Page 7 - HPB Handbook - May 30 2022 (Flipbook) v2

Page 7 of 22

2) Palliative care team to consult and discuss palliative care philosophy with patient/family members.
3) Referral to Social Work - Medical team completes a referral to Social Work so PCU placements can be discussed
with patient once patient is assessed by palliative care team.
4) Once referral is launched, complete appropriate sections of application in RM&R (Medical, Social Work)

**If patient is Palliative, clear documentation must be present in patient’s chart to support this decision. The MRP or
delegate has had a code status discussion with patient and/or family members and they are in agreement with referral to
palliative care.
If patient is going to Long Term Care
1) Ensure all other options for placement have been explored with team (rehab, retirement home, CCC, Convalescent
care, Home First)
2) Once all other options are deemed inappropriate by team/patient/family, consult with CCAC to begin LTC
discussion with patient/family, to determine eligibility
3) Capacity Assessment will be started by Social Work if patient is eligible, and application will be launched by
CCAC

For ALL alternate care settings…
Ensure appropriate Allied Health members have been consulted before discussing any discharge destinations with
patient/families as patient may not be eligible. See section on Support Staff, page 12.

Off Hours Coverage
Patients who are potentially unstable overnight, either post-op or due to (e.g.) sepsis, NEED to be formally ‘handed over’ by
both the senior and junior resident to the corresponding residents on call for the evening. It needs to be explicitly stated what
the unit ‘chain of command’ is for that patient in the event of problems. If a test has to be reviewed, make sure that you speak
to the person who will review the test. DO NOT rely upon the nursing staff as this medical sign- over is not their responsibility.
An internet based handover is to be updated by those coming off call.

Fellows Cover
Fellows might be expected to round and cover for the senior resident each Thursday a.m. while the senior is at teaching. Also,
the HPB fellow is expected to round approximately one weekend in four. The dates should be worked out between the two.

Mt. Sinai Call
The HPB staff consults on HPB patients at Mount Sinai. The HPB fellow (not the residents) may be expected to assist with
care of these patients, either in consult or in the operating room.

Resource Accountability
Please THINK when ordering tests for our patients. We are all responsible for limited public health care resources. Refrain
from ‘routine’ bloodwork or imaging tests, i.e. bloodwork ordered for 3-4 consecutive days after surgery. Nursing staff in the
SDU are well-versed in the need for tests for SDU patients; please work with them when considering frequent bloodwork on
SDU patients.

Responsibility for documentation
Record Keeping Requirements
 Make sure the service date and time is listed correctly on all notes during rounds. You represent the care we give
to these patients so records should be kept up to date, be accurate and thorough.
 Dictate every operation where you are the first assist. List the procedures we did. It helps to go over it with us
prior to the completion of the case to ensure we are on the same page and then list them on the top of the OR
dictation. If your operative report does not match our billing card, we will not be able to submit to the Ministry.
 If a procedure commences in the evening, night, or on a weekend or holiday, you are required to dictate the start
time of the procedure into your operative record in order for time premiums E409/E410 to be payable.
 All codes claimed must not only be listed in your note, but also described in the body. The Ministry does look for
detail.