HAMILTON GENERAL HOSPITAL
Orientation Package:
GENERAL SURGERY ROTATION
1.
GOALS AND OBJECTIVES
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2.
SERVICE
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3.
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.
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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. Gregor, Dr. Sanders
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
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.
HGH Orientation Package
Updated April 2012
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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 for more than 1 week as well as any
patient with a complication, or complicated stay 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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5.
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
With any difficulties arranging tests, do not hesitate to call your staff/chief resident for backup
All CTs (unless known to be 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.
HGH Orientation Package
Updated April 2012
6.
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.
TEACHING
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Teaching Rounds
o Monday
Chief Resident Rounds
o Tuesday
Medical Student Rounds
o Tuesday
Trauma Rounds
o Wednesday Surgical Resident Academic Half-Day
o Thursday Resident Rounds
o Thursday Trauma Fellow Rounds
o Friday
Medical Student Rounds
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8.
1600h
0715h
1600h
0715h
0715h
1600h
0715h
6N Teaching Room
6N Teaching Room
Theatre Auditorium – Basement level
JHCC – 4th Floor Lecture Room
6N Teaching Room
6N Teaching Room
6N Teaching Room
Monthly – Morbidity and Mortality Rounds are held on a Monday AM replacing Chief Resident
Rounds that week. At the nursing station there is a book where all patients to presented for M&M
rounds should be entered. The resident taking care of the patient needs to enter the relevant
information into the book.
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.
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.
HGH Orientation Package
Updated April 2012
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9.
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.
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
Monday
Tuesday
Wednesday
Thursday
Friday
Sne
Academic
AM Endo
PM OPD
PM OPD
OR
Bowser
AM Endo
PM Office
AM Office
PM Office
Variable Clinic
PM MUMC SSU
Grimsby
OR
Alt with Baillie
Acad/SSU/
ColoScreen’g
Oct-OR
PM OPD
AM OPD
PM Endo
OR (till end Sept)
Academic Day/
Colorectal
Screening
Gregor
AM Office
OR
Academic Day
AM Office
PM SSU
PM OPD
Baillie
OR
AM OPD
AM MUMC OPD
PM MUMC SSU
Academic Day
Academic Day
PM OPD
AM OPD
Kahnamoui
Alt with Bowser
Faidi
PM OPD
Academic Day
AM Endo
OR
OR Sept
Clinic in Office
AM MUMC
SSU
OR Oct
AM OPD
OR-Aug
AM OPD-Aug
OR May/June
Acad.-Aug
AM OPD
May-Sept
OR-Oct
Sanders
Reid
AM Endo
* 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
Office
Back-line
44665
Pager #
Dictation #
Secretary
Cell 541-8280
5130
513089
Rebecca
Darlene
Bowser
522-0262
44654
546-8610
513005
Gregor
527-5121
44541
540-0343
513009
Kahnamoui
46320
46311
513065
Jennifer
Faidi
44736
513093
Marilyn
Baillie
44237
2345
MUMC
2184 MUMC
513301
Rena
Reid
73188
3001 MUMC
Sanders
12.
Brenda
905-387-1367
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
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
HGH Orientation Package
Updated April 2012
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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