	Donna
64	Laura
65		Mac	3	730	Parathyroid	APP
66			3	940	Parathyroid	APP
67			3	1130	Parathyroid	Elman
68			3	1320	Parathyroid	Elman
69			3	1510	Parathyroid	Heidt
70
71		Fitz		9-5PM	Clinic	Heidt AM
72
73
74
75
76	SATURDAY/SUNDAY
77
78	Attending on call:	Mac
79	Saturday / Sunday APP:
80	Green Resident Days:
81	Green Resident Night:


1
2	Cases	Plan to cover all of the breast & melanoma cases, plus occasional other skin lesion cases.	If there are multilpe cases going at once, check in with Green chief to determine who can provide additional coverage. All attendings are independent and do not need cases covered, but want to know if they will be without a resident.
3
4	Rounds	Round on any inpatients you have in the hospital. It is usually not many.	Do round on all overnight breast patient's in scarborough or bramhall Anybody that Plastics operates on, Plastics becomes primary. They will handle all dispo stuff.
5
6	Clinic	Location	Scarborough breast center - right-most entrance as you face the building. Go in, take first big right, then double doors to the waiting room are on your left. Go to the right of the desk then straight back.
7		Overview	The breast center is a very well-organized operation, staffed almost exclusively by women. Appointments for benign conditions and surgical follow-ups look pretty much like you would expect. However, appointments for cancer diagnoses are a bit different - the patient will be roomed with their faimily members in one of the 4 "Consult Rooms" - these have carpet and soft chairs, and a separate exam area in the back. Patient's with new cancer gnereally see a slew of people - one of the APPs initially, a surgeon (often at a later visit), their APP again, and Cindy the breast cancer navigator who gives the patient a tote bag (this is called "toteing" the patient) full of resouce pamphlets and funny-shaped pillow. (Breast cancer is very well funded.)	The center has mammography and ultrasound in the same suite. Medical oncology is in an adjacent suite. Everyone works pretty closely together.
8		Where to sit	If you go straight back from the desk and turn right and go past the photocopiers, there is a small room with 2 computers labeled "Provider Dictation." The room has no permanent inhabitants - Dr. Rutstein will sit there when the are in clinic - and it is usually fair game to put your bag in there and use one of the computers as a home base.
9		Charting	The clinic is on Epic for records. There is a new patient info sheet, either completed at the visit, or sometimes prior and in "media" tab. This is very helpful for history, risk factors, etc. when doing notest. There are dot phrases for Dr. Teller/Desjardin, just ask which they want you to use. Rutstein still usually dictates all her H&P's, but was ok with resident's writing follow-up visit notes.	Beware, there is (as of July 2015) currently no way to designate a co-signer on outpatient notes. You have to tell the attending you wrote the note, and then they can add their addendum. Yes, it's stupid. They're "working on it."	After the note, you have to asign a level of service to the encounter and put follow-up requirments in the "wrap up" screen. Talk to the attending before signing the encounter.
10
11		People in Clinic	APP's are starting to cross cover everyone but have some Drs they work with more
12		Lynn Ried -	APP that works with Dr. Rutstein, and Dr. Teller/Desjardin as well - SHE IS THE PERSON TO TALK TO if you are going to a Rutstein clinic. When Rutsteins sees new patients, Lynn has generally seen them all first and dictated a full H&P at a prior appointment and ordered all the appropriate studies and work-up - by the time they see Rut there is basically a plan already made and they "meet with the surgeon" as more of a fomrality. Check in with Lynn about the day before clinic starts; she can direct you who is good to see.	Currently, the APPs don't feel they are equipped to have residents shadow or work with them for their clinic days. This may change
13		Karen Gronberg	APP that works with Dr.Desjardin and Teller. Also does the full work-up before patients meet with their surgeons. Also a great reasource; maybe a bit less itnerested in teaching than Lynn.
14		Dr. Liz Pietras	One of the breast radiologists. Willing to discuss imaging wity you and allow you to watch biopsies
15		Mary Tard & Alicia ...	MA's at the fron desk - check patients in and if you let them know who you are going to see, will give you the chart and let you know when they are in a room
16		Andrea	Is some form of radiology coordinator. Her office is to the left past the breakroom. Check in with her if you want to arrange shadowing the mammo or ultrasound techs or watching biopsies (it seems good to attach yourself to a tech for biopsies, so you get to see the process of positioning prior to the radiologist coming in).
17
18	Breast tumor board	Where/when	Thursday at 12:00-1:00 in the conference room off the little "library" area which is on the right as you come in the buidling and head towards the breast center. Just ask one of the attendings to show you on your first clinic day. It's very close.	However, this is subject to frequent change. Update this sheet if time or location of breast conference changes!
19		Who	Attended by surgery including APPs, med onc, radiology, pathology, social work, genetics. Having all these people at the table is part of requiremnets for accreditation as a breast center.
20		What	There are several types of questions generally trying to be answered by the group at tumor board - For a new cancer diagnosis, does the pt need surgery or medical therapy first? - If surgery is done, does pathology etc indicate need for any MORE surgery, or do they go on to med onc? (ie "path review") - Given receptor status and risk profile including age, does a patient need chemo or just endocrine therapy, or both? - For patients with incompelte work-up, is any special imaging needed, like MRI? - How agggressive should we really be with this octegenarian? (or nonagenarian?) - Is the patient a candidate for genetic testing based on family history? Of course there are more, but those are the common ones
21		Expectations	You are expected to attend tumor board. You are expected to present a few patient's per week. KEY: You won't be on the email chain, so talk to Cindy on Monday or Tuesday and she can give you the schedule with full names - make a copy so you can figure out who to present. Dr. Desjardin volunteered to send my the tumor board sheet by email, I just had to remind her. Talk with Lynn and Karen about who you will present, and they will let you do the talking. If the surgical attending is actually going to conference (hopefully this will happen more in future) you should talk to the attending too.	When presenting patients, the appropriate format is: "This is a 46 y/o woman with right infiltrating ductal carcinoma, clinical stage IIB (T2N1), ER-/PR-/H+, s/p neoadjuvang chemo (AC x4, Taxol x12), now s/p right RSL lumpectomy/ALND on 12/31/2013 needing a post-op path review." Adjust the content as necessary.
22
23	Specifics by Case	Lumpectomy	Unless this is for a palpble mass, most will be an RSL (radio-seed localized) lumpecotmy - patients have a radioactive I-99 seed placed up to 5 days before OR and you find it using the radiation probe in the OR. Take note of the in-vivo and ex-vivo counts (in-vivo should be higher than ex-vivo).	Almost all will go home the same day.	Can't use suction in the wound with the seed due to fear of loosing seed (apparently this creates havoc) - so only dab until seed confirmed in specimen by xray.
24		Mastectomy	Without reconstruction	Routinely stay overnight. Will have received pre-op teaching including some info about drains. See in AM and discharge; usually attending will want to see them too before they go home.
25			With reconstruction	Routinely stay overnight. PLASTICS will handle all their d/c stuff including instructions and scripts. They get extensive pre-op teaching. They get antibiotics until the drains come out.
26		Breast sentinel node biopsies	Radiology tech will come in Pre-op and inject technetium-99 in 4 areas around nipple. They carry special little box. Dr. Rutstein routinely uses methylene blue injected while patient asleep under nipple. Dr. Teller/Desjardin, only if no radio tracer signal is present in the axilla.	Use probe and blue color to locate sentinel nodes. After first (usually highest) count node is removed, remove any additional nodes with counts >=10% of highest count - up to 3 nodes.
27		Melanoma with sentinel node biopsies	Especially for turnk melanomas, need to have sentinel lymph node localized before operation. Will be booked for appt with radioloy ~2 hrs before surgery and get techentium-99 injected at melanoma site and then imaged -- nodal basin will light up and rads will mark the skin overlying the hot node	May drain to more than one basin (ie bilateral axilla) Also inject blue dye in OR once pt asleep.	Same rules as breast for finding and removing nodes.
28		Scarborough Cases	FYI if they stay overnight - 1st call is the attending
29
30	Spedifics by attending
31		Dressings	All attendings use mastasol/steris/tega
32		Dr. Desjardin	does the running sub q monocryl with knots, the other two are without knots.
33			She does her mastectomies with tumesence and sharply, and routinely takes extra margins from lumpectomy sites
34		Dr. Teller/Rutstein	Do their cases in similar techniques. Mast/lump with cautery, selective margin takers.
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