All inpatients are cared for at University Hospitals Rainbow Babies & Children’s Hospital. Fellow responsibilities center on the care for all cardiac patients in the hospital. All cardiology medical patients in the hospital are admitted to the cardiology service. The inpatient cardiology team serves as consultants for cardiac patients in the cardiothoracic intensive care unit (CTICU), and participates closely in their care. Upon leaving the ICU, patients are transferred to the cardiology service in the brand new, state-of-the-art cardiac stepdown unit (CSDU).
All inpatient consultations are initiated by the fellow on-service, often with the assistance of residents from UH Rainbow’s general pediatrics program. Similarly, with post-operative cardiothoracic patients in the CTICU, the on-service fellow serves as the primary consultant. Fellows take part in collaborative decision-making with the cardiology attending, who supervises all of their inpatient activities.
Fellows are responsible for review of all patients scheduled for surgery. The review initially takes place during the Combined Surgical/Catheterization Conference the week prior. Fellows are then responsible for daily evaluation and consultation during patients’ post-operative stays. Post-operative patients are evaluated daily and clinical rounds take place in conjunction with the cardiothoracic surgical and intensive care teams. Additional diagnostic and therapeutic interventions are undertaken after collaborative rounding and data review between the surgical, CTICU and cardiology services.
During inpatient service months, fellows round with the faculty on average three to four hours per day. The primary rounding occurs in the morning and consists of rounding in the CSDU and CTICU. Patients in the CSDU are covered by UH Rainbow pediatrics residents. Follow-up of inpatients and new consults are addressed throughout the day. Additional, less formal afternoon rounds allow the review of patient progress and responses to therapy.
Fellows spend considerable time learning echocardiography in UH Rainbow’s Pediatric Echo Lab. State-of-the art echo machines for transthoracic and transesophageal imaging, as well as the reading and reporting software, are learned and then mastered over the three years of fellowship.
Cardiac Catheterization and Electrophysiology Labs
In 2019, UH Rainbow opened two brand new hybrid cardiac catheterization and electrophysiology labs. These combine the most up-to-date technology with an aim toward maximizing patient safety and clinical outcomes. Fellows learn the integrated systems of these labs over the course of their training.
Fellows are paired with a faculty member to attend outpatient clinic. In clinic, fellows see the patients and independently generate a differential diagnosis and treatment plan. These are reviewed and approved by faculty. Fellows are expected to effectively communicate these findings to patients/families and arrange appropriate testing and follow-up. Fellows generate clinical notes of these ambulatory visits, which are approved by faculty and sent to referring physicians and staff. Fellows are always supervised by attending cardiologists in clinic.
The outpatient experience is designed to provide continuity of care between the inpatient and outpatient services. Many of the inpatients who are new to pediatric cardiology and seen by the fellow on the inpatient service will be followed by the fellow in the outpatient setting.
Fellows maintain a panel of patients for whom they assume the primary responsibility, in conjunction with appropriate supervision by the pediatric cardiology attending of record.
Fellows have the opportunity to get involved in basic science research projects, with research resources available through the Clinical and Translational Science Collaborative at Case Western Reserve University School of Medicine.
The Samuel J. Horwitz, MD Pediatric Learning Center (PLC) is oriented to support resident and fellow education, as well as to assist in continued learning for all UH Rainbow faculty and staff.
The facility houses a printed reference collection, a number of electronic work stations, and provides access to printing, scanning and photocopy equipment.
The center is staffed by a full-time librarian and is open 24/7 with a door key code. Along with printed books and journals, the library subscribes to a number of electronic resources, available from the PLC website, and provides a number of specialized research guides and tools. Library services include reference and mediated literature searching, database training, and interlibrary loan assistance.Pediatric Learning Center