Duke Vascular Handbook

Duke University Hospital vascular service expectations:

DUH Vascular is an busy service. Our patients are often relatively sick, we run multiple ORs a day, and plans can change dramatically and often. It can be a very fun and rewarding experience when the whole team pulls together - and it can be stressful, chaotic, and dangerous for patients when communication and follow through are poor. With that in mind, we've put together the following expectations to help the service run smoothly and safely.

First, a note about the service structure:

DUH Vascular is currently split into two teams, the "Elective" service and the "Doc of Week" (DOW) service. This is a new service split, so please be patient as we work through all its implications. The "Elective" service consists of (a) patients who are booked through outpatient clinic/referrals for specific surgeon or (b) patients who were inpatient/ED consults that the on-call attending would like to keep.  The DOW service consists of patients who are ED/inpatient consults and who are not "owned" by a specific surgeon.

Senior level expectations:

DUH Vascular is staffed by a Vascular Surgery chief and a Vascular/General/Cardiothoracic surgery senior.  The chief and senior will do 2 weeks each of "elective" and "DOW" service. The trainee running the "Elective" service will be responsible for staffing patients with attendings each morning, which can be done in person or, more often, on the phone. The trainee running the "DOW" service will be responsible for staffing patients with DOW attending in the morning and as needed as new consults arise during the day. Each DOW attending will have their own preferences for rounding/list running.

The Vascular Surgery chief is responsible for sending out weekly case postings and modifying those as needed over the course of the week. The trainee running each service has preference for cases related to that service (i.e. elective-service cases for the elective trainee & vice versa) except for open abdominal cases and complex endovascular cases, for which the Vascular Surgery chief has preference.

The DUH chief and senior are in the DUH/VA call pool along with the VA chief. Call is Q3. We are trialing a new weekend structure this year to try to better manage the multi-night in-hospital stretches, in which the weekend is divided into Friday + Saturday/Sunday. In addition to staffing consults/cases appropriately with the on-call attending, it is essential that the on-call trainee communicate overnight cases and consults/admissions with the day team via text, email, or call.  

Intern level expectations:

Interns are absolutely critical to the smooth functioning of DUH Vascular. Luckily, we have an excellent team of APPs who are experts in the care of vascular patients who can guide you. To derive maximum benefit from your time on vascular, you will need to be an engaged and proactive team player. It is our hope that you leave the service with an appreciation for the acuity of vascular patients and some of the subtleties of their care. In addition, for those of you who will rotate with us as consult/senior residents, your time as an intern will allow you to establish strong relationships with the vascular faculty and APPs.