Pediatric Trauma Service Team Overview

 

Pediatric Trauma Service Team Overview, including Member Responsibilities

 

The Pediatric Surgical service provides general & emergency surgery care, as well as trauma care, to pediatric patients. The Pediatric Trauma Service is structurally a service within the Pediatric Surgical service (PDS). Pediatric trauma care in the Level 1 Trauma Center of Kentucky Children’s Hospital is held to specific standards/criteria of the American College of Surgeons – Committee on Trauma (ACS-COT) to maintain Level 1 verification.

 

Trauma Care Specifics

·         The Pediatric Trauma Service accepts pediatric trauma patients from age 0 to 15 years.

·         Trauma patients age ≥ 16 years are to be evaluated by the Adult Trauma Service.

·         Pediatric trauma activations are based on established criteria.  Patients may arrive via EMS ground or air medical or POV/walk in. (NOTE: Occasionally existing Emergency Medicine pediatric patients with a traumatic MOI may have an acute deterioration event while in the Emergency Department resulting a trauma activation.)

·         Pediatric trauma activation criteria and care are NOT the same as the adult service. Residents are required to be familiar with Pediatric Trauma System Processes, Activation Criteria, and Roles and Responsibilities outlined in the pediatric trauma guideline manual.

·         Patients under age 16 referred to the Pediatric Trauma Service from another hospital are considered pediatric trauma expects. Pediatric trauma expects with minor injuries and not meeting activation criteria can be evaluated by the Emergency Medicine Service.

·         Patients in the Emergency Department become the responsibility of the PDS residents either by consult request from the Emergency Medicine Service or by pediatric trauma activation (TA or TAR).

·         Initial assessment and evaluation of pediatric trauma patients shall proceed according to ATLS protocol.

·         The PDS Chief Resident assumes responsibility for timely evaluation, management, and disposition of all pediatric trauma patients; including prompt notification of the PDS Attending surgeon.

·         The PDS Chief Resident is allowed to take call from home.  However, the PDS Chief Resident is expected to return to the hospital for pediatric activations after hours and on weekends.

·         The in-house Trauma Surgery Chief Resident (PGY-4 or PGY-5) will begin evaluation and management of the patient until the PDS Chief Resident arrives and assumes care.

 ·    Patient disposition should be determined within 30 minutes of ER arrival.

 ·    Entire diagnostic evaluation/disposition should not exceed 120 minutes.

·         A surgical resident will accompany all hemodynamically unstable patients outside the ER for all diagnostic procedures.  Physicians are not required to accompany stable patients.

·         ED nursing staff will accompany trauma patients for any testing or procedures performed outside the ED.

·         During the highest level trauma activation, an operating room is placed on hold. The Chief Resident is responsible for releasing the OR suite as soon as it is determined that the OR is not needed.

·         Occasionally, a patient may be directly admitted to the PICU from a referring facility and bypass ED evaluation.

 

Pediatric Surgery & Trauma Team Members:

Attending Physicians

·         Pediatric Surgical Service (PDS) attending physicians have overall responsibility for patient care.

·         PDS Attending surgeons have oversight of residents working on the pediatric surgery service.

·         PDS Attending surgeons take calls from outside physicians requesting consults or referring patient to the service.

·         Attending surgeons take pediatric surgery calls through UKMDs 24/7.

 

Nurse Practitioner or Physician Assistant (APPs)

·         The role of the APP on the Pediatric Surgery Service is versatile.

·         Rounds with team on weekday mornings.

·         First assist in OR when needed.

·         Assists with floor questions/problems, patient phone calls.

·         Facilitates home health referrals and transfers to rehabilitation facilities.

·         Functions as a primary provider in PDS clinic, specifically mTBI, and is able evaluate follow-up patients & some new patients.

·         Assist Attending and Resident physicians with other duties as requested.

 

Chief Resident

·         The PGY-4 General Surgery Resident is in charge of the Pediatric Surgery Service during his or her rotation.

·         Pre-rounds with the team Monday through Friday on all patients before first activity of the day – conferences, OR starts, etc.

·         Has final responsibility for upkeep of daily patient census and morbidity/mortality list.

·         Assigns case coverage for all residents.

·         Responsible for fielding parent and patient phone calls after hours.

·         Rounds with the Attending surgeon on call.

·         Leads weekly educational sessions for students and residents on service.

 

Junior Residents

·         Record medical history and physical exams on all new patients.

·         Record daily exam and progress notes on all patients and consults.

·         Maintain the daily patient list.

·         Prepared to present patient on rounds. Junior residents present patients during teaching rounds.

·         Follow all consults during hospitalization.

·         Obtain operative permits and verify preoperative notes and orders. If unsure of operative plan, clarify prior to consenting patient & family.

·         All patients MUST be seen in preoperative holding area for a final check of diagnosis, verify paperwork, and mark surgical site.

·         Assists with operations and log cases.  Before entering OR, review & prep for procedure.

 

4th Year Medical Students (Als)

·         Perform the duties of the PGY-1 Resident, supervised by either a Resident or Attending.

·         Record medical history and physical exams.

·         Record daily exam and progress notes on patients and consults.

·         Be prepared to present 2-3 patients during Teaching Rounds.

·         Present 15-minute talk on topic in pediatric surgery to the team.

·         Participate in rounds and procedures with team.

·         Read about assigned patients.

 

Third Year Medical Students

·         Record medical history and physical exam on at least 1 patient per week.

·         Record daily exam and progress notes on at least 1 patient per day.

·         Be prepared to present at least 1 patient during Teaching Rounds.

·         Participate in rounds and procedures with team.

·         Read about assigned patients.

 

Pediatric Surgery Conferences

·         All team members are expected to attend unless pre-empted by urgent patient care responsibilities.

·         All team members are given access to the PDS Teams Channel for ongoing communication as well as access to resource materials.

·         The Pediatric Surgery Conference is a mandatory weekly conference.  

·         Teaching Rounds, rounds, and running the list times are determined by the faculty on call and communicated through PDS Teams channel.