ROTATIONS‎ > ‎

VIR (INTERVENTIONAL)


FOR RESIDENTS ON VIR ROTATIONS, PLEASE STAY ON ROTATION IN LIEU OF MEGACONFERENCE.
VIR @ BI
  • Faculty representative: Dr. Rajesh Patel 
  • Location: Cath lab at BI Dazian floor 11 (IR reading room 11D88, x20-3883) every day except Tuesdays (CT area floor 2). 
  • BI IR resident/fellow pager 13215. Consults received via pager or IR secretary ( x20-2509)
  • Mon-Fri at BI (7:15 am latest until the last case finishes). An MSH IR fellow or resident might rotate with you.
  • Dr. Patel works at BI Tue/Wed Fri (he is at clinic Mon/Thu). Dr. Rastinehad works at BI Tue/Thu.
  • Coverage should be discussed with the VIR attending and fellow prior to Monday 
  • When there are 2 residents scheduled on IR for the block (one at SL and one at BI, and no resident schedule at West), the BI VIR resident will divide their time between West and BI. 
    • Mon -  rotate at West (if no VIR W resident)
    • Tueslocation will depend on the caseload at each site. The resident will go to the busier site after reviewing the case schedule on Monday and notify both Attendings (Friedman and Patel) by Monday at 4pm where they will go on Tuesday
    • Wed - rotate at BI
    • Thur -  rotate at West (if no VIR W resident)
    • Fri - rotate at BI
  • You can borrow radiation protection glasses, but please return them promptly at the end of the rotation.
  • Charting and rounding through PRISM
VIR @ W
  • Faculty representative: Dr. Adie Friedman
  • Mon-Fri at W (8am until the last case finishes). An MSH IR fellow or resident will rotate with you.
  • Coverage should be discussed with the VIR attending and fellow prior to Monday
  • W VIR Pager 36481
  • Tips on this rotation can be found at VIR on Call
  • Charting and rounding done through EPIC
VIR @ SL
  • Faculty representative: Dr. Ronald Dreifuss
  • Mon/Wed/Fri (7:30am - catch the 6:45am Jitney - until 4:30pm or until the last case finishes).
  • SL VIR Pager 31118
  • You will either be on consult day for Tue/Thu or go to W to work with Dr. Dreifuss.
    • Check with Dr. Dreifuss beforehand and carry your pager those days!
  • Tips on this rotation can be found at VIR on Call
  • Charting and rounding done through EPIC
VIR CONFERENCES
  • REQUIRED: Mon @ 8:00 AM - Monthly didactic lectures - via webconference: LINK
  • Optional/Recommended: Wed @ 7:15 AM - MSH IR Resident Didactic - via webconference
  • Optional/Recommended: Thu @ 7:00 AM - MSH Multidisciplinary Tumor Board - via webconference, including 16 Baird Hall when at BI.
RESPONSIBILITIES
  • Pre-procedure evaluation 
    • Informed consent form
    • Pre-procedure note in patient’s chart
      • Check relevant lab results (especially PT/INR, platelets, Cr, K)
      • Check for anticoagulation medications
      • Check NPO status pre-procedurally 
      • Mallampati, BMI should be in preop H&P for patients getting monitored sedation 
  • During procedure
    • The degree of involvement in procedures will be determined based on demonstrated ability and interest
    • Familiarity with the clinical presentation, including history, physical examination, laboratory and other tests, pathophysiology of the disease process, and an appropriate assessment should precede resident involvement in any case
    • Residents who acquire competent clinical skills and adequacy in the roles of first and second assistant will graduate to primary operator on appropriate cases
  • Post-procedure 
    • surgical style notes and orders will be written on the patients that the resident has performed procedures on
    • Cases may be dictated during the work day only if there are no ongoing procedures without physician first and second assistants
    • Otherwise, dictations should be done after completion of all procedures and readout
    • All procedure dictations and sign offs should be completed before the end of the work day
  • Inpatient SIGN OUT
    • To communicate between the daytime staff and night and weekend coverage
    • W: This sign out is the responsibility of the residents and fellows and can be found on the HDrive under our Radiology Dept, SLW Residency, sub-folder VIR sign-out
    • BI: The sign out can be found on the desktop of the Room 4 computer and is often managed by the PAs during the day.
    • In addition to the sign out, you should email or call the call resident to transfer care for any patients they need to trend labs, write notes, and/or round on over the weekend
    •  The night and weekend coverage should inform the daytime team of any procedures they did as the daytime team will have to follow the patient
  • Consults
    • Place a consult note after seeing the patient and discussing the case with the attending 
    • Keep track of inpatients on the schedule board.
    • At BI, there is a PRISM Consult note on the Room 4 desktop computer you should use for all notes!
  • Rounding
    • This may be accomplished prior to start of the work day or after completion of all procedures and readout in the department
    • More active patients may be seen both prior to and after the work day
    • Less active patients may be seen less frequently or dropped from the inpatient list (this will be determined on a case-by-case basis by the attending Interventional Radiologist)
VIR PROCEDURE LOG (IMPORTANT!)
  • Make sure you keep a procedure log of your procedures on New Innovations, this is the only way to be HIPAA compliant to share it with another program.
  • You may log procedures you are the first assistant in, or a minor procedure you performed it under supervision of senior resident/fellow.
  • An easy way is to take a patient MRN sticker from the chart and keep it in a physical notebook on the rotation, keep a file on your smartphone, or go through Powerscribe to find dictations you did (but the Powerscribe list may not reflect all the procedures you participated in).
  • For any dictations you perform, please remember to report the DAP and air kerma in your dictations!
DOCUMENTATION
  • All procedures require a consent, pre-procedural and post-procedural note 
  • Outpatient notes are handwritten
  • Inpatient notes are placed in the EMR
  • Informed consent on Neuroradiology Primer or on paper at nursing bay
INTERPRETER SERVICES
  • Non-English interpreters can be reached at 36-5096 at W (remember to record the translator #) or using Pacific Interpreters at BI (ask an RN for the number). At BI cath lab, there is a portable translating device in the nursing bay. 
  • There are certified Spanish translators at W (Manny, Geraldo, Marcus) that may be able to assist.

RECOMMENDED BOOKS
  • Interventional Radiology: A Survival Guide by David Kessel (best intro book, there should be a copy at BI at all times).
  • Vascular and Interventional Radiology: The Requisites by John A. Kaufman
  • Vascular and Interventional Radiology by Karim Valji
IR LINKS