Welcome to the consult service at West Bloomfield Hospital (WBH). Below are the essentials for a successful rotation at WBH.
PARKING
Physician parking is on the “hill” outside of the main entrance. The patient and family parking lot is the lower lot outside the main entrance. Of note the parking by ED is no longer available to fellows or residents.
ROUNDS
Rounds will typically begin in the afternoon after the ICU staff has completed rounding in the ICU. The consulting staff will be either the 2C ICU rounder or the 1C MICU rounder, and that staff rounds for a week at a time on consults. Please consult momentum to determine which staff is rounding each day
CONFERENCES
On Friday afternoons, it is expected by the program that you attend fellow conference. If there is no conference on a given Friday, you are expected to remain at WBH until the end of the workday.
PROCEDURES
All bronchoscopies are part of your responsibilities.
To schedule a bronchoscopy:
- Call 248-661-6602 and ask to speak to the scheduling nurse. They will ask for the usual information and give you a time.
- Obviously, schedule for a time that your staff and you are available to do the procedure
- An order should be placed in Epic for “Bronchoscopy Flexible”
- Remember the “Bronchoscopy- Pulmonary Medicine” order is for a bronchoscopy at HFH-Detroit; if you enter this order, you will schedule the patient for a bronch in Detroit.
- Make sure that you communicate with the primary team to keep the patient NPO, etc.
It is possible that staff/fellows from HF-Columbus will contact you regarding bronchoscopies for their outpatients. Please do your best to accommodate these providers and their patients as best you can.
If you wish to do other pulmonary procedures as an inpatient (thoracentesis), that would be fine also. The hospital has a procedure team (or IR) who do many of these for the GPU patients. However, if you are consulted for a patient and wish to do the procedure yourself, discuss with your staff.
RIGHT HEART CATHETERIZATIONS
These procedures are performed with low frequency at HF-West Bloomfield. However, there is a distinct possibility that there is no cardiology fellow to assist. If you have an interest in doing these procedures with the interventional cardiologist, please contact Dr. Modi (smodi1@hfhs.org), the cardiology chief at WBH, to show your interest.
Some things to keep in mind
- WBH does relatively few RHC procedures, so volume will be low
- Participation vs observation should be clarified. The former should include the fellow to participate in the consent and H&P, as that falls on the shoulders of the interventionalist at WBH. If time will be taken to go through and guide a procedure, as well as review and assess hemodynamic tracings, then the cardiology team deserves direct input and assistance.
- clarification of contact # and availability to do the procedures, as more commonly they are inpatient procedures and only known about the morning of the procedure (i.e you will often not get a ton of warning time)
You are not obliged to participate, so the lack of communication to Dr. Modi at the beginning of the month indicates that you do not wish to do them. You will not be rewarded/penalized in any way based upon your decision.
Finally, your consultation workload takes precedence over right heart catheterizations.
WEEKENDS
You have the weekends off.
CONSULTS
Around 8am, the operator will likely send a HALO message to Fellow/Staff listed per schedule in HALO with pulmonary consults overnight and any new consults during the day. If you don’t find your name in HALO listed under consults please contact Dr. Starosta to add you to the schedule via phone 313-986-8713 or email dstaros1@hfhs.org
In epic, the consults will be listed under following;
- please check this several times during the day in case operator misses a consult:
Patient lists -> Available Lists -> West Bloomfield -> Consults-Physicians -> Pulmonary.
This is the best and most accurate place to retrieve new consultations.
When a consult is placed, the hospital expectation is the following:
- Routine consult: seen within 24 hours
- Stat consult: seen within 1 hour
- Consults in CDU: seen within 4 hours
It is the expectation of the hospital and the rotation that you will directly contact the consulting physician/APP and provide him/her with pulmonary recommendations.
- Any pulmonary specific imaging and/or laboratory testing can be ordered by our service as long as this is communicated to responsible staff
- It is an expectation to follow up on any tests ordered for or by our service
SIGNOUT
Before leaving for each day, please let your staff know. As you will also have clinic during this month frequently, please work with the staff to confirm what mornings your will not be present.
ICU
You do not have any ICU responsibilities during this rotation. If anyone attempts to give you ICU duties, please ask them to contact Dr. Geneva Tatem or me to resolve this issue.
EDUCATION
As part of the rotation, you will have the responsibility to create a “lunch and learn” pulmonary topic to review with the APP’s and nursing from the ICU. The APPs, your staff and you should mutually agree upon the topic at the beginning of the month. You can either provide a handout or a short PowerPoint presentation to those who attend. The presentation should take between 30-60 minutes.
Please feel free to contact me with any questions or concerns.
Thanks.
Dominik Starosta
Possible Topics for “Lunch and Learn” sessions
- ILD
- PFT’s
- COPD
- Asthma
- Pulmonary embolism
- Pulmonary nodule/lung cancer
- Pneumonia (HCAP or CAP)
- Dyspnea
- Sarcoidosis
- Hemoptysis
- Pleural effusion, w/u and management
- Pulmonary hypertension
- Pulmonary vasculitis (this can include: Goodpasture’s syndrome, Granulomatosis with polyangiitis (formally Wegener’s Granulomatosis), Microscopic polyangiitis)
- Unusual pulmonary infections—Mycobacterial disease, fungal disease.
Topics already used for Lunch and Learn Sessions
| Topic | Month presented |
| Pleural effusion | August 2015 |
| COP and other pulm vascular diseases | September 2015 |
| Pulmonary hypertension | October 2015 |
| Pneumonia | January 2016 |
| Hemoptysis | February 2016 |
| Eosinophilic pneumonia | March 2016 |
| Pulmonary embolism | April 2016 |
| Sarcoidosis | August 2016 |
| Obesity and pulmonary disease | November 2016 |