Harborview Medical Center
Michael K. Copass, MD
Director, Emergency Services
Amy Baernstein, MD, Associate Professor, Medicine/GIM
Office Phone: (206) 744-3263
325 9th Avenue
Seattle, WA 98104
OVERALL EDUCATIONAL PURPOSE
- 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
- Perform procedures including central line insertion,
paracentesis, lumbar puncture, arterial puncture, phlebotomy, and peripheral
- Evaluate and manage a spectrum of medical problems
related to substance abuse, including overdose, intoxication, and withdrawal
- Make appropriate medical decisions based on available
- 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.
Prior to the start of the rotation each resident must attend a mandatory
4 hour didactic/orientation session and complete two rides with Medic
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.
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 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.
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
- Radiology support within the Emergency Trauma Center 24 hours
- 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
Principle Educational Materials Used
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.
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.