Preparing For and Navigating Clinic - Revision history

JenniferH: /* Otitis media in patients less than 3 months of age */

2020-11-11T20:57:32Z

Otitis media in patients less than 3 months of age

← Older revision		Revision as of 20:57, 11 November 2020
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	Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.		Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.

	[[:category:Pediatrics]]
			[[:category:Pediatrics\|Pediatrics Main Page]]

JenniferH: /* Otitis media in patients less than 3 months of age */

2020-03-31T01:04:34Z

Otitis media in patients less than 3 months of age

← Older revision		Revision as of 01:04, 31 March 2020
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	All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.		All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.

	[[~~Otitis Media 3 months–12 years~~\|Otitis Media Clinical Guideline]]		[[media:AOM_peds.pdf\|Otitis Media YKHC Clinical Guideline]]

	Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.		Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.

	[[:category:Pediatrics]]		[[:category:Pediatrics]]

JenniferH at 01:30, 25 June 2018

2018-06-25T01:30:38Z

JaneM at 23:49, 9 February 2018

2018-02-09T23:49:43Z

← Older revision		Revision as of 23:49, 9 February 2018
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	You will have adolescent patients who come from various facilities such as the McCann Treatment Center (MTC) and Bethel Youth Facility. In general you should ask the escort why they are being brought in. Often times it is for a monthly physical that is required while they are in the facility. This is a good time to address any medical concerns, refill chronic meds, update immunizations etc. The initial exam for patients first entering the MTC needs to include an EKG, a CBC, and a comprehensive as these patients are at risk for anemia, hepatotoxicity, and prolonged QT. These studies need not be repeated after the initial exam unless an abnormality is detected. All YKHC residential facilities require a completed medication reconciliation form and a copy of the exam with any recommendations at the time of the visit – please complete your note and send a copy with the escort. If you require further information, please contact the respective facility.		You will have adolescent patients who come from various facilities such as the McCann Treatment Center (MTC) and Bethel Youth Facility. In general you should ask the escort why they are being brought in. Often times it is for a monthly physical that is required while they are in the facility. This is a good time to address any medical concerns, refill chronic meds, update immunizations etc. The initial exam for patients first entering the MTC needs to include an EKG, a CBC, and a comprehensive as these patients are at risk for anemia, hepatotoxicity, and prolonged QT. These studies need not be repeated after the initial exam unless an abnormality is detected. All YKHC residential facilities require a completed medication reconciliation form and a copy of the exam with any recommendations at the time of the visit – please complete your note and send a copy with the escort. If you require further information, please contact the respective facility.
	===Child Advocacy Center Well Child (CAC) follow-up===		===Child Advocacy Center Well Child (CAC) follow-up===
	These "CAC follow up appts" are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. These patients have been interviewed at the CAC and are presenting for physical exam. Acute exams, less than 96 hours, are completed by a pediatric SANE provider who collects and processes forensic data including photographs with colposcope. See ~~'''~~Suspected Prepubescent Child Sexual Abuse Procedure~~'''~~ for details on the process.		These "CAC follow up appts" are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. These patients have been interviewed at the CAC and are presenting for physical exam. Acute exams, less than 96 hours, are completed by a pediatric SANE provider who collects and processes forensic data including photographs with colposcope. See [[Suspected Prepubescent Child Sexual Abuse Procedure\|Suspected Prepubescent Child Sexual Abuse Procedure]] for details on the process.

	===Otitis media in patients less than 3 months of age===		===Otitis media in patients less than 3 months of age===
	All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.		All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.

JaneM at 23:38, 9 February 2018

2018-02-09T23:38:42Z

← Older revision		Revision as of 23:38, 9 February 2018
Line 27:		Line 27:
	All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.		All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.

	[[~~Acute~~ Otitis Media 3 ~~months –12~~ years\|Otitis Media Clinical Guideline]]		[[Otitis Media 3 months–12 years\|Otitis Media Clinical Guideline]]

	Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.		Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.

	[[:category:Pediatrics]]		[[:category:Pediatrics]]

JaneM: updating

2018-02-09T23:24:40Z

updating

← Older revision		Revision as of 23:24, 9 February 2018
Line 1:		Line 1:
	# Review clinic schedule with assigned nurse. It is a good idea to review the chart, health summary, Vaccine Registry, radiological/ laboratory studies recently ordered PRIOR to seeing a patient. Another provider or several different providers ~~will~~ have seen many of our patients before being seen in the ~~pediatric clinic~~. This makes reviewing the chart essential to providing quality care. If you do not check the computer you will not know that labs exits. Avoid missing abnormal labs by checking the lab section on all follow up patients.		Before starting your day and periodically throughout your clinic day:
	# Check to make sure that you have appropriately scheduled patients. For example, if you are unable to do skin biopsy then ~~they~~ should be rescheduled with another provider. In general we try to work in any ~~CPP~~ that needs to be seen that day. There should be at least two pediatric providers in clinic every day; our access is fairly good. Some patients may be added as overbooks each day; if more time is needed to manage a particularly complicated problem, you may need to reschedule a longer visit for that purpose.
	# Please try to maintain efficiency in clinic. You may be on call that day starting at 5PM. Please be respectful of your colleague who may need to give sign out. You need contact the peds wards person, have beeper turned on and be ready to get sign out at 5 p.m.		*Review clinic schedule with assigned nurse. It is a good idea to review the chart, health summary, Vaccine Registry, radiological/ laboratory studies recently ordered PRIOR to seeing a patient. Another provider or several different providers or health aides may have seen many of our patients before being seen in the clinics in Bethel. This makes reviewing the chart essential to providing quality care. If you do not check the computer you will not know that labs exits. Avoid missing abnormal labs by checking the lab section on all follow up patients.

			*Check to make sure that you have appropriately scheduled patients. For example, if you are unable to do a skin biopsy then the patient should be rescheduled with another provider. In general we try to work in any CPPs that needs to be seen that day. There should be at least two pediatric providers in clinic every day; our access is fairly good. Some patients may be added as overbooks each day; if more time is needed to manage a particularly complicated problem, you may need to reschedule a longer visit for that purpose.

	===Hospital Discharge Follow ups===		===Hospital Discharge Follow ups===
Line 9:		Line 11:
	Review previous documentation in the chart. Check labs, cultures and radiological images. Check to make sure patient is on appropriate dose of medications if dispensed from ER.		Review previous documentation in the chart. Check labs, cultures and radiological images. Check to make sure patient is on appropriate dose of medications if dispensed from ER.

	~~––Patients~~ are often followed in clinic for several days while rooming in at the Hostel. For example, patient requiring IV antibiotics for pneumonia will often receive several days of outpatient IV Ceftriaxone prior to switching to oral medications. Unless a pneumonia patient requires oxygen, IV fluid, or looks septic they will not be admitted. Patients that would often be an automatic admit in the Lower 48 may be treated as an outpatient in Bethel. Check with ~~the “old timers”~~ before admitting a patient until you are familiar with our system. Remember that some simple follow-ups are appropriately handled by the health aid in the village. For example, a patient need not return to Bethel for ~~an otitis media~~ follow up exam. The health aide in the village can do this. The health aides are a great resource; so remember to use them if appropriate.		–Patients are often followed in clinic for several days while rooming in at the Hostel. For example, patient requiring IV antibiotics for pneumonia will often receive several days of outpatient IV Ceftriaxone prior to switching to oral medications. Unless a pneumonia patient requires oxygen, IV fluid, or looks septic they will not be admitted. Patients that would often be an automatic admit in the Lower 48 may be treated as an outpatient in Bethel. Check with more experienced providers, before admitting a patient, until you are familiar with our system. Remember that some simple follow-ups are appropriately handled by the health aid in the village. For example, a patient need not return to Bethel for a pneumonia follow up exam. The health aide in the village can do this. The health aides are a great resource; so remember to use them if appropriate.

	===Weather delays===		===Weather delays===
	Consider having your nurse call in your Bethel patients to be seen earlier that day for village patients arriving later d/t weather. If you have no patients to be seen consider pulling level 4/5 patients from the ER. Discuss with your charge nurse.		Consider having your nurse call in your Bethel patients to be seen earlier that day for village patients arriving later d/t weather. If you have no patients to be seen consider pulling level 4/5 patients from the ER. Discuss with your charge nurse.
	===Hallway Peds Consults===With ~~our move~~ into the family ~~practice~~ hallways, we have changed the consult system to some extent. Curbside consults on patients being seen that day in the hallway or managed via RMT will usually be directed to the pediatric provider in that hallway. If it is a very complicated situation or will require ongoing management that might get in the way of your clinic schedule, the question can be referred to the ~~on-call~~ pediatric provider.		===Hallway Peds Consults===With pediatric providers integration into the family medicine hallways, we have changed the consult system to some extent. Curbside consults on patients being seen that day in the hallway or managed via RMT will usually be directed to the pediatric provider in that hallway. If it is a very complicated situation or will require ongoing management that might get in the way of your clinic schedule, the question can be referred to the hospitalist pediatric provider.
	===Dental Pre-ops===		===Dental Pre-ops===
	We frequently get dental pre-op patients who need to be examined prior to their procedure. ~~The~~ dental pre-op ~~form~~ is self ~~explanatory~~ and needs to be completely filled out. If ~~you find something that needs follow up~~ in ~~pediatric clinic reschedule~~ the ~~patient after they have had surgery~~. If you decide not to clear the patient for ~~some reason please~~ call the OR~~/CRNA and inform~~ them ~~as they will need~~ to reschedule the patient. We have CRNA’s that do anesthesia for pediatric cases here. ~~More complicated~~ patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage. One of our jobs in doing preoperative exams is to determine if a patient has any risk factors that make him/her a poor candidate for surgery in Bethel. This includes any respiratory illness in the past four weeks! If the patient has a history of prior respiratory or other disease that has now resolved, please document that assessment. If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery.		We frequently get dental pre-op patients who need to be examined prior to their procedure that day or the following day. There is a dental pre-op note in RAVEN. The powernote is self directing and needs to be completely filled out. If the child has any high risk medical conditions found on chart review or if the child has had any respiratory illness in the prior 4 weeks, the procedure needs to be canceled and rescheduled. If you decide not to clear the patient for surgery call the OR to let them know to reschedule the patient.

			Our dental cases are elective. We are very conservative about only doing procedures on healthy low risk kids. We have CRNA’s that do anesthesia for pediatric cases here. Complicated patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage. One of our jobs in doing preoperative exams is to determine if a patient has any risk factors that make him/her a poor candidate for surgery in Bethel. This includes any respiratory illness in the past four weeks! If the patient has a history of prior respiratory or other disease that has now resolved, please document that assessment. If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery.
	===Adolescent McCann Treatment Center (MTC) and Bethel Youth Facility Patients===		===Adolescent McCann Treatment Center (MTC) and Bethel Youth Facility Patients===
	You will have adolescent patients who come from various facilities such as the McCann Treatment Center (MTC) and Bethel Youth Facility. In general you should ask the escort why they are being brought in. Often times it is for a monthly physical that is required while they are in the facility. This is a good time to address any medical concerns, refill chronic meds, update immunizations etc. The initial exam for patients first entering the MTC needs to include an EKG, a CBC, and a comprehensive as these patients are at risk for anemia, hepatotoxicity, and prolonged QT. These studies need not be repeated after the initial exam unless an abnormality is detected. All YKHC residential facilities require a completed medication reconciliation form and a copy of the exam with any recommendations at the time of the visit – please complete your note and send a copy with the escort. If you require further information, please contact the respective facility.		You will have adolescent patients who come from various facilities such as the McCann Treatment Center (MTC) and Bethel Youth Facility. In general you should ask the escort why they are being brought in. Often times it is for a monthly physical that is required while they are in the facility. This is a good time to address any medical concerns, refill chronic meds, update immunizations etc. The initial exam for patients first entering the MTC needs to include an EKG, a CBC, and a comprehensive as these patients are at risk for anemia, hepatotoxicity, and prolonged QT. These studies need not be repeated after the initial exam unless an abnormality is detected. All YKHC residential facilities require a completed medication reconciliation form and a copy of the exam with any recommendations at the time of the visit – please complete your note and send a copy with the escort. If you require further information, please contact the respective facility.
	===Child Advocacy Center Well Child~~/SART~~ follow-up===		===Child Advocacy Center Well Child (CAC) follow-up===
	These are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. ~~Often these~~ patients have been interviewed at the CAC and are presenting for physical exam. Acute exams less than 96 hours are ~~often~~ completed ~~in the SART room in conjunction with the SART nurse~~ who ~~assists in collecting~~ forensic data including photographs with colposcope. See ~~guidelines~~ for details on the process.		These "CAC follow up appts" are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. These patients have been interviewed at the CAC and are presenting for physical exam. Acute exams, less than 96 hours, are completed by a pediatric SANE provider who collects and processes forensic data including photographs with colposcope. See '''Suspected Prepubescent Child Sexual Abuse Procedure''' for details on the process.
	===Otitis media in patients less than 3 months of age===		===Otitis media in patients less than 3 months of age===
	All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.		All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.

Mfaubion: /* Otitis media in patients less than 3 months of age */

2015-11-05T20:48:24Z

Otitis media in patients less than 3 months of age

← Older revision		Revision as of 20:48, 5 November 2015
Line 21:		Line 21:
	These are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. Often these patients have been interviewed at the CAC and are presenting for physical exam. Acute exams less than 96 hours are often completed in the SART room in conjunction with the SART nurse who assists in collecting forensic data including photographs with colposcope. See guidelines for details on the process.		These are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. Often these patients have been interviewed at the CAC and are presenting for physical exam. Acute exams less than 96 hours are often completed in the SART room in conjunction with the SART nurse who assists in collecting forensic data including photographs with colposcope. See guidelines for details on the process.
	===Otitis media in patients less than 3 months of age===		===Otitis media in patients less than 3 months of age===
	All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic. [[Acute Otitis Media 3 months –12 years\|Otitis Media Clinical Guideline]]		All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.

			[[Acute Otitis Media 3 months –12 years\|Otitis Media Clinical Guideline]]

	Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.		Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.

	[[:category:Pediatrics]]		[[:category:Pediatrics]]

Mfaubion: /* Otitis media in patients less than 3 months of age */

2015-11-05T20:47:58Z

Otitis media in patients less than 3 months of age

← Older revision		Revision as of 20:47, 5 November 2015
Line 21:		Line 21:
	These are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. Often these patients have been interviewed at the CAC and are presenting for physical exam. Acute exams less than 96 hours are often completed in the SART room in conjunction with the SART nurse who assists in collecting forensic data including photographs with colposcope. See guidelines for details on the process.		These are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. Often these patients have been interviewed at the CAC and are presenting for physical exam. Acute exams less than 96 hours are often completed in the SART room in conjunction with the SART nurse who assists in collecting forensic data including photographs with colposcope. See guidelines for details on the process.
	===Otitis media in patients less than 3 months of age===		===Otitis media in patients less than 3 months of age===
	All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic. [[~~Link to peds OM guideline here~~]]		All infants less than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic. [[Acute Otitis Media 3 months –12 years\|Otitis Media Clinical Guideline]]

	Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.		Follow up appointments should be made with the provider who initially evaluated the patient. If provider is not available, please schedule with another pediatrician with appropriate sign out. Please update the problem lists.

	[[:category:Pediatrics]]		[[:category:Pediatrics]]

Mfaubion at 20:45, 5 November 2015

2015-11-05T20:45:04Z

← Older revision		Revision as of 20:45, 5 November 2015
Line 1:		Line 1:
	1. Review clinic schedule with assigned nurse. It is a good idea to review the chart, health summary, Vaccine Registry, radiological/ laboratory studies recently ordered PRIOR to seeing a patient. Another provider or several different providers will have seen many of our patients before being seen in the pediatric clinic. This makes reviewing the chart essential to providing quality care. If you do not check the computer you will not know that labs exits. Avoid missing abnormal labs by checking the lab section on all follow up patients.		# Review clinic schedule with assigned nurse. It is a good idea to review the chart, health summary, Vaccine Registry, radiological/ laboratory studies recently ordered PRIOR to seeing a patient. Another provider or several different providers will have seen many of our patients before being seen in the pediatric clinic. This makes reviewing the chart essential to providing quality care. If you do not check the computer you will not know that labs exits. Avoid missing abnormal labs by checking the lab section on all follow up patients.
			# Check to make sure that you have appropriately scheduled patients. For example, if you are unable to do skin biopsy then they should be rescheduled with another provider. In general we try to work in any CPP that needs to be seen that day. There should be at least two pediatric providers in clinic every day; our access is fairly good. Some patients may be added as overbooks each day; if more time is needed to manage a particularly complicated problem, you may need to reschedule a longer visit for that purpose.
	2. Check to make sure that you have appropriately scheduled patients. For example, if you are unable to do skin biopsy then they should be rescheduled with another provider. In general we try to work in any CPP that needs to be seen that day. There should be at least two pediatric providers in clinic every day; our access is fairly good. Some patients may be added as overbooks each day; if more time is needed to manage a particularly complicated problem, you may need to reschedule a longer visit for that purpose.		# Please try to maintain efficiency in clinic. You may be on call that day starting at 5PM. Please be respectful of your colleague who may need to give sign out. You need contact the peds wards person, have beeper turned on and be ready to get sign out at 5 p.m.

	3. Please try to maintain efficiency in clinic. You may be on call that day starting at 5PM. Please be respectful of your colleague who may need to give sign out. You need contact the peds wards person, have beeper turned on and be ready to get sign out at 5 p.m.

	===Hospital Discharge Follow ups===		===Hospital Discharge Follow ups===

Mfaubion: /* Hospital Discharge Follow ups */

2015-11-05T20:43:52Z

Hospital Discharge Follow ups

← Older revision		Revision as of 20:43, 5 November 2015
Line 6:		Line 6:

	===Hospital Discharge Follow ups===		===Hospital Discharge Follow ups===
	Have case manager or nurse obtain records from parent or from discharged facility. For example NICU discharges often come from Providence Medical Center. We do not have direct access to their system like ANMC. Check to make sure patient has appropriate follow up appointments with specialty providers if needed. If patient was started on meds, make sure they have them ordered in our system and refills ordered if needed.		Have case manager or nurse obtain records from parent or from discharged facility. For example NICU discharges often come from Providence Medical Center. We do not have direct access to their system like ANMC. Check to make sure patient has appropriate follow up appointments with specialty providers if needed. If patient was started on meds, make sure they have them ordered in our system and refills ordered if needed.

	===ER Follow ups===		===ER Follow ups===

← Older revision		Revision as of 01:30, 25 June 2018
Line 1:		Line 1:
	Before starting your day and periodically throughout your clinic day:		Before starting your day and periodically throughout your clinic day:

	*Review clinic schedule with assigned nurse. It is a good idea to review the chart, health summary, Vaccine Registry, radiological/ laboratory studies recently ordered PRIOR to seeing a patient. Another provider or several different providers or health aides may have seen many of our patients before being seen in the clinics in Bethel. This makes reviewing the chart essential to providing quality care. If you do not check the computer you will not know that labs ~~exits~~. Avoid missing abnormal labs by checking the lab section on all follow up patients.		*Review clinic schedule with assigned nurse. It is a good idea to review the chart, health summary, Vaccine Registry, radiological/ laboratory studies recently ordered PRIOR to seeing a patient. Another provider or several different providers or health aides may have seen many of our patients before being seen in the clinics in Bethel. This makes reviewing the chart essential to providing quality care. If you do not check the computer you will not know that labs exist. Avoid missing abnormal labs by checking the lab section on all follow up patients.

	*Check to make sure that you have appropriately scheduled patients. For example, if you are unable to do a skin biopsy then the patient should be rescheduled with another provider. In general we try to work in any ~~CPPs~~ that needs to be seen that day. There should be at least two pediatric providers in clinic every day; our access is fairly good. Some patients may be added as overbooks each day; if more time is needed to manage a particularly complicated problem, you may need to reschedule a longer visit for that purpose.		*Check to make sure that you have appropriately scheduled patients. For example, if you are unable to do a skin biopsy then the patient should be rescheduled with another provider. In general we try to work in any CPP patient that needs to be seen that day. There should be at least two pediatric providers in clinic every day; our access is fairly good. Some patients may be added as overbooks each day; if more time is needed to manage a particularly complicated problem, you may need to reschedule a longer visit for that purpose.

	===Hospital Discharge Follow ups===		===Hospital Discharge Follow ups===
	Have case manager or nurse obtain records from parent or from ~~discharged~~ facility. For example NICU discharges often come from Providence Medical Center. We do not have direct access to their system like ANMC. Check to make sure patient has appropriate follow up appointments with specialty providers if needed. If patient was started on meds, make sure they have them ordered in our system and refills ordered if needed.		Have case manager or nurse obtain records from parent or from discharge facility. For example NICU discharges often come from Providence Medical Center. We do not have direct access to their system like ANMC. Check to make sure patient has appropriate follow up appointments with specialty providers if needed. If patient was started on meds, make sure they have them ordered in our system and refills ordered if needed.

	===ER Follow ups===		===ER Follow ups===
	Review previous documentation in the chart. Check labs, cultures and radiological images. Check to make sure patient is on appropriate dose of medications if dispensed from ER.		Review previous documentation in the chart. Check labs, cultures and radiological images. Check to make sure patient is on appropriate dose of medications if dispensed from ER.

	–Patients are often followed in clinic for several days while rooming in at the Hostel. For example, ~~patient~~ requiring IV antibiotics for ~~pneumonia~~ will often receive several days of outpatient IV Ceftriaxone ~~prior to switching to oral medications~~. Unless a ~~pneumonia~~ patient requires oxygen, IV ~~fluid~~, or looks septic they will not be admitted. Patients that would often be an automatic admit in the Lower 48 may be treated as an outpatient in Bethel. Check with more experienced providers, before admitting a patient, until you are familiar with our system. Remember that some simple follow-ups are appropriately handled by the health ~~aid~~ in the village. For example, a patient need not return to Bethel for a pneumonia follow up exam. The health aide in the village can do this. The health aides are a great resource; so remember to use them if appropriate.		–Patients are often followed in clinic for several days while rooming in at the Hostel. For example, an infant <3 months old requiring IV antibiotics for rule out sepsis workup will often receive several days of outpatient IV Ceftriaxone until cultures have been confirmed negative. Unless a patient requires oxygen, IV fluids, or looks septic they will not be admitted. Patients that would often be an automatic admit in the Lower 48 may be treated as an outpatient in Bethel. Check with more experienced providers, before admitting a patient, until you are familiar with our system. Remember that some simple follow-ups are appropriately handled by the health aide in the village. For example, a patient need not return to Bethel for a pneumonia follow up exam. The health aide in the village can do this. The health aides are a great resource; so remember to use them if appropriate.

	===Weather delays===		===Weather delays===
	Consider having your nurse call in your Bethel patients to be seen earlier that day for village patients arriving later ~~d/t~~ weather. If you have no patients to be seen consider pulling level 4/5 patients from the ER. Discuss with your charge nurse.		Consider having your nurse call in your Bethel patients to be seen earlier that day for village patients arriving later due to weather. If you have no patients to be seen consider pulling level 4/5 patients from the ER. Discuss with your charge nurse prior to pulling patients.
	===Hallway Peds Consults===With pediatric providers integration into the family medicine hallways, we have changed the consult system to some extent. Curbside consults on patients being seen that day in the hallway or managed via RMT will usually be directed to the pediatric provider in that hallway. If it is a very complicated situation or will require ongoing management that might get in the way of your clinic schedule, the question can be referred to the hospitalist pediatric provider.		===Hallway Peds Consults===With pediatric providers integration into the family medicine hallways, we have changed the consult system to some extent. Curbside consults on patients being seen that day in the hallway or managed via RMT will usually be directed to the pediatric provider in that hallway. If it is a very complicated situation or will require ongoing management that might get in the way of your clinic schedule, the question can be referred to the hospitalist pediatric provider.
	===Dental Pre-ops===		===Dental Pre-ops===
Line 21:		Line 21:
	Our dental cases are elective. We are very conservative about only doing procedures on healthy low risk kids. We have CRNA’s that do anesthesia for pediatric cases here. Complicated patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage. One of our jobs in doing preoperative exams is to determine if a patient has any risk factors that make him/her a poor candidate for surgery in Bethel. This includes any respiratory illness in the past four weeks! If the patient has a history of prior respiratory or other disease that has now resolved, please document that assessment. If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery.		Our dental cases are elective. We are very conservative about only doing procedures on healthy low risk kids. We have CRNA’s that do anesthesia for pediatric cases here. Complicated patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage. One of our jobs in doing preoperative exams is to determine if a patient has any risk factors that make him/her a poor candidate for surgery in Bethel. This includes any respiratory illness in the past four weeks! If the patient has a history of prior respiratory or other disease that has now resolved, please document that assessment. If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery.
	===Adolescent McCann Treatment Center (MTC) and Bethel Youth Facility Patients===		===Adolescent McCann Treatment Center (MTC) and Bethel Youth Facility Patients===
	You will have adolescent patients who come from various facilities such as the McCann Treatment Center (MTC) and Bethel Youth Facility. In general you should ask the escort why they are being brought in. Often times it is for a monthly physical that is required while they are in the facility. This is a good time to address any medical concerns, refill chronic meds, update immunizations etc. The initial exam for patients first entering the MTC needs to include an EKG, a CBC, and a comprehensive as these patients are at risk for anemia, hepatotoxicity, and prolonged QT. These studies need not be repeated after the initial exam unless an abnormality is detected. All YKHC residential facilities require a completed medication reconciliation form and a copy of the exam with any recommendations at the time of the visit – please complete your note and send a copy with the escort. If you require further information, please contact the respective facility.		You will have adolescent patients who come from various facilities such as the McCann Treatment Center (MTC) and Bethel Youth Facility. In general, you should ask the escort why they are being brought in. Often times it is for a monthly physical that is required while they are in the facility. This is a good time to address any medical concerns, refill chronic meds, update immunizations etc. The initial exam for patients first entering the MTC needs to include an EKG, a CBC, and a comprehensive as these patients are at risk for anemia, hepatotoxicity, and prolonged QT. These studies need not be repeated after the initial exam unless an abnormality is detected. All YKHC residential facilities require a completed medication reconciliation form and a copy of the exam with any recommendations at the time of the visit – please complete your note and send a copy with the escort. If you require further information, please contact the respective facility.
	===Child Advocacy Center Well Child (CAC) follow-up===		===Child Advocacy Center Well Child (CAC) follow-up===
	These "CAC follow up appts" are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. These patients have been interviewed at the CAC and are presenting for physical exam. Acute exams, less than 96 hours, are completed by a pediatric SANE provider who collects and processes forensic data including photographs with colposcope. See [[Suspected Prepubescent Child Sexual Abuse Procedure\|Suspected Prepubescent Child Sexual Abuse Procedure]] for details on the process.		These "CAC follow up appts" are 60 minute appointments for evaluation of cases of child sexual abuse which are non-acute greater than 96 hours. These patients have been interviewed at the CAC and are presenting for physical exam. Acute exams, less than 96 hours, are completed by a pediatric SANE provider who collects and processes forensic data including photographs with colposcope. See [[Suspected Prepubescent Child Sexual Abuse Procedure\|Suspected Prepubescent Child Sexual Abuse Procedure]] for details on the process.