Admissions and Consultations
The residents decide when to admit non-private patients for surgery. The URO-4 resident manages the operating room schedule. The urology chief resident posts all surgical cases from the clinic and has ample time to schedule with one of the faculty.
In this age of outpatient and short patient stays, the initial evaluation of the urologic patient is usually done on an outpatient basis. For non-private patients, that would be the responsibility of the URO-4 resident. For private patients, every attempt is made to involve the residents with decision-making, but the attending actually decides when admission is appropriate. The initial history and physical, as well as orders are written by the resident, usually URO-1.
Therapy on all patients is decided on a joint basis. For nights and weekends, the URO-4 resident is contacted for every potential admission or question by the more junior residents. The URO-4 resident decides the severity of the problem and contacts the attending on-call as necessary by phone. The URO-4 resident has the authority to admit, and for more minor illnesses (renal colic, epididymitis, etc.) the resident may wait until the next morning to contact the attending.
For serious illnesses or operations, the attending is always contacted. For trauma cases, the URO-4 resident contacts the attending, but has the authority to scrub with a general surgery attending on multiple trauma cases. Long-term care of non-private cases is the URO-4 resident's responsibility.
For private patients, most long-term care is the responsibility of the private physician.
The urology resident communicates regularly with other services, obtaining and giving consultations on problem cases. In general, cases on the urology service are taken care of by the urology service. However, when patients are in the Intensive Care Unit (ICU), the surgery residents in the ICU have the authority to manage situations that may arise emergently and the anesthesia residents have the authority to manage respirator and pain problems on urology patients.
Multiple trauma patients are admitted to the trauma services and the urology residents are expected to handle the general urology (GU) problems only. Trauma patients with exclusively GU injuries are admitted to the urology service.
Urology residents do a great number of radiologic procedures, including percutaneous nephrostomy, ultrasonography, and retrograde pyelography. The radiology service does not participate in all of these procedures and has no responsibility for patient care in those particular instances.
The urology service admits and has full responsibility for patients undergoing brachytherapy for prostatic cancer. The radiation oncology service only has responsibility for radiation safety concerns on these patients. In the act of consultation, urologists try to educate the other services in urologic care. Residents are responsible for providing teaching sessions to physicians and nursing groups requesting them.