Floor work

• Teams
• Colorectal White: Kirilcuk, Gurland and Morris (R1 + R4/R5)
• Colorectal Red: Shelton and Kin (R1 + R4/5)
• R3 floats between services but is really on endoscopy
• Rounds typically start 5:45-6:00 AM
• Often will round red+white together if the services are light. You'll probably end up crossing over to help each other out
• Weekend rounds - Goldens and Blacks. you will crosscover both Red and White. You'll usually be on call at least one weekend day during the month.
• Multidisciplinary rounds happen at 10:20AM every morning starting on E3. You run the list with the charge nurse, case manager, social worker, physical therapist, dietician, etc.
• Let the case manager (Linda for colorectal) know estimated dates of discharge so they can start working on contacting insurance for home health needs, etc
• Will typically PM round - should know interval events, key vitals/in-outs. PM rounds typically happen around 3-6 PM.

• 	M	T	W	Th	F
  Conference	7-8 AM: M&M	7-8 AM: Grand rounds	Tumor board 3:30-6 PM in CC 2205 (Med students go, interns do not)
  Clinic	Kirilcuk	Shelton Gurland (in RWC, interns don't go)	Morris PM?		Kin
  OR				OR	OR

OR

• You will cover the butt cases.
• Orders
• Butt cases: order set “Day of Surgery”; do “No Abx” and “No Mechanical or Chemical VTE prophylaxis needed” (e.g. don't need SCDs or heparin)
• Abdominal cases (usually the NP/PA will write at clinic pre-op visits): SCDs, abx per preference, Tylenol 650g PO, celecoxib, and gabapentin 300mg po. 
• When in doubt, all you need is 'antibiotics per preference' and 'SCDs'.
• The surgeries last anywhere from 5-20 minutes.
• They are all clean contaminated cases (i.e., you need to gown and glove but don’t need to scrub)
• (Morris does scrub though)
• They are all (mostly) done under MAC
• How to set-up a butt case:
• Patients should be in prone Jackknife position (the bed is scissored so the hips are lifted and the legs and head is low) aka face down butt up
• For taping, each attending has their preference (shocking, I know)
• Dr. Kirilcuk and Dr. Morris like to split the tape. Kirilcuk likes Benzoin before tape.
• Dr. Kin and Dr. Shelton do not split the tape
• Gown and glove, and drape the patient.
• Dr. Kirilcuk likes to create a small pocket on your side for the suction and bovie, clamped with mosquito clamps on the two ends. 
• Post-op care: .crsdcanorectal
• Kirilcuk likes to send people on pain meds (usually norco, she or you write Rx), recticare (5% lido TP cream 15g), fiber (psyllium 6g TID), and po mineral oil (15 cc TID)
• Kin (tylenol3, psyllium, recticare). 
• Morris: Pain med, recticare, sitz bath
• Shelton: usually same as Kin.  Follow-up is usually 3 weeks after surgery. Shelton will do all the post-op orders himself!
• Gurland: typically eprescribes the narcotics
• Follow up in ~ 1 month.

Clinic

• Schedule - see above. Usually they are well staffed with APPs so it's not a huge deal if you need to leave clinic to do floor work.
• For new patients, use the .CRSHP dot phrase, and for follow-up patients use the .CRSFOLLOW dot phrase.
• Do not change the format of the note.
• In general, do NOT do a rectal exam on patients.  
• Ask the attending if they like to have the patient gown up or not in preparation for the rectal exam with the attending (for example- Kirilcuk has patients stay in their clothes)
• Try your best to write notes in-between seeing patients while waiting to present.  Some attendings will close the encounter as soon as the clinic is over (which means you won’t be able to edit your note) so try your best to have all your clinic notes done before the clinic is done.

ERAS protocol (Early Recovery after Surgery) - early fluids/feeding to minimize hospital stay