It is essential that every chart of every patient admitted to the hospital have a completed cumulative patient profile and that this cumulative patient profile be kept updated on a regular basis following each admission especially for complex, chronic patients. This is an expectation from the Royal College and should be a mandatory part of each and every chart. The residents are responsible to keep the updated CPP.

All complex patients admitted to the hospital and residing in the hospital for over a week should have a summary of interval progress documented every Thursday by the resident or assigned learner. This should consist of a brief update of events of the week, significant physical findings, investigation results, and care provided during the preceding week. This will facilitate the provision of care over the weekend as well as help keep the numerous sub-specialists involved with each such patient updated. Further this weekly summary will be a great help in dictating the final discharge summary.

The discharge summary dictation is the responsibility of the pediatric resident and for these complex patients should be done by the resident most involved with the child a day or two in advance of the expected discharge date. Completion of discharge summary of these complex patients should not fall on the resident on call for weekends or holidays.

All patient care meetings such as those conducted with parents or multispecialty meetings should be documented in the chart by the learner assigned to the case, with a summary of the discussion. Face sheet completion prior to discharge is the responsibility of the pediatric resident as is the documentation of a short daily progress note.

The Division of General Pediatrics will work with medical records to ensure that each and every pediatric chart has a growth and head circumference graph. Completion of these graphs will be the responsibility of the resident looking after the patient.

All referrals to sub-specialists will take place with the explicit consent and request of the attending rather than a direct referral from the resident to the sub-specialists. The referral request will specify the question for which subspecialty input is required. Parents need to be aware of the request for subspecialty consult, especially involving Mental Health / Adolescent Medicine. The urgency of the consult should be relayed to the sub-specialist being called. The MRP should be fully aware of the patient’s details, as should the Resident / Learner calling the sub-specialist.

Random chart audits will be conducted for both teams by the end of each teams rotation. The exact details of this will be worked out over the next few weeks.

As there are a large number of learners on the wards, a well conducted monthly orientation ward round is essential right at the start of each group's ward rotation. Such orientations have not been happening on a regular basis and we will meet with the chief residents to ensure that a proper plan is in place for ward orientations. The residents will develop a checklist for this in the next few weeks.

The role of the senior pediatric resident was also briefly discussed and will need to be further identified. The senior residents will work on this and will meet with us to finalize the job discussion of both the senior as well as junior pediatric residents.

It will be extremely useful, especially so for senior pediatric residents to be able to learn and effectively bill patients seen. Proper knowledge of billing is especially important in light of the ongoing billing audits. Pediatric attendings are willing to teach this, during ward rounds to interested residents.

A short standardized discharge summary should be given to all parents at the time of discharge and to the family physician as well as referring pediatrician should there be one. Completion of face sheets should include all diagnoses, as this has a significant impact on the case weight and therefore payment received by hospital for each patient.

The face-sheet will be completed in detail, at the time of discharge, and will serve as a temporary discharge. Information on this will include salient course in hospital, diagnosis at discharge, and follow up plan. The ward clerk will be given the face sheet along with names of the family and follow up physicians. The ward clerk will copy this document, and provide one to the parents, at the time of the discharge, and also fax it to the family physician, and the physicians that will follow up with the patient.