HAMILTON GENERAL HOSPITAL
Orientation Package:
GENERAL SURGERY ROTATION
Updated 2014
1.
GOALS AND OBJECTIVES
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SERVICE
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Develop a list of your own goals and objectives at the start of your rotation. Your program should provide
you will your goals and objectives prior to the start of this rotation (See One45).
Review these with your staff person(s) early in your rotation
Midway through your rotation, meet with your staff person(s) to evaluate your progress, areas of
strengths and weaknesses so as to better achieve your goals by the end of your rotation. A mid unit
evaluation will be distributed by One45 if you rotation exceeds 3 months (general surgery residents only)
It is your education, your learning, your responsibility to set up these meetings prior to the end of your
rotation.
There are eight staff general surgeons at the Hamilton General Hospital
o Dr Bowser, Dr. Baillie, Dr. Reid
o Dr Sne, Dr. Faidi
o Dr Kahnamoui, Dr. Sanders, Dr. Engels
o ACS – faculty rotating
The general surgery/trauma ward is 6S. There is a Surgical Step Down Unit on 6S.
There are three surgical teams, as listed above
Medical students are assigned to individual staff preceptors, but will work with you on your team. There
are a variety of educational activities for residents to participate in.
 OR
 Clinic
 Endoscopy
 Rounds
 Trauma
This team based format allows residents to see patients preoperatively, operatively, and perioperatively,
allowing for good continuity of care
The priority of activities is as follows: OR, Clinic, ER/Trauma, Endoscopy.
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You or a member of your team must always be in the OR when your staff is operating. Multiple
team members can attend the OR as long as there is room. You may even attend the other
team’s OR if there is an interesting case, or lack of residents.
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Always find out your staff’s schedule and what you are expected to attend. Frequent checking in
with your staff shows your enthusiasm and keenness.
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There will always be someone covering ER during the day, but if they become overwhelmed with
consults/trauma, you may be asked to help out and may have to leave other clinical duties.
Again, always check with your staff.
COVERAGE
Day Call
There is a day call schedule. The initial month has been arranged for you. It is your professional
responsibility and CANMEDS role to work with the entire group to cover day call for the month. If
HGH Orientation Package
Updated April 2012
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there are conflicts, resolve them amongst yourselves so that there is always someone available for
coverage. The subsequent months will be up to the group of residents to organize.
Night Call
The night call schedule will be arranged by the chief resident.
Vacation Requests
 Any vacation requests, professsional leave requests or any planned days off MUST be discussed
with the chief resident or CTU director as far in advance as possible to avoid any conflicts. Please
submit a request online through your medportal account.
 Days off are not guaranteed and granted on a first come, first serve basis.
 The call schedule will be delivered two weeks prior to the start of the month.
 All vacation requests must be approved by the chief resident, CTU director and your Program
Director.
 PAIRO guidelines will be observed and respected.
Consults
 Must be completed on the day requested, even for non-urgent consults.
 Cases are to be discussed with the staff surgeon.
 All staff are to be notified in a timely fashion of all consultations.
 All operative cases must be reviewed by the chief resident.
Admissions and Consults
 A history and physical exam is to be present in the chart.
 Notes must be dictated for all consultations, and the number must be transcribed in the chart.
 A copy of all dictations needs to be sent to the family MD, the referring physician and the on-call
physician.
Discharge Summaries
 The summary face sheet needs to be accurately filled out for all inpatients and post op patients.
 Discharge summaries must be dictated for all patients admitted and the number left on the face
sheet.
Post-Call
 If you are post call it is your responsibility to notify paging that you are signing out as well as
informing them of which one of the residents will be covering for you.
 When you are in the OR, please notify paging before you start, check your pager between cases,
and notify paging when you have finished.
 When you are scrubbed in the OR, your pager should be left on the desk in the OR.
 If your staff is on call while you are in the OR, arrange for another resident to cover ER for you.
4.
ROUNDS
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Morning rounds should be completed prior to starting in the OR.
Evening rounds consist of checking in on post-operative patients, unstable or sick patients, and with the
charge nurse for uncompleted tasks at the end of the day.
Handover with the chief resident occurs each morning at 0730 am and at the end of the day to review
each patient and completed tasks.
Progress notes need to be written on active patients daily.
Progress notes need to be written on ALC patients once a week.
You are expected to round on your patients when you are on call on the weekend.
It is optional to round on your own post-operative patients, unstable patients, ICU patients.
RADIOLOGY
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Radiology requisition forms must be filled out for all tests ordered
The radiology triage staff must be called as soon as the test becomes ordered to arrange priority booking
If required urgently, then the request must be made directly to the staff radiology responsible for the test
that day (eg. Talk to the staff doing CT that day)
All interventional radiology requests will be made directly to the staff on call
At night and over the weekend, all requests are made through the radiology resident on call
Many times arranging tests requires visiting the actual radiology department and speaking to the
resident/staff in person to arrange the test
Results may also require visits to the actual radiology department
HGH Orientation Package
Updated April 2012
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6.
With any difficulties arranging tests, do not hesitate to call your staff/chief resident for backup
All CTs (unless known to be non-contrast) and all MRIs now require creatinine level, I believe within 60
days, or if pt has had exam with dye since last creatinine level then again before test.
CALL AND HANDOVER
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Handover is preferable in person, face to face. Page and arrange to meet the resident.
You should always have a list of patients and a list of items to be looked after.
In the evening:
o Prior to leaving the hospital in the evening all sick patients should be signed over to the resident
on call.
o All patients in the step down unit are sick, and should be handed over.
In the morning:
o New patients and all sick patients need to be handed over to the oncoming resident as soon
as they come in, before 0800h on weekdays.
On weekends:
o As above
o Handover is at 0900h on 6S
o The resident who saw the patient should arrange any diagnostic tests that need to be done.
o For emergency cases, the resident who did the admission may come for the case if they want,
even if they are not on call.
Residents are expected to cover general surgery and be available for the trauma team when on call.
Residents may send medical students to do consults after ensuring that the patient is stable.
All consults done by medical students need to be reviewed by the resident on call, and the patient
examined by the resident on call.
There is always back up available for residents on call.
Should you feel uncomfortable or overwhelmed, call the chief surgical resident, the ICU resident or the
surgeon on call.
The surgeon on call must be notified of all admitted patients, prior to discharging patients, as well if there
are sick patients admitted to hospital.
Should the status of a patient change overnight, the treating surgeon should be contacted, if they do not
answer, leave a message with their office, and notify the staff on call.
Call rooms are located in the McMaster wing; there are three sets of call rooms for the surgery team, a
surgical clerk room, junior resident room and senior resident room.
7. TEACHING
Teaching Rounds:
Monday
Tuesday
Wednesday
Thursday
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Chief Resident Rounds/M&Ms
Trauma Rounds-1st Tues/Month
Surgical Resident Academic Half Day
Jr. Resident Rounds
Trauma Fellow Rounds
1600h
1600h
0730h
1630h
1600h
6 N Teaching Room
Theatre Auditorium-Basement Level
JHCC-4th Floor Theatre
6N Teaching Room
6N Teaching Room
Morbidity & Mortality rounds are held the first Tuesday of every month. You may be asked to present at
these rounds. Please maintain a list of interesting cases that would benefit from being presented in this
type of forum.
HGH Orientation Package
Updated April 2012
Tuesday Regional Trauma Rounds:
These rounds are held every Tuesday at 1600 hours in the Theatre Auditorium at the Hamilton General Hospital.
All specialties that contribute to the management of trauma patients participate in these presentations. Fellows
are expected to find speakers and topics for presentation and inform the trauma office of names and dates of
same. They will then advertise the sessions to our staff and to our community colleagues who view our rounds
via web cast.
Trauma simulation sessions take place Tuesday afternoons from 1300-1530 in the simulation lab.
Thursday Trauma Rounds
These rounds take place every Thursday at 1600 in the 6N teaching room and are presented by fellows,
residents or other members of the team. They are for clinical clerks and students. Residents are expected to
present at least once during their rotation. There is a bank of topics that need to be covered (see list on bulletin
board in the trauma fellow’s’ office).
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It is the resident’s responsibility to teach medical students.
On a daily and ongoing basis, residents should teach medical students the basics of a surgical history
and physical, how to manage common surgical problems, basic anatomy, postoperative and preoperative
orders and peri and postoperative care.
Residents are required to give formal teaching rounds; dates should be set for all the topics on the list
provided during the first week of the medical student’s rotation.
8. OR ETIQUETTE
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Check the OR schedule the day before.
The schedule can be found at the OR desk
There is also a schedule in OR booking which has the entire weeks’ schedule.
Read around cases the day before so you can better follow the operation.
Arrive early enough to review the chart and introduce yourself to the patient, and help position and prep
the patient.
At the end of a case, please stay and help transfer the patient.
o Your prompt attendance, up-to-date knowledge and enthusiasm all go toward increased graded
responsibility.
9. ISSUES
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Every rotation can have problems that arise both personally and professionally.
The earlier you make these issues known to your supervisors the more easily we can take care of them
to still allow for a meaningful rotation.
Both your chief resident and your CTU Director, Dr. Sne, are always available to discuss any conflicts
that may have arisen.
SCHEDULES
Sne
Engels
HGH Orientation Package
Monday
Tuesday
Wednesday
Thursday
Friday
Academic Day
AM Endo
PM OPD
PM OPD
GHA Surg
Centre
Upp. James
OR
OR
Academic Day
Academic Day
PM SSU
PM OPD
Updated April 2012
Bowser
AM Endo
PM Office
AM Office
PM Office
Variable Clinic
PM MUMC SSU
Grimsby
OR
Alt with Baillie
Kahnamoui
Baillie
Academic Day
OR
AM OPD
PM Endo
AM Acad
PM OPD
AM SSU
PM Colorectal
Screening
OR
PM SSU
AM MUMC 4V1
AM OPD
Academic Day
Alt with Bowser
Faidi
PM OPD
Academic Day
AM Endo
OR
AM OPD
AM SSU
HGH
Clinic in Office
AM SSU
MUMC
OR Oct
Sanders
AM SSU
MUMC
AM OPD
OR-Aug
AM OPD-Aug
OR May/June
Acad.-Aug
AM OPD
May-Sept
OR-Oct
AM Endo
Reid
* Please check with staff surgeon’s office to ensure no changes to the above schedule
HGH Orientation Package
Updated April 2012
11.
CONTACT INFORMATION
Office #
Sne
Pager #
Dictation #
Secretary
44665
Cell 541-8280
513089
Rebecca
Bowser
522-0262
44654
546-8610
513005
Darlene
Engels
521-2100
44520
2333
13915
Jamie
Kahnamoui
46320
Paging
513065
Jennifer
Faidi
44736
513093
Marilyn
Baillie
44237
2184
13302
Rena
Reid
73188
3001
Sanders
12.
Office
Back-line
905-387-1367
2345
Veronica
Lynette
IMPORTANT NUMBERS
Admitting: 46233
Ambulatory Care Clinics: 46266
Conference Room: 46604
Endoscopy Suite: 46206
Endoscopy Booking: 48006
Operating Room: 46277
Paging: 46311
Surgeon’s Lounge: 46341
Outpatient Dept: 46266
Diagnostic Imaging:
Booking: 46256
U/S and CT Booking: 46900
Ultrasound: 46939
ER X-Ray: 46244
Verbal Report: 46906
Interventional: 46514 (call this to find out who the Radiology Interventionalist on call is)
Labs:
Stat Chemistry: 46132
Stat Hematology: 46189
Pathology: 46164
Microbiology: 46175
13.
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ORDERS AND NOTES
Consult
Name, Date, RFR, CC, PMHx, PSHx, Medications, Allergies, SocHx, FamHx, HPI, O/E, Labs, Imaging, Imp,
Plan, Signature, Title, Pager#, Dictation#
Progress Notes
HGH Orientation Package
Updated April 2012
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Date, Title, POD#, Subjective, Objective, Assessment, Plan, Signature
Include all vitals, urine/NGT/drain outputs, pertinent results of labs, cultures, imaging
Operative Note
Date, Title, PreOp Dx, PostOp Dx, Procedure, Surgeon, Anesthetist, Findings, Complications, EBL, Blood
Products, Labs, Drains, Specimen, Condition, Signature
Admission Orders
Date, Title, Admit to, Dx, Diet, Activity, Vitals, IV, Labs, Drains/Tubes, Imaging, Cultures, Other tests,
Analgesia, Anti-emetics, Anticoagulation, Antibiotics, Home Meds (List all, hold if necessary)
Post-Op Orders
Date, Title, Diet, Activity, Vitals, IV, Labs, Drains/Tubes, Imaging, Cultures, Other tests, Analgesia, Antiemetics, Anticoagulation, Antibiotics, Home Meds (List all, hold if necessary)
Common Orders
Analgesia
Morphine 2-8mg IV/SC q3h prn
Demerol 25-50mg IV/IM/PO q4h prn
Dilaudid 2mg IV/SC q2h prn
Toradol 15-30mg IV/IM/PO q6h prn
Tylenol ES/#2/#3 1-2tabs PO q4h prn
Percocet 5/325 1-2tabs PO q4h prn
Anti-emetics
Gravol 25-50mg IV/IM/PO q4h prn
Ondansetron 4-8mg IV/PO q4h prn
Prokinetics
Maxeran (metoclopramide) 10mg IV/PO q4h prn
Stemetil 10mg IV/PO q4h prn
Domperidone 10mg PO q4h prn
Antibiotics
Ancef(cefazolin) 1g IV q8h
Keflex(cefalexin) 500mg PO qid
Ciprofloxacin 400mg IV q12h, 500mg PO q12h
Metronidazole 500mg IV/PO q12h, q8h
Ampicillin 1g IV q8h
Tazocin 4.5g IV q8h
Anticoagulation
Heparin 5000u SC q12h
TEDS
Drains
Foley cath to urometer
NGT to low intermittent suction
JP drain to Hemovac
Monitor ins/outs
Potassium
KCl Bolus 10meq/100cc NS x1-3 boluses each over 1hour
KCL Elixir 20meq/40meq PO
Klyte 25meq PO
Consider checking Ca, Mg, PO4, albumin if lytes abnormal.
Phosphate
Potassium phophate 22meq/15mmol IV bolus
Phophate novartis 1-2tabs PO bid
Magnesium
Magnesium sulphate 2 or 5g/250cc NS or D5W IV bolus over 4-6h
Magnesium Rougier
Calcium
Calcium gluconate 1g IV bolus over 1h
Calcium chloride 1g IV bolus over 1h
HGH Orientation Package
Updated April 2012