BRONX-LEBANON HOSPITAL CENTER

Jolly Radhakrishnan, M.D.

The Inpatient Service is staffed by one team during spring and summer, and by two teams during the fall and winter. Each team is headed by an attending physician. Thus, at a given time there may be one or two attending physicians on service.  During each cycle, four interns and two to three senior (PL 2/3)  are assigned to the Inpatient Service.

In addition, third and fourth year medical students from the Albert Einstein College of Medicine may be assigned to the teams. Bronx-Lebanon Hospital Center also has an active Physician Assistant Training Program, and trainees from the program may be assigned to the teams for their clinical rotations.

The attending physician has overall responsibility for the Inpatient Service. They are also responsible for house staff education, the conduct and content of rounds, and for house staff evaluation. Although the house staff plays a major role in determining the work up and treatment of all the inpatients, the input of the attending must be incorporated and they must be informed of any unexpected changes in a patient’s condition.

The Chief Residents play an important role in supervising the activities of house staff. They help in coordinating patient flow and supervising medical management. They are available to the house staff twenty-four hours of the day for assistance with problems involving patient care.

GOALS & OBJECTIVES

The Inpatient Service rotation should allow the house officer to gain experience in:

The performance of a comprehensive admission history and physical examination the formulation of a differential diagnosis

The formulation of proper admission orders including appropriate therapies and  laboratory evaluations

The writing of clear, concise and informative admission and daily progress notes

The clear, concise presentation of patients on work and attending rounds

The orderly and complete signing out of patients to covering physicians

The performance of technical procedures in accordance with established delineation of privileges guidelines.

Care of patients with a wide range of general pediatric and subspecialty pediatric conditions.

§    Working with other disciplines such as Social Service, Child Life, Discharge Planning, Home Care, Nutrition, Nursing. Formulation of comprehensive discharge and follow-up plans. The teaching of medical students and junior house officers.

Primary Goals for this Rotation

Common Signs and Symptoms

Evaluate and manage common signs and symptoms associated with acute illness and hospitalization.

Evaluate and manage, with consultation of indicated, patients with signs and symptoms that commonly present to the Inpatient Unit.

Common Conditions

Recognize and manage common childhood conditions presenting to the Inpatient Unit

Evaluate and manage, with consultation as indicated, patients with conditions that commonly present to the Inpatient Unit.

Diagnostic and Screening Procedures

Utilize common diagnostic tests and imaging studies appropriately in the inpatient setting

Demonstrate an understanding of the common diagnostic tests and imaging studies used in the inpatient setting, by being able to:

Apply knowledge of diagnostic test properties, including the use of sensitivity, specificity, positive predictive value, negative predictive value, false-positive and negative results, likelihood ratios, and receiver operating characteristic curves, to assess the utility of tests in various clinical settings.

Use common laboratory studies when indicated for patients in the inpatient setting:

1.       CBC with differential, platelet count, RBC indices.

2.       Blood chemistries: electrolytes, glucose, calcium, magnesium, phosphate.

3.       Renal function tests.

4.       Tests of hepatic function (PT, albumin) and damage (liver enzymes, bilirubin).

5.       Serologic tests for infection (e.g., hepatitis, HIV).

6.       C-reactive protein, erythrocyte sedimentation rate.

7.       Therapeutic drug concentrations.

8.       Coagulation studies.

9.       Arterial, capillary, and venous blood gases.

10.    Detection of bacterial, viral, and fungal pathogens.

11.    Urinalysis.

12.    Cerebrospinal fluid analysis.

13.    Gram stain.

14.    Stool studies.

15.    Other fluid studies (e.g. pleural fluid, joint fluid).

16.    Electrocardiogram.

Use common imaging or radiographic studies when indicated for patients on the inpatient unit:

1.       Plain radiographs of the chest, extremities, abdomen, skull, sinuses.

2.       Other imaging techniques such as CT, MRI, angiography, ultrasound, nuclear scans, and contrast studies (interpretation not expected).

3.       Echocardiogram.

Monitoring and Therapeutic Modalities

Understand how to use physiologic monitoring and special technology in the general inpatient setting, including issues specific to care of the chronically ill child

Demonstrate understanding of the monitoring techniques and special treatments commonly used in the inpatient setting.