All inpatients are cared for at University Hospitals Rainbow Babies & Children’s Hospital. Fellow responsibilities revolve around care for all cardiovascular patients in the hospital. They are involved as primarily consultants for all patients in the ICU setting. These patients are seen and rounded on in conjunction with the appropriate ICU services. The cardiology service/fellows become the admitting service for these patients once they leave the ICU setting. In addition, all cardiology medical patients admitted to the general floor are admitted to the cardiology service. All inpatient consultations from other medical or surgical services are initially seen and evaluated by the fellow on-service. Similarly, with post-operative cardiothoracic patients, on-service fellows serve as the primary consultants. They are responsible for review of all patients scheduled for surgery. The review initially takes place during the Surgical / Catheterization Conference the week prior. The fellows are then responsible for daily evaluation and consultation during the patients’ post-operative stay. Post-operative patients are evaluated daily and clinical rounds take place in conjunction with the cardiothoracic surgical team. Additional diagnostic and therapeutic interventions are usually undertaken after collaborative discussions and data review between the surgical and cardiology services. The fellows are expected to take part in collaborative, decision-making processes with the cardiology attending who supervises all of their inpatient activities. Other inpatient based rotations include ECHO, cardiac catheterization lab, and the Cardiothoracic Surgical Service where fellows provide bedside minute-to-minute care of post-operative patients.
During inpatient service months, fellows round with the faculty, on average three to four hours per day, or 15 to 20 hours per week. The primary rounding occurs in the morning and consists of rounding on ICU patients along with the PICU and CT surgical teams. These services will in turn have additional residents/fellows in attendance as well. Review of patient clinical data is followed by additional discussion of impressions/plans, usually incorporating a didactic component related to the patients’ specific anatomy and pathophysiology. After the ICU rounds, the cardiology team will usually see floor patients and consultative follow-up together, and again meet with the floor resident team at 10 a.m. daily for approximately one hour. After this, the fellow will have an opportunity to follow-up on patient care issues, complete inpatient notes and see consults and new patients as appropriate. Additional, less formal “walk rounds” usually occur around 5 p.m. daily to review patient progress, responses to therapy, etc. Similar “one on one” fellow and attending time is set aside for other rotations as well, such as ECHO or Cath Lab, where the fellow has an opportunity to review and discuss studies/cases with the attending covering the specific service.
Fellows are given a set clinic day on a weekly basis with an attending physician. Fellows are responsible for independent evaluation and formulation of a differential diagnosis and treatment plan. These are reviewed and approved by faculty. The fellow is expected to effectively communicate these findings to patients/families and arrange appropriate testing and follow-up. Fellows are encouraged and expected to arrange follow-up with their continuity patients during these clinic times. Fellows are then expected to dictate the salient points of these ambulatory visits for dissemination to the appropriate referring physicians and staff. Fellows are always supervised by attending cardiologists.
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 clinic to maximize his or her continuity experience with their patients.
The fellow will have a panel of patients for whom they assume the primary responsibility in conjunction with appropriate support/supervision by a designated pediatric cardiology attending of record.
Clinical Research Facilities
Under the guidance of Dr Watanabe, fellows have the opportunity to get involved in basic science research projects. Additional research resources are available through the Clinical and Translational Science Collaborative at Case Western Reserve School of Medicine.
Basic Science Research Facilities
Additional research resources are available through the Clinical and Translational Science Collaborative at Case Western Reserve School of Medicine.
The Samuel J. Horwitz, MD Pediatric Learning Center (PLC) is a clinically oriented library focused on Pediatrics and geared to support resident and fellow education as well as assist in continued learning for all Rainbow faculty and staff.
The facility houses a printed reference collection, a number of computer-equipped 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.