Program Structure

Teams

The Pediatric General Surgery Service is divided into two separate teams, the Gross and Ladd services, in order to group patients according to their primary disease process (e.g. Short Bowel Syndrome, Transplant, Esophageal Atresia).  There is a chief pediatric surgery fellow assigned to each service.

The two service team approach allows us to more evenly distribute the number of inpatients that are cared for by the fellows, residents, interns and nurse practitioners. 

The team includes:

  • General Surgery senior residents (2-4 residents a month) who rotate from area hospitals including the Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Boston Medical Center, Lahey Clinic and St. Elizabeth Medical Center
  • Two general surgery interns
  • A core group of 18 nurse practitioners who cover the service 24/7
  • 2-3 critical care surgical fellows assigned to the NICU/MSICU
  • 8-10 surgical research fellows who assist with call coverage at night

Rounds

Morning Rounds

Staffing:

  • Each team is composed of one fellow, one senior resident, one intern and two nurse practitioners, and either the Surgeon of the Week (SOW) or senior fellow (+/- additional senior/intern residents)
  • Lee Ranstrom, senior nurse practitioner, will round with the non-SOW team

5:45 AM: Overnight sign out (10NW conference room)

  • At 5:45 AM, the overnight nurse practitioner, overnight resident, SOW, fellows, and NP's will meet in the 10NW conference room (Mandell meeting room).
    • The overnight resident will make brief presentations on the patients who were admitted to the hospital overnight
    • The overnight nurse practitioner will discuss any issues from overnight
    • We will discuss any anticipated staffing/OR coverage issues

6:00 AM: Floor rounds begin

Gross to start on 10S, then 10NW, then 10E

Ladd to start on 10E, then 10S, then 10NW

  • The intern or nurse practitioner will present the patients (overnight events, vitals, I/O’s)
  • Either the fellow or senior resident will examine the patient
  • Plans will be outlined for the day

6:45 AM: ICU rounds begin

  • Ladd chief rounds on 7N (NICU)
  • Gross chief rounds on 7S (MSICU)
  • SOW will go to 7N at 6:45 AM and round in the NICU 

7:15 AM: Chiefs, SOW, and Surgeon of the Day (SOD) meet for sign out

Evening Sign-out

  • This will occur in the same location as morning sign-out, 10NW conference room (Mandell conference room)
  • Both services will sign out at the same time around 5:30 PM
  • Written sign out is also provided by the NP's/interns covering the floors

Overnight Call

  • In conjunction with the resident/moonlighter on call, the on call nurse practitioner is responsible for sending a sign out email with patients assigned to either the Gross or Ladd service.  New patients who are added to the census list will be assigned a service according to their primary attending.  If there is any question regarding which service a patient should be assigned, please discuss with the overnight SOD (the on call fellow can also be contacted if there are any questions).
  • Fellows are on call from home available for urgent inpatient concerns or fellow level OR cases at their discretion.