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Session One — Pediatric GI Rounds

Patients​

Patient I​

~5 yo F. Liver transplant. Mom was present and consulted for info.

Patient II​

~7 yo F. Haemolytic Anaemia. Liver transplant. Leakage for G2. Issues w/colostomy bag.

Patient III​

~60 mo F. Liver transplant awaiting. Mom in the room.

Patient IV​

~5 yo M. Vomiting, diarrhea. Lots of ‘otomies’. Left arm got swollen (natural) from last blood draw and affected dad who stated he did not want any more blood taken. Informed that this would affect discharge. Dr said we would revisit this tomorrow. In this case try to get it drawn or note “Dad Refused”.

Note that the clinician is allowed to override parents if this were life-threatening. They don’t send patients who have abnormal labs/values home. Child Protective Services, Social Workers, and Patient Services in the hospital can be involved.

Patient V​

~25 day old F. TPN. Used a yellow bag that was entirely customized for her. There is a standard for how much kids need. There is a cheatsheet used to enter the order. There is a special pharmacy that prepares and delivers these bags every day.

Random Notes​

  • “Strict I’s and O’s” → Monitor literally everything in and out of patient.
  • TPN → Total Parenteral Nutrition (IV with all the essentials (carbs, etc))
  • “Nurses are Heroes! So give up the Zeroes!”
  • X-Rays are read inside-out (looking into the x-ray)
  • “Floor-Stable” means the person is not in the ICU.
  • Pediatrics is called “Peds” (pronounced peeds). I was in Peds GI.
  • Note-writing is a lot of summarization.
  • EPIC “allows for a lot of customization”
  • EPIC does not allow for simultaneous note edits.
  • Gram -ve bacteria come from stool.
  • UTICalculator was used during rounds discussion.
  • Translation is done by a ‘live’ human being with the doctors present.
  • You can be a “primary” or “secondary” care doctor. If you are the latter, you are on the care team but the primary; you only make recommendations.
  • “Run the list” → Make a list of the patients they will see that day. Mixed, pri/secondary.
  • Vital signs are monitored every 4 hours on the floor (one parent refused to wake up child in the middle of the night).
  • ARFID - Avoidant/Restrictive Food Intake Disorder. Three subtypes.
  • “PO calorie Count”: Tube/TPN/Whatever. You do this over 3 days.

ChatGPT​

Discussed a case where ascites were confounded with metastases and led to cancer diagnosis. CAT scan revealed some ‘pieces’ in the peritoneum but this was scarring from surgeries. Mere imaging cannot tell cancers apart. ChatGPT noted that this was a common misdiagnosis, doctor verified with experts. Patient ended up having endometriosis-related complications.

Adverse Events​

These may be things like professional misconduct. They are reported via a separate interface (RLDatix KeepSafe). They are used by a committee to emerge any possible sustematic issues with the department or hospital. We noted the case of a small child (TODO: what happened?)

Questions​

Rounds​

  • What is the typical composition of the group? All residents, fellows?
  • What data is being updated in EPIC as a result of these rounds?
  • What are the printouts people are holding and marking?
    • Where do the annotations/information/data end up?
  • Is there a “Biggest Issue” discussion? CC?
  • Is there a hierarchy of topics?
  • Is the entire problem of documentation burden due to insurance and/or ass-covering reasons? Has it gotten any better over time?
  • Who participates in “Run the List”?