VISITING RESIDENT PROGRAM
SURVIVAL GUIDE
2005-2006
Division of Emergency Medicine
The Children’s Hospital of Philadelphia
~~~~~~~~~~~
Nicholas Tsarouhas, M.D.
Director, Visiting Resident Program
Tsarouhas@email.chop.edu
(215) 590-1963
Richard J. Scarfone, M.D.
Head, Resident Scheduling
Scarfone@email.chop.edu
(215) 590-7422
Renee A. Mills
Coordinator, Visiting Resident Program
MillsR@email.chop.edu
(215) 590-3948
Kathy N. Shaw, M.D.
Division Chief, Emergency Medicine
Shaw@email.chop.edu
(215) 590-1944
Jane M. Lavelle, M.D.
Associate Director, Emergency Department
LavelleJ@email.chop.edu
(215) 590-1968
TABLE OF CONTENTS
Welcome!...................................................................... 4
Overview....................................................................... 4
Mission Statement......................................................... 4
Schedules ...................................................................... 4
Absences ....................................................................... 4
First Day Orientation .................................................... 5
CHOP-DEA Number .................................................... 5
ID Badge ....................................................................... 5
Hours For ID Badge Photos .......................................... 5
E.D. Conferences .......................................................... 6
Staffing Roles: .............................................................. 6
Teamwork / Flexibility ................................................. 6
Attendings/ Senior Fellows ........................................... 6
Visiting Residents ......................................................... 7
Nurses ........................................................................... 7
Emergency Department medics .................................... 7
E.D. Organization ......................................................... 7
Wellsoft Computerized Tracking System and the
IDX/RAD System ***see attached file......................... 8
Triage............................................................................ 8
In-Room Registration.................................................... 8
Picking Up Patient Charts ............................................. 8
Charting ........................................................................ 9
Discharge .................................................................... 10
Orders ......................................................................... 10
Medications ................................................................ 10
Laboratory .................................................................. 10
Radiology.................................................................... 11
Respiratory therapy ..................................................... 11
Subspecialty Consults ................................................. 11
Child Life .................................................................... 11
Social Service ............................................................. 11
Child Abuse Procedure ............................................... 11
HIV counseling & testing in the ED…..…………..…12
Psychiatric Evaluation ................................................ 12
Poison Control Center ................................................ 12
Pharmacy .................................................................... 12
E.D. Extended Care Unit (EDECU) ........................... 13
Answering Telephones ............................................... 13
How to use the Beeper System ................................... 13
Dress ........................................................................... 13
Storage of Personal belongings................................... 13
Kitchen Areas ............................................................. 13
Cafeteria ..................................................................... 13
Vending Machines ...................................................... 14
McDonald’s ................................................................ 14
Gift Shop .................................................................... 14
Bank Services ............................................................. 14
Parking****see attched file ........................................ 14
Getting to the E.D. from the Wood Garage ................ 15
Directions to The Children’s Hospital of Philadelphia:
.................................................................................... 15
From New York and Northern New Jersey: ............... 15
From Southern New Jersey: ........................................ 15
From Delaware and South: ......................................... 16
From Western or Northern Pennsylvania: .................. 16
Driving Alternatives: .................................................. 16
Septa ........................................................................... 16
Bus:............................................................................. 17
Subway: ...................................................................... 17
Trains:......................................................................... 17
Taxis: .......................................................................... 17
2
FACULTY
Evaline Alessandrini, M.D.
Alessandrini@email.chop.edu
Cynthia Jacobstein, M.D.
Jacobstein@email.chop.edu
Elizabeth Alpern, M.D.
Alpern@email.chop.edu
Mark D. Joffe, M.D.
Joffe@email.chop.edu
Jill Baren, MD
Baren@email.chop.edu
Stephen Ludwig, M.D.
Ludwig@email.chop.edu
Louis M. Bell, M.D.
BellL@email.chop.edu
Rakesh Mistry, M.D.
Joanne M. Decker, M.D.
Cynthia Mollen, M.D.
Mollenc@email.chop.edu
Aaron Donoghue, M.D.
Donoghue@aemail.chop.edu
Fran M. Nadel, M.D.
Nadel@email.chop.edu
Dennis R. Durbin, M.D.
Durbind@email.chop.edu
Kevin C. Osterhoudt, M.D.
Osterhoudtk@email.chop.edu
Angela Ellison, M.D.
Barbara B. Pawel, M.D.
Pawel@email.chop.edu
Mirna M. Farah, M.D.
Farah@email.chop.edu
Jill C. Posner, M.D.
Posner@email.chop.edu
Joel A. Fein, M.D.
Fein@email.chop.edu
Emily Shapiro, M.D.
Pollak@email.chop.edu
Eron Friedlaender, M.D.
Friedlender@email.chop.edu
Joseph J. Zorc, M.D.
Stacy Gordon, M.D.
Gordons@email.chop.edu
Zorc@email.chop.edu
Fred M. Henreitg, M.D.
Henretig@email.chop.edu
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4th Year Fellows
Sondra Schwab, M.D.
Schwab@email.chop.edu
Diane Calello, M.D.
2nd Year Fellows
Calello@email.chop.edu
Christine Cho
Manoj Mittal
Bryan Upham
3rd Year Fellows
Suzanne Beno, M.D.
Beno@email.chop.edu
1st Year Fellows
Oluwakemi Badaki
Mercedes Blackstone
Melanie Prusakowski
Esther Sampayo, M.D.
Sampayo@email.chop.edu
3
Welcome!
The Division of Emergency Medicine staff welcomes you to our emergency department.
We are confident that you will find your experience here an invaluable part of your pediatric
training. Our goal is to provide an outstanding educational experience while delivering high
quality care to our patients.
This survival guide is designed to outline your responsibilities and goals, and to familiarize
you with the facilities, the system, and the personnel of the Emergency Department.
Please take the time to read it before your rotation begins, but feel free to ask any
questions or request assistance. We look forward to working with you!
Overview
The Emergency Department of The Children's Hospital of Philadelphia sees > 70,000
children each year. We have a staff of 24 Pediatric Emergency Medicine (PEM) Attending
Physicians and 10 Fellows in PEM. Also providing care to our patients in the ED are
CHOP Pediatric Residents, Penn Medical Students, Visiting Residents and students from
outside institutions. In addition to our commitments to clinical care and education, we
maintain a very active clinical research program.
Mission Statement
The mission of the Emergency Department is to provide high quality, efficient,
compassionate care to all pediatric patients needing medical care on a non-appointment
basis. The roles of the Emergency Department include:
(1)
Stabilization of the critically ill or injured
(2)
Determination of the need for hospitalization
(3)
Diagnosis and treatment of episodic illness or injury
(4)
Management of acute psychosocial crises
(5)
Referral to appropriate subspecialty or continuity care
The mission of the Emergency Department training program is to provide for professional
training in the management of acute illness and injury (both major and minor) from a
pediatric perspective. The training is conducted at many levels including medical student,
house officer, fellowship, and continuing medical education.
Schedules
Your schedule should have been sent to you at least two weeks prior to the first shift of
your rotation. Dr. Scarfone is in charge of resident scheduling. No changes are permitted
unless approved in advance by Dr. Scarfone. Please contact Ms. Renee Mills, our
Residency Coordinator at 215-590-3948 for schedule conflicts.
Absences
You are an integral part of the clinical team; you are not scheduled as “an extra.” Absences
put a strain on your colleagues and affect patient care. If an emergency arises, or you are
seriously ill and must “call out,” please call the ED (215-590-3480) and ask to speak to the
Team 1 ED attending. Additionally, please call the Administrative Offices at 215-590-3948
and speak directly with the Residency Coordinator, or leave a message on the voicemail.
All absences are recorded, and this information is forwarded to your program director.
Excessive or un-excused absences may result in your failure to satisfy the requirements of
your PEM rotation.
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Lateness
It is important to be on time for your shifts. If you are going to be late, please call the ED
(215-590-3480) and ask to speak to the Team 1 ED attending and also leave a message
with the Visiting Resident Coordinator at (215-590-3948).
First Day Orientation
On your first day, report to Team 1 in the main ED and introduce yourself to the attending
physician. He/she will direct you to your assigned team, where you will receive a brief
orientation by the Senior Resident, Fellow or Attending Physician.
At some point during your first day shift for each CHOP ED rotation, you should report to
the Emergency Medicine Administrative Offices to meet with Ms. Mills. Her office is located
on the 2nd floor, Main Building--look for the sign that says Emergency Department Offices.
She will assist you in getting your ID badge and temporary CHOP DEA number.
Additionally, she will take your picture. This picture is used by the attending physicians
during your end of rotation evaluation.
CHOP-DEA Number
If you already have a CHOP-DEA number from a previous rotation and you can’t remember
your numbers, please check with the Visiting Coordinator. On the other hand, if you don’t
have a CHOP-DEA number, you will be given a number at the time of your orientation.
When you write any type of prescription for CHOP patients, please use the CHOP-DEA
number distributed to you. Also, make sure to include your MT or OT number on all
prescriptions you write at CHOP. NOTE: Do not use your own DEA number while at CHOP.
The CHOP DEA number is to be used during your CHOP rotation(s) only. Keep it handy. In
this way, CHOP can keep track of who is writing prescriptions for its patients. CHOP-DEA
Numbers are not given out over the phone.
ID Badges
If you already have a CHOP ID that needs to be re-activated, you still need to meet with
Visiting Coordinator to obtain computer passwords, beepers and any new handouts. If this
is your first rotation at CHOP, please report to Ms. Mills’ office for your brief orientation.
After the orientation, she will escort you to security department to have your picture taken.
Note: Your ID will expire the day after your final shift. If you are doing other rotations at
CHOP (or returning to the ED) you must “re-register” with new department (or in the EM
offices again.) If you fail to do so, you will not have access to the hospital.
Note: If you are missing any piece of information, you will not be permitted to start your
rotation at CHOP. A few weeks before your rotation at CHOP, you might want to check
with your institution’s residency coordinator to make sure everything is in order with our
Medical Staff Affairs Office. Claudine may be reached at 215-590-4671.
Hours For ID Badge Photos
ID BADGES must never be loaned or used by a person other than yourself. Report any
loss or theft of your ID BADGE immediately to the Security Staff. There is a $10
replacement fee if it is lost. Damaged ID BADGES will be replaced without a fee.
Replacements due to name, department, or position changes are also free. NOTE:
5
Hospital Policy requires ID BADGES be worn at all times. They should normally be at chest
level on the outermost garment.
ID BADGES may be obtained in the security office during the following times:
TUESDAY
3:00 A.M. – 4:00 A.M.
10:00 A.M. – 11:00 A.M.
8:30 P.M. – 9:30 P.M.
WEDNESDAY
3:00 A.M. – 4:00 A.M.
2:00 P.M. – 3:00 P.M.
8:30 P.M. – 9:30 P.M.
THURSDAY
3:00 A.M. – 4:00 A.M.
10:00 A.M. – 11:00 A.M.
8:30 P.M. – 9:30 P.M.
The Security Department may be reached at 215-590-2374.
Evaluations
At the end of your rotation, the attending physicians meet and prepare a “group”
consensus evaluation of your performance. These evaluations are done in accordance with
the guidelines set by your program. Additionally, we ask that you evaluate us; you will be
given a post evauation3 blank evaluations for you to complete at the end of your rotation
(more available upon request!) We ask that you evaluate at least 3 of the PEM attendings
with whom you’ve worked. Our evaluation of you will be returned to your program director
when we receive these 3 evaluations of our faculty. Your evaluations of us can be
anonymous; please feel free to be candid!
E.D. Conferences
 Resident conferences is held each Friday morning from 8:00 A.M. – 11:00 A.M.
 Wednesday is Pediatric Grand Rounds in the Stokes Auditorium.
 Occasionally, some conferences (radiology, toxicology, critical care) are held at earlier
times or in different locations. Check the monthly schedule for details.
 Attendance at conference is mandatory unless you are expected to attend a weekly
prescheduled conference at your own institution. Residents scheduled for day and for
the day’s afternoon shifts, are expected to attend. Residents scheduled for that day’s
evening shifts as well as the “over-night” residents are not expected to attend.
 Attendance will be taken and forwarded to your program director.
Staffing Roles:
Teamwork / Flexibility
The E.D. is staffed by attendings, fellows, CHOP residents at all levels, residents from
other pediatric, emergency medicine, and family medicine programs, and Penn medical
students. There is an attending or a 3rd year PEM research fellow on duty 24-hours a day.
Although roles are defined for all members of the ED team, in reality, roles and
responsibilities often overlap. The E.D. runs best when we work as a team. Remember:

Be able to shift gears and pick-up the pace as the charts pile up

Assist the nurses with procedures when they are very busy

Clean up after yourself so rooms can be turned over quickly

Advocate and communicate
Attendings/ Senior Fellows

Legally responsible for seeing all patients in the E.D. (No patient should ever be
discharged without an Attending/ Senior Fellow evaluation.)
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

The final authority for all medical questions in the E.D.
Manage patients, supervise clinical care, teach, and administrate the smooth
functioning of the E.D.
Visiting Residents

See patients in the order that the charts are placed, taking into account the level
of acuity, as well as the waiting time.

Always have a CHOP fellow or attending as a preceptor for every patient.

Document clearly and completely.

Know when to call for help from senior residents/ fellows / attendings.

Maintain a professional demeanor with patients, families, colleagues,
consultants, and all ED staff members.
Nurses
The nursing staff are well-trained, integral members of the E.D. team who assist in
facilitating, implementing, and coordinating pediatric care. Don’t be scared to ask them
for their advice as they have a lot of experience dealing with both sick and well children.
Always communicate the needs of the patient (labs, IV’s, medications, x-rays), as well
as the disposition plan (admission, discharge, transfer) with the nurses. Keep them in
the loop! Flexibility is also key. Offer to help the nurses with procedures when
possible.
EMERGENCY DEPARTMENT CLERKS (PCA: PATIENT CARE ASSOCIATE)

Present 24-hours a day

Answer all incoming calls

Page other consulting and primary care physicians
Emergency Department medics

Transport stable patients

Draw blood; start IV’s

Assist in holding patients for procedures

Stock supplies
E.D. Organization
The E.D. is divided into teams, each responsible for certain rooms/ patients:
Team 1:
day.
Team 2:
Team 3:
Team 4:
Team 5:
Acute Rooms 1-11, and the resuscitation/ trauma room. Operates 24-hours a
Acute Rooms 24-32. Operates 9:00 A.M.-2:00 A.M.
Acute Rooms 12-23, and the cast room. Operates 1:00 P.M.-1:00 A.M.
Urgent Care Rooms in Primary Care. Operates 11:00 A.M.-2:00 A.M.
South Tower “quick” urgent patients.
Each team is led by an attending physician, and consists of specifically designated
nurses, fellows, residents, and students. The residents will rotate through all of the
teams. While all of the zones may handle any type of patient, team 3, during the
summer “trauma season,” is designated as the “minor trauma zone.” Also, during
overnights and busy mornings, rooms 12 & 13 are used by team 1, until team 3 opens
at 1 P.M. Team 4 is the Urgent Care team, and is usually staffed by attending
pediatricians and nurse practitioners. Team 5 is a new team which is staffed by an
7
attending, and usually sees “urgent” patients who are likely to need relatively
uncomplicated interventions.
TRAUMA
Major trauma is managed initially in our 2 bay trauma/ resuscitation room located in
Team 1. Trauma “alerts” are managed collaboratively by the Trauma and the
Emergency Department staff. Each day, an emergency department resident is
designated as the “Trauma Resident,” who will be responsible for the primary/
secondary surveys during trauma alerts. This assignment is posted on the schedule
located in Team 1.
Wellsoft Computerized Tracking System ***SEE ATTACHED FILE
The CHOP ED uses a computerized patient tracking system. You will be oriented to
this system on your first day in the ED. This system allows you to decide which patient
is next to be seen. It gives you a great deal of information about each patient in the ED
including: age, complaint, acuity, location, waiting times, nurse, attending physician,
studies pending, inpatient bed assignment, referring physician info. Additionally, the
system is used for discharging patients. Finally, laboratory results can also be obtained
on the Wellsoft system. Attached you will note a Wellsoft summary file “Resident
Orientation to the ED Tracking System,” which was created by Dr. Joe Zorc, our faculty
coordinator for the Wellsoft system.
Triage
Patients are triaged upon arrival to the ED. The triage nurse will evaluate the patient
and assign them a color-coded acuity level:
 Purple – Critical
 Green – Emergent
 Red – Urgent
 Blue – Non-Urgent
After triage and registration, they are sent to the waiting area of the ED.
In-Room Registration
 Some patients in the E.D. are registered while in the room, rather than waiting at the
front desk registration area. This is done to improve patient care and decrease patient
waiting times. Unfortunately, this leaves you and the patient in the room before a
complete chart is prepared.
 If the chart isn’t ready when you see the patient, you can obtain a blank chart at the
nursing station. On this temporary blank chart, write the patient’s name, date, and MR#
(when available) on it. When the registrars have completed the official chart, staple the
temporary chart with your H&P to it. Please do not always wait for the “official” chart
before going to see all patients.
Picking Up Patient Charts
The ED nurse calls the next patient to be seen, and places the patient in a room. The
nurse records the patient’s room # and acuity on the Wellsoft tracking system. The
chart is placed in a bin “to be seen.” The residents select each patient based on acuity
level and waiting time. The charts should be kept in the bin when not being used.
8
Charting
All patients seen in the E.D. must be registered in order that there be a record of the visit.
The chart is a legal document which must be completed in accord with standards set by
the Joint Commission on Hospital Accreditation (JCAHO).
Please sign the chart legibly as soon as you pick it up, and print your name beneath your
signature. All charts must be signed by an attending physician before the patient is
admitted. Make sure a parent signs the chart at discharge.
The History on the chart should include:

Chief complaint

History of present illness. The HPI should always include a statement as to the
recent general health of the child, activity level, and oral intake.

Medications

Allergies

Immunization status

Primary care provider

Past medical history (hospitalizations, surgeries)

Social history

SCAN: This box should ALWAYS be checked; it states that you have at least
“considered the possibility of “Suspected Child Abuse or Neglect.” We consider
this each time we walk into the room of ANY patient, so ALWAYS check this box!

Review of systems--no need to be redundant about things already mentioned in
the HPI, but there must be at least two pertinent positives or negatives noted.
Always check the box “all other systems negative.”
The Physical on the chart should include:
 General appearance of the child. Be descriptive! For example, “alert, playful,
smiling,” paints a vivid picture of the child, while “NAD” conveys nothing meaningful.
Avoid extreme words like “irritable, lethargic.”
 Vital signs. If the nurse’s triage vitals are abnormal or worrisome--repeat them and
document your repeat vitals! Simply saying, “I don’t think the kid is breathing that
fast,” is not acceptable.
 Describe all positive findings.
 Note a few pertinent negatives. Most kids should at least have a documented heart,
lung, abdomen exam (in addition to their other findings.)
Additionally, all charts must include the following:
 Time seen by physician
 Condition on admission
 Preceptor’s name
 Consultants’ names, services, and times called (page 2)
 Laboratory orders and results
 Medication orders
 Radiology orders and x-ray preliminary readings
 Procedure notes for suturing, I & D, LP, removal of FB, etc. (page 2)
 Documentation of patient's course in E.D. (e.g., playful at D/C; drinking juice)
 Diagnosis at discharge
9




Disposition with the time the patient was discharged
Condition on discharge (All patient’s should go home in “good” condition!)
Parent signature (page 1)
Your signature (page 1)
Discharge
Patient discharges are done on the Wellsoft Computer System. This allows the
patient’s name to be removed from the computerized tracking system. If a call-back
from a referring physician was requested, the system will prompt you to call the
physician back, before it allows that patient to be removed from the screen. If a
radiology study was done, the system will also prompt you to enter your preliminary
reading.
The faculty has created pediatric discharge instructions for many the most common
diagnoses. When possible, please select a Wellsoft diagnosis with the suffix “.chp” as
these will prompt the print-out of one of these pre-programmed discharge instructions.
Note that all patients with fever should have “fever” entered as at least one of their
diagnoses to prompt the print-out of the “fever.chp” discharge instruction sheet.
When the patient is discharged, one copy of the discharge sheet is kept with the chart
(the “Disposition Summary”) and one copy is given to the family (the discharge
instructions.) Prescriptions and work/ school notes can also be done on the Wellsoft
system.
Make sure the parent (and you!) sign the face sheet of the chart prior to discharge.
Please also write the discharge diagnosis on the ED face sheet under “discharge
impression.” The empty clipboard is returned to the bins, and the completed chart is
placed in the top bin in each zone labeled “attending unsigned charts.” The attending
reviews, then signs all charts.
Orders
It is usually best to discuss all orders with the attending physician or supervising fellow. Of
course, as your (and our!) level of comfort increases, this policy may be modified by each
attending with you on an individual basis. Don’t be scared to ask each attending about
their specific preferences.
Medications
All medications and fluid orders must be entered into “SCM” (Sunrise Clinical Manager).
Each team has several CHOP formularies available to help you with pediatric dosing. Also,
the CHOP formulary can be accessed on-line from all ED computers. Medications should
be calculated as mg/kg and the dose should be written in mg. The route should be
specified. Infusion rates should be in cc/hr. In addition to entering the order, tell the nurse
about the order as well.
Laboratory
All lab orders must be entered into SCM. Let the nurse know about the lab orders as well.
All lab specimens must be labeled with the patient’s name. All specimens must be labeled
clearly (source), signed and dated. ED lab results may be accessed directly on Wellsoft, or
by going into SCM.
10
Radiology
X-rays are done in the ED radiology area 24 hours a day. When ordering an x-ray, please
record the clinical indication (cough, chest pain, etc.) All x-ray orders must be entered
into SCM. Let the nurse know when an x-ray has been ordered for his/her patient. When
the x-ray techs are ready for the patient, they will call for the patient in the ED. We have a
new digital x-ray system (IDX-RAD) which allows us to retrieve all patient x-rays from the
computers in the ED. Radiology results can also be reviewed through SCM. While the ED
staff reads our own x-rays, an attending radiologist reviews all x-rays and will report any
discrepancies to the PEM attending. For urgent consultation, there is an in-house
radiology resident (beeper #10132) available to read films at all times.
To order an Ultrasound or CT, page the tech in their respective department. When
patients return from CT, page the radiology/neuroradiology resident/fellow to “let him/her
know” that a scan has been done for him/her to read. During the day and early evening CT
scans are read by neuroradiology; after that, it is the regular radiology resident. When
patients return from Ultrasound, a preliminary paper report should return with the patient.
Respiratory therapy
The E.D. has its own designated respiratory therapists. If they are not in the ED giving
treatments, they are available by page. Most attendings physicians encourage you to
get asthma therapy started by writing for their aerosolized albuterol therapy
Subspecialty Consults
After discussion of the case with the ED attending physician, if subspecialty consultation is
desired, please document your consultant’s name, service, and time called on the patient’s
chart. Also, note the time the consultant returned your call. Consultants cannot write
orders on the ED chart. They must communicate their recommendations to you. If your
attending physician concurs with their recommendations, you should write the orders.
Child Life
Child life services are provided 7 days a week for the benefit of our patients as well as
their young siblings. The child life specialists are especially helpful when a painful or
frightening procedure is anticipated. Ask the charge nurse to page child life if you have
an appropriate patient.
Social Service
The ED is fortunate to have 24-hour access to in-house social workers. You are
encouraged to use the social workers for consultation, referrals, and resource information.
All suspected child abuse/ sexual abuse cases must involve the CHOP social
worker. Call the social worker before seeing the patient to minimize the trauma of the
patient/ parent repeating the history multiple times.
Child Abuse Procedure
 If you are considering the possibility of child abuse, always inform the ED attending and
the ED social worker first.
 A specialized chart (“Sexual Assault Checklist”) has been developed for suspected
cases of sexual abuse. Write “see sexual assault checklist” on the ED chart to obviate
the need for duplicate documentation.
11


In cases where appropriate suspicion is present, fill out a CY-47 form (with the
assistance of the social worker) to officially “file” the report with the Child Protective
Services Agency.
You should defer the genital exam of the patient until the attending or fellow is present
to minimize the trauma to the child.
HIV Counseling and Testing in the ED
Through a grant from the Philadelphia Department of Public Health, we have been able to
hire a full-time health educator, Keira Ragsdale, to provide HIV counseling and testing in
the ED to any patient aged 14 years or older who the health care providers feel might
benefit from the intervention (based on chief complaint, diagnosis, risk factors uncovered
during the history, etc). She can provide counseling with or without testing, depending on
the desire of the patient. She is highly skilled in dealing with this issue, including patient
confidentiality. You do not need to talk to the patient about HIV testing – she does it all.
She also performs the post-test counseling, and links the patient to the CHOP Adolescent
HIV initiative if the results are positive. We have also hired a full-time social worker,
Mohan Krishna (beeper 16889), to work with Keira in providing services for high-risk youth
who test negative. You'll probably see both of them around the ED - please page Keira,
beeper 16888, for any patient you'd like her to meet. Her hours are a bit variable, but
generally she's here M-F for at least most of the evening hours (3-8pm) - sometimes later.
If you have any questions, please page Cynthia Mollen, beeper 19838. Thank you for your
help in referring patients to this program!
Psychiatric Evaluation
We see a large number of patients referred for psychiatric evaluation who need “medical
clearance.” Call Social Work prior to your evaluation. Once we determine that the patient
has no evidence of organic disease, the psychiatrist should be informed to come to
evaluate the patient for transport to a facility that supports pediatric psychiatry. Psychiatric
patients should be carefully observed while in the E.D. Often these children are at risk for
elopement.
Poison Control Center
The Delaware Valley Regional Poison Control Center is located at 3600 Market Street,
Suite 220. The Center is staffed by full-time poison information specialists/ medical
consultants and utilizes the latest technology for the retrieval of poison information. They
are available on a 24-hour, 7-days a week basis. This is an excellent resource and should
be used freely. The phone number is 1-800-222-1222. (inside CHOP, dial: 4-2100.) Feel
free to visit the Center. They have excellent reprint files, textbook references, and they can
provide an up-to-date printout in minutes on the toxic effects of almost anything.
Pharmacy
 The CHOP outpatient pharmacy is open:
Monday-Friday
9:00 A.M. - 7:00 P.M.
Saturday, Sunday 9:30 A.M. – 5:00 P.M.
CLOSED 12:00PM-1:00PM ON WEEKENDS AND ON ALL MAJOR US
HOLIDAYS.
 A list of 24-hour pharmacies is posted in the ED.
 After hours: Patients are often dispensed their “middle of the night” dose of medication
until they can find an open pharmacy in the morning. The Nurse cannot dispense this
dose, however; the Physician must deliver the medication to the patient.
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
Narcotics are only accessed by RNs.
E.D. Extended Care Unit (EDECU)
This is a 23 hour unit reserved for patients with non-complicated diagnoses who need
relatively “simple” therapeutic interventions and have a clearly defined disposition plan.
While sub-specialty patients may be admitted to the unit (most commonly ENT patients),
the ED attending remains the attending of record. The EDECU is staffed by nurse
practitioners from 7 A.M. to 1 A.M. each day. The resident should page the NP (beeper
19666) and inform her of all admissions to the EDECU during these hours. The resident is
also responsible for writing the admission orders to the unit. The ED attending will write
the admission H&P. The EDECU may also be used as a short-term “observation” unit for
patients in the ED. Even though these patients are not formally “admits” to the unit, the
resident must still write relatively simple orders for these patients. Finally, when the
hospital is full, patients are sometimes admitted to the EDECU while “waiting for a bed.”
These patients also need orders.
Answering Telephones
The unit clerks (PCAs) will answer all telephone calls in the ED. They will usually put
incoming calls on “hold” by “parking” them on a line. To pick up a “parked” call, dial
“#936800X,” where “X” is the number of the “parked” line. For example, a call “parked”
on line 2 will be answered by #9368002.
How to use the Beeper System
Step 1:
Dial 81
Step 2:
Listen for the prompt, then dial the 5-digit beeper number, then “#”
(Assume 10xxx if given only 3 digits – i.e. “beeper 646” = 10646)
Step 3:
After the prompt, dial in your return telephone number.
Dress
Please dress professionally for your ED shifts. Your white jacket is optional so long as
you are professionally dressed. While neatly worn scrubs are acceptable, CHOP does
not supply scrubs for ED residents.
Storage of Personal belongings
There are a limited number of lockers located in the nursing lounge for visiting
residents, but you are encouraged to “pack light” and carry valuables with you.
Kitchen Areas
There is a kitchen area for the staff. It is located in the nursing locker area. Ask
someone to show you where it is and how to get in the door. It has a microwave,
refrigerator, sink, and seating area. You are free to use these facilities. Just remember
to clean up after yourself.
Cafeteria
Located on the 1st floor of the MAIN Building.
Hours:
Breakfast
6:30 AM – 10:30 AM (Grill closes at 10:00 AM)
Lunch
11:15 AM – 2:30 PM
Dinner 5:00 PM – 7:30 PM
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A coffee stand is located in the rear of the cafeteria from:
6:30 A.M. – 7:00 P.M Weekdays
6:30 A.M. – 11:30 A.M Weekends
Vending Machines
Vending machines with soda and assorted snacks are located just outside the entrance
closest to the “observation” room. The cafeteria has a wider assortment of vending
machines. These vending machines are accessible 24 hours a day.
McDonald’s
Located on the 1st floor of the MAIN Building. McDonald’s is open 24 hours a day.
Gift Shop
Located on the 1st floor of the MAIN Building. Hours: 9:00 A.M. – 8:00 P.M. Books,
cards, gifts, magazines, soda, snacks, toiletries, and toys are available.
Bank Services
PNC Bank and an automated teller machine (MAC) is located on the 1 st floor of the
MAIN Building. Unless you are a PNC Bank customer, this MAC machine charges a
fee. There are also MAC machines on the 1 st floor of the Wood Center (no fee) and the
1st floor of the Children’s Seashore House (fee, unless you are a credit union
customer.)
Reimbursement for Expenses
CHOP does not reimburse rotating residents for expenses incurred while doing a
rotation. This includes damaged or lost ID BADGES, parking, meals, tolls,
transportation, etc. Check with your individual residency coordinator to see what they
will reimburse. Free “holiday” meal vouchers, however, are sometimes distributed.
Parking
Free Parking for the 8a-8p shifts can be obtained by using our CHOP Remote Parking Lots.
Please see attachments for information and driving directions. You may also contact the
Parking and Transportation Department at (215) 590-4375. Employees are not allowed to
park in the Wood Garage between the hours of 6:00 a.m. – 10:30 a.m.
Wood Garage:


If entering after 1:45 p.m. on weekdays, or anytime on weekends:
You must “swipe” your valid CHOP ID badge upon entering
Do Not pull a ticket!
Upon exiting the garage, swipe your badge.
Your parking will be free.
If entering before 1:45 p.m. on weekdays AND your shift ends after 9 p.m.:
You must pull a ticket
Do Not swipe your card this time!
After your shift has ended (after 9 p.m.), go to the security office
(Security is located on the 1st floor in the main building)
Have your ticket “validated” by Security.
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


Security will “swipe” your badge (remotely) in their main office.
(This will “program” your badge for free parking upon your exit.)
Upon exiting the garage, “swipe” your “programed” badge.
Parking will now be free.
If your shift times don’t allow you to take advantage of the “free parking”, the full
charge in the Wood Building Underground Garage is $16/day.
An alternative to paying $16/day for your day shifts is parking in the Above
Ground Lot. To make use of this lot, rotating residents (who are
considered by CHOP Security to be temporary employees) must with their
ID in hand go to the cashier’s window (which is around the corner the
corner from the gift shop across form the Chapel) on weekdays between
noon and 4 P.M. and buy tokens. Four tokens cost $10. You need one
token to let you into the above ground parking lot (see below for
directions), and another to let you out.
The Above Ground/Health Center Garage is located on the south side of Curie
Boulevard and accommodates 1,383 vehicles, of which Children's Hospital has
557 spaces. It is owned and operated by the Philadelphia General Hospital
Development Corporation (PGHDC) and is used for permit parking by the three
members of the Corporation: The Children's Hospital of Philadelphia, Children's
Seashore House, and the University of Pennsylvania. It is managed by DLC
Management, which will staff the facility during operating hours and provide 24hour coverage within the garage.
Getting to the E.D. from the Wood Garage
Take the elevator to the 2nd floor of the Wood Center. Walk down the hall to the
“bridge” to CHOP. This now puts you on CHOP’s 3rd floor. Walk down the hall to the
“grand staircase” which will lead to CHOP’s main atrium. Walk through the atrium and
proceed through the entrance located near the ED Triage area. Have someone show
you to “Team 1.” Introduce yourself to the Team 1 Attending on duty--he/she will direct
you accordingly.
Directions to The Children’s Hospital of Philadelphia:
From New York and Northern New Jersey:
Take the NJ Turnpike to Exit 4 (Camden). Bear right off the exit ramp onto Route 73
North and follow signs for 295 South (approximately ¾ mile on the right). Travel 295
South for 9 miles to Exit 26, (end of 295 is a fork, stay left) to Walt Whitman Bridge (left
lane). Cross the bridge onto 76 West (Schuylkill Expressway) to Exit 40 (left lane),
South Street. Turn left onto South Street (which becomes Spruce Street), then turn left
onto 34th Street (third light). Follow parking directions below.
From Southern New Jersey:
Atlantic City Expressway to Route 42. Cross the Walt Whitman Bridge into
Philadelphia. Follow Route 76 West to Exit 40 (left lane), South Street. Turn left onto
South Street (which becomes Spruce Street), then turn left onto 34 th Street (third light).
Follow parking directions below.
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From Delaware and South:
Take I-95 North to Exit 11-291, Central Philadelphia, Interstate 76. Cross the bridge,
which becomes Penrose Avenue. Turn left (at the first light) onto 26 th Street and follow
signs to 76 West (Schuylkill Expressway). Take 76 West 3 miles to Exit 40 (left lane),
South Street. Turn left onto South Street (which becomes Spruce Street), then turn left
onto 34th Street (third light). Follow parking directions below.
From Western or Northern Pennsylvania:
Take the PA Turnpike to Exit 24, Valley Forge Interchange. Take 76 East (Schuylkill
Expressway) approximately 17 miles to Exit 40 (left lane), South Street. Turn right onto
South Street (which becomes Spruce Street), then turn left onto 34 th Street (third light).
Follow parking directions below.
DIRECTIONS TO THE WOOD CENTER PARKING GARAGE: (once in Philadelphia)
Proceed on 34th Street, which becomes Civic Center Boulevard at the bend, to the third light
(past CHOP). Make a right at the light, and proceed straight ahead 100 feet. A ramp entrance
to this underground garage is on your right, underneath the Wood Center. The garage
accommodates vehicles up to 6’7” in height. Park in the section for Staff and Physicians.
When you enter the parking garage for the first time and you have NO valid CHOP ID badge,
take a parking ticket. Once you have a valid ID badge, follow the instructions above under
“Parking.”
Driving Alternatives:
Septa
SouthEastern Pennsylvania Transportation Authority (SEPTA) has bus, streetcar
(trolly), subway/elevated train, regional rail and light rail transportation vehicles: 215580-7800
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Bus:
SEPTA bus routes 30, 40, 42, 90, and the “LUCY Shuttle”” run in front of/ near CHOP.
SEPTA: 215-580-7800
NEW JERSEY TRANSIT (to and from New Jersey): 215-569-3752
Subway:
SEPTA Market Street – Frankford line stops at 34th and Market Streets. Follow 34th
Street south toward CHOP.
SEPTA: 215-580-7800
Trains:
The University Avenue Station on Spruce Street between 33 rd Street and the South
Street Bridge is the closest stop. It is a direct connection to 30th Street Station.
AMTRAK: 215-824-1600
PATCO (to and from New Jersey): 215-922-4600
Taxis:
Taxis are available throughout the city; refer to the Yellow Pages for cab company
numbers. A taxi stand is located outside the MAIN Building.
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