Harborview Medical Center

Emergency Services

Facutly Contacts
Michael K. Copass, MD
Director, Emergency Services

Amy Baernstein, MD, Associate Professor, Medicine/GIM
email: abaer@uw.edu
Office Phone: (206) 744-3263

Address
Box 359702
325 9th Avenue
Seattle, WA 98104

OVERALL EDUCATIONAL PURPOSE

Residents will:

  • Resuscitate and stabilize critically ill patients.
  • Assist medics in pre-hospital management of critically ill patients.
  • Evaluate and manage a broad range of common acute medical problems, particularly those affecting indigent, immigrant, homeless, and incarcerated persons.
  • Perform procedures including central line insertion, paracentesis, lumbar puncture, arterial puncture, phlebotomy, and peripheral IV insertion.
  • Evaluate and manage a spectrum of medical problems related to substance abuse, including overdose, intoxication, and withdrawal syndromes.
  • Make appropriate medical decisions based on available data.
  • Document medical information under time constraints.

PRINCIPAL TEACHING METHODS

Case discussion and review


There is a daily case-based review of every patient seen in the Emergency Trauma Center facilitated by the Director of the Emergency Trauma Center.

Didactics

Prior to the start of the rotation each resident must attend a mandatory 4 hour didactic/orientation session and complete two rides with Medic One.

EDUCATIONAL CONTENT

Mix of Diseases

Patients presenting to the Emergency Trauma Center are frequently brought in by Medic unit or Airlift with the following acute medical problems: toxic ingestions, coma, stroke, myocardial infarction, septic shock, respiratory failure, subarachnoid hemorrhage, and vascular emergencies such as aortic dissection. Obstetric/gynecologic problems frequently encountered include vaginal bleeding, ectopic pregnancy, and pelvic inflammatory disease. Infectious disease affects many patients, including TB, complications of AIDS, and infections in patients from Asia, Africa, and Central America.

Patient Characteristics

Patients presenting to the Emergency Trauma Center represent a full socio-economic spectrum. Many of our patients belong to our “Mission Population:” patients who are indigent, homeless, incarcerated, immigrant, affected by substance abuse, and those with sexually transmitted diseases.

Types of Clinical Encounters

Clinical encounters include:

  • Evaluation and treatment of all patients who come to the Emergency Trauma Center with acute medical problems.
  • Consultation with surgical, pediatric, and psychiatric staff regarding medical problems in patients being managed by those services.
  • Telephone and radio contact with Medics and Airlift personnel, providing assistance and physician supervision of critically ill patients in the field and during transport.

Procedures

Procedures performed during this rotation include central line insertion, paracentesis, lumbar puncture, endotracheal intubation, arthrocentesis, arterial puncture, phlebotomy, peripheral IV insertion, urinary catheterization, and placement of nasogastric tubes.

Services

Harborview Medical Center is owned by King County and operated by the University of Washington. Harborview is the region’s only Level 1 trauma center and has a full range of services which include:

  • Burn, neurosurgical, medical, trauma, and cardiac intensive care units.
  • Radiology support within the Emergency Trauma Center 24 hours per day.
  • Complete range of surgical and subspecialty consultative services.
  • Social work services available 24 hours per day.

Rotation Specific Schedule

Call and Weekend Responsibilities

Residents are assigned approximately 23 12-hour shifts a month. Residents work either nights or days with a minimum of twelve hours off between shifts.

Principle Educational Materials Used

Recommended Readings

The residents have access to reference books in the ER. Multiple computers with connections to various clinical resources are available on-site. Additionally, Harborview Medical Center has a library.

EVALUATIONS

METHODS OF EVALUATING RESIDENT AND PROGRAM PERFORMANCE

The Director of the Emergency Room provides feedback to the residents during case-based discussions. At the end of the rotation, the resident is evaluated via computer by the attendings that he or she has interacted with most. The evaluator rates the resident on a nine-point scale in each component of clinical competence (i.e., patient care, medical knowledge, practice based learning improvement, interpersonal and communication skills, professionalism, system based learning, educational attitudes, leadership, overall clinical competence).

The resident is given the opportunity to evaluate via computer the quality of the curriculum and the extent to which the educational goals and objectives of the rotation have been met. The resident also evaluates the teaching competence of each attending with whom s/he has interacted for a significant amount of time.

LINES OF RESPONSIBILITY

EXPLICIT LINES OF RESPONSIBILITY FOR CARE OF PATIENTS ON THIS SERVICE

The director of the Emergency Trauma Center and medicine attendings supervise residents and medical students. The residents also provide supervision to the students.

The residents are responsible for the evaluation and treatment of all patients who are “triaged to medicine” in the Emergency Trauma Center. Residents present all patients to a medicine attending, who then sees the patient.