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Each G.I. Faculty: supervises the Endoscopy Rooms, sees consultations, conducts ward rounds, runs a G.I. or medical clinic, rotates through night (emergency) and weekend coverage, gives lectures and participates in conferences and clinical research projects.
- Each G.I. Fellow: has the same assignments as the Faculty, under Faculty supervision for a more extended period.
- The G.I. Nurses: schedule all the G.I. procedures, participate in patient education and preprocedure evaluation and assist in all G.I. procedures, including emergency night coverage.
- The G.I. Technologist: maintains all the equipment, endoscopic instruments and supplies, assists the endoscopist, and participates in emergency night coverage.
- The Division Chief: is committed full time to the organization, operation and supervision of all the above clinical and scholarly activities and he is responsible for the overview of training in Gastroenterology, according to ACGME standards.
- The Gastroenterology Core Curriculum, the Master Plan, The General Supervision Guidelines, the Specific Guidelines, the Training and Evaluation forms and the Guidelines for Rotating Residents and Students are available, they are revised annually and given to related staff.
Consultative Services
Inpatient Consultations are routine ones average: 4 per day, emergency ones average: 2 per day, and evenings, nights, weekends, and holidays.
- The consultation team consists of one Faculty, one G.I. Fellow, a second-year medical Resident and a medical student occasionally. They round 10:00-12:00 noon in rapport with other medical disciplines.
- The outpatient consultations are seen in the G.I. Clinic and are referrals from community and regional medical clinics. The number of referrals are over 2,5000 per year, corresponding to 9% of all the referrals to KDMC, the 2nd of the top ten clinics after Ophthalmology, ahead of Orthopedics and Dermatology.
Those services constitute the basis and are the first aspect of the G.I. teaching program.
G.I. Endoscopy - Special Procedures
This subdivision of Gastroenterology comprises the highest volume of work, the greatest number of patients and involves the greatest number of medical personnel and resources. Because of operational and sanitary imperatives, G.I. Endoscopy is physically divided, into Upper G.I. Endoscopy, Lower G.I. Endoscopy, Pancreato-Biliary Endoscopy and Miscellaneous Procedures.
- The total number of procedures performed under conscious sedation protocol for the year 2001 were 2,330 with an upward trend. Each team consists of one Faculty, one Fellow, two G.I. Nurses, and the G.I. Technologist floating between.
- The Upper G.I. Endoscopy Team: performs average 5-7 EGD's and PEG's per day, including 1-2 emergencies.
- The Lower G.I. Endoscopy team: is also the Pancreato-Biliary and Endoscopic Ultrasound (EUS) Teamand perform average 3-4 colonoscopies and 1-2 ERCP's or EUS per day.
- Miscellaneous Procedures: Most of those procedures such as liver biopsies, abdominal paracentesis or motility studies are performed by the consultation team, except the dilation procedures done by the endoscopy teams.
Ward Rounds
All inpatients seen in consultation are followed on ward rounds by the Consultation Team according to the division policies and procedures. After discharge the patients are referred to G.I. Clinic if needed.
Routine G.I. Clinics
The outpatient G.I. Clinic operates twice a week, on Thursdays and Fridays from 1:00-4:30p.m. The average number of patients are forty (40) per clinic session and the minimum staff are two G.I. Fellows, four medical Residents and one or two Faculty members. Two categories of patients are seen; either new patients until the G.I. problem is resolved and the necessary procedures are completed or patients, who need long-term subspecialty care, which cannot be handled by their primary physicians.
Emergency Services
Emergency consultation requests are immediately responded to 24 hours/day, but majority of these are made at night, after hours. Those consultations are centered around 3 major clinical entities, i.e. Acute G.I. hemorrhage, obstructive jaundice and/or acute pancreatitis and hepatic coma. Approximately 80-90% of the consultation requests are for endoscopy on G.I. bleeders. These observations indicate areas of critical responsibility: such as: emergency night coverage, staff availability, up-to-date equipment and house staff education and training in the management of these life-threatening diseases.
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