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HAND FELLOW PEDIATRIC ROTATION MANUALRobert Carrigan, M.D.Benjamin Chang, M.D.Bong S. Lee, M.D.Ines Lin, M.D. DATE \@ "MMMM d, yyyy" December 7, 2016CONTACT INFORMATIONRobert Carrigan267-226-3221 carriganr@email.chop.eduBen Chang215-570-1788benjamin.chang@uphs.upenn.eduBong Lee856- 304- 9143LEEBO@email.chop.eduInes Lin215-738-0426Ines.Lin @uphs.upenn.eduOrtho 215-590-1527Kim LaVelle: lavellek@email.chop.eduHoun Lim, PA: limh@email.chop.eduPlastic Surgery 215-590-2208Kathleen Capuano (surg scheduler)Capuano@email.chop.eduTHE HAND TEAMPA extraordinaire: Houn Lim (ortho)Coordinator: Kim LaVelle (ortho)Plastic surgery resident travels with BC to HUP and CHOPOrthopedic residents at CHOP cover all the ER consultsHand Fellow: some months @CHOP“200 level” medical studentRotates for a 2-week period. Tues. 7:30 Dr. Chang lecture in CHOP Plastic surgery clinic Attend & be prepared to give talk.Weekly ScheduleMon.8:00 amRC ortho clinic**(2,3,4,5)Tues.7:30 amStudent lecture*8:00 amBC plastics hand clinic*1:00 pmBC ortho clinic**5:30 pm Plastic surgery conf.+Wed.7:15 amBC/RC OR all dayThurs.8:00 BC ortho clinic (1,3,5)**1:00 pm BL ortho clinic**Fri.7:00 amRC OR, BC clinicNoonBC OR, RC clinic* 1 Wood** 2 Wood+ 10 Penn Tower++ CAM, 1st floorDAY BEFORE ORReview office notes (Epic)Review x-rays, retrieve from PACSReview and print pathology for tumorsMake sure any special equipment or implants are availableCheck OR schedule for missing or add- on cases, scheduling conflictsREAD about casesOR DAYMark operative site in holdingPull up x-rays on PACS in ORPut path reports in chart (send to path)Make sure circulator has equipment or ImplantsAntibiotics only for: Implants or grafts Contaminated or infected wounds Case length over 2 hour Cardiac prophylaxis Open fracture or jointEQUIPMENTALL HAND CASES: Hand table, tourniquet, Hand instrument trayBipolar cautery (hand) Monopolar cautery (forearm) FRACTURES: SuctionFluoroscopy, lead Synthes drill (CHOP)Cast cartForearm Shaft: Small Frag setDistal Radius: Medartis distal radius plate set 0.062 k-wires & driverMetacarpal/Phalangeal: Medartis hand plate set OR Synthes hand modular set 0.045, 0.035 double-ended k-wiresNERVE REPAIR: Micro instruments, possible neurogen nerve conduit, cast cartTYPICAL HAND OR SET-UPRotate OR table 45-90 degreesAttach hand tableWrap Webril around upper armApply tourniquet (18” adult, 12” child)Cover tourniquet/Webril with plastic 1000 drape, keep prep off WebrilAttach inflation cable to tourniquetChlorhexidine prep hand, forearmScrub tech covers hand table with sheet and puts down a blue towel folded in half lengthwise under arm tourniquetWrap blue towel around tourniquet, clipPut arm through extremity drapeCover legs with down sheetSuction for trauma or fracture casesBipolar pedal under hand tableFlouro on operative sideFlouro screen on opposite sidePOST-OP INSTRUCTIONSPain meds unless skin only caseAntibiotics for implants or infectionFollow-up (dressing off, return visit)Trigger5 day2 wksLesion2 day2 wksExtencast4 wksexam OOCFlexorcast4 wksexam OOCSyndactcast2 wksexam OOCCTR2 day2 wkssut. outK-wirecast1 wkx-ray in castPlate splint1 wkx-ray OOCSkin graft no1 wkbolster offNervecast4 wkexam OOCARRANGING FOLLOW-UPCHOP Plast215-590-2208Ortho215-590-1527 Email all OR cases at end of day to:benjamin.chang@uphs.upenn.edulavellek@email.chop.eduPAYNEB@email.chop.edu?deuber@email.chop.edu?; LIMH@email.chop.edu?; elamt@email.chop.edu?; SOTO@email.chop.edu?; DEVINNEY@email.chop.edu?; MAGUIREMA@email.chop.eduEmail should contain:NameMRNProcedureF/u when?X-ray, in or out of castHAND CLINICEPIC Progress NoteSelect appropriate Smartphrase If no Smartphrase, SOAP note with .BCNAD(CHOP)Edit template as neededF2 through entire noteReturn patients: import last note & editPay attention to detail!Minimize abbreviationsName fingers: index, long, ring, smallNote goes into letter to PMD Do not refer to “Dr. Chang” in noteIMP: “Healing well after” not S/PSpend time on the PLAN explain what we plan and why treatment: OT, meds, surgery tests: x-ray, EMG, labs follow-up when? ?x-ray, in or out of castDiagnosis – Look for coding cheat sheets in each roomUseful site for hand codes: search term into EPIC orType EXACT ICD-10 code: xxx.xxBe specific: MC shaft or neck fx?Add to problem listOrdersEnter CPT codes XXXXX.999 suffix “Cast Consult” to have cast or splint placed or removed in cast roomMed Rx print out on special paper “Occupational therapy” (CHOP)Bill for fracture care in office If we initiate definitive fracture care Subsequent visits <90 d are post-op Enter CPT code (e.g. 25600)For pre-op patient:Surgical consent – fill in EPIC, print out and have parent sign, date and timeOR case orderLOS – level of service Established – seen within 3 years Post-op – surgery or fracture care within 90 days Consult – referred by MD -57 modifier for same day procedure shortcut: N3for New patient, level 3 Enter Attending as provider Associate with diagnosisPatient instructions – SmartphrasePrint AVS after visit summaryFollow-up – when, ? x-ray, cast on or offNP clinic for simple fracture f/uNote for school: open a letter on ortho stationary.BCSCHOOLDO NOT close encounterCHOP EPIC CHECKLISTVitals – pain scoreChief Complaint: DOI, DOSAllergy: Update and check REVIEWEDOrder Rec: Update and REVIEWED Progress NoteDiagnosis: add to problem listLOS:Auth provider (Chang)Modifier 57 for fx carePatient instructionsFollow-up: x-ray? Cast on/off?Orders for fracture care:Cast room orderCPT code for fx xxxxx.999DIRECTIONS to satellitesExton (45-50 min.)I-76 West, 18.4 mi.Exit 327-328A-328B for US-202 W toward US-422 W/KOP/W ChesterExit 328A on the left and merge onto US-202 S toward W Chester, 11.5 mi.Exit onto US-30 W toward Downingtown/Coatesville, 5.1 miTake the US-30 BUS/Lancaster Ave exitTurn right at US-30 BUS E/ E Lancaster Ave, 1.1 mi.Turn right at Campbell Blvd, 390 ft.1st right onto John Young Way, 210 ft.481 John Young Way, Exton PA 19341King of Prussia (KOP, 25-30 min.)I-76 West, 18.4 mi.Exit 327-328A-328B for US-202 W toward US-422 W/KOP/W ChesterExit 328A on the left for US 202 SKeep left toward Mall BlvdExit 327 for Mall BlvdRight on Mall Blvd210 Mall Blvd, King of Prussia, PA 19406 ................
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