Patient Care Policies & Procedures

Consultation Policy

The Chief Resident is responsible during weekdays for receiving and responding to requests for consultation submitted by other services. On weeknights and weekends, the senior resident is responsible for general pediatrics consults. They should be discussed with and signed off by the general attending. Pediatric subspecialty consults should be directed to the appropriate subspecialty attending or fellow. When a request for consultation is received, it must be responded too as soon as possible.

A note must be written in the chart at the time of consultation. All consultations should then be presented to the appropriate staff member who may choose to write an additional note in the chart.

It is not appropriate to expect other services to “do their own septic work ups” or “handle simple problems” themselves. A consultation is a request for help. Whether the nature of that help is simple and basic, or complex and tertiary, is irrelevant. The speed, courtesy and accuracy of our consultation service determine the reputation of this Department within the medical complex. Let us make it a well-deserved reputation of excellence.

Pediatric Patient Care and Rotation Policies

(Level of Responsibility)

  1. Inpatient Pediatric Wards
    1. PL1’s: All patients are to be pre-rounded on prior to morning report (8:00am). The interns are responsible for seeing all of their assigned patients, even if there is a medical student following them. Every patient must have a daily physical exam, progress note, and specific plan. The intern is primarily responsible for scheduling all necessary procedures. The intern is also primarily responsible for all non-routine phlebotomy draws that cannot be scheduled with Shands phlebotomy team. All procedures (spinal taps, bladder taps, etc) must be done with the aid of a senior resident, fellow, or attending until the PL1 is proficient in the procedure. The attending physician must be notified immediately of any changes in a patient’s condition, transfer to another service or unit (PICU), or impending discharge. All discharge summaries must be dictated within 24 hours after the day of discharge/transfer. Short call interns take admissions from 3pm to 6pm on weekdays. The other two interns on the team alternate admissions as assigned by the senior resident from 7am to 3pm and are responsible for any admissions that are known about and present at Shands Children’s Hospital before 3pm. The night float interns take admissions from 6pm to 7am Monday through Thursday and all day on Sunday. PL1s should notify the primary care pediatrician of all admissions and discharges.
    2. PL3’s: The senior residents’ primary role is supervisory. From 7am-7:30am, they must review admissions from the previous night float shift and review labs, studies and vitals on the rest of the team’s patients. The PL3 will see, write notes on and present all patients admitted after midnight Tuesday through Friday and then assign them to the appropriate intern following rounds. The PL3’s should attend morning report (8:00 am) every day and one ward senior per day is expected to present morning report… The seniors should lead rounds and limit daily work rounds to the time allotted. If an attending is not present for rounds, the PL3 should contact the specialty attending to discuss their patients on a daily basis. The PL3 is also responsible for supervising the acting intern(s) and co-signing all orders and notes. Short call seniors take admissions from 3pm to 6pm weekdays. Night float seniors supervise admission and cross-cover from 6pm to 8am Sunday through Thursday nights. Senior residents are responsible for helping to make patient assignment lists for the weekends, and for helping to write notes on weekends and holidays if the census is large. Seniors should write an accept note on all admissions, and check all orders written by interns. The PL3 is responsible for supervising all procedures until the intern is qualified to perform the procedure independently.
  2. NICU
    1. PL1: The PL1 pre-rounds on their assigned patients before rounds which begins around 8am. They are responsible for daily physical exams, progress notes, and any consults or procedures that need to be done. They are also responsible for updating parents and referring physicians. The PL1 will take the junior role in attending deliveries when on Labor and Delivery Call.
    2. PL2 & 3: The senior residents perform the same duties as the PL1, as well as take senior responsibility in the delivery room, on call, and aid in the supervision of interns.
  3. ER: The residents are responsible for all pediatric patients in the ER. They are responsible for seeing patients in the appropriate order according the severity of the complaint. The residents perform all necessary procedures. Appropriate labs and X-rays should be drawn and checked before the patient is admitted. Notify the chief resident of day admissions (between 8am and 4pm) and the PL3 on call (between 4pm and 8am) about night admissions. On weekends the on call resident should be notified 24 hours a day. Once an admission has been discussed with the Chief Resident or PL3, then brief admission orders should be written.
  4. PICU:Residents are responsible for notifying the accepting senior resident as well as writing a transfer summary of any transfers from the PICU to the pediatric service.
    1. PL2: The PL2 pre-rounds on their assigned patients before rounds which begins around 7:30am. They are responsible for daily physical exams, progress notes, and any consults or procedures that need to be done. They are also responsible for updating parents and referring physicians.
    2. PL 3: The senior residents perform the same duties as the PL2, as well as aid in the supervision of PL2s.
  5. Acute: Acute clinic hours are 8 am to 5 pm. Residents are responsible for seeing all patients and performing needed procedures in the clinic. Should a patient require transfer for admission they also are responsible for making the needed arrangements.
  6. PAH: Hours are from 6 pm to 9 or 10 pm depending on the time of year and day of the week. . Residents are responsible for seeing all patients and performing needed procedures in the clinic. Should a patient require transfer for admission they also are responsible for making the needed arrangements. Overnight from 10pm to 6am residents are responsible for taking phone calls and faxing the phone call sheets to the appropriate physicians the next day, except on weekends.
  7. Newborn Nursery (NBN): PL1 and PL2: Responsible for NBN from 7:30am to 5:30pm. At least one NBN resident must be present to checkout to the NICU nightfloat resident at 5:30pm. The PL2 has primarily a supervisory role in the NBN. It is their responsibility to make sure all maternal and infant labs are checked and all infants receive an admission physical within 24 hours and an appropriate discharge physical. The residents in the NBN should have all appropriate paperwork and charting completed for any babies that may be discharged on the weekend. A complete checkout list must be left for the weekend coverage.
  8. Adolescent and Development rotations: PL1’s and PL2’s should obtain their schedule from the General Division Office or Adolescent Nurse Coordinator prior to beginning their rotation.
  9. Electives: See subspecialty specific objectives.
  10. Continuity Care Clinic (CCC): Morning clinic starts at 800 am and afternoon clinic at 100 pm. Friday morning clinic starts at 9:00 am. When a resident is assigned to an ICU rotation who has a morning clinic, their first patient will be scheduled at 9:30am. Interns and PL2’s on call rotations should give their beepers to the seniors to carry during their clinic. They are expected to remain at clinic for 4 hours. Clinics cannot be cancelled with less than 2 months notice. If this is absolutely necessary, it must be discussed with the CCC attending and the resident is responsible for rescheduling patients. Residents cannot ask other residents to cover their CCC without permission from the Chief Resident and CCC attending.
  11. Bullpen: PL2 residents are responsible for covering one weekend PAH shift during the year. PAH shifts are 2-9 or 10pm on Saturdays and 1-9pm on Sundays.
  12. Medical Students:
    1. Third year medical students are paired with pediatric interns on their in-patient rotation. The student takes call with the intern, and typically picks up 2-4 patients on call and follows 3-5 patients. The student should write daily progress notes to be reviewed by the intern. The intern should still see very patient every day and write an independent note. MS3’s take call on weekends also. The 3 rd years are excused from call after 6pm on the night before their written and oral tests. Third year students on the out-patient rotation do ER, NBN, and clinics. In the ER, they should be paired for most of the week with a PL2/PL3 and work those assigned shifts, and one weekend shift. In NBN, they work all five days and one weekend day during the week in the NBN.
    2. Fourth Year medical students on acting internships will take call every 5th night. Weekend/holiday policy is the same as for third year students. They will alternate admissions with the on call intern. All orders and notes must be co-signed by the PL3. They will type all discharge summaries prior to completion of the rotation in order to receive a grade.
  13. Family Practice: Family Practice Residents spend 1 month with the Department of Pediatrics as interns on the blue team and one month as a 2nd year in the newborn nursery.