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HMC HIV Service
Introduction and goals: Since 2002, between 514 and 658 HIV infected patients have been admitted to HMC annually. While most patients have been admitted for traditional HIV related complications and infections, others have suffered from medical, psychiatric and surgical problems not typically associated with HIV. Regardless of the reason(s) for hospitalization, consultation with an HIV service should facilitate the care of patients by providing expert HIV advice and helping negotiate the transition from the inpatient wards to the Madison clinic or other outpatient settings.
The goals of the HIV service are to: 1) provide expert advice regarding HIV care, 2) facilitate communication between inpatient teams and outpatient HIV providers and 3) provide HIV teaching for housestaff, ID fellows and students.
Logistics: The service will be composed of an infectious diseases attending and fellow and the 4th year medical student rotating on the HIV medicine elective (MEDECK 612). The service will operate Monday through Friday with the ID service covering the HIV service on holidays and weekends.
HIV infected inpatients will be identified by Gerald Tebo (Madison clinic case manager, phone 744-2010, page 559-9530, email email@example.com) who queries HMC admission logs each day (M-F) for all patients who have ever had an HIV western blot, HIV RNA or CD4 T-cell count performed. Gerald emails this preliminary list to all team members before 10 am each day (Monday through Friday) and then screens the list (by chart review) to eliminate those obviously not infected and sends the screened list to all team members as well (the preliminary list is sent to provide the fellows additional time to evaluate patients but does require that they review charts to ensure that patients are truly HIV infected).
The fellow and student evaluate all new admissions and round on all established patients in preparation for attending rounds in the afternoon. At ~1:30 the HIV and ID services gather in the ID team room for combined teaching for 20 to 30 minutes. The HIV and ID attendings share responsibility for these didactic teaching sessions and may cover selected ID and HIV topics on alternate days. The HIV team then proceeds to the wards to see all established and newly admitted patients. Notes should be written using the ORCA templates for the HIV service (initial and follow up templates). Finally, all patients should be assigned a diagnosis (both an ‘infectious syndrome’ and an ‘organism’ (if applicable)) within their medical record using the “Diagnosis and Problems” section.
Fellows: The HIV fellow will be responsible for following all HIV+ inpatients as long as they remain hospitalized. This will include performing new consults on all admissions and completing daily follow-up rounds on all HIV+ inpatients. The HIV fellow may occasionally assist the ID fellow when the balance of work is heavily in favor of the ID service.
Attendings: The HIV attending will alternate responsibility for daily teaching rounds with the ID attending. After teaching rounds the attending will round on all HIV+ inpatients with the fellow and student. Attending notes should be written on all HIV infected inpatients each day; not seeing all HIV infected inpatients every day should be the exception. Attendings will also assume the HIV/AIDS MEDCON responsibilities for the time they are on-service.
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