CHILDREN'S NATIONAL MEDICAL CENTER
EMERGENCY DEPARTMENT
Welcome to Children's National Medical Center (CNMC) Emergency Medical
Trauma Center (EMTC). There are over 70,000 patient visits a year to the
EMTC. The EMTC serves as the Level I pediatric trauma center for the District
of Columbia and outlying areas, and CNMC is the source of definitive pediatric
care in the area.
Schedule requests should be emailed two months in advance to Dr. Dafina
Good (dgood@cnmc.org) who serves as the director of residency education for
the CNMC EMTC. The schedule will be emailed to residents about 1-2 weeks
before the start of the rotation. In addition, a visiting resident informational
package will be emailed to you by Hilda Rojas (EMTC Staff Assistant,
hrojas@cnmc.org) at the beginning of the fiscal year and a reminder one month
before the start of the rotation. Included in this package is a list of required
paperwork that must be completed and returned to the CNMC Medical Staff
Office one month prior to start of the rotation.
On the first day of the rotation, you should report to Hilda Rojas in the
Emergency Room Administrative Office (East Wing, Floor 1, by Room E1.184). .
If all the paperwork is complete, you will be issued a parking permit and CNMC
ID.
The CNMC emergency department is staffed by pediatric emergency medicine
attending physicians, pediatric emergency medicine fellows, and pediatric
associate physicians. At all times there is either an attending or fellow physically
available in the ED. They will help you with the day to day procedural/logistical
questions of the functioning of the ED. All patients seen in the ED must be
“presented to” and seen by an attending, fellow, or associate.
All Emergency Treatment Records (ETR) must include H&P, diagnostic
procedures, treatment, diagnosis, signature, discharge time, and discharge
instructions. Results of labs, x-rays and consultations should be documented.
Discharge instructions and prescriptions are generated via Cerner Power Chart
(the computerized patient tracking system). The parent should sign and receive
a copy of the discharge instructions.
Please take note the EMTC referral sheet and contact referring physicians for all
admissions and when requested. Patients requiring follow-up should be seen by
their PCP, HMO or CNMC clinic as appropriate. If necessary they can be seen in
the ED for the return visit on weekends. Patient care should be as efficient as
possible. Patients should not be retained in ED more than 4 hours. If there are
extenuating circumstances that delay the patient disposition, contact the
attending/fellow/associate, and inform the charge nurse.
If it is thought that a patient is either physically or sexually abused, the Child
Protection Worker must be contacted. It is also best to discuss the patient with
the attending/fellow/associate. Laboratory specimens for ASA patients are
handled through the legal "Chain of Command" process. Pelvic examinations
require the presence of a female staff member. Permission should be obtained
from the parent/guardian. Written consent from parents must be obtained for
lumbar punctures and for procedural sedation/analgesia.
The admission procedure requires several steps. Ask the attending for
assistance in contacting the appropriate accepting inpatient attending for medical
(i.e., non-surgical) admissions and the appropriate admitting resident. Most
importantly, it is the ED’s responsibility to establish the patient management plan
with the admitting attending. When you speak to the attending regarding
admission you need to be prepared to discuss specific plans for the patients. Be
sure to ask about medications (e.g. exactly which antibiotics and how often) and
special studies for the morning. When you call the admitting resident, you will
need to communicate the accepting attending’s specific plans for the patient.
The entire CNMC staff hopes your rotation will be both educational and
enjoyable. If there are any problems or questions, please contact Dr. Badaki
(obadaki@cnmc.org). Your evaluation of the rotation and attendings you’ve
worked with would be greatly appreciated. Goals and objectives for this rotation
can be found in the Orientation Book that you will be given at the start of your
CNMC rotation. You will be evaluated by Dr. Badaki at the completion of your
rotation. Please remember to hand out the end-of-shift trainee evaluation cards
to ED faculty members (attendings, fellows and associates) that you work with to
facilitate compilation of your summary evaluation.