Clinical Site: Hartford Hospital

Green, Red, Blue (General Surgery)
Three services at HH provide care for general surgery patients. Patient distribution among the services is determined by the operating resident (i.e.: if the R4 operates on a patient, then that patient goes to his or her service). In the case of consults or ED admissions, those patients are admitted to the service of the on-call chief. All attendings are covered by all services. All resident services are capped at 20 patients.

Services: Blue – R5, R3, R2, R1, Advanced Practitioner (AP – both Physician Assistants and Nursing Practitioners)
              Green – R5, R4, R2, R1, AP
              Red – R5, R3, R1, R1, AP

The Green Chief serves as the “administrative” chief. Responsibilities: daily operative case assignments, clinic assignments, maintaining a census of 20 patients on each service, and the call schedule. Service Chief responsibilities: daily walk rounds with the interns on all floor patients, attending communications, ensuring junior residents work hours and clinic attendance, updating and maintaining M&M lists, presentation of M&M’s, Vignati round presentations.

R4 responsibilities: similar to that of the R5 chiefs but is mainly responsible for afternoon rounds. The R4 usually rounds on the ICU patients and/or higher level acuity outlier patients, The R3 and R2 serve as the “workhorse” of the team. They are designated as the first responders for the consult pager during the day and night call. They should help the interns with the daily floor work of the service, particularly on the “outlier” patients. R1’s help with the daily work of the service including: discharges, checking A.M. labs and replacing electrolytes, ordering and following-up on various tests and studies discussed at sign-out, first response to problem patients on the floor and maintaining “the list”.

Team Organization: Fellows in Trauma surgery, General Surgery R4, Emergency Medicine R3, General Surgery R1, Orthopedic Surgery R1, Emergency Medicine R1, AP’s.

The team leader is the R4. The trauma fellow(s) will help direct the plan of care during sign-out, run activated traumas, and take senior level call. The make-up of the intern level participants varies each block.

Senior resident responsibilities: Daily oversight of the juniors, running activated traumas, seeing all consults, communication with the attending physicians, presentations at weekly conferences and M&M’s, primary care of all of the ICU patients is up to the senior ER resident, surgical R4 and trauma fellow including coordination of procedures and dictations.

Junior resident responsibilities: Patient care (changing wound vacs/dressings), obtaining consults and checking for updated recommendations, patient disposition and discharge dictation, begin initial workup of a trauma consult in the ER and present it to the senior resident on call.

The “in house” trauma attendings all share responsibility for their patients. There is an attending of the week model; that attending is assigned for the week, and rounds with the team and assists the chiefs in patient care and decision making.

Gold Surgery (Thoracic/Vascular Preceptorship)
Team Organization: Vascular fellows, R4, AP’s

The Hartford Hospital Gold Surgery rotation allows residents to gain an experience and appreciation in the pre-, peri-, and postoperative care of primarily Thoracic and Vascular Surgery patients. On this rotation, the PGY-4 resident functions in a preceptorship role. Typical thoracic cases include mediastinoscopy, bronchosopy, lung resections, thoracic portions of esophagectomies. Vascular cases include carotid endarterectomies, lower extremity bypass, and abdominal aortic aneurysm repairs.

Call Responsibilities: home call for vascular, and once a week in-house call for general surgery and vascular.

     Every Monday- 7:00 A.M. Vascular Basic Science (run by the vascular fellows)
     3rd Thursday – 7:00 A.M. Thoracic M&M (the responsibility of the PGY4 resident)
     2nd Thursday – 7:00 A.M. Vascular M&M (run by the vascular fellows)
     Every Friday – 7:00 A.M. angio conference (run by the fellows)
     Every Wednesday – 7:00 A.M. Multidisciplinary Thoracic conference
     Every Friday – 8:30 A.M. UConn surgical lectures (formal attire)

This rotation provides a rich and highly organized experience to caring for some of the most critically ill patients in the hospital.

The Team: one attending each week, 1-3 fellows, 1-3 AP’s, and 1-2 surgery PGY1, Emergency Medicine PGY1, Anesthesia PGY 2-3

Daily Responsibilities:
The post-call intern/resident presents all of the patients. The AP enters orders during rounds. The patients are divided up amongst the residents and AP’s who are there for the day.
After rounds, you call consults, follow up on studies, etc., for “your” patients. First dibs on lines/line changes/procedures are given to the resident who will be taking call that night.

Call Responsibilities: The on-call resident and fellow are responsible for ICU and Step down patients. The on-call resident is responsible for examining all patients and writing notes before morning rounds the next day.

You will be evaluating ICU level patients and should be prepared to call your supervising fellow for questions/concerns. Any invasive procedure or higher level intervention (possible need for intubation, starting pressors, etc.) should be run by a fellow. If the fellow is unavailable (evaluating patients for ICU placement or assisting in another ICU), the in-house general surgery chief is your next available senior and should be utilized accordingly.

Plastic Surgery
Residents: R2 (serves as chief), surgery or orthopedic R1, AP’s

The Hartford Hospital Plastic Surgery rotation allows the junior resident to gain experience with both cosmetic and reconstructive surgery. This rotation will help residents refine their basic surgical operating techniques including simple and complex wound closure, developing proper tissue planes, and tissue handling.

Resident will also be exposed to hand surgery, for which they will periodically take ED hand call, and every Friday have a chance to spend time with Dr. Castiglione or Dr. Cech at CT Children's dealing with craniofacial reconstruction.

The service is run by the categorical R2 and at times will have anywhere from 2-3 residents depending on the month. The plastic surgery AP handles a majority of the floor work during the day so that residents have adequate operating time. Residents attend hand clinic and office hours with any of the plastic surgery attendings.

Cases: breast augmentation and reduction, breast reconstruction following mastectomy, hand surgery cases, simple and complex reconstructive procedures

     Plastic surgery conference
     Hand conference

Residents: General surgery R3’s (UConn and other programs), AP’s     

The Hartford Hospital Transplant rotation allows the resident to gain an experience and appreciation for patients in the pre-, peri-, and postoperative period of organ transplantation and exposure to liver and kidney transplantation. The resident will also be involved with access surgery, including dialysis catheter and fistula formation.

Call Responsibilities: home call

      1st Thursday – Path conference
      2nd Tuesday – Clinical conference
      2nd Thursday – M&M (surgical resident is responsible for presenting)
      Weekly – Pre-transplant conferences for kidney and liver (with medical attendings)