Logistics - SCVMC Urology

Admin lists/documents

OR schedule

Clinic phone number

  • Patient Phone: +1-408-793-2560 
  • Fax: +1-408-885-7645 
  • Back lines: x56755 x56761 (Leo & Erin)
  • Mona/surgery scheduler: x57971 

 

  M T W Th F

Conference

5:30 PM - Stanford teaching

2nd and 4th Tues

  • 1-2 PM - tumor board (clinic conference room). R3 presents
  • 4-5 PM - GU radiology conference (Clinic conference room). R2 presents.

3rd Tues

  • 4-5 PM - Path conference (across street from ED, 2nd floor). R2 presents.

5-6 PM after conference - Interesting case/teaching

  • R2 presents interesting case (usually from upcoming week of OR), R3/R5 get asked questions

 

  

7:30 AM in Allo conference room (VSC 4th floor)

  • 1st Fr - Grand Rounds (PGY-2 and PGY-3 one each, chief presents 2)
  • 2nd Fr - Interesting cases (PGY-2 presents 2 cases)
  • 3rd Fr - M&M (PGY-3 and chief present)
  • 4th Fr - residents at Stanford for didactics

Clinic (usually)

Elliot all day

CHarris (AM procedure, PM clinic (R3))

Abidari AM (R3)

PM Elliott rehab (on 1st floor)

Chief clinic

Reese procedure clinic AM

Abidari all day (PM)

 Elliott clinic AM Chief clinic

OR (usually)

Abidari

Reese

 

R Harris

Elliott

 C Harris  

Conferences and Teaching 

  • The list
    • Both conferences have a respective list on EPIC
    • Make the Excel list for rads and path conference. Rads conference is a bit more detailed in terms of HPI but only you and the radiologist/pathologists see it so up to you how detailed you want it to be.
    • Fax it to the appropriate number the Friday before; at latest the Monday before so they have time to review imaging/pull slides
    • When faxing, make sure it is in large font
    • You can let Jewel know it's ready to fax, but she frequently takes off Fri/Mon so be careful; she will usually respond to the email and mark it as faxed
  • Rads Conference 
    • Second and fourth Tuesday of the Month at 4p in the radiology conference room.
    • PGY-2 responsible for making this list and presenting (full HPI). Only you and the radiologists see it, so it's up to you how detailed you want to make it.
    • PGY-3 should document each discussion after in a new "Documentation" encounter and forward it to the respective attending using the "Route" tool in chart review that's available after you sign the new encounter. Include the radiology findings discussed. 
  • Path Conference 
    • Third Tuesday of the Month.  
    • This one is mostly for teaching; does not need to be documented
  • Tumor board - 2nd and 4th Tuesday (with rads conference). PGY3 preps the list, PGY-2 documents the note
  • If there is a 5th Tuesday, it's mock oral boards
  • Grand Rounds - when it is your turn, see who the academic attending of the month is and work with them to pick a topic
  • Interesting cases - Present HPI and show some images. Community urologists will also present cases; will need to set up the CD drive beforehand to load images
  • M&M - Chief/PGY-3 present

Epic set-up:

  • Request access to shared lists from Jewel:
  • Urology Official
  • Urology Stent List - everyone who has a stent goes on here, to make sure it comes out
    • When rotating off - attach your inbox to the next R2, that way they can continue to edit the reminders
  • Uro Peripheral - maintained by the chief, usually to keep track of who needs to keep their f/u appts, etc
  • Uro MM, GU Path, GU Radiology, GU tumor board - self-explanatory

Clinic

  • Located on the 4th floor of the outpatient building, Suite 440 (751 S Bascom) 
  • There is a chief room that is available to do work but Rob Harris is in here sometimes

Call room

  • 4M028, near the elevator from the OR front desk 
  • Request badge access from Jewel/Tanya

Pager

  • You carry the pager from 6-6
  • R2 pager#: 4082880011

People

  • Fortune - NP
  • Tony Hoang – uroflow and procedures including catheter exchanges 
  • Leo - basically the boss, knows a ton including attending preferences 
  • Erin – helpful and knowledgeable, doesn’t take shit from anyone 
  • Mariah/Annabel - help with UDS
  • Kathy - super helpful!
  • Mona – surgery scheduler
  • Jewel – official admin jewel.ray@hhs.sccgov.org
  • Tanya – the *real* admin 
  • Case Managers 

Consults 

  • All consults need an order for "Inpatient Consult to Urology" or "Inpatient Consult to Pediatric Urology". Then choose note type 'Consult' and select the consult listed.  Enter the note under the same encounter as the patient's other care. 
  • Urology Cart 
    • We have started a urology difficult catheterization cart that can be taken to inpatient for bedside cystos and catheter placements. The cart is in the Supply Room in the 4th floor outpatient clinic in the Valley Specialty Center. 
    • It’s still a work in progress.  If you use it, please check off all the supplies used on the check list clipboard and leave on Leo’s desk to restock. Leave used scope in Soiled Utility room on Procedure side. Scopes x 2 in hard cases in metal cabinet beside cart. You need to bring the battery for the light source to the hospital. 
      • The light cord from this cart is not compatible with the OR cysto tower. If you get a cysto tower from the OR make sure to ask for their light cord/camera cord.

EMR tips

  • PVRs for Inpatients: Nurses chart the PVRs in the Input/Output flowsheet. To get there add "Review Flowsheets" to your sidebar and manually add "Intake/Output" tab

Discharges 

  • All patients who are being brought back to clinic need orders for "Follow-up Referral to Urology" placed. 
    • This includes patients who are being brought back for procedures.  When the order for the procedure is placed the referral is automatically generated. 
    • All patients who are coming back for a Foley pull and trial of void or a Uroflow (only place procedure order) need a staff message sent to "VSC URO/GU ONC NURSE" and "VSC URO/GU ONCOLOGY FRONT DESK" (can also CC the attending). 
    • Here's how to find these 'pool' recipients: Click 'To' and search under Pools for VSC Urology. 
  • Include plan in “Visit orders” or tell staff face to face after seeing pt (Either is fine, both is even better since we get busy & forget). **Be sure to place all orders for labs, procedures, imaging  
    • If patient is being brought back for another water case, then order the urine culture on discharge. 
    • If plan is for uroflow, cysto, stent removal, etc - these all need orders
  • When you discharge patients, you must select a PCP to receive the care summary document.  One way to deal with the PCP not being populated is to find the original referral to urology under referrals within chart review and select the person who sent them to Urology. 

Clinic

  • Outpatient Clinics 
    • Search for "VSC REHABILITATION" then find the "VSC REHAB UROLOGY" schedule for Elliott's Tuesday clinic. This clinic is located on the 1st floor of the VSC. The work room is 1Q252 and is accessible from the center stairwell from the fourth floor. 
    • Everyone else is under "VSC UROLOGY" 
  • Clinic Procedures 
    • Nurses have written protocol & will enter medication orders for these medications
    • Cysto Keflex 500 mg PO
      PNBX

      Ceftriaxone 1 gram IM, Lidocaine 1% 20 ml (Prostate block)

      • Pt must purchase Fleet Enema and administer 2 hrs prior to appointment. Written instructions say to stop Anticoagulation medication 14 days prior, most Attendings ok with 7 days.
      • Reese: Injects 3 ml at the prostate and seminal vesicles
      • Elliott: Injects 10 ml 1% lidocaine at junction of on both sides
      • Harris: Targets dentate line with lidocaine
      Vasectomy (Reese) Emla, 0.25% Marcaine, Uses clips
      Vasectomy (Harris) Lidocaine 1%, Uses 4.0 Chromic sutures and no clips 
      Circumcision/Penile Biopsy

      Keflex 1,000 mg PO, 0.25% Marcaine/ Lidocaine 1%, Bacitracin
  • Clinic Procedure Orders 
    • Clinic procedure include: Circumcision, Vasectomy, Cystoscopy, Suprapubic tube placement, Prostate needle biopsy, Uroflow/PVR Uroflowmetry, UDS aka Cystometrogram, Voiding pressure studies 
      • These are all available within the “URO IN-CLINIC PROCEDURE PREOP” order set.
      • If the patient is an outpatient you have to enter the orders in an ‘orders only encounter’. If the patient is an inpatient you can use an orders only encounter or enter the non-OR ADT navigator and enter the order as a discharge order.
      • If you are in a clinic encounter you can order it under Dx/Tx or under order entry. 
    • Clinic cystoscopy: "Office cystoscopy", Type "GU procedure"
    • Office PVR: add "PVR" under "Charge Capture; this is how to bill for in office PVRs but that’s not really required and usually the nurses do it. 
    • Uroflow/PVR: Under "Dx/Tx", find "Urology Ambulatory Standing Orders"
    • Urodynamics: Specify Video (Elliott day) vs Non-Video when ordering
  • No Shows 
    • If you would like a pt to be rescheduled within a specific timeframe or have any specific instructions regarding sending “no show letter” or do not reschedule, please send leo a message in Healthink or talk to leo, otherwise pt will be rescheduled only if they call the clinic to do so. 
  • Vasectomy clinic
    • The 1st Friday of the month. All Vasectomies and Vasectomy Consults will be scheduled in the PM of this clinic. (Jr Res has been helping with Consults, Reese & Harris to assist with Vasectomy procedures).
    • The PM330 is signed during Consult and pt must wait a minimum of 30 days prior to having procedure. PM330 expires after 6 months.
    • Patients need Valium 10 mg prescription prior. Pt must have ride and wait to take med in clinic with RN. Please ask them to shave prior.
  • Scheduling Clinic Visits
    • Message "VSC URO/GU ONC NURSE" and "VSC URO/GU ONCOLOGY FRONT DESK"
    • Linda Tovar LVN or Romeo Labra RN for VSC Rehab

OR

  • OR Case Requests: Open the Prep for Surgery tool and select the patient by their MRN.
    • This seems to generate a new encounter that lets your put in the case requests using the "Urology Outpatient PreOp Orders" order set. This generates a new "Prep for Procedure" encounter.  You may also be able to accomplish this through the Patient Station tool.
  • Mona keeps up-to-date surgery schedule in spreadsheet. She will send message if cases in near future are being rescheduled.
  • Urine Cultures
    • This needs to be done at least a week out, and no more than 1 month out. Try to set it up 2 weeks out, so I can order cultures for people that are coming to their pre-op visits that don't have them ordered yet.
    • Cases that need "High Risk Urine Culture" - TURP, URS/LL, high pressure cases
    • Cases that are OK with UA to reflex - slings, cysto only, etc. When in doubt, order high risk
      • Select "Pre-instrumentation" as the specimen for UA and UCx.
      • Be aware that cases change frequently so you need to be checking it frequently.
      • I would run all Harris cultures by her first. Harris may prefer just urinalysis reflex culture.
      • For the rest of the attendings I just did what I wanted, but in the beginning, I would ask Kyla or Will what they think should be done. Beware of preliminary urine culture results.
    • If symptomatic - need full treatment course. If asymptomatic - usually 2 days of abx will do. Avoid cipro if possible (black box warning)
    • Lab Locations and Hours
      • https://www.scvmc.org/patients-and-visitors/for-patients/Pages/Laboratory-Locations-and-Hours.aspx
      • https://www.scvmc.org/clinics-and-locations/scvmc/Pages/Overview.aspx
      • SCVMC Lab
        • 751 S. Bascom Ave, San Jose, CA 95128
        • 24 hours per day - May only be able to do outpatient labs for 'Stat' orders
        • Blood draw hours: M-F 7:30-6:15p
        • Holidays 7:30-4:30p
        • Phone: 408-885-6500
      • VALLEY SPECIALTY CENTER
        • 751 S. Bascom Ave, San Jose, CA 95128
        • Monday – Friday: 7:30am - 6:30pm
        • Saturday – Sunday: Closed
        • Holidays (except Christmas and Thanksgiving): 7:30am - 4:00pm
    • Weekend Options
      • VALLEY HEALTH CENTER DOWNTOWN
        • 777 E. Santa Clara Street, San Jose, CA 95112
        • Monday – Friday : 8:00am - 9:30pm
        • Saturday – Sunday: 8:00am - 4:30pm
        • Holidays (except Christmas and Thanksgiving): 8:00am - 4:30pm
      • Valley Health Center East Valley
        • 1993 McKee Road, San Jose, CA 95116
        • Monday – Friday  8:00am - 9:30pm 
        • Saturday – Sunday 8:00am - 5:00pm
  • Orders for Big Cases
    • PCNL, Open Prostate, Nephrectomies, RPLND
    • All need T&S, T&C x 2 U RBC done within 72 hours of OR (but cannot be done day of surgery unfortunately).
  • Water Cases
    • Any case that touches the urothelium need urine cultures.
  • Pediatric cases
    • UCx only needed for things that touch the urothelium - cysto, URS, ureteral reimplant, pyeloplasty
    • Not needed - hernia, circ, orchiopexy, orchiectomy, buried penis repair, first time hypospadias, chordee. If exceptions, Abidari will order it.
  • Age > 60 = order EKG
  • UTOX positive - need 2 neg UTOXes before surgery; order these
  • If you contact a patient for labs/UA/anticoag instructions, document this in chart
author: admin | last edited: Sept. 3, 2020, 9:37 a.m. | pk: 183

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