West Los Angeles Veterans Administration Healthcare Center - Orthopaedic Surgery
Clinic coverage. Two residents or more are generally needed in each clinic. These residents should not leave the clinic to perform elective surgery. When there are two surgeries scheduled at once the residents available out of the clinic (usually the other two) may need to decide to each go to a different case, or a staff surgeon not needing an assistant can work independently while both residents are in the other case. Dr. Ghiassi or I can schedule time to assist an outside staff physician or each other if a resident is not available.
Amputation clinic. The chief resident will assign who will attend the Thursday amputee clinic with Dr. Eric Schmitter 11:00 AM - 12:30 PM.
CPRS. All patient chart notes should be entered into the Computerized Patient Record System (CPRS).
History and Physical. The admission and pre-op examinations are tracked by CPRS. Please use the correct note title when entering notes into CPRS. When entering this type of note your selection of the corresponding title will avoid having the chart be flagged as incomplete (Orthopedic <History & Physical -Orthopedic>, Orthopedic <pre-op History and Physical update…>, or History & Physical-Orthopedic) . If the chart is thought to be incomplete it will delay surgery or other needed treatment and waste your time when you are asked to correct this.
Non-Formulary drugs. Non-formulary drugs, such as Celebrex or Synvisc injections, must be approved by pharmacy. This is entered as a "Pharmacy Benefits Management" consultation request in CPRS. Ask the case manager or me for the procedure if you have any question. Give the name of the patient requiring non-formulary drugs to the case manager for follow up.
Outside referrals. If a patient needs to be referred outside of this VA for treatment or evaluation this can be requested with a note in CPRS, select the title "Request for Outside Procedures". Notify me if this is needed. This note will need to be signed by me, cosigned by the appropriate administrative physicians, and approved by the administration. Please notify the case manager of these requests.
Orthopaedic Consult Requests. Dr. Ghiassi will screen requests for clinic consults. "Orthopaedic clinic admission criteria" will be implemented. The case manager will return denied consults to the referring clinician and primary care physician. In general these criteria recommend that the patient is willing to consider surgery, the patient is medically stable to have surgery, and has failed conservative treatment. A patient with a non-urgent problem who has not been examined and evaluated by their primary care physician, or has not been treated is usually not yet a candidate for consultation. The patient should have been evaluated by his primary care physician, with a history and physical exam documented, and appropriate imaging studies completed and evaluated before referral. The guidelines should not be used to delay urgent or emergent patient care, or to delay surgical treatment of a problem that should not be managed non-surgically. They are outlined in more detail on the VA Intranet at the Orthopaedic Home Page at http://vhawlaweb1/Surgery/ORTHOPEDICHomePage.htm.
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