Page 8 - HPB Handbook - May 30 2022 (Flipbook) v2

Page 8 of 22

O.R. Bookings & Patient Marking
Elective cases
 Elective ORs will be booked by surgeons’ assistants.
Urgent cases – senior resident responsibility
 notify operating room (ext. 3405) of the case and designated priority (1A, 1B or 1C) and have someone
personally go to the OR desk to officially book the case
 notify on-call anaesthetist as appropriate
 make sure relevant test results have been checked (bloodwork, CXR, ECG, crossmatch) and a post-op bed
available
UHN operating room policy mandates that ALL patients are MARKED in the POCU or on the ward prior to transport to the
operating room. There are no exceptions to this rule which is designed for the safety of our patients and to ensure appropriate
communication between patients and their caregivers. It is the staff’s responsibility to ensure that all elective patients are
marked in the POCU no later than 07:45 for 08:00 start times (08:45 for 09:00 start times). Occasionally the staff will request
assistance from the residents in marking the patient though this will be the exception. It is absolutely expected that all
residents going to the OR meet the patient and become familiar with all details of the case, including a review of the
appropriate imaging. This will provide better continuity of care for the patient and a better educational experience for the
resident. Emergency cases are to be marked on the ward, in the emergency department or in the operating room.

Stepdown Unit (SDU)
The SDU is reserved for patients requiring closer monitoring and more intensive nursing care. There is a document on the
ward that outlines criteria for admission and discharge to the SDU. Please make yourself aware of this document. Potential
conflicts related to admission to, or discharge from the SDU will be resolved with input from the staff and the senior nurse-
in-charge. Residents will answer calls promptly for issues related to SDU patients. The senior resident will manage SDU
patients.

Prior to leaving each day, the senior resident will review the next day’s OR list and assess the need for post-op SDU beds for
HPB patients. The resident should confer with the other general surgery senior residents to ensure availability of beds. If
problems are anticipated, the senior should call the on-call attending to review the issues. Do not wait until the next morning.
SDU extension is 14-8556.

RESIDENT AND FELLOW DUTIES

Principles of Resident and Fellow Interactions

Overall Approach
We support excellent patient care in the setting of a collegial, team-based and flexible approach between the residents and
fellows that supports all trainees’ learning needs.

Background
The University of Toronto provides both general surgery training and tertiary and quaternary general surgery services. General
Surgery Residency Training needs as well as Fellowship training needs must both be met in a mutually respectful manner.
There are sufficient clinical resources at the University of Toronto to meet both training mandates.

The tertiary/ quaternary patient populations provide clinical fellows opportunities to train in complex surgical care at a post-
residency level. The clinical fellow positions that have evolved have arisen from these national and international educational
needs and unique opportunities at UHN.

A. Team Based Approach

Pre-operative and Post-operative Care
Consistent with the Royal College of Physicians and Surgeons of Canada guidelines, it is the department’s policy that, under
the supervision of the attending staff, the senior or chief resident has primary responsibility for patient care and is responsible
for daily rounds on the patients and patient care. The fellow is expected to round on the patients daily (with or without the team
after discussion with the attending staff) and be aware of patient status and their operative results and act as a resource for the