Discuss each case with the attending staff surgeon before scheduling surgery. An “S&PC ATTENDING PREOPERATIVE NOTE-ORTHOPEDICS” note written by the attending of record is required in CPRS.

All elective joint replacement patients should have dental clearance prior to surgery and should not be booked before they have been cleared. Patients with glucose >200, hemoglobin A1c >7.9 diastolic blood pressure > 100, systolic blood pressure >160 should be referred to the patient’s assigned VA primary care clinic before consideration of the elective surgery.

Give the name of the patient to the Case Manager, Evelyn Lawson, when scheduling surgery, then schedule surgery in the green "Ortho OR Book" in the clinic.

Request and order all needed implants and any special instrumentation that will be needed when the case is booked. For primary THR and TKR an attending note is required when not using a DePuy, Zimmer, or Smith Nephew implant. For cervical, thoracic, and lumbar spine cases L1 and above request SSEP monitoring.

Order x-rays that will be needed for surgical planning and when indicated, film copies for templating.

Pre-operative physical therapy evaluation and treatment is available before arthroplasty, ACL reconstruction, rotator cuff repair, and spinal fusion surgeries. The pre-op PT/OT Teaching consult should be ordered when surgery is scheduled. This and the lab orders are included options in the pre-op order dialog box in CPRS. If PT is notified in advance of outpatient surgeries, a therapist can be available for crutch training, etc. when needed.

Procedures requiring informed consent include arthrocentesis, all central lines, and surgical procedures.

At the time of scheduling elective surgery order braces (such as lumbar corset) and equipment from prosthetics that will be needed post-op, when possible.

Each surgery should begin with a briefing and a time out and end with a debriefing discussion with the entire team.

The criteria for discharge after joint arthroplasty include meeting goals of therapy. (For example, after knee replacement there should be 90 degrees flexion and less than 10 degree extensor lag with leg lift against gravity.

Operative notes should be dictated at the conclusion of surgery. Please record the confirmation # in the logbook in the OR and in your brief CPRS Op Note.

After elective arthroplasty surgery, the PT and OT can begin on POD#1 if there is a progress note with documentation of the need for therapy, and weight bearing status that is printed to the PT printer, NE158.

Discuss vacations or days off with the chief resident in advance, so the OR schedule reflects your availability.

Post-operative amputation and hand surgery inpatients should be seen on orthopaedic rounds.

Steve Zeitzew will join you for morning rounds on Tuesday, Wednesday, Thursday, and Friday.

Discuss inpatients with the attending of record daily. Discuss all new patients, new ER or inpatient consults, and new problems with the attending of record each day. Each consult should be personally seen and examined by a senior level resident.

Two residents (or more) are generally needed in each clinic. These residents should not leave the clinic to perform elective surgery.

The chief resident will assign who will attend the Thursday amputee clinic with Dr. Eric Schmitter 11:00AM - 12:30PM. The intern, or one resident, should be assigned each week.

The encounter form dialog box should be completed for each clinic patient.

Please discuss all new patients and new problems with the clinic attending. After a patient is discussed with or seen with an attending please make note of it in the chart.

There is an orthopaedic library in the Orthopaedic Surgery Clinic Office, Room 0400 (back door) [code 1352].

Core lectures at UCLA 6:45 a.m. each Wednesday.

On the 1st Wednesday of each month there will be a UCLA Grand Rounds conference following the core lectures.

On the 2nd and 4th Wednesday of each month there is a clinical case conference in room 3232 at 10:00 a.m.

On the 3rd Wednesday of each month, there is an MRI conference. A list of patients appropriate for review is kept in the clinic. If possible bring arthroscopy photos for review with radiology.

The final Wednesday conference of each two-month block should include a morbidity and mortality presentation. Patients who do especially well should also be presented.

Call me (310) 268-3663 or page me (213) 286-0179 #73060, alpha page 3100073060@page.metrocall.com as needed. Please inform me of problems, or disagreements. If you have ideas for improvements, for needed equipment, or needed changes please let me know. Help me improve the quality of resident education and patient care.