INTRODUCTIONTOGROOTESCHUURHOSPITALINTERNALMEDICINEPROGRAMME

GeneralAdmin:1. Leave:Besurethatyouarrangeleavetimeously:

a. Annualleaveisarrangedwellinadvancefortheacademicyearstartingon1Februaryandendingon31January,sothatallrosterscanincorporateregistrarandmedicalofficerleavedays.Yourleaveaffectsotherswhomayhavetocoverforyousopleaseensurerequestsaresubmittedearly.

b. The22daysofannualleavearesplitinto4weeks,eachoftheweeksstartingonaMonday,and2additionaldays.The4weeksofannualleavecanbetakenasseparateweeks,oras2consecutiveweeks.Ifyouwouldliketotake4consecutiveweeksofleave,thisneedspriorapprovalbyProfRaubenheimer,andwillonlybeallowedinspecialcircumstances.

c. Allannualleaveneedspriorapproval:i. The4weeksofannualleave(whethertakenasindividualweeks,astwo

consecutiveweeks,ormore)willbesignedoffbyProfRaubenheimer.DonotsubmitannualleaveformsforfullweeksofleavetoHeadsofDivisionortheHeadofDepartment,asallleaveformsareprocessedcentrally,throughProfRaubenheimer’soffice.

ii. Theadditionaltwodaysofleave(tomakeupthe22days)needapprovalbytheHeadofDivisionfromwhereyouwouldliketotaketheadditionalleavedays.

d. AllleaveformsforthenewacademicyearneedtobesubmittedtoYasminaCraven’sofficeby31January.Registrarsormedicalofficersstartingafter31January,mustsubmittheirleaveformswithintheirfirstmonthofcontractatGSH.

i. The4weeksofleavemustbesubmittedtoYasminaCraven’soffice,theDivisionswillbeinformedofyourleave,anditwillreflectontherosterssentouttotheentireDepartment

ii. Theadditional2daysmustalsobesubmittedtoYasminaCraven’soffice,afterithasbeenapprovedbytheHeadofDivisionfromwhereyouwilltakeleave.

e. Undernocircumstancesareyouallowedtochangeyourleavedateswithouttheknowledgeandapprovalofthechiefregistrar(applicabletoregistrars)andProfessorRaubenheimer(applicabletomedicalofficers).Underspecialcircumstanceswewilltrytoaccommodateyourrequest,butthisneedstobecommunicatedtimelytothechiefregistrarandProfessorRaubenheimer.Ifyou

donottakeyourleavewhenithasbeenallocated,wecannotguaranteethatyoucouldbegrantedleaveatanothertimeduringtheyear.Also,swopsareincrediblydifficult,asithasaknock-oneffectonvacreliefandseveralspecialunits.

f. Specialleaveforms(illness,familyresponsibility,exams)needtobesubmittedwithproofofreasonforabsencetoYasminaCraven’soffice.HRcannotprocessspecialleavewithoutproof,andwillotherwiseprocessspecialleaveasannualleave.

2. Vacrelief(vacationrelief):whenregistrarsinGeneralMedicinerotationsgoonleave,aregistrarfromaspecialunitwillbesenttostandinwhilstonleave.Thiswillbereflectedonthevacreliefroster.VacreliefissplitequallybetweentheDivisionsdoingvacrelief.

a. Rotationsforwhichvacreliefissent:GflooratGSH,C15,Mitchell’sPlainHospital,SomersetHospital,VictoriaHospitalandanyspecialunitwheretheregistrardoesnotworkwithaseniorregistrarormedicalofficer

b. Rotationsfromwhichregistrarscanbeaskedtodovacrelief:Endocrinology,GIT(whentworegistrarsareallocated/duringde-escalationperiod),InfectiousDiseases(duringde-escalationperiod),Liver,Neurology,RespiratoryandRheumatology

c. Duringvacrelief,registrarsarerequiredtodoi. 1weekdaycallandpossibly1weekendcallifallocatedto1weekofvac

relief(thetwocallsmustbespaced5daysapart)ii. 2weekdaycallsand1weekendcall(middleweekend)ifallocatedto2

weeksofvacrelief(vacreliefstartsonMondays,weekendspriorneedtobecoveredbytheregistrargoingonleave.However,itissuggestedthatrostersareplannedinsuchawaythatregistrarsgoingonleavedonotdocallstheweekendpriortotheirleave)

d. RegistrarswhodoC15shiftsfortheirovertime(Endocrinology,GIT,InfectiousDiseases,Liver,Neurology,RespiratoryandRheumatology)willhave

i. 1weekshiftdeductedforthemonthofvacrelief,ifallocatedtodo1weekofvacreliefthatmonth

ii. 2weekshiftsdeductedforthemonthofvacrelief,ifallocatedtodo2weeksofvacreliefthatmonth

3. Registrarrotationsarethreemonthsandmedicalofficerrotationsfourmonths.Be

awarethatwhenrotatingthroughspecialunits,overtimeresponsibilitiesincludefourshiftsamonthintheyellowareainC15.Wherepossible,youmaytrytoarrangeyouryellowareashiftonthesamedayasyourcallforyourunit.

4. ParkingandGSHIDcards:onFfloorinoldmainbuilding,trytodothisassoonaspossibleandpreferablybeforestartingwork.Parkingisusuallyallocatedin“Nzone”orsometimesinP3/P4.Ifyouarecalledinafter-hoursyoumayusetheparkingadjacenttoC15whichyouaccessbydrivinguptheramp.Accessisallowedafter4pm.

5. Contracts:HR(OldmainbuildingHfloor)requiresseparatecontractsforyourappointmentandyourovertime.Overtimecontractsmustbesignedyearly.Thisisdoennolaterthan31DecemberatMsWakefield’soffice.

6. Speeddials:FillinaformatD3(switchboard).ThismustalsobesignedbytheHOD;youneedtoarrangeaspeeddialbeforestartingthespecialrotationstofacilitatereferralswhenyouareoncall.

7. Whatsappgroups:Thereareseveralwhatsappgroupswhicharecentraltocommunicationbetweenregistrarsandmedicalofficers.MOsshouldjointheMOwhatsappgroupandtheregistrarsgroup.RegistrarsshouldjointheMedRegWhatsappGroup.Askaroundtobeadded.Wheninspecialunitsyouwillalsobeaddedtotheunit’swhatsappgroup.

8. AskforthepasswordfortheRegistrarloungeonGfloor–itisopentoallregistrarsandMOs.SpeaktoYasminaCravenforalocker.(021)4046154

9. Isite/PhysicianUtility:passwordsforrequestingradiologycanbeobtainedfromBrandon77163.Pleaseobtainoneassoonaspossiblesoyoucanrequestandaccessxrays/CTs.Radiologyisverystrictaboutclinicianssharingpasswordsasthismakesitdifficultforthemtoreporturgentfindingstotherequestingclinician.Pleasedonotuseotherpeople’sloginsastheywillbecutofffromthesystem.Rathergetyourownloginassoonaspossible.

10. NHLSaccess:YouneedyourownlogintoaccessNHLSresults.11. Dischargesummaries:WhenontheG-floororinspecialunits,dischargesummariesare

doneelectronicallyontheCCRsystem.ArrangealoginwithProfRaubenheimer.12. Dailyoncallrosters:Itisusefultophonepaging(3333)duringthedayandasktohave

youremailaddressaddedtothelisttoreceivethedailycallrosterviaemail.Thisissentouteverydayataround8:30am.

Academics:

DepartmentofMedicineMeetingsareonThursdaysfrom16:00till17:00andeveryoneisencouragedtoattendifyouarenotoncall.RegistrarsandMOsregularlypresentcasesatthismeeting.IfyoupresentyouhavetheoptiontosendyoursummaryforpublicationtotheSAMJCEM.DailyBedSideTeachingSessionsareaimedatFCP2candidatesbutareextremelybeneficial.Findoutfromtheorganisingregistrarswhichsessionsyoumayattend.MostsessionsareopentoallregistrarsalthoughsomearespecificallyforthosewritingFCP2inthenextsession.RegistrarteachingtakesplaceeveryThursdaybeforethedepartmentmeetingfrom14:00–16:00intheBillHoffenbergroomJfloorOldmainBuilding.Youmaybeaskedtoassistwithorganisingsomesessions.FCPpart1teachingisarrangedbyagroupwhowillbewritingtheJanuary/Junesessionsandisalsoheldfrom14:00–16:00onaThursday.

ClinicalteachingaimedatMOsandjuniorregistrarsisplannedforTuesdayafternoonsat17:00andwillbearrangedbytheteachingcommittee.Attendasoftenaspossibleandvolunteertopresent.

FCPpart1refreshercourseoccursonceayear(usuallyfirstweekendofMay)andisafantasticwaytoprepareforyourpartoneexams.SpeaktoLiziweFiglantoregister.0214066841

DivisionteachingisarrangedbytheDivisionsandusuallycaterstopeoplerotatingthroughthatDivision.Detailsofweeklyteachingcanbefoundinthedivisionsectionsinthisdocument.

Additionally,therearemanyseminarsorganisedonayearlybasisbothbydivisionsinthemedicinedepartmentandbyothers.Ensureyouareonthedepartmentalmailinglistwheremanyoftheseareadvertisedastheycomearound.Alsopleaseensureyouarereceivingteachingemails.

RegistrationwithUCT

YoumustensurethatyouareappropriatelyregisteredwithUCT.Registrarsneedtoregisterandpayeachyearfor“FCP1”ifyouhavenotyetpassedthisexamorfor“FCP2”ifyouhavepassedFCP1.Thisappliesforeveryyearofyourregistrartime,evenifyoustartafterannualregistrationatUCThasclosed.PleaseliaisewiththePostGradOfficeassoonasyoustartasaregistrar.Youmustalsoberegisteredforyour“MMed”intheyearinwhichyouplantosubmityourMMed.Thiscarriesanadditionalfee.RegistrationisdonewithThobekaMngazaatthepostgradofficeatmedschool.Youcanreachheron0214047768oronthobeka.mngaza@uct.ac.za

Asidefrombeingcompulsory,registrationasaUCTstudentenablesyouto

a. AccessUCTlibrariesincludingoffcampusloginb. AccessVula(registrar’sacademicwebsite)c. AccesstoUpToDateonyourcellphoneandotherdevicesd. AccessEduroam(Wi-Fi)andtogetaUCTemailaddressifyouwouldlikeone.

IfyouareanMOyoudonothavetoregisterwithUCT.However,youshouldgeta“T-number”whichisfreeandaffiliatesyoutotheuniversityenablingyoutoaccessthelibraries,vula,andeduroam.SpeaktoSharonWakefieldonJfloorinoldmainbuilding.Shecanbecontactedon0214066209.OnceyouhaveaT-number,speaktoProfPeterRaubenheimer(peter.raubenheimer@uct.ac.za)whowilladdyoutotheappropriatecoursesonvula.

FortechnicalproblemswithwifiandUCTlibraryinternetaccess:speaktoICTSatmedschool(0216504500).

Volunteering

OurteachingprogramreliesonregsandMOstohelparrange,coordinateandfacilitatetutsandworkshops.Pleaseparticipateinpresentingandorganisingwhereyoucan.ThisisofcourseeasierwhenyouarerotatingatGSH.Considerjoiningtheteachingcommittee.

Recommendedcourses:Asidefromtheregularacademicactivitiesinthedepartment,thereisagreatvarietyofcoursesandseminarsavailable.Usefulcoursesinclude:ACLS:

Cardiocare:GeraldDalbock0219398390;gdalbock@cardiocare.co.za

MDInc.EmergencyPhysicianshttp://mdinc.co.za/contact/:DrIbrahimD’Andrea0737314412dandrea@mdinc.co.za

ProfessionalEmergencyCare:+27217056459http://www.pec.co.za

ECGcourse:

LiaisewiththeDivisionofCardiologywithregardstoannualECGcoursesforregistrars.

Alternatively,youcouldattendtheEmergencyPhysicians’course:

http://mdinc.co.za/courses/ecg-training-courses/MDInc.EmergencyPhysicianshttp://mdinc.co.za/contact/

DrIbrahimD’Andrea0737314412dandrea@mdinc.co.za

BASICICUcourse:

ThisisaninternationallyaccreditedcourserunbyourICUandbookingsfillupmonthsinadvance(Ingrid.wilson@westerncape.gov)

PointofCareUltrasoundCourse

0214869222;jolandi@onscreenav.co.za

Thiscoursecaterstoemergencymedicineregsbutisnonethelessusefulandinteresting.

Statisticscourseonline

www.coursera.orgUnderstandingClinicalResearch(nowarequirementforyourMMed)

Upperendoscopycourse

Aonedaycourserunperiodicallybythecontinuingeducationdepartment.Contactce.administration@uct.ac.za

BROOKLYNCHESTHOSPITAL

STRUCTUREOFTHEHOSPITALANDWARDS

SERVICES

§ Audiology§ Counsellors§ Dietician§ OccupationalTherapy§ Physiotherapy§ OPD§ Psychology§ Radiology§ SocialWork

WARDS

WARD DESCRIPTION EXTENSION

A Drug-sensitiveTBMale 7431

B Paediatrics 7432

C MDRFemale 7433

D Drug-sensitiveTBFemale 7434

E XDR-TBMale 7435

F Pre-XDR-TBMale 7436

G Pre-andXDR-TBFemale 7438

H Pre-andXDR-TBFemale 8320(Security)Askforsister

3 Paediatrics 7440

WEEKLY&MONTHLYROSTERWEEKLY

• Mon(DS-TB)Wed(MDR)Thurs(Pre&XDR):“Readings”08h00:Weeklyadmissions.MDTdiscussions.Referralstoalliedmedicalcolleagues

• Mondays08h00:WardroundinwardB(ProfSchaaf)• Tuesdays08h00:Operationalclinicalmeeting(wholehospital)• AlternateTuesdays13h30:PulmonologyProfDheda/ProfDawson:

§ ProblemcasesandX-raysmainlyfromtheclinics

• Wednesdays9H30am:IDwardroundDrSiphoDlamini:

§ AdmissionstowardsA&Dandanydifficult/interestingcases

• Wednesdaysat09h30:Paedsclinicalmeetings• Fridays11h00:DoctorsJournalclubmeetings(inprocessofapplyingforCPD)

MONTHLY

• FirstTuesdays08h00:MonthlyGrandRound:30minutepresentationanddiscussiononanyrelevanttopicfromeachdepartment.Aimedatdoctorsandnurses

• FirstFridays08h00:PTC(PharmaceuticalandTherapeuticsCommittee).PleasebringyourADRformstothismeeting

• SecondFridays14h00:StellenboschMedSchool§ TBpresentationandcasediscussions.§ Pleaseensureyourwardiscoveredwhenyougo

• FourthWednesdays14h00:M&Mmeeting§ Pleasebringanyunexpecteddeaths;casestolearnfrom;poorreferralsandall

resuscitations

CALLS• Pleasecomeintothehospitalontheweekendsandpublicholidaystoredflaggedpatientsand

toseeifthereareanynewproblems.Familiariseyourselfwithwhatmedicinesareavailableintheafterhourscupboard(listattached);thefridgeandtheemergencytrolleys

• PleaseencouragetelephonicpresentationofpatientproblemsbynursingintheA-B-Cformat:§ Age§ Admissiondate§ Backgroundconditions(includingHIVstatus,diabetes)§ Baselinefunction

• Mobility(fullymobile,shortdistanceorbedbound)• Mentalstate(interactingnormally,mildlyorseverelyconfused)

§ Changeincondition(currentproblem)§ Currentobservations§ Chartmedications

• TheportableECGmachineisavailableintheNightSistersofficeinwardD• ThereisonlyoneSisteronatnightforthehospital:Nightsister’scell:0716195807• YouwillbecoveringthewholehospitalincludingwardsBand3(Paeds).OurPaedsdoctor,Dr

Willemse,isusuallyavailableoverthephoneshouldyouhavepaedsproblems(sd5023/0829374490)

• PleaseletDrJulianteRiele(ClinicalManager)knowwellinadvanceifyouhavecalldaterequests

ADMINISTRATION

• NatalieFabrik(Ext7401)isyourgo-toperson• YouwillneedtoseeSrEsbach(OccupationalhealthExt8331Sd5096)regardingyourmaskfit

test,pre-employmentCXR,etc)• Youwillneedaspeeddialnumbersoyoucanbecontactedonyourcellphoneswhenyouare

notintheward• Pleaseinformyourward,thecoverpersonandNatalieifyouaregoingoffduty• Pleaseforwardmeyouremailaddressandcellphonenumbers.• Thereshouldbeaninternaltelephonelistinyouroffice• MrSnydersatswitch(99)canassistyouwithyourPINnumbertomakeoutsidecalls,otherwise

gothroughswitch.Allprivatecallsareforyourmonthlyaccount• ThecurrentpracticeatBrooklynChestisthatallstaff(includingDoctors)isexpectedtoclockin

andoutofthefacilityonadailybasis.Thesearecheckedonamonthlybasis• Allpatientsneeda“TBdata”(anin-housedatabase)printoutaspartoftheirdischarge• YouwillbeguidedontheAdmissionandDischargeprocesstobefollowedinthewards.Mr

FeltonatOPD(8310)isouradmissionsofficer

RESEARCH

• TherearethreemaingroupsofresearchersatBrooklynChest.

§ TASK-currentactivities

§ Multiple“novelcombination”(NC)studies§ NIXstudy.6monthinjectable-freetreatmentshorteningstudyforXDRandDR-

TBpatientswithoutoptions.Enrolling§ Bdq/Dlmsafetytrial

§ DesmondTutu-currentactivities§ MultiplepaediatricPKstudies

§ UCTLunginfectionandimmunityunit–currentactivities§ NEXTstudy.6monthinjectable-freetreatmentshorteningstudyforMDR-TB

SPECIALPOINTS

• Youareexpectedtoprovideregularinformalteachingfornursingstaffinyourward.Tryto

makeasmanyinteractionswithnursing(andalsowithpatients)informativeandeducational• Pleasediscussanyplannedoperationalresearchwiththeclinicalmanager• ManagementofnosocomialsepsisatBrooklynChest-thecurrentS.O.P.

TBpatientreferralpathwayv

Drug sensitive

MDR Pre XDR / XDR

Male

Female • Defaulting meds

• O2 depends on availability

• Ambulant • Short term cases • Homeless

• Full nursing care • 24hr O2

dependent • ICD cases • Stretcher cases

DPM

BCH BCH BCH DPM

Pleasenote:

1. Pleasemakesureeveryattemptismadetogetaculturefor1stand2ndlinesensitivitiestothelabafteraGXPdiagnosisorfollowingaperiodofdefault.IfthereisaGXP/culturefromanothersitewealsowantacurrent/newsputumcultureinthepipelineplease.

2. Referralformsareavailableinthewards3. Pleasecompletewiththefollowinginformationattached:

a. Hardcopyofrecentlabresultsb. Treatmentdatestartedc. CTBrainreportsd. Abdominalultrasoundreportse. Dopplerultrasoundreportsf. Xrayreportsg. HIVstatusandARThistory(defaultinghistoryandpreviousmedication)h. Reasonforadmission

4. ReferalsarefaxedbyIndie(Medicinesecretary)toBCHorDPMorboth.Pleaseindicatewhereyouwouldlikethepatienttobereferredontheform.

5. BCHandDPMinformthewardclerkswhetherapatienthasbeenacceptedornot6. BCHorDPMtransportarrivestocollectthepatient7. Medicallystablepatientswithadherenceissuesmayneedtobedischargeddirectlyto

theirclinic- EnsureaBCHOPDdateisarrangedforthepatientatdischarge

Ifproblemsarise:BCH

- PendingfemaleMDRadmissioncontactDrNihaldeVrieson0823009744- Otherwise,contactDrJulianteRieleon0741826726- AdmissionsclerkBCH–MrFelton0215088310- BCHFaxno–0215087423

DPM- Femalepatients:DrJanetScott0217137688,0847654543- Malepatients:DrCroxford0217137617,0837033442- MaleMDRpatients:DrHarding0217137643,0823264721- AdmissionsclerkDPM–MrsShereenSallie0217137606- DPMFaxno’s–0217121057/Switchboard0217130335

C15EMERGENCYUNIT

C15isoneunityouwillrotatethroughmultipletimes.Considerithomeandeachstintwillbeeasier.It’sbesttobeopen-mindedaboutpractisingemergencymedicineinanInternalMedicineprogrammeandyouwillfindthereisalottobelearned.TheunithasanextensiveintropackwhichyouwillreceivewhenyoustartinC15;thisinductionpackprovidesaverybriefoutline.STRUCTUREOFTHEUNIT

• C15Anteroom,HoldingArea,OverflowandMedRegarea:totalcapacityof28beds

• AnteroomResus:7beds

• C12HighCareUnit:10beds

• C13lowcare/shortstay:15beds

• Minors(Yellow/GreenTriageArea):thisisawalk-inareawhichseespatientsfromGSHdrainageareawhotriagegreen/yellowandhavebeenreferredfromaGP,primarycarefacilityorbelongtoatertiaryclinic(suchastheoncologyclinics).(DrParoliswillexplainthisfurtherwhenyoustartinC15)

• RapidAccessClinic:thisisafacilityavailableforreviewingpatientsseeninyellowareawhoarereturningforresultsorinvestigationsthatneedtobeperformedsemi-urgentlyinordertofacilitateacleardiagnosticplan(patientsrequiringsputumresultsforTBcanfollowupatCHCbutpatientswithalarmsymptomsreturningforG-scopewouldbereviewedatRapidAccessasanexample)

STAFF

• CONSULTANTS§ DrGerryParolis77094§ DrAnnemarieKropman77117§ DrPatrykSzymanski76348

• NURSINGSTAFF

§ Pleaseintroduceyourselftothenursingstaffasyougothroughtherotation-itmakesaworldofdifferencetotheefficientfunctioningoftheunitandeveryone’smentalhealth!

• OTHERSTAFF§ C15secretary:NandieMaketesi(inconsultant’soffice)§ SocialWorker:PreciousKopane

C15ROSTERThisisorganisedintodayandnightshiftswhichcanvaryonaday-to-daybasis.DrSzymanskidoesthemonthlyrosterforeveryonerotatingthroughC15andDrParolispreparestherosterforthespecialunitscoveringtheminorsarea.Itisamammothtaskandtomakerequestsyouneedtowriteintherequestbookintheconsultant’sofficebythe15thofthemonthprecedingyourrequest.Youcanmakearequestforaspecificweekendoffandforaspecificweekdayoff.C15SPECIALUNITSROSTERWhenrotatingthroughspecialunitsthatdonothavesleepincalls,youwilldosomeshiftsintheminorsareaofC15.DrParolispreparesthisrosteranditismadeavailablethroughthesecretaryattheendofeachmonth.Youcanalsomakerequestsintherosterrequestbookwherethisrosterisconcerned.ItisoftenhelpfultodobothyourspecialunitcallandC15shiftonthesameday.TEACHINGANDRESOURCES

• FormalteachingisonFridaymornings• ThereisafolderonthedesktopofmostofthecomputersinalltheareasofC15labelled

studytopicswhichhasdocumentsandarticlesonanumberofdifferentemergencymedicalproblemssuchasoverdose;acutecoronarysyndromes;endocrineemergenciesetc.

IMPORTANTCONTACTDETAILS

• C15emergencyline5209• Alistofimportantnumbersisonthewalljustabovetheemergencylineinanteroom

TIPSANDHINTS

• Acceptingpatientsfromreferralcentres:pleaseensurethenursescoveringResusAreaareawareifthereisanintubatedpatientenroutesothataresusbay,ventilatorandotherequipmentcanbepreparedandthenursingstaffisreadyforthepatient.

• Trytodoasmuchasyoucanforyourpatientsbeforehandovertothenextteam:thisincludes-makingsureyouhavedoneaSuicideRiskScaleforODs,makingsureyouhavemadethenecessaryradiologyrequests,bloodsorreferralstospecialunitsifpossible

• Bloodtransfusions-:hereisasurchargeafterhoursthusyouneedtoconsiderwhetherthetransfusioncanwaitfor08h00.Ifadecisionismadetotransfuse,pleasetrytoensureyouhaveconsent,abloodproductsformfilledandhaveputupabloodgivinglinewhenyoumakethedecisiontotransfuseasthebloodmayonlybereadywiththenextshift.

• G-scopes:trytoensureyouhaveobtainedconsentandfilledaG-scopereferralformonceyouhavemadethedecisiontoscopeapatient.

• C15isatoughrotation:everyoneisexhausted;tryandsupportandencourageyourcolleagues,thisalwaysmakesforabettershift!

CARDIOLOGYSTRUCTUREOFTHEUNIT/WARDHOTSIDE(C26CCU)

§ 6beds,fullcardiacmonitoringandventilatorcapacity§ Runseparatelytotheward§ Only for acute coronary syndromes or patients with primarily cardiac disease

requiringintensivecare§ TheConsultantandSeniorregoncallfortheweekruntheHotSideforthatweek

COLDSIDE(C26WARD)

§ 12bedunit,runasanormalward§ ForelectiveadmissionsorstabletransfersfromCCU§ Completely closed from Friday after 4pm till Monday 7am (no patients and no

nursingstaff)§ MaysometimeshouseMedregoutliersifnotfull

E17CLINIC

§ ClinicrunsMondaytoFriday(exceptThursdayafternoons)§ Morningclinicsaregenerallyfornewpatients(referralsbookedbytheconsultantor

seniorreginthesubspecialty)§ Afternoonclinicsstartpromptlyat2pmandallregistrars/MOsaretoattendunless

postcallorhaveapressingemergencytoattendto.

C25CATHLAB• 2separatelabsavailablethatcanfunctionindependently• Allinvasivediagnosticandinterventionalprocedureshappenhere• DrPandie’sofficeandtheCardiacTechnologists’officearealsoinC25• TheSeniorRegofficeforAngioreportsisalsoinC25andwillbewherealltheAngio

discsandreportsfordailycathmeetingsarekeptROSTERING• Thereareusually5-6MOs/MedRegsrotatingthroughcardiologyatanygiventime

§ 2inHotSide§ 2or3inColdSide§ 1inE17Clinic

§ One registrar/MO is rostereddaily to performexercise stress tests and TilttabletestingonE17clinicpatientsfrom09H00to13h00

• Thisisrotatedeveryweekormonthsothateachpersongetsatleastamonthineacharea• ThisrosterisdrawnupbyaMedRegoranMO

Everyonedoesatleast5-6callspermonthwhichrunfrom08H00tillthefollowingdayaftertheCathMeeting(13h59)

STAFFCONSULTANTS REGISTRARSProfMpikoNtsheke(HeadofDivision)76377DrAshleyChin76531DrBlancheCupido76887DrMukeshChhiba76849DrKhulileMoeketsi76177DrShaheenPandie76233

DrArthurMutyaba77303DrBrianKiggundu77058DrChishalaChishala76779Dr.ZimasaJama77102Dr.PhilaMkoko77090Dr.CharleViljoen77470

• NURSINGSTAFF

§ NursingteamCCUisledbySrFaizaKasker§ NursingteaminColdSideledbySr.SereneWessels§ NursingteamE17ClinicledbySr.MichelleGowie§ NursingteamC25ledbySr.JoanneHartnick§ Pleaseensureyou introduceyourselftothenursingstaffatthebeginningofthe

rotation.§ C26ColdSiderequiresthattheplanforthepatientsunderyourcareishandedover

toasisterorseniornurseattheendofeachday

• OTHERSTAFF§ ClerkC26:NaomiDavids§ ClerksE17:LinandRehana§ ClerksC25:PhaphamaMagadla,Bonita§ Cardiac Techs: Marclyn Govender, Kimberleigh Thangaveloo, Glenda Govender,

ThaboNgaka,UnesuChikavhanga,PikkieJanevanZyl,Francoisandstudents.§ Prof’s Secretary: Shanaaz Davids (email: 01441024@uct.ac.za, ext 6084 – please

contactherpriortoarrivingintherotationfortherosters,andpleasesubmitrosterstoher)

§ Otherpart-timeconsultants(Legends):ProfCommerford,ProfMayosi,ProfScottMillar,DrStevens(theywillprobablybeseenintheclinicsorinEchoroomandarealwayswillingtoteach)

WEEKLYROSTER

Alldaysstartbetween7:30-8am(insomecasesconsultantsmayaskyoutocomeinearlierforHotSidehandover)

• Monday08h00-12h30:ColdSideadmissions(TheadmissionbookiskeptwiththesistersonColdSide–theywilltriagepatientsonarrival.ThesepatientsaresplitamongsttheColdSideregsandadmitted)08h00: Hot Sideward round- new overnight admissions are presented first and E17morningclinicstarts(MedReg/MOallocatedgoesstraightuptoclinic)13h00:EP/ECGteaching(pleasegiveinterestingECG’stoDrChininprepforthismeeting)14h00:Clinicstarts(allMedRegsandMO’stoattend,post-calldoctorleaves)16h00:ColdSidepresentationofadmittedcasestoconsultantsandseniorregs(thiscanruntill8pmattimesandHotSidehandovertotheoncalldoctorhappensafter)

• Tuesday08h00:HotSidehandover(ColdSideteammayjoinforteaching,orcanprepdischargesfortheirpatients)12h45:CathMeetinginE17conferenceroom(pleasegetthelistfromtheRegofficeinC25,ensurethatfilesordischargesummariesforthesepatientsaretakenupwithyouaseachpatientispresentedpriortotheangioreviewanddiscussion)14h00:E17Clinic

• Wednesday

08h00-12h30:ColdSideadmissions08h00:HotSidewardroundorClinicReg/MostartsinClinic12h45:CathMeeting14h00:E17Clinicstarts(allMedRegsandMO’stoattend,post-calldoctorleaves)16h00:ColdSidepresentationofadmittedcasestoconsultantsandseniorregs

• Thursday08h00:HotSidewardround,ColdSideprepdischarges,ClinicReg/MOstartsinclinic12h45:CathMeeting14h00:MedRegs/MOstoattendThursdayteaching,on-calldoctorremainsinCCU

• Friday08h00:HotSidewardround,ColdSidedischargesortransfer-outsmustbecompletedbefore12h00,ClinicMedReg/MOstartsinClinic12h00:CathMeeting14h00:E17Clinicstarts(allMedRegsandMO’stoattend,post-calldoctorleaves)16h15:SurgicalMeetingstarts(AllMedregsandMO’stoattend),HotSidehandovertoalldoctorsonforweekendstartsthereafter.

CALLSTheoncallteamismadeupofaMedReg/MO,SeniorCardiologyRegandConsultant

Youarerequiredto:§ Takealloutsidereferralsforurgentangiographyoracutecases(from16h00–priorto

thistheHotSideteamshouldtakereferrals)§ Capturethereferralsontothereferralformandattachtothefax(no0214042033)and

thendiscusswithyourseniorregistrar,whowillmakeadecisiononthecase–youwillthenfeedbacktothereferringdoctor

§ ManagetheCCUpatientsovernight§ RemoveanyfemoralsheathsforpatientsinCCUorC12HighCare§ Domorningbloods forCCUpatients (try tomakeyourbloodpacksearlyand thenat

around04h30-05h00takethebloodssothatyourresultswillbeoutbeforethemorninground)

§ AssistingCardiothoracicswithorderingRBC’sfortheatreisalsopartofyourresponsibility§ GSHconsultsareseenbytheseniorRegs,exceptifitisanafter-hoursacute(Hot)case§ MakenotesforalltheCCUcasesbeforethemorninground

TEACHINGANDRESOURCES

• Teaching and academic initiative are important in Cardiology and there are plenty ofopportunitiesforformalandinformalteaching.

• The formal teaching takesplaceduringECG teaching sessions, JournalClubandPeer-drivenpresentations

• MedicalregistrarsandmedicalofficersareexpectedtopresentcasesonMondaysandWednesdays in the formofCold Side admissionswhere informal bedside tutorials onthesepatientsarethengiven.

• PleasebuyDrStevens’CongenitalHeartAbnormalitiesbookfromShanaaz,itisinvaluablewhenstudyingthispartofcardiology.

IMPORTANTCONTACTDETAILS

• CCU0214042020• HotCaseFax0214042033• ColdCaseFax0214046070• ECGladies77866/0214046099• E17Clinic0214046092/3• Shanaaz0214046085• CardiacTechs021404/4094

TIPSANDHINTS

• Dischargesummaries§ Arecomputerised.§ Please ensure that these are completed appropriately as youwill often need to

presentusingtheminthecathmeeting(DetailssuchasECGchanges,baselineandEchofindingsareimportant)

§ Ensurethatyoualwayshaveatleasttwocontactnumbersonthedischargesummaryandforthemeeting

• Cardiologyisseenasoneofthemoredifficultspecialities,however,probablyoneofthemostvaluablelearningopportunitiesintheMedRegprogram.Alotofthenursingstaffandseniorregsareverysupportiveandtheconsultantsharbourawealthofknowledge.Ifyoudon’tmindhardwork,alittlebitofsacrificeandpatience,youwillutterlyenjoythisblock.

ENDOCRINESTAFF

CONSULTANTSProfLevitt(HeadofDepartment)76813ProfRoss76814ProfRaubenheimer77062ProfDave76815ProfSandlerDrToet

• OTHERSTAFF

§ DepartmentalSecretary:LiezelFisher(liezel.fisher@uct.ac.za)WEEKLYROSTERDay Time Activity LocationMonday 08h00-

09h0009h0013h0016h00

SeewardpatientsThyroidclinic BisphosphonateclinicpreparationWardround

F-floorOPDF-floorOPD

Tuesday 08h00-09h0008h3011h3013h3016h30

SeewardpatientsBisphosphonateclinicCombinedAcademicmeeting/lunchGeneralfollow-upclinicWardround

C9BillHoffenbergF-floorOPD

Wednesday 07h3011h0016h30

SynacthentestsNewPatientClinicWardround

G16F-floorOPD

Thursday 08h00-09h0009h0013h30

SeewardpatientsDiabeticclinicPituitarycliniconalternateThursdays

H-floorOPD

Friday 08h00-09h0009h0014h0015h15

SeewardpatientsDiabeticclinicCombinedmeetingWardround

H-floorOPDG4

• Monday§ EarlymorningsomeoneshoulddropoffalistofthebisphosphonatepatientsatC9in

orderfortheclerktorequestthefolders§ Thethyroidclinicisaverybusyclinic–becarefulnottogettooabsorbedinother

complaints.Seeingnewpatientsiseasyifyoufollowtheformatoutlinedontheclerkingsheet

§ Pleasedoeverythinginduplicate–ifthereisnobuff,thenkeepacopywithastickerandthenurseswillmakeabuffattheendoftheday.

§ Makesurethatthebuffsarekeptseparatefromtheyellowfolder–theyhelpenormouslywhenfoldersgomissing

§ Discusseachpatientwithaconsultant,especiallyearlyintheblock§ Keepaneyeoutforstablehypothyroidpatients,especiallythosewhohavehad131I

therapyinthepastandarenowonEltroxinreplacement–theycanallbedischargedtoprimarycare

§ Priortotheendoftheday,doplanningfortheBisphosphonateClinichappeningonTuesday:reviewthebloodresultsandDexascanstodeterminewhoshouldreceiveadoseandwhoshouldberebookedforDexascans

• Tuesday§ TheBisphosphonateCliniccanbechaosifnopreparationdonebefore:thereisonly

onecomputertobesharedwiththeclerkanditisimpossibletocheckDexascansandbloodresultswhen10(ormore)patientsarrive

§ Importantbloodresultstocheckare:o Ca2+level–ifbelow2.2donotgive,checkifthepatientisactuallytaking

TitralacandVitD,reschedulehavingmadesureaVitDlevelisalsorequested.Zoledronicacidcancrashthecalciumdownandcausedangeroushypocalcaemia

o VitD–ifdeficientdonotgive,ratherreschedule&makesurethepatientistakingthetablets

o Creatinine–dosingofZoledronicacidisaccordingtoeGFR–thereisadosingadjustmentscheduleonthewallinC9toguidetherapy

§ Dexascansneedtobedoneat2yearintervals–reviewthescansthedaybeforetoevaluateresponsetothebisphosphonate&discusswithconsultant.Patientsoftenarrivewithcompanions;sendthecompaniontoC9tomakearepeatappointmentwhilewaiting

§ ThereisuncertaintyaboutthedurationofZoledronicacidtherapyatthemoment,(aprotocolisbeingdrafted)andatthemomentpatientsneedtobereviewedinthegeneralEndocrinefollow-upclinicafterthe3rddose(i.e.3rdyear)onZoledronicacid.Manyofthepatientsinthebisphosphonateclinicdonothavefollowupdatesforreview–thisneedstobeaddressed,andtheyneedtorebookedonanon-urgentbasisfortheTuesdayfollow-upclinic.DonotrebookfortheC9clinicuntiltheyhavebeenreviewedbythegeneralEndocrineclinic.

§ AtthemomentbookingforC9workslikethis:o Onthedaythatthepatientarrives(e.g.Tuesday10January2017)thepatient’s

stickerisplacedinthe2017bookonthatdate(althoughthebookingwillbeforadatein2018)

o Writethedatein2018nexttothesticker(i.ethecorresponding1stTuesdayin2018willbe9January2018)Ifthepatientisrebookedforanotherdatein2018,thenplacethestickeratthecorresponding2017date

o Pleasemakesureeverypatienthasavalidtelephonenumbero Thenursesneedtogivethepatientadatetotakebloodspriortotheclinic,

andpatientsneedtobeissuedwithaform–bloodstobetakenare:Creat,Ca2+andVitD

• Wednesday§ ShortSynacthentestsaredoneonoutpatientsarrivinginG16§ Thepatientsareduetocomeinat08h00,butneednotbecancellediftheyarrive

later§ ShortSynacthentestsaredonelikethis:

o Baselinecortisol(yellowtop)andACTH(purpleonice)aredrawno 4mlequaling1mcgofSynacthenistheninjectedIVo 30minafterinjectionanothercortisollevelistaken

§ PatientsneedtosignconsentandamodifiedSection21formwhichneedstogotopharmacywithaTTOformonwhich1mgofSynacthenisordered–thebestistoalwayskeepastockofSynactheninthe“Endocrinebox”inthemedicationfridgeinG16

§ MixtheSynacthenasfollows:InjecttheentireampouleofSynactheninto1LNaCl–thiscanbekeptforafewdays,aslongasitisrefrigerated.WeoftenhavetodoshortSynacthentestsonotherinpatientse.g.theneurosurgeryward.Makesureitisclearlylabelledwithayellowstickerandanexpirydate,otherwisetheG16nurseswilldiscardit

§ TheNewPatientClinicstartsat11h00onF-floorinOPD.Expecttobebusyuntil16h00,eventhoughonlyafewpatientstypicallyarrive(7arebookedbutnotallofthemarrive)

• ThursdaysandFridays§ DiabeticClinic-verybusy!§ Newpatientsareseenfirst&discussedwithconsultants§ Nobuffsarekeptinthisclinicandsoduplicationofnotesisnotrequired§ Trytolimitcounselingtothebasicsandbookpatientsfortheeducatorsbutwrite

clearlywhatyou’dlikethemtobeeducatedon§ PatientsgoroutinelytoC17forHbA1Candfastingglucosetestonthemorningof

theirvisit,theydon’tneedformsforthat.Bloodformsareonlygivenifyouwantextrateststobedoneatthesametimepriortothevisit,i.e.fastinglipidsand/oracreatinine.

§ VeryfewpatientsknowwhatanHbA1Cis,butitisausefulmotivationaltool§ Askaconsultantifyouthinkapatientisfitfordischarge(eitherverypoorly

controlleddespitealongtimeintheclinic,orverywellinformedandexcellentlycontrolled)

§ Usetheglucosemonitoringsheet–thecomputersonH-floornowprinttoaremoteprinterinthefrontoffice.Givetopatientstodohomemonitoringandmotivatethemtoself-adjusttheirinsulin

§ Iftherearenoglucometersandpatientshavethemeanstobuytheirown–thebrandisAccucheckActive,andthenthehospital-issuedstripsarecompatible

§ Order2boxesofstripsonscriptforpatientsonbasal-boluswhoneedtocheck4timesperday

TEACHINGANDRESOURCES

• Vula• C15EmergencyFolderonEndocrineEmergencies• JEMSDAguidelines• AmericanAssociationofEndocrinologistshasmanyfreeguidelines

OTHERCONTACTDETAILS

• LE32:4272/3• NuclearMedicine4389• E10Pharmacy3218/9• OPDPharmacy5400• MRIbookings6374(ifurgentoutpatientMRI:requestunderMedicineSemi-Urgent

slots)• Gfloorporters5239

TIPSANDHINTS• Alwaysaskpatientsfortheirphonenumbers:folderphonenumbersarealwayswrong• LE32scripts:calltheclinicat4272/3tocheckifthereareanyscriptsforyoubefore

headingtoNewPatientClinic• Ifyouseeaninterestinginpatient,Isuggestyoucheckwhentheunitisnextdueto

present;youdon’twanttoprepareapresentationover3days!

THEGFLOORSTRUCTUREOFTHEFIRMS&CALLS

• Tworegistrarsperfirm(Monday,Tuesday,Wednesday,Thursday)• Callsaredonebythefirmontheirallocatedweekdayandwiththeirallocated

consultant• Theweekendrosterisworkedoutonarollingbasis.Itisuptoeachfirmtodecide

whichcallswillbecoveredbywhichregistrars§ Whenoneregistrarisoncallforafirm,theotherregistrarisresponsiblefor

pinkiesuntil16h00onweekdays§ Onweekends,oneregistrarcoversbothintakeandreferrals.Theregistraron

intakeisexpectedtostayuntil23h00oruntilsuchtimethatallthereferredpatientshavebeenseen.Theyarealsoexpectedtoreturnduringthenightiftheyarecalledforemergenciesrelatingtooneoftheirpatients,orifemergencyreferralsfromotherdepartmentsaremade

WEEKLYSCHEDULE

• WARDPATIENTS:Eachfirmisexpectedtoseeeveryoneoftheirpatientsonadailybasis.Patientsseenbyinternsshouldbereviewedeitheronawardroundorverbally.

• CONSULTANTROUNDS:dependentoneachfirm,butshouldhappenatleast3timesperweek.

• MOPD:EachfirmisalsoresponsibleforrunningMOPDononedayoftheweek.OneregistrarisexpectedtoattendMOPDfrom10h00untilabout13h00.Theyseenewreferralsaswellasfollow-uppatients.IfapatientneedsadmissionfromMOPD,itiscourteoustoadmitthepatienttoyourownfirm.Thismaybediscussedwiththeconsultantoncallintheclinic.

§ MondayMOPD-:WednesdayFirm§ TuesdayMOPD:ThursdayFirm§ WednesdayMOPD:MondayFirm§ ThursdayMOPD:TuesdayFirm

• ANTIBIOTICSTEWARDSHIPROUNDS:everyTuesdayat12h00ING17.Allregistrarsareexpectedtoattend.

• REGISTRARTEACHING:14h00-16h00onThursdayafternoons,andmaybeattendedifwardworkiscompleted.Academicmeetingsrunfrom16h00-17h00onaThursday.

• DEPARTMENTMEETING:08h00everyFridayintheBillHoffenberg.Theformatchangesfromtimetotime,butgenerallyitisacasepresentationbyoneofthefirms.ThelastFridayofeverymonthistheMorbidityandMortalitymeetingandeveryfirmisexpectedtopresenttheirownstatistics.

• TIPSANDHINTS

§ TherearenootherformalscheduledactivitiesonG-floor,aspatientcareisthepriority.

§ Manytutorialsandstudentteachingslotsalsoariseduringtheblockandoneregistrarinafirmmaybeexpectedtoattend.Pleaseliaisewithyourcolleaguestoensurethatthefirmisalwayscovereduntil17h00ifyouareattendingotheractivities

GASTROENTEROLOGY

STRUCTUREOFTHEUNIT/WARDThe Groote Schuur Hospital GIT Clinic is a multidisciplinary clinic comprising medicalgastroenterology, three surgical sub-divisions namely hepatobiliary surgery, foregut andcolorectalsurgery&stomatherapy.ItisabusyclinicprovidingaspecialistreferralserviceintheGSHdrainageareaandsupporttootherspecialtieswithinthehospital.Theendoscopysuiteincludesfacilitiesforupperendoscopy,lowerendoscopy,ERCPandarecoveryroom.ThedailyclinicsalsorunoutofE23.The unit has been allocated 4-6 beds in ward G12 which are almost exclusively used byinflammatory bowel disease patients either for elective admission for investigations or foremergencyadmissionwithexacerbationsoftheirdisease.ThereisadailywardroundinG12.Usually the medical officer rotating through GIT will be primarily responsible for the wardpatientswithaseniorregistrar.Responsibilitiesincludeensuringthatresultflowsheetsarekeptup-to-dateandthatx-raysandotherresultsareavailable,referralsaremadetimeouslyegmostGITpatientsshouldbereviewedbythedieticianearlyintheiradmission.Atypeddischargeletter(GSHformat)shouldbecompletedondischargeofeverypatient.Pleaseensurethatthereferringdoctorand/orGPreceiveacopyofthissummaryaswellasChantallStewart,whokeepsafileofthesummariesinheroffice.GSHpolicydictatesthatallsummariesareICDcodedtoensurethatalldiagnosesareaccompaniedbytheappropriatecode.VenoferclinicTherewillbeavenoferclinicattheendoscopyunit(E23)forourownpatientsonaWednesdayandThursday.Thereisamaximumof4bookingsperdayandusuallythemedicalofficerwillrunthevenoferclinic.Pleasemakesureyoudon’tbookvenoferclinicsifthemedicalofficerisonleave,unlessa registrar is available to run theclinic.Venoferneeds tobepre-bookedat theinpatientpharmacy(besttopreorderitonedaybeforetheclinic)andstockedinyourofficeatE23.InfliximabThereare currently4patients receiving infliximab.Please check thewardbookatG12 to seewhenthepatientsarebooked.Thepatientwillbeadmittedonthedayofadministration.BeforeadmissionyouneedtochecktheFBC/dif.OnceyouhavecheckedtheFBC+patientshasbeenadmittedofficially,youcanordertheinfliximabfromthesterilepharmacy(withuseoftheblueboard).Ondischarge,pleasecheckfollowupdatesforclinic/infliximabbooking(normallyevery8weeks).Themedicalofficerusuallyadministerstheinfliximab.STAFF

CONSULTANTS REGISTRARS

ProfSandieThomsonDrGillWatermeyer76375DrSabeloHlatshwayo76952DrDionLevin76138

DrLeolinKatsidziraDrMirthevanderValkDrNimrodMokhele77412DrColinRush76486

DrSassaBotharunsthepH-studies/manometrylaboratoryandhassessionsfromWednesdaytoFriday.

• NURSINGSTAFFSr.MarévanWykistheOperationalManagerandisinchargeofnursingintheclinic.CharmaineAlexanderisthesisterinchargeoftheIBDclinic.

• OtherstaffChantallStewartisthesecretarytoProfThomson,youmayaskhertoassistyouwherepossible.Theclerks in thereceptionofficeareAllieLippertandLindyGlover. KarinFenton isourUCTadministrator.WEEKLYROSTER

• Monday7:30Dailywardround(MOandseniorreg)Newpatientclinic+followupclinicMedicalofficertoemailDrLocketztoprepareforhistopathmeetingonTuesday

• Tuesday7:30Dailywardround(MOandseniorreg)This is academicday.At 2pm there is an academicward round,usually attendedbycolleaguesinprivatepractice.At3pmthereisahistopathologymeetingatD8todiscussbiopsycases.Thisisfollowedbyateaandlecture.Pleasewatchtherosterforyourturntopresent.IBDclinic

• Wednesday7:30Dailywardround(MOandseniorreg)8am:JournalclubNewpatientclinic8.00-9.0 enoferclinic(max4bookings)

• Thursday7:30Dailywardround(MOandseniorreg)IBDclinic8.00-9.00venoferclinic(max4bookings)

• Friday7:30Dailywardround(MOandseniorreg)Followupclinic

10.00ThereisoftenateasponsoredbyapharmaceuticalrepCALLSOncalldutiesinvolveclerkingandadmittingknownGITpatientstoG12.TheIBDclinichasanopen-doorpolicysomostpatientsarrangeadaytimeappointmentiffeelingunwell.After-hoursadmissions are thus infrequent. In the event of an after-hours admission, please feel free tocontacttheconsultantoncalltodiscussthecaseatanytime.Ingeneral,non-IBDnewpatientswith GIT problems are admitted to either general medicine or surgery. GIT referral is thenarrangedthenextworkingday.Onweekendstheon-callpersonwilldoadailywardroundandbeavailabletocoverwardproblemsandcasualtyreferralsshouldtheyarise.Notethatthereisaspecificpersononcallforemergencyscopes,separatefromthegeneralGIToncallpersonandthatthismaybeamedicalorsurgicalseniorregistrar.Manyreferrals,especiallythosemadeduringtheday,areforupperendoscopyrequestsandthereferringdoctorshouldbeinformedthatthepatientwouldbeplacedonthenextemergencyendoscopy listwhichoccursonadailybasis. It isnot required that thesepatientsare seen.Referralsforcolonoscopy,videocapsuleendoscopyorPEGplacementmustbediscussedLeoninKatsidziraasthisisalimitedresourceandonlyappropriatecaseswillbeaccepted.Otherreferralsmustbeseenonthedayofreferralandthecasebediscussedwithaseniorregistrar/consultantbeforeembarkingonadetailedclerkandworkup.TEACHINGANDRESOURCESIMPORTANTCONTACTDETAILSTIPSANDHINTSTeaandcoffeeareavailable inChantall Stewart’soffice,Room93or in thesistersoffice.OnFridaysat10o’clockthereisusuallyateainourlibrarysponsoredbyapharmaceuticalcompany.Shouldproblemsariseduringyourstayinthedepartment,pleasediscussthesewithProfSandieThomson(oroneoftheotherconsultantsinhisabsence).ProceduresGastroscopyandcolonoscopyaremoredifficultprocedurestomasterandduetoyourshortstayindepartmentitisnotpracticalforyoutobetaughttheseprocedures.Youarehoweverwelcometospendtimeintheendoscopyroom,onceotherdutiesarecompleted,towatchandassistwithendoscopy.Ifyouwouldliketoparticipateinlearninggastroscopy,youwillneedtoaskSrvanWyktogiveyouanintroductorylessonfirst.ProfThomsonalsowillprovideyouwithalettertothe nursing staff explaining that youwill be training in upper endoscopy. There is an upperendoscopycourserunperiodicallywhichisveryuseful ifyouareabletocompletethiscoursebeforeorduringyourGITrotation.Contactce.administration@uct.ac.zatofindoutwhenitwillberunning.Conclusion

Wetrustyouwillenjoyyourstayinthedepartmentandfinditavaluablelearningexperience.

HAEMATOLOGY

STRUCTUREOFTHEUNIT/WARD

• E5:TheHaematologyClinicandDayWard:o AllHaematologyclinicstakeplacehere.o DayWard:administrationofchemotherapy,givingbloodproductsandfor

admittingpatients.o TheCellSupportRoom:BloodProductsIrradiator,areawhereStemCell

harvestingandplasmapheresistakeplaceo Thebloodproductsstoragefridge:containsallFactorproducts

• G8/G7:Generalhaematologywards:10bedsbetweenbothwards,sharedwithOncology

• F4:HaematologyICU:IsolationfacilityforpatientsundergoingintensivechemotherapyandBMtransplantation.

• AllocationofMOs/Regs:o MOs:ThetwoMOsallocatedtoHaematologywilldividethe4monthrotation:

EachMowillspend2monthsinF4andassistinginthegeneralward;andthen2monthsintheclinic.

o Regs:ThetwoRegsallocatedtoHaematologywilldividethe3monthrotation:eachwillspend6weeksintheGeneralWard;andthen6weeksintheclinic.

• Clinicduties:o Checkingofbloodandotherbloodproductswiththesisterso Clinicalassessmentofpatientsbeingfollowedupo ClinicalassessmentofnewpatientsreferredtoHaematologyo Administrationofintra-thecalchemotherapyo Administrationofdonorlymphocytesandautologousstemcells(asoutpatient)o RemovalofHickmanlinesunderlocalanaesthesiao BonemarrowbiopsieseveryFridayo Patientsshouldalwaysbediscussedwithseniorregistrarand/orconsultant

• Wardduties:o Clinicalassessmentandrepeatingofbloodsonthein-patientsonadailybasiso Administrationandirradiationofbloodandbloodproductsforthein-patientso ConsultantwardroundseveryMondayandThursdayo Administrationofintra-thecalchemotherapy

STAFF

CONSULTANTS SENIORREGISTRARS

Prof.N.Novisky(HOD)Dr.E.VerburgDr.C.DuToitDr.J.Opie(Haem-Path)

760847656977176

DrJustinDuToitDrKathrineAntel

7646876110

• OTHERSTAFF

§ Clerks:ElaineYoung,GaafsaSchalkwyk:3084/3383§ ClinicSisters:Sr.Charles3083§ HaemophilliaCo-ordinator:Sr.Cruikshank76195/0827881038§ SocialWorker:NomalizoSineke:76905/3089§ Secretary:ChantalMcCarthy3077Fax:3088

WEEKLYROSTER

MONDAY

07h45Radiologymeeting(C7MRISeminarRoom)

08h15

Grandwardround:E5tearoom

09h00

MyelomaClinic(DrDuToit)13H30InfectiousDiseaseMeeting:Consultantoncall,SeniorReg,F4MO

TUESDAY

08h00

JournalClub:E5tearoom

09h00CML/CLL/HighGradeLymphomaClinic(ProfNovitzky)

WEDNESDAY

08h00

Haemoglobinopathy/LowGradeLymphomaClinic(DrDuToit)

THURSDAY

07h30

Grandwardround:E5tearoom

09h00

NewpatientClinic/MyeloproliferativeNeoplasmsClinic(DrVerburgh)

16h00-17h00

DeptofMedicineClinicalMeetingsVenue:LT2

FRIDAY

08h00

Haem-pathMorphologymeeting:“Fishbowel”inNHLSLab

09h00

BleedingDisorderClinic(DrDuToit)

CALLSWhenoncall,youareresponsibleforreceivingoutsidecalls(fromperipheraldayhospitalsandclinics)foradvice.Youarealsoresponsibleforin-patientreferrals.Allpatientsneedtobediscussedwithseniorregistrarand/orconsultant.From8amto4pm:clinicaldutiesandtelephonicconsultsandreferrals.IfthepatientisreferredfromC15asanemergency,youarerelievedofyourclinicaldutiestoassessthepatientinC15aspreference.After4pmtill8am(nextday):responsibleforoutsideandin-patientreferrals,aswellasafterhoursclinicaldutiesinG7/8andF4.Mostlyyouareresponsibleforrepeatingtumorlysisbloodsorcoagulationprofilesandbloodculturesifpatientsdeveloptemperaturespikes.Ifaplanforaparticularpatienthasn’tbeenformulated/handedover,thepatientsmustalwaysbediscussedwiththeseniorregistrarand/orconsultant.Currentlywedonotdosleepincalls,howeverwhenoncallyouneedtostayonsiteuntil8pm.IfthesisterinF4wantsyoutoassessapatient,itisyourresponsibilitytocomeinfromhometoassessthepatientasthesepatientsreceiveintensechemotherapy(astreatmentorconditioning)orhasreceivedabonemarrowtransplant.Mostly,weekendcallsareFriday/Sundaycalls.Youareresponsibletoassessthein-patientsandrepeatbloodtestsinG7/8andeveryalternateweekendtoassessthepatientsinF4isolationunit.Theseniorregistrardoesthewardroundeveryalternateweekend(whentheMO/registraronlyseesthein-patientsinG7/8)anddoawardroundwiththeMO/registrarinG7/8oncetheyhavecompletedthewardroundinF4.Youareresponsiblefortheoutsideandin-patientreferrals.TEACHINGANDRESOURCES

• Resources:

o HaematologyandHaemophilliaprotocolsareprovidedonarrivalo OnrequesttheUCTstudentsHaematologyTextbookisagreatrevisiontoolo ForallthebuddinghaematologiststryEssentialHaematologybyHoffbrando UponarrivalinE5,theseniorregistrarwillsupplyyouwith12differenttopics

thatwillbedividedbetweentheseniorregistrarandmedicalregistrars.Itwillbeexpectedofyoutoprepareapowerpointpresentationontheparticulartopic.

ThesetopicswillbediscussedeveryFridayafternoonaftertheclinichasbeendone.Iftheclinicisextremelybusy(oftenthecase),wecandiscussthetopicthefollowingMondayastheMondaygeneralclinicifoftennottoobusy.

OTHERCONTACTDETAILS• Bloodbank:4091/4092• Bleedingroom:3086• Cellsupportroom:3170• Haem-pathbench(tobookbonemarrowbiopsies/requestbloodfilms):3092/4018• Haemtechnologist:3191• GillBlackbeard(FlowCytometry):3092/6331• Cytogenetics:4449/4509

TIPSANDHINTS

1. OneoftheclinicdoctorsneedstobeavailableinE5from07h30onwardstocheckandinitiatebloodproducts

2. EnsureyoucorrectlycompletethepatientsfoldersasperDrVerburg’slayout.

3. InF4:beorganised,themorningsareveryearlyandyouneedtoensurethatallyourbloodformsarepreparedforthenursestotakesamples.Highlyrecommenddoingalltheformsfortheweekaheadoftime.Ensurethatyourtoxicologysamplesaresentoffbefore10:00withtheporterdirectlytothetoxicologylab.

INTENSIVECAREUNITTheICUrotationisbothachallengingandanenjoyablerotation.Thereisaclearlystructuredmodusoperandiandanapproachableteamofspecialists.Youwillbetrainedintherequisite

skillsrequiredandthereisastrongfocusonteaching.ThisguideshouldbeusedsupplementtotheICUintrothatyouwillreceivewhenyoustart.

STRUCTUREOFTHEUNIT/WARDYouwillrotatethroughC27(medical)andD12(surgical)ICUduringyourtimeinthisrotation.ThemedicalICUwilladmitasurgicalcaseandviceversaifnecessaryandatthediscretionoftheconsultantoncall.C27:8bedunitwhichincludes3potentialIsolationICUbedsinE26D12:8bedunitUCTPAHICU:upto20beds(variable)STAFFCONSULTANTS ROTATINGSTAFFProfIJoubert76172DrRRaine76161DrMMillar76406DrJPiercy76407ProfMichell76326DrDThomson76740

Consultants&SeniorRegistrarsfromRespiratoryMedicineJuniorConsultantsfromAnaestheticsConsultantssub-specialisinginCriticalCare

• OTHERSTAFF§ ICUSECRETARY:IngridWilson–Ingrid.wilson@westerncape.gov.za;(021)404-3279

BeforearrivingondayoneitisstronglyrecommendedtopopdowntoC27andvisitIngrid.ShewillgiveyouanintropacktoICUandisthego-topersonwithregardtoanyrosterissuesorbasicallyanyproblemsduringyourrotation.CallrequestsandleaveforthefollowingmonthneedtogoviaIngrid.

WEEKLYROSTERC27/D12dailywardroundsareat08h30and15h30.

Allpatientsneedtobeclerkedwiththedailyclerkingsheet(whichyouwillfindatthenursesstations)Generallythisrequiresarrivingbetween07H00and07h30–thedailyreviewisexpectedtobethoroughanddetailedsousethetimewisely.Thereareusually4-5registrarsperunitsodividethepatientsaccordinglyWeekendwardroundsareatthediscretionoftheconsultant.

• Monday

12h30Journalclub-intheC27registrarroom(Ingridwillletyouknowifarepisbringinglunch)

• Tuesday13h00GrandRound–venuewillbeannouncedontheday

• WednesdayPracticalteaching(U/S,centrallinesetc)

• Thursday11h00Registrartutorials–usuallyinD23

• Friday14h00RegistrarpresentationsLastFridayofthemonth–M&M

CALLS

• TheC27MedReg/MOoncalldoescoverforUCTPAHduringweeknightsfrom21h00.ItisadvisabletogetasdetailedahandoveraspossiblefromtheUCTregistrarastherecanbecomplicatedcases.

• OnweekendstheC27MedReg/MOcoversfrom12h00asabove• TheD12MedReg/MOcoversD22CardiothoracicICUafterthePMwardround(although

thereisalsoaCardiothoracicRegoncall).

TEACHINGANDRESOURCESBASICICUCOURSE

• TheDepartmentofCriticalCarerunsthistwodaycoursewhichisagoodcomprehensiveintrotoICUincludingventilatortroubleshooting.

• SpeaktoIngridtoputyourselfdownforthenextcourse.

OTHER

• AskDrJouberttoaddyoutotheVulacriticalcaregroup–thereisawealthofarticlesandresourcesavailablethere

• Don’tbeshytoaskforhelplearningaprocedure–itismucheasiertogettaughtsomethingduringthedaythantolearnitatnight

TIPSANDHINTS• TheICUnursingstaffaresuperbandifyoucommunicatewiththemwellyouwillgetthe

fullbenefitoftheirexpertiseandassistance.• LearntheapronrulesandinfectioncontrolroutinesonDay1–askoneofthesisters!• Thedailyclerkingsheethasanumberoffeaturesonit–egRSBI(rapidshallow

breathingindex)–thesearenottherebychance.Youwoulddowelltofindoutwhatallthesethingsareearlyandwhytheyhavebeenprioritisedtobeontheclerkingsheet

• Youwillreceiveacallreferralformwhichneedstobehandedinthenextmorning–ifyouforgetIngridwillbecallingyoupost-call

ASSESSMENTThepurposeoftheassessmentistoreviewtheknowledgeyouhaveacquiredduringyourrotationandthequestionsarethereforepracticalandrelatedtocoretopicsthatyoushouldhaveencountered.• Presentation:youwillbeallocatedapresentationdate&Ingridwillgiveyoualistof

availabletopics• Endofblockoralassessment

INFECTIOUSDISEASES&HIVMEDICINE

Duringyour3-monthrotationyouwillgainexperienceonthediagnosisandmanagementofthe

InfectiousDiseasesseeninouracademicreferralsetting.Wearephysiciansandworkcloselywithateam

ofmicrobiologists,infectioncontrolnursesandpharmacists.Therotationallowsopportunitytodevelop

clinicalandpresentationskills,andcoverInfectiousDiseasesandantibioticpharmacotherapytheory

requiredfortheFCPexam.

STRUCTUREOFTHEUNIT/WARDIDCLINIC

• G26IDClinicisprimarilyanAntiretroviralTherapyclinic,runbyProfDlamini• ItprovidesanexcellentopportunitytodiscusscomplicatedARTregimensandART

Resistancetesting.

RAPIDASSESSMENTUNIT

• TheRapidAssessmentUnitinG26operatesMonday-Thursdaybetween08h00and16h00.

• Thereisadoctorrosteredtobeavailabletoseepatientsbookedforthisservice.Thesepatientsareusuallyreferredfromperipheralclinicsandhavebeendiscussedwithaconsultant.

REFERRALS

• Allreferralsmustbeseenonthedayofreferralifpossible(ClerkingbooksinG26andSRoffice).

• WardreferralsarenottobeseeninG26IDclinic.• Whenseeinganewpatient,performathoroughhistoryandexamination,updateall

relevantmicrobiologyandhistologyresults(printersinSRofficeandG26clinic).• Dailyfollowupallreferralsuntildischarge/death.Allpatientswhohavetravelled

outsideSouthAfricainthelast5yearsrequireaGeosentinelsurveillanceformtobecompletedandhandedintoProfMendelson(formsinSRofficeandoutsideProfMendelson’soffice).

• AllpatientswithS.aureusbacteraemia(MSSAandMRSA)requireunsolicitedIDconsultation;themicrobiologyregistraroncallprovidesthepatient’sdetailsonthe

relevantWhatsappgroup(formsinSRoffice)

STAFF

CONSULTANTS SENIORREGISTRARSProfMarcMendelson(HeadofDivision)76758ProfSiphoDlamini76380DrTomBoyles77320ProfGaryMaartens(weeklyteachinground)

DrDenashaReddy76827DrSandraNgongang77010SupernumeraryseniorregistrarfromBerlin(ApriltoOctober)

• OTHERSTAFF

§ Clerks:Sylvia(G26)0214045328§ HIVCounsellors:NoxoloandVivian0732375207&0726493409

TheDivisionalsohostsmanyinternationalobserversrangingfrommedicalstudentstoinfectious

diseasesspecialists.

WEEKLYROSTER• Monday

08h30NewReferralsandfollow-upconsultations12h00BloodCultureMeeting-C18MicrobiologyLab14h00ComputerCaseReview-SeminarRoom&ConsultantRounds

• Tuesday08h30G26IDClinic(ProfDlamini)12h00G17AntibioticStewardshipRound(ProfMendelson)16h00ConsultantRounds(ProfMaartens)

• Wednesday08h30SeniorRegOutreachatDPMaraisorNewReferralsandfollow-upconsultations14h00ConsultantRounds

• Thursday09h00MicrobiologyPlateRoundC18,IDTeachingRound&Tea12h00BloodCultureMeetingC18MicrobiologyLab14h00ConsultantRounds16h00DepartmentofMedicineMeeting

• Friday

08h30NewReferralsandFollow-Upconsultations14h00IDAcademicMeetingG16SeminarRoom15h00X-raymeeting(ProfGoodman)G16SeminarRoom16h00ConsultantRounds

CALLS• WeekendandweekdaycallsaredividedamongstmedicalregistrarsandIDSRs.• Medicalregistrarsareexpectedtodoaminimumof1weekendpermonth,and2

weekdaycallsperweek(allWednesdays).• SRscovertheremainingweekendsandweekdays(allThursdays).Whenoncall,youare

expectedtocomeouttoseeurgentcases(e.g.ICUandtransplantpatients)andIDemergencies(e.g.malaria,suspectedVHF).

• AllcasesshouldbediscussedwiththeIDconsultantoncall.• Non-urgentweekendreferralscanbeseenonMonday,includingStaphylococcusaureus

bacteremiaconsultations.

TEACHINGANDRESOURCES

• DownloadtheSAASP,AntimicrobialRecommendationsWesternCape,SanfordGuideto

AntimicrobialTherapy• Readuponallcasesseen;mostofyourlearningwillbeonclinicalwardrounds

TIPSANDHINTS

• Nowhitecoats,tiesorscarves• Discusspatientswithmicrobiologyatweeklybloodculturemeetings• Pleasehandoveryourpatientsbeforeanyleave.Ensurethatnamesandlocationsofpatientsare

correctlydocumented• AllleavetobeapprovedbyProfMendelson

LIVERSTRUCTUREOFTHEUNIT/WARD/HCU• 5bedsinG12and2bedsinE12(Liver)transplantHCU• Thereisonlyonefirm,headedbyProfessorWendySpearman.Thefirmincludesone

Liver/GITseniorregistrar,2medicalregistrarsandoccasionallyonesupernumerarymedicalregistrar.Themedicalregistrarsaresplitbetweenthegeneralmedicalward(G12)andHCU(E12:Livertransplantunit).Monthlyrotationsbetweentheunitsoccurdependingonthenumberofrotatingregistrars.

STAFF

CONSULTANTS SENIORREGISTRARProfWendySpearman(HeadofDivision)76879ProfMarkSonderup77185DrNeliswaGogela

DrMirtheVanDerValk(GIT)76172

NURSINGSTAFF

§ Nursingteamfor:• generalwardadmissionsareledbyG12SisterRoy.• transplantadmissionsareledbyE12SisterSolomon.

§ Pleaseensureyouintroduceyourselftothenursingstaffatthebeginningoftherotation.

§ G12andE12requiresthattheplanforthepatientsunderyourcareishandedovertoasisterorseniornurseattheendofeachwardround.

OTHERSTAFF§ Clerks:G12–Rushida§ SocialWorker:MrLungi§ Dietitian:LynetteCilliers § ProfSpearman’ssecretary:FoziaFrancis

WEEKLYROSTER

• MondayHCU

8:40E12wardround.PatientsintheHCUshouldbeclerkedbeforethewardround.Basicbloodsaredonebythenursingstaffat4am(excludingcultures).Allnewresults(excludingdruglevels)shouldbeoutby8am.EveryHCUpatientgetsabloodculture,CMVVL,EBVVL,urineculturetogetherwithFBC,CEU,LFT,INRandtacrolimusor

cyclosporineleveleveryMonday.Thenursesdousafavourbypullingbloodsat4am,pleasecherishthisrelationshipandhelpthemwiththeoccasionaldifficultvenesection.9:15–clerkingoutliers,newreferrals(ifoncall)andassistingwithG12wardwork

G12Everypatientgetsabloodculture,withFBC,CEU,LFT,INRandtacrolimusorcyclosporinelevel(ifappropriate)everyMonday.12:30wardround,startsinG12doctorsroomwhereallbloodresultsfromthemorningarereviewed.Alloutlierpatientsarethendiscussed.TheroundendsinE12withoutstandingtacrolimusorcyclosporinelevels.Thereafternewconsultationsarediscussedwiththeoncallconsultant.

• TuesdayHCU

8:30E12wardround9:00Liverclinic(don’tbelate!!!)

G128:00reviewallwardadmissionsanddodailybloods(FBC,CEU,LFT,INR,druglevel)9:00Liverclinic(don’tbelate!!!)Clinicusuallyfinishesat15:30–16:00.ThewardroundthenstartsatG12doctorsroom,endinginE12.

• WednesdayHCU

8:30E12wardround9:00Transplantclinic(alternateWednesdays)otherwisereviewalloutliers,newreferrals(ifoncall)andassistingwithG12wardwork.ThetransplantclinicusuallyincludesProfSpearmanandtheseniorregistrars,howseveryouwillbeaskedtohelpifshortstaffed.

G128:00reviewallwardadmissionsanddodailybloods(FBC,CEU,LFT,INR,druglevel)12:30WardroundstartsatG12doctorsroom,endinginE12.

• ThursdayHCU

8:30E12wardround9:00ParacentesisclinicinC9.(usually3-4patientsforparacentesisandvenesections).Tip–leaveyourspeeddialwiththesisterinC9andtheywillcallyouwhenthepatientsarrive.Don’tbookmorethan3-4patientsadayasyouareusuallyalone.Thereafterreviewalloutliers.

G128:00reviewallwardadmissionsanddodailybloods(FBC,CEU,LFT,INR,druglevel)12:00WardroundstartsatG12doctorsroom,endinginE12.14:00RegteachingatBillHoffenberg

• FridayHCU

8:30E12wardround9:00reviewalloutliers

G12

8:00reviewallwardadmissionsanddodailybloods(FBC,CEU,LFT,INR,druglevel)10:00WardroundstartsatG12doctorsroom,endinginE12.11:00HistologywithDrMikeLocketzinD412:00AcademicpresentationsatJflooroldmainbuilding–seminarroombeforeFalconetheatre.Pleasegetkeyandsettheprojectorup(housedatLiziwe’soffice).

CALLSRotatingGITseniorregistrar,DrMirthevanDerValkdrawsupthemonthlyrosterandacademicpresentationroster.Pleaseemail/WhatsAppherwithanyrosterrequestspriortostartingtherotation.Youareusuallyoncallfor7daysinarow.ThecallstartsonMonday8amandendsonMonday8amthefollowingweek.WeekendcallsAllpatients(G12,E12andoutliers)needtobeseenwithdailybloodstakenby09:30.WardroundwillbegininE12,movingtoG12andthentheoutliers.Pleasecalltheoncallconsultantwithoutstandingdruglevels(12pm)asimmunosuppressivedosagesmaychange.OvertimeYouarerequiredtodotwoC15–yellowareashiftspermonthonaFriday(onlydayyouwillleaveby16:00).ItwouldhelpifyouarrangeyourcallsforthesameweekyouareoncallforLiver.(discussC15dateswithDrParolus)TEACHINGANDRESOURCES

• Thisisabusyrotationhoweverithasoneofthebestbedsideteaching.Maximizethisone-on-oneopportunity.

IMPORTANTCONTACTDETAILS

• G12–0214043243• G12–doctor’soffice0214043468• G12–wardclerk0214043304• E12–nursesstation0214043312• Liverclinic(OMB)0214066394• Referralsareemailedtofozia.francis@uct.ac.za

TIPSANDHINTS

• DischargesummariesG12–onECCRE12–shortadmission-handwritten.Longadmission–detailedtypedletteronaletterheadfoundontheE12Doctor’scomputer.

• TherewillbealotofwardreviewsinG12thatneedbloodstakenorresultsreviewed.Pleasekeepabookwiththeirstickersandtrendofbloodresultspervisit.PleaseshowProfattheendofeachwardround.

• E12-Achemistryformcontainingthenecessaryrequests,togetherwithapharmacologyformmustbefilledoutforthefollowingdayandattachedatthenursingtableforbloodstobedrawnat4am.

• ItwouldhelptheweekendoncallregistraralotifallbloodformsarewrittenoutonFridayandhandedtothesistersinE12.

MITCHELL’SPLAINDISTRICTHOSPITALSTRUCTUREOFTHEUNIT/WARD

• FIVEMEDICALTEAMS(AtoE)o EachconsistsofaMedicalRegistrar/MedicalOfficerandeitheranIntern/

Cosmo.OneteamconsistsoftwoMOs• Thereare4RegistrarsallocatedtoMPDHand3ofthesewilleachbeallocateda1

monthResearchblock.• PIWRMon-ThursaredonebyDrsMaughanandCrede.FridayiscoveredbyDrBana.

Starteither07h30or08h00.Weekendroundsstartat07h00• MOPD

o Eachteamwillbeabletobookpatientsforreviewpostdischarge.Useyour“teamdiary”provided,andavoidbookingpatientsonyouron-callday.Donotfollowuppatientsforprolongedperiods(ratherrefertoGSH)anddonotbookpatientsforyourcolleaguestoseeonceyourrotationhasended.

o IDpatientscanbediscussedwithAshrafDavids,whorunstheIDserviceandishappytoreviewID-relatedproblemsinhisclinicpostdischarge.

o TherearecurrentlynonewpatientMOPDbookingsfromoutside,althoughthismaychangeduringtheyear.

o Exercisestresstestsaredoneonyourownpatients,oryoumaybeaskedbytheECstafftodoOPDESTsonlowriskpatients,whichtheECconsultantshavepersonallyreviewed

o BooktheseinyourownOPDdiary• CARNATIONWARD

o Step-downfacilityforstablemedicalpatients,allpatientsreferredtoCarnationmusthavestickersplacedinthe“CarnationBook”inFemaleandMaleMedicalWards.

STAFF

CONSULTANTS DrCredeDrMaughanDrDeVriesDrBanaDrViljoen

70377451703908380017860825653361

WEEKLYROSTER

MONDAY

13h00

DepartmentalBusiness/Social/lunchmeeting

TUESDAY

09h00MedicineHuddle

14h00

FortnightlyMultidisciplinaryround(amemberofeachteammustattend)

WEDNESDAY

11h30

AntibioticStewardshipRound

15h00Academicpresentationasperweeklyroster,monthlyM&M

THURSDAY

08h00

JournalClubasperroster

14h00-16h0016h00-17h00

FCP2TeachingBillHoffenbergGSHDeptofMedicineClinicalMeetings(LT2GSH)

FRIDAY

14h00

WeekendHandoverMeeting

CALLS

• Eachteamisoncallevery5thday(D1)• D3youwillhaveaconsultantroundtoreviewallpatients.Consultantsarehappyto

reviewpatientsonotherdays,andhelpwithOPDreviews.Askandyouwillgethelp!• Registrarsareexpectedtobeonsitetill23h00andtocomeoutifthereisanICU

admissionoranemergency.Sleep-infacilityavailableifneeded(ante-natalward)• DuringtheResearchBlocktheRegistrarwillcover4weekdaycallsfrom16h00fora

colleagueaswellasthePIWRandoneSaturdayandthePIWRonSunday.• Onweekends,notallpatientsinthewardsareseenduetostaffingconstraints.

Criticallyillpatientsareidentifiedonthehand-overonFriday,andthesepatientsareseenonbothdays.Ononedayallfemalepatientsareseen,incloutliers,andtheotherdayallmalepatientsarereviewed.Pleasemakeclearhand-overnotesontheFriday.Adedicated“weekendmanagementplan”sheetmustbeusedfortheweekends.

OTHERCONTACTDETAILS

• EMS7228• GSHSwitchBoard7117• SOCIALWORKERS

§ MrsLucas7073§ MsSallie7552§ MrsWilliams7551

• Laboratory4780• Porters2144• Pharmacy4599• OPDBookings2151• G-Scope4771• FEMALEMedicalWard4715• MaleMedicalWard4696• OvernightWard4654• BedManager(MrsAbrahams)7062

TIPSANDHINTS

• Referralstootherspecialtiesaremadetelephonically,plusawrittenreferral• eCCRisusedforadmissionsanddischarges-accesscodewillbeprovided• ECM:MPHusesanelectronicnotestoragesystem.Usethistoobtainoldnotes.

Passwordwillbegiventoyouwhenyoustartwork• Radiologylogin–willbeprovided• Speeddial–willbeprovided

NEUROLOGYSTRUCTUREOFTHEUNIT/WARD• 18bedsintotal:10neurology,6stroke,2geriatrics• TherearetwoNeurologyfirms,headedbytheNeurologyregistrars.Themedical

registrarsandmedicalofficersaresplitbetweenthetwofirms,andpatientsareallocatedtoeachofthem.

STAFF

CONSULTANTS REGISTRARSProfAlanBryer(HeadofDivision)77267DrEddyLeePan77439ProfJeannineHeckmann76861DrLawrenceTucker77438DrKathleenBateman76346

DrHelenCross76504DrSarvaniChetty77616DrWongaMatshikiza77493DrSaaraNeshuku77394DrSilvanusWabwire76334DrHermanEkea77458

• NURSINGSTAFF

§ NursingteamledbySisterBlouws§ Pleaseensureyouintroduceyourselftothenursingstaffatthebeginningofthe

rotation.§ E7requiresthattheplanforthepatientsunderyourcareishandedovertoa

sisterorseniornurseattheendofeachday.

• OTHERSTAFF§ Clerks:CynthiaandMichelle§ SocialWorker:BelindaDixon(officeinE8,nearEEGsection)§ Neurophysiologytechnicians:CarlaBailey,KellyMalefo,HencovanDyk§ OT:CorienTheron(stroke),NatashaNaidoo(neuro)§ Physio:SamanthaGelderblom§ Dietitian:LynetteCilliers § Speechtherapy:LeeMeyer § ProfBryer’ssecretary:JoleneWoolley

WEEKLYROSTER

• Monday8.00journalclub–MacgregorRoom,E89.00onwards–clerkingnewadmissionsorseeingawarddaycase

13.30strokewardround,E7withProfBryerandthemultidisciplinaryteam14.00registrarwardround–eachfirmseesthenewadmissions/problemswitholdcases

• Tuesday8.15consultantwardround(mainteachingroundoftheweek)11.00wardadminmeetinginMacgregorRoom,E8(casesforFridaypresentationswillbeallocated)12.00socialround13.00NeurologyOPD(Epilepsy/Headachemostly),floorHOPDbuilding

• Wednesday8.15radiologymeeting9.00E7wardclinic13.30strokewardroundwithDrdeVilliersandmultidisciplinaryteam

• Thursday8.15Consultantwardround,E79.30Neurologyoutpatients,floorFOPDbuilding14.00Openforteaching

• Friday8.301stand3rdofmonth–MyastheniaGravisclinic2ndofmonth–TygerschuurmeetingatTygerbergHospitalLastofevery2ndmonth–MotorNeuronDiseaseclinic12.00AcademiccasepresentationsinLT2,Efloor.13.30Academicmeeting:difficultcasediscussion/researchpresentation/IDmeeting

CALLSHelenCross,theseniorNeurologyregistrar,doesthemonthlyroster.Pleaseemailherwithanyrosterrequestspriortostartingtherotation.

• Neurology§ Theneurologycallsarea24hcallcoveredbytheneurologyregistrarsandrotating

medicalregistrars.§ Allcasesarediscussedwiththeconsultantoncall.

• Stroke

§ ThesecallsarecoveredbyMedicalRegistrarsandMedicalOfficers.§ Strokecallsaretohaveadoctoronstandbyforpotentialthrombolysiscases,and

toseeotherward/casualtystrokereferrals.

§ PleasereadthestrokeprotocolbeforeyourfirststrokecallandmakesureyouunderstandtheNIHstrokescalescoringsystem.

• Ward§ Themedicalofficersdothewardcovercalls.Thisusuallyrotatesonaweeklybasis.§ Themedicalofficeroncallthatweekwillcomeinontheweekendmorningsand

seeallthewardpatients.

TEACHINGANDRESOURCES

• TeachingandacademicsareregardedasimportantinNeurologyandthereareplentyofopportunitiesforformalandinformalteaching.Alltheconsultantsareapproachableandmaygiveextratutorialsifasked.

• TheformalteachingroundisonaTuesdaymorning,anditisadvisabletoreadaroundthepatientsinyourfirmonaMondaynight.

• MedicalregistrarsandmedicalofficersareexpectedtopresentinterestingcasesonaFridayafternoon.

• TherecommendedtextbookforNeurologyisNeurologyandNeurosurgeryIllustratedbyKennethLindsayetal.

• Thereisafolderonthedesktopofoneofthecomputersinthedoctors’officelabelled“DrTucker’sreviewarticles”,whichcontainsreviewarticlesonmanyofthecommonneurologicaltopics.

IMPORTANTCONTACTDETAILS

• Nursingstation0214043204/5• Doctors’office0214043444• Clerks0214046029/4043209• Jolene0214043198• Belinda0214045446• FaxnumberforNeurologyreferrals0214045350• HelenCross(forrosterrequests):helenmargot@gmail.com

TIPSANDHINTS

• Dischargesummaries§ Arecomputerised.§ PleasegiveDrLeePanyourfullnameandemailaddressatthestartoftherotation

sohecanassignyoulogindetails.• Neurologyisseenasamore‘chilled’rotation,becauseoftherelativelylownumbersof

patients.Howeveritgivesyouampleopportunitytohoneyourclinicalneurologicalexaminationskillsandtodevelopanapproachtothecommonerneurologicalproblemsthatwillbeencounteredasaphysician.Theconsultantsareveryapproachableandwewouldsuggestyouaskthemforextrateaching-Wednesdayafternoonsaregenerallyagoodtime.

NEWSOMERSETHOSPITAL

STRUCTUREOFTHEUNIT/WARD

• Thereare5medicalteams:A-EthateachconsistofaMedicalRegistrarandeitheranIntern/CosmoorMedicalOfficer.Eachteamisallocatedtoaspecificconsultant.

• Eachteamisoncallevery5thday• MOPD:RunsonWednesdaysandThursdays,theRegwillbeinclinicpre-call(D4)and

yourinternwillbeincliniconD3STAFF

WEEKLYROSTER

MONDAY

08h00

ICUWardRound

12h00

AntibioticStewardship14h30Registrarteaching(DrVallie)

TUESDAY

08h00

ICUWardRound

12h00

AcademicMeeting:2Regswilleachpresenta30mintopic.LastweekofthemonthreplacedbyM&M(Indiekeepsfolders,Regsneedtopreparetheirteamspatientsasperprovideddocument)14h00ECHOswithDrLachmann

WEDNESDAY

08h00

ICUWardRound

08h30MOPDasperRoster(tilllastpatientseen)

CONSULTANTS DrVallieDrBanderkerDrMoosaDrWoolfe(PrivateConsultant)

292625782927

THURSDAY

08h00

ICUWardRound

08h30MOPDasperRoster(tilllastpatientseen)

14h00-16h0016h00-17h00

FCP2TeachingBillHoffenbegGSHDeptofMedicineClinicalMeetingsVenue:LT2GSH

FRIDAY

08h00

ICUWardRound

14h00

WeekendHandoverMeeting

CALLS

• Registrarsareexpectedtobeonsitetill00h00andtocomeoutifthereisanICUadmissionoranemergency.

OTHERCONTACTDETAILS

• Indie(Secretary):6543

• Pharmacy:6362/6460

• Physio:6468/6350• OT:6481• Dietician:6486• SocialWorker:

• BikerstethFemaleWard:6353• KingEdwardMaleWard:6208• BaileyTBWard:6129• 1stfloor:6211• 6thfloor:6330/6316• ICU:6215

• OPDfax:0214026369• OPDclerk:6202/6203

• Radiology:6243

• PACsCo-ordinator:Shaun6189

• NHLSGreenpoint:2165(0214179300)• NHLSGSH:0214044129

• GSH:2050

TIPSANDHINTS

• StressECGsaredoneonFridaysbytheMOs,youneedtodiscusswithaconsultanttobookatest.

• OutpatientECHOscanbebookedwiththeclerks,detailsofinpatientECHOscanbegiventotheMO/CosmodoingtheECHOsthatdaybutyouareresponsibletoensurethatthepatientisattheECHOroomby14h00

RENALSTRUCTUREOFTHEUNIT/WARD

• RenalisdividedintoTransplant,General,AcuteDialysisandClinics.• Medicalregistrarsandmedicalofficersareallocatedtoeachdivisionforacertain

numberofweeksduringtheirrotation.• TheRenalTransplantUnitisinE12,andiscoveredbymedicalandsurgicalregistrars• Renaldoesnothaveaspecificward,andconsultsalloverthehospitalwhenother

specialitiesrequiremanagementofpatientseitherforgeneralrenalinputoracutedialysis.

• RenaldoeshaveelectiveadmissionsforbiopsiesintoG12,onaMondayandWednesday,andtheycanbebookedintotheadmissionsbookinG12

STAFF

CONSULTANTS SENIORREGISTRARSProfBrianRayner(HeadofDivision)77034ProfIkechiOkpechi76953ProfNicciWearne77312DrZunaidBarday76786DrErikaJones

DrBiancaDavidson77326(untilFeb2017)DrMeganBorkum77371DrChimotaPhiri76995DrShepherdKajawo76594DrMarthaAmwaama76587DrWalterMoloi77096

• OTHERSTAFF§ Clerks:AnwarandJoy0214043314§ SocialWorkers:LungiandAdele0214043229or76784§ ClinicSisters:SisterGoliath,NurseduPlessisandNurseMariamAmardien§ Dialysissisters§ RenalTechs§ Dietitian:LynetteCilliers § Typist:AlisonOosthuizen0214042024§ Secretary:DeniseBlankenberg0214045215

WEEKLYROSTERThiswilldifferaccordingtowhereyouareworking.TransplantRoundsareat9.00everydayinE12

• Monday8.00AcademicMeeting–Seminarroom(alltoattend)9.00onwards–HypertensionClinic/Dialysisrounds/TransplantRoundandclinic

13.30GeneralandDialysiswardroundswithconsultant

• Tuesday8.00U10Clinic9.00TransplantRound12.00NewPatientClinic(alltoattend)

• Wednesday8.00TransplantClinic9.00TransplantRound12.00NephriticClinic(alltoattend)

• Thursday8.00HIVANandPDClinic11.00RegistrarTeaching(alltoattend)12.00RenalReplacementMeeting(alltoattend)13.30AdolescentClinic(noteveryweek)14.00Openforteachingifalldivisionshavefinishedtheirwork

• Friday8.00TransplantClinic10.00Tea(alltoattend)12.00BiopsyMeeting(alltoattend)Pre-weekendwardroundsareheldonFriday,atatimethattheweekendconsultantdecides.Allregistrars/MOsinvolvedinAcuteDialysis,General,andthoseoncallfortheweekendaretoattend.

CALLSRenalcallsarefrom16h00onweekdays,andweekendsarecoveredbythesameregistrarfromaFridaytoaSunday.

• WeekdayCalls§ InitiallyallregistrarsandMOsareoncallwithaseniorregistrarandaconsultant.

Thismaychangetowardstheendoftherotation,wheretheregistrarsareoncallwithonlyaconsultant.

§ Allcasesarediscussedfirstwiththeseniorregistrar,whowilldiscusswiththeconsultantoncall.

§ Ifapatientisfordialysis,youwillberequiredtocallouttherenaltechniciansafter-hourstosetupthemachines,aswellasadialysissisterifthepatientisbeingdialysedoutsideICU

• WeekendCalls

§ Roundsusuallystartat06h00sothatyoucanbereadytodiscussallthepatientswiththeconsultantoncalljustafter09h00.

§ Oncealltheworkisdone,youcancallfromhome,andcomeinwhennecessarytoseepatientsandassessfordialysis.

§ RegistrarsrotatingthroughRenalarenotexpectedtodoYellowAreacallsinC15.§ OntheSundaynight,youwillbeexpectedtoemailtheweekendlisttotheteam,

sothattheGeneralandAcuteteamsknowwhotostartwithinthemorning.

• Transplant§ TheTransplantUnitmaycallyouovernightwithaproblemwithoneofthe

transplantpatients,ortoclerkinapatientthathasbeenadmittedfortransplantthenextmorning.

TEACHINGANDRESOURCES

• TheteachinginRenalisexcellent,andprovidesagoodoverallreviewofgeneralnephrologytopics.

• FormalteachingforregistrarsisintheformoflecturesonaThursdayat11h00.• Medicalregistrarsandmedicalofficersareexpectedtopresentintheacademic

meetingsonaMondaymorning.Youwillberosteredtopresent,andmustdiscussyourchoiceoftopicwithyourseniorregistrarorconsultant.

OTHERCONTACTDETAILS

• RenalTransplantUnit0214043312or0214043327• DialysisTechnicians0214043366• AcuteDialysis0214043310or0214043478• ChronicDialysis0214043275or0214043215• PD0214043297• HypertensionClinic0214045378or0214046905or0214046102• RenalFax(referrals)0214045215

TIPSANDHINTS

• AcuteDialysis§ Whenyouareonforacutedialysisyouwillneedtostartat06h00inordertosee

allthepatientsandhaveadialysisplanforthesistersby08h00• Whenyoustart,giveyourcardstothesecretarysothataccesstotheunitcanbe

arranged

• Tryandobserveorputinlinesinyourfirstweek,sothatyouhavealreadydoneafewbythetimeyouareoncall

• NewpatientsatHypertensionClinicallneedaletterthatmustbedictatedbythedoctorwhohasseenthem.ThiscanbedictatedintoavoicenoteandsenttoAlison,oryoucanemailhertheletter,whichshewillformat.ThetemplateiswithSisterBarrettintheHypertensionClinicinE17.Tryandgettheselettersdoneonthesameday,otherwiseitbecomesimpossibletodothemweeksdowntheline

RESPIRATORYSTRUCTUREOFTHEUNIT/WARD

• TheRespiratoryCliniccomprisesofthefollowing:out-patients,in-patients,consultative"cold"service

• The clinic registrars & MOs are jointly responsible for patients in G17 (attached toWednesdaySymonsFirm).ConsultantsdowardroundsbyarrangementwithregistrarorMOinchargeoftheircases.

• Consultations during working hours (08h00 -15h00) are split evenly between theRegistrarsandMOsonarotatingsystemthatisallocatedbytheSecretary(Ms.Robertson)

• YouwillbeemailedtheRespiratoryClinicHandbookpriortostartingtherotation,ensureyoureaditcarefullyasitcontainsimportantinformationabouttheclinic,patientnotesandbuffs,specialinvestigationsandhowtorequestthem

STAFF

CONSULTANTS SENIORREGISTRARS Prof.KeertanDheda(HeadofDivision)Prof.GillAinslieDr.RickyRaineDr.GregSymonsDr.GregCalligaroDr.AllieEsmailDr.LynelleMottayProf.RichardvanZyl-Smit(HonConsultant)Prof.RodneyDawson(HonConsultant)Prof.E.Bateman(EmeritusAss.Prof,HonConsultant)Ass.Prof.P.Wilcox(EmeritusAss.Prof,HonConsultant)

76586760887616176688

DrShikarMothilalDrTrevorMnguni

7746377414

• OTHERSTAFF

§ Clerks:MrCliveDavids,MrsWashielaRus,MsAbrahams4142/4369§ ClinicSisters:SisterCooper4375/4300§ Lungfunctions:MrPeterSephaka(Tech)4372

§ Secretary:BeverleyRobertson–Hawtrey4360 WEEKLYROSTER

MONDAY

Consultantoncall:DrSymons

08h00

Dheda/vanZyl-SmitNewPatient&Follow-upClinic

ProfDheda/ProfvanZyl-Smit,

08h30

InvasiveBronchoscopy/ThoracoscopyList

DrCalligaro,ProfDheda

14h00

AdolescentAllergy/RespiratoryClinic&SmokingCessationClinic

ProfvanZyl-Smit

14h00

CombinedBronchusClinicVenue:LE34

SeniorRegs

15h00

MDR&XDRTBCombPulm/SurgeryClinic

DrCalligaro,ProfDheda,ProfLinegar,

TUESDAY

Consultantoncall:DrCalligaro

08h00

AinslieNewPatientClinic

ProfAinslie

08h00

OccupationalLungDiseaseClinic

DrAdams

09h00

InterstitialLungDiseaseClinic:ProfAinslie

ProfAinslie

13h30

DRTBClinicVenue:BrooklynChestHosp

ProfDheda/DrCalligaro(alternating)

WEDNESDAY

Consultantoncall:ProfDheda

08h00

Symons/DawsonNewPatient&Follow-upClinic

DrSymons/ProfDawson

13h00

SleepStudyReportingMeeting

DrRaine,DrSymons

14h00

RaineFollow-upClinic

DrRaine

16h00

RespAcademicMeetingVenue:E16SeminarRoom4thFriofmonth:PathMeetingVenue:PathSemRoom,C32LEBlock

ALLMEDICALSTAFF

17h00

RespJournalClubVenue:E16SeminarRoom

ALLMEDICALSTAFF

THURSDAY

Consultantoncall:ProfAinslie

08h00

RespiratoryX-rayMeetingVenue:C11SeminarRoom

ALLMEDICALSTAFF

09h00-13h00

AinslieFollow-upClinic

ProfAinslie

10h30-13h00

ExerciseTesting

DrRaine,DrCalligaro

11h30-13h00

BronchoscopyList

SeniorReg

12h00-14h00

4thThursdayofmonth:SleepClinic

DrSymons

12h00-14h00AdolescentAllergy/RespiratoryClinic&SmokingCessationClinic

ProfvZyl-Smit,DrMBateman

14h00-15h00

CysticFibrosisClinic

DrCalligaro

16h00-17h0017h00-18h00

DeptofMedicineClinicalMeetingsVenue:LT2

ALLMEDICALSTAFF

FRIDAY

Consultantoncall:DrRaine

08h00

WardWork

08h30-13h00

CalligaroNew&Follow-upClinic DrCalligaro

14h00

ICUClinicalMeetingVenue:D27SemRoomAnaestheticDept

CALLS

• Theregistrars&MOalternatewardcallonaweeklybasis,MondaytoSunday.

• It isexpectedtoreceiveafterhours/weekendcalls frompatients,GPs, theEmergencyUnitandpatientswhoarewellknowntotheClinic,whileathome.

• Suchpotentialadmissionsshouldbediscussedwiththerespiratoryconsultantinchargeofthepatientpriortoacceptingthepatientforemergencyadmission.Failinghim/her,itcanbediscussedwiththeconsultantoncall.

TEACHINGANDRESOURCES

• TheteachinginRespiratoryisexcellentandmostteachingtakesplaceonaone-onebasisduringpatientpresentations.

• MedicalregistrarsandmedicalofficersareexpectedtopresentintheacademicmeetingsonaWednesdayafternoon.Youwillberosteredtopresent,andmustdiscussyourchoiceoftopicwithyourconsultant

• TheRespiratoryE16Bookletisanexcellent,detailedresourceandincludesimportantdetailsaboutclerkingnotes,patientsummariesandthelayoutthedoctorsareexpectedtouse.Readthisbookletcarefullyespeciallywhendoingtheelectronicpatientsummaries.

• Resources:o TheSAThoracicSocietyGuidelinesforbothasthmaandCOPDwhichare

availableonboththeRespiratoryClinicandMedicalRegistrarsVulasites.TheSAThoracicSocietywebsite(www.pulmonology.co.za)

o GOLD2017:http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/

o TheNormalLung.JohnMurray(Saunders)o RespiratoryPhysiology–TheEssentials.JohnWest(WilliamsandWilkens)o Guidelineforofficespirometryinadults,2012.SAfrJMed2013;103(1);52-61.

DOI:10.7196/SAMJ.6197o LungFunctionTesting;selectionofreferencevaluesandinterpretivestrategies.

AmericanThoracicSociety.AmerRevRespirDis1991;144:1202-18o AmericanThoracicSociety(1995)Standardizationofspirometry.1994Update.

AmJRespirCritCareMed1995;152:1107-1136.o MillerMR,CrapoR,HankinsonJ,etal.Generalconsiderationsforlungfunction

testing.EurRespirJ2005;26:153–161.o MillerMR,HankinsonJ,BrusascoV,etal.Standardisationofspirometry.Eur

RespirJ2005;26:319–338.o WangerJ,ClausenJL,CoatesA,etal.Standardisationofthemeasurementof

lungvolumes.EurRespirJ2005;26:511–522.o MacIntyreN,CrapoRO,ViegiG,etal.Standardisationofthesingle-breath

determinationofcarbonmonoxideuptakeinthelung.EurRespirJ2005;26:720–735.

OTHERCONTACTDETAILS

• TheLungInstitute:71/6119• RespiratoryFax(referrals)0214044369• CTbookings:4209

TIPSANDHINTS

4. Keepuptodatewithyourelectronicsummariesastheycanbuildupfast.

5. EnsureyoucorrectlyplotallPFTsinthepatient’sfolders.

6. Youwillberesponsiblefordoing2-3departmentalpresentationsduringyourtimeinthedepartment.Makesureyoumeetwithyourconsultanttimeouslytochooseatopicandthereviewthepresentationwiththempriortothemeeting.

References1. TheRespiratoryClincHandbook–ProfAinslie

RHEUMATOLOGYSTRUCTUREOFTHEUNIT/WARD

• Rheumatologyislargelyanoutpatientbasedspecialitywithemphasisbeingplacedontheteachingstudentsandregistrars(focusismainlyplacedonexaminationskills)

• ClinicsareheldeitherintheOutpatientsBuildingonHfloor(ArthritisandLupus)orinWardD6(Combinedorthos’andarthritis)inthemainhospital

• Thereareonly2bedsinWardG16forRheumatology,whichareusedfortheadmissionof stable new patients to expedite investigations, or for taking over management ofstable,purelyrheumatologicalpatientsfromotherdepartments

• WardD14bedsareavailableifpatientsrequirerehabilitation

STAFFCONSULTANTS SENIORREGISTRASProfAKalla76863(HeadofDepartment)DrAGcelu77285AuxiliaryConsultants:DrRBreeds(Lupusclinic)DRNAbrahams(everyaltThurs)DrSBotha77279(Mon,Wed&FriClinics&doescalls)DrTooke

DrFMoosajee76994DrAGMohammedDrWLatief(sessionalMOàassistsinArthritisfollowupclinics)

NURSINGSTAFF

• ArthritisSister:MargiePhillipsàdedicatedtotheunitandassistsinpatienteducationandcounselling

• SisterinchargeinWardD6isSrTopandshewillhelpwiththerehabbedbookingandmanagementofthosepatients

• SisterinchargeinH-floorclinicsareSrDavidsorSrMina,whowillhelpwithanyquestionsyouhaveonsortingoutdatesandinvestigationsforpatients

OTHERSTAFF• NellyisthewardclerkinD6andshewillassistwithMondayNewpatientclinicbookings

andwillrequestthefoldersforCyclophosphamide/RituximabinfusionpatientsandfortheXraymeeting

WEEKLYROSTER• Monday8amNewpatientclinicinWardD61:30pmArthritisclinicatHfloorOutpatientBuilding• Tuesday8amLupusCliniconHFloorOutpatientBuilding1pmCombinedOrthosClinicWardD6(1stTuesofthemonth)BiologicsClinicWardD6(2ndTuesofthemonth)• Wednesday7:45amXraymeetingC5/C7(onlyonthe2ndWedofeverymonth)8:30amAcademicmeetingatBillHoffenbergOMB(allotherWed)12pmDGCliniconHFloorOutpatientBuilding• Thursday8amNewPatientClinicHFloorOutpatientBuilding2pmGeneralRegteaching• Friday8amArthritisClinicWardD6CALLS

• The calls are usually week long (Mon – Sun) and entail you taking all inpatient andoutpatientcall/referrals

• DiscussionwiththeConsultantoncallfortheweekisadvisedforallreferrals• AspartofbeinginaspecialunityouwillalsocovertheYellowareaC15for2evening

(4pm–11pmshift)andapossibleweekendshift–Theserequestsarenotrelatedtotherheumatologydepartment

TEACHINGANDRESOURCES• Teachingoccursaroundthebedsideandwith thepresentationofnewpatientsat the

WednesdayAcademicmeetings• TheXraymeeting isalso invaluable in learninghowtorecognisethecommonchanges

associatedwithspecificRheumatologicconditions• Suggestedreading:

o ClinicalExamination:RheumTutor,Highimpactrheumatology(ACRwebsite–freeonEduroam)

o Reading:§ HighImpactRheumatology§ GreenRheumatologyUCTbook

§ Rheumatologyapp§ KumarandClark§ Uptodate

IMPORTANTCONTACTDETAILSLupusclinic/Rheumatology0214045566Orthosarthritis0214045388 TIPSANDREGDUTIES

• Pleaseinformaseniorregistrarorconsultantifyouareunwellorunabletocometoaclinicforwhateverreason.

• Ifyouseeapatientintheclinicthatrequiresadmission,eitherdirectlytoaRheumatologybedortotheMedicalregistrarteams,youwillberesponsibleforthatpatientduringtheirhospitalstay.ThemedicalofficerwillalsolookafteranypatientsadmittedbytheSeniorregistrarstothewardsinRheumatologybeds.

• Try to see all your in-patientsand examine them, on aMonday or at the very latestTuesday afternoon in preparation for theWednesday Academic Round. (Preparing asummaryandaddingallnewinvestigations if thepatientwaspreviouslypresentedwillhelptoensurethingsflowontheround–thenewresultsshouldbeprintedandfiledintherheumfolder)

• Theseniorregistrarsareapproachableandhelpful,discussionwiththemonclinicpatientsandreferralsarewelcomeifyouareunabletocontacttheconsultant.

• ItgoeswithoutsayingthatalltheBloodresultsforNewpatient,RA,LupusandD6Arthritisshouldbecheckedonaweeklybasis–ifaresultisabnormalrequestthefolderanddiscusswiththeSeniorregistrarsorconsultants.

• Onthe2ndWedofeverymonththerewillbeanXraymeeting,youwillneedtoprepareasummaryofallthepatientsforreviewatthismeetingandrequestalltheirfolderstobringtothemeeting.PleasetakeatypedoutsummarytoDrAhmedontheMondayafternoonbeforethex-raymeeting.

• You will also be in charge of the IV cyclophosphamide and biologics bookings. On aMondaymorning before new patient clinic. Please always check FBC results beforegivingCyclophosphamide

• Toparticipate inAcademicpresentations,Journalclubandeven5pmMedicinetalksasallocated

• Theremaybeanin-blockassessmentforyoutowardtheendofyourrotationfocusedonclinicalexaminationofthejoints,soensurethatbytheendofyour3monthrotationyourexaminationskillsareonpoint.

SUPERNUMERARYINFORMATIONSUPERNUMERARYWELCOMEPACKWelcometothedepartmentofMedicine,GrooteSchuurHospital.Thispieceisaimedatguidingyouthroughyourearlymonthsinthedepartment,andtofacilitateyourintegrationintothedepartment.ACCOMODATIONContact-Ms.LiziweFiglanTheclosestaccommodationresidencetoGrooteSchuurhospitalisRochesterOthers:AllAfricanHouse+27216504152IAPO:0216502822/3740canbeofassistanceVacationaccommodation+27216501049/50/51/52OBZsquareFOODForthoseresidinginRochester,youcangetyourpayablemealsfromthecanteen,alsoatSparandPickNPay.YoucanalsobuyyourgroceriesatSparandPickNPick.WithintheGrooteSchuurHospital,youcanhaveyourmealsatLeGroote’sonE-floorBetteradvice:Ifpossiblemakeyourownmealstosavecost.UCTREGISTRATIONMs.Thobekaatthepostgraduateofficeisveryhelpful.ObtainastarterpactfromMs.Liziwe,includingyourLogbookBANKINGYouwillrequireasupportingLetterfromthedepartment,proofofaccommodationdulystamped,admissionofferandIDCardpreferablyyourinternationalpassport.ContactMs.LIziweFiglanAvailablebanksincludeStandardbank-thoughthereisbranchatMowbray,onlythebranchatRondeboschdealswithinternationaltransactions.Otherbanks:FNBandABSAallatMowbrayalongthemainroad.PreferablysortoutUCTregistrationandopeningofbankaccountbeforereportingtowork.WARDSYouwillbeassignedtoaunitasamedicalofficertoworkwitharegistrarandinternsifstartingonGfloor.TheprimarywardsapportionedtothemedicalunitonGfloorincludes12,16,17,and25.Eachwardhasaninternofficewithcomputers.Consumablesarestoredinthestoresroomsoneachward,andalsointhelockers.Whereyou’reunabletolocateanyconsumable,askthenursesontheward.RadiographicinvestigationsarebookedviatheIsitefromthecomputers.RegisterwiththeIsiteandNHLStogetaccesstothecomputerbasedinvestigation/resultpanelYoushouldbegivenlogindetailsonregistration,inthemainwhile,theinternscanbeofassistancetoyou.Youshouldhaveaccesstoup-to-dateasthisremainsawealthofresourcematerialsforyou.Mostcomputersintheinternofficearestockedwithresourcematerials.EXAMSAimatwritingyourFCP1anddiplomaexamsassoonaspossible

StartyourMMEdasearlyaspossible,preferablyimmediatelyafterbothexams.LICENSERENEWALThisiscrucialforyourcontinuouspractice,thestaffoftheHPSCAwillalwayscomeforonthespotregistration,commonlyaroundMarch/AprilinGSH.Endeavortoutilizetheopportunity.AlwaysliaisewithMsLIziweandMsThobeka.VISASEnsurethatyourvisa/Permitarenotexpiredonyou.Starttheprocesspreferably3-4monthsbeforetheexpiration.YouwillneedaletterofmotivationfromtheHODtoprocessyourrenewal.PleaseendeavortoliaiseMsLiziwe.

VICTORIAHOSPITALSTRUCTUREOFTHEUNIT/WARD

Thereare2medicalwards(SandesmedicalmalesandSandesmedicalfemale).Thereisacombinedsurgicalandmedicalward,Wrightward.Thiswardconsistsofgeneralmedicalandsurgical,aswellasasectionforTBpatients.ClinicisMondaytoThursday.Itmustbeattendedbyregistrarsunlessoncallorpostcall.

STAFF

CONSULTANTS DrNasifvanderSchyffDrClintCupido

07219108350726275227

• OTHERSTAFF

§ Secretary:FatimaGallow0846214490-shewillassistwithbookingechodatesforpatients

§ Secretary:NicholaDaniels0846746745WEEKLYROSTER

MONDAY

07h30 Grandwardround:HCU(DrCupido)08h30 PIWRProfHodkinson11h00 ICUroundwithconsultantfromGSH12h45 Diabetic/asthmaclinic(registrarsandinterns)

TUESDAY

07h30 Grandwardround:HCU(DrV/dSchyff)08h30 PIWRDrV/dSchyff/Cupido

08h30 infectiousdiseaseroundwithProfMendelsonandantibioticstewardship

12h00 MOPDandwardfollow-ups WEDNESDAY

07h30 JournalclubatresourcecentreandlastWednesdayofmonthatDPM

07h30 PIWRDrEbrahim09h00 MOPDendocrineclinic

12h00 MIDCclinic,internsandMondayoncallregistrar(infectiousdiseaseclinic)

THURSDAY

07h30 Grandwardround:HCU(DrTurner)08h30 PIWRDrV/dSchyff09h00 Rheumatologyclinic

FRIDAY

07h30 Grandwardround:HCU(DrvanderWalt)08h30 PIWRDrCupido08H30 TeachingDrV/dSchyff08h30 EchowithDrLachman,(pre-callregistrartoassist)12h00 Handover

CALLS

• First:thisissubjecttochangeduetothesafeworkinghours• Internsdo24hourcalls• Registrarisoncallfrom08h00till08h00,butyouareexpectedtopresentyourpatients

onpostintakewardroundandstillseeyouroldpatients.However,theregistrarisallowedtoleaveat23h00,butyoumaybeaskedtocomeseeanyadmissionsthatneedtogotoHCU.TheemergencydepartmentwillseeacuteemergenciesbuttheregistrarneedstoadmitthemtoHCU.Ifyouareconcernedyoumayhaveadifficultintubation,pleasecalltheanaesthetiststocomeandassist.Theyareverywilling!

• MostpatientswillbeadmittedfromtheemergencydepartmentandsomefromMOPD.However,ifaregistrarseesapatientthatneedsadmissionfromMOPDtheyareexpectedtoadmitthepatienttotheirfirm.However,ifthepatientfromMOPDneedsadmissionandisseenbyoneofthemedicalofficersthentheon-callteamisexpectedtoadmitthem,butitisstilltheresponsibilityofthemedicalofficeratMOPDtodothenecessarybloods,drips,etc.

• Surgicalwardandpsychiatrymayaskyoutoseesomewardconsults,thisshouldbedonebefore16h00,unlessthereisanemergencythentheywillaskforhelp.

• RegistrarsareexpectedtoacceptcallsfromGP’s,FalseBayHospital(FBH),DPMandotherreferralcentres.FBHdoesnothaveaHCU,sotheirpatientsmaycomethroughtous.However,ifHCUisfullthentheyareexpectedtoconsultC15/ICU.Ifyouareunsureifthepatientneedstocomethroughitisalwaysagoodideatoconsulttheconsultantoncall.GP’smaycallforadviceoraskforthepatienttobesentthroughtoMOPD

• DrCupidoandDrvanderSchyffarethe2fulltimeconsultants,butDrSmit,DrBangani,andDrTookeworkat2militaryhospital.Alloftheconsultantswillbeoncallataweekatatime.Soitisalwayswisetoconsulttherosterifyouneedtodiscussapatientafterhours.

OTHERCONTACTDETAILS

• Themostimportantnumbertorememberis#56323369258*0,thiswillallowyoutocalloutofthehospitalwithoutgoingthroughswitchboard.

• Switchboard• X-raysafterhours:1176/1173• SMM1188/1291• SMF1177/1185• Wrightward:1195/1216• HCU1119• Emergencyunit1183• Pharmacy1150

TIPSANDHINTS

• IfyouhavenotworkedintheWesternCape,pleaserememberitisexpectedforthe

registrartocallthevariousspecialities’atGSHforassistance.Furthermore,pleaseremembertoalwaysaskaboutthepatientsbaseline.I.e.askabouttheirabilitytoperformADLs

• TherearenoCTscanfacilitiesatVictoriasoallpatientsneedtobediscussedwithCTatGSH.IfitisafterhoursorsickpatientsthenC15needstobeinformedasthepatientwillgotoCTviaC15.WedohoweverhaveultrasoundfacilitieswhichisdonebyDr.Millford

• ThereisnoNHLSlaborbloodbankon-site,soresultsandbloodproductsmaytakealittlelonger.

• ThereisanorganizationwhichisrunbyDrCupidowhichiscalledAbundantLife,thereareanumberofpeopleinvolvedwiththis,butthemostimportantsistertoknowisSr.

Pitout,shewillbetheoneseeingyourreferrals.Thisorganizationwillassistwithhomebasedcareofpatientsthathaveaguardedprognosis

• Occasionallythereisteambuildingwiththeotherfirms.Don’tmissout!• TheSaturdayoncallteamisexpectedtobuyfoodforthehandoveronFridayafternoon.

Thisisanicetimetobondwithyourcolleagues• TheMOSTimportantthingtorememberistopleaseslotyourselfintotheteamvibeof

Victoria,youneverknowwhenyouwillneedhelpfromoneofyourcolleagues.Thisincludesworkingwiththesurgeons,theyareverywillingtohelpussoweshowthemthesamerespect.