Acute Care Orientation
Welcome to the CHC Acute Care Rotation
What you will be doing:
You will be assessing and caring for children with acute illness. Some sessions you will be the CHC Urgent Care resident and will be seeing scheduled illness appointments or ER/inpatient follow ups. Other sessions you will be scheduled to see walk-ins (all providers help with seeing the walk-in patients as well). If the nurse is concerned about a sick child who walks in, we will ask you to do the initial assessment if you are available. We do want you to primarily see children with acute illness but sometimes you will also see a patient for routine well child care (this more commonly happens in the summer when there is a high volume for well child care and not as many illness visits)
Our teaching schedule
8-8:30 am each morning except Wed (Grand Rounds). The teaching sessions will be led by the CHC Senior resident or by attendings.
Resident Noon conference (The expectation is that you don’t pick up walk-in patients after 11:30 so that you can finish charting and get to conference. Let the preceptors know if you are having patient flow issues because of a complex patient)
1-1:30 continuity clinic conference- we welcome your participation in conference. The same topic is covered each day during a week. If you have heard the topic before, you can decide if you will start seeing patients instead.
Acute Care Rotation Objectives
1. Develop evaluation and treatment plan for patients with common acute illness complaints such as fever, wheezing, abdominal complaints, and rash.
2. Recognize, evaluate and treat in a timely manner, patients with severe illness (including those that need transfer to a higher level of care)
3. Develop evaluation and treatment plan for patients with chronic conditions (such as asthma, sickle cell disease, cerebral palsy etc) who present with an acute illness complaint.
4. Develop an evaluation and treatment plan for a patient who presents with a complaint that is chronic (for example headache, abdominal pain)
5. Communicate effectively with consultants (surgical and medical subspecialists and the emergency room)
Things to Focus on During this Two Week rotation:
History taking- Taking a focused history but including needed elements including medication reconciliation. Think about how you are gathering information and using illness scripts.
Physical Exam skills- We are happy to come in and observe you or double check exams. This is a good time to continue to work on ear exams (ears are hard to examine in screaming toddlers), lung, abdomen and orthopedic exams. Don’t forget- attendings ask each other for help and to double check exams as well.
Developing treatment Plans- Become familiar with the evidence behind your recommendations including practice guidelines. Review the literature on common acute conditions such as otitis media, diarrhea and fever. Look up what you don’t know- this is a great time to do a PICO question and upload to your portfolio. Work on developing plans with the family’s input re: their concerns and their ability/barriers to carry out the treatment plan.
Managing Patient flow- In this rotation, you will be seeing high volume of children- some of whom have only minor illness and others who will be quite sick. Work on your efficiency and also on prioritizing care.
Identification of the Sick child- We want you to be able to rapidly identify the sick child who may need a higher level of care.
Working with consultants including transfers to the ER- Work on formulating what you need to ask a consultant and then when you call- being clear about your question from the beginning (SBAR format is helpful). Don’t forget that this a great opportunity to do a referral SCO.
Feedback:
We don’t do a formal feedback session during your two weeks but any of the attendings are happy to give you feedback after a patient or after a clinical session. Let us know if you have specific things you would like to work on during this rotation.