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Childrens Hospital Colorado (CHCO) ​

Most recently updated by Alex Linse, MD in September, 2025

Primary Contacts ​

Residency Rotation Site Director

Administrative Assistants:

Phone Numbers: (also see cards)
  • Main CHCO Hospital Operator: x71234
  • Anesthesiologist Charge: x78339
  • Anesthetist Charge: x72255
  • Anesthesia Tech Charge: x73939
  • Acute Pain Service (APS): x75433 (7-LIFE)
  • Chronic Pain Clinic/Consults: x74122
  • Anesthesia OB Provider: x70037
  • Omnicell: x76747
  • OR/ICU pharmacy: x76741/76742
  • PICU: x73239
  • NICU: x76857
  • Main OR Front Desk: x76492
  • General Computer Help: x74357 (7-HELP)
  • EPIC help: x73739 (7-EREX)

Emergency Operator (Codes, Massive Transfusion, Security): x75555

One Call (paging provider to provider): x73999 (also see “On-Call Finder”, top right in EPIC)

Remote access, including Epic and CHC intranet: ​

https://go.childrenscolorado.org/vpn/index.html

To setup Haiku (or Canto), visit haikusetup.childrenscolorado.org

The CHCO EPIC helpdesk can also assist with getting haiku configured.

Phone tips: ​

To reach an extension from off campus call 720-77 + [the 5-digit extension starting with 7]. Extensions starting with 6 can only be reached from off campus via the CHC operator.

Prior to the rotation, you will be provided a phone list each via email (“roster”) with all the attendings’ home/office phone numbers and pager numbers for calling your attending the afternoon or evening before cases.

Potential shifts ​

Res-CHC-OR – (~6am- 5pm) This is a “normal” OR day (non-holiday, non-weekend). The days are busy, fun, and full of learning. Cases turn over faster than at UCH (OR staff will bring the patient back to OR before they count instruments). In a busy, high turnover room you can do ~10 cases in a day. Expect to finish the cases in your room, and you may be surprised with early relief. The “expectation” is to be out around 5PM. However, if you stay past 5PM the charge attendings do communicate with each other and they often try to get you out a little early the next day.

Res-CHC-C2 – (7am – 7am Weekdays): This is a Weekday call/late shift with a post-call day the following day. You will be the last person relieved from the OR with the exception of the overnight call C1 fellow. Once you are sent home, you will be on home call for the remainder of the shift and will be required to report back to CHCO from home within 30 minutes of being called. You may be asked to come in the next day in the case of a mass casualty. Expect to take about 1 of these per week, sometimes 2.

Res-CHC-C1P - (5pm Saturday – 7am Sunday): This is a Saturday overnight call shift, typically they try to assign you a “short” assignment the Friday before in which you will actually round with the acute pain service, so you know the patients on the pain service before your Saturday shift. You should plan to arrive around 4:15pm for your first shift to receive handoff from the APS advanced practice provider, change into scrubs, and receive sign-out from the anesthetist in the OR before assuming patient care promptly at 5pm. You may arrive a bit later on subsequent shifts once you know your way around and exactly how much time you will need. Call the APS phone (x75433) when you first arrive to arrange for sign-out. Sign into the “Anes Emergency Alert” role on your PCD upon arrival so you are notified of any codes/ airways/ Level 1 trauma pages. Take over the Code Team badge from the day anesthetist. Please keep your cell phone on Saturday morning in case of a massive casualty situation where we would need all available help earlier in the day.

Res-CHC-C1A – (7am Sunday – 7pm Sunday): Report in time to take over any ongoing cases by 7am, or early enough to set up for a 7:30 start. Sign into the “Anes Emergency Alert” role on your PCD upon arrival. Take over the Code Team badge from the overnight resident. Check the board on EPIC/go to the Control Desk to see what is scheduled or call the attending charge phone (this is a dynamic process on weekends). You may be covering this shift on holidays as well.

Occasionally you may be asked to cover a weekend or holiday C2 call if the fellows cannot cover it. You will be expected to report to the OR in the AM for C2 call, if there are 2 rooms running on the weekend, without being called. However, if you think you may not be needed (check the OR board from home for case schedule), call the attending in charge around 06:00-06:30 to see if you need to come in. If you are not needed for the first case, you must be able to be in the OR in 30 minutes after being contacted at all times during your shift. C2 call is for 24 hours, and home call after the 2nd room is done for the day.

This rotation is no longer eligible for Academic Wellness Days as there are enough Non-Clinical Days now that residents are taking the C2 Call during the week. Please schedule appointments on the non-clinical days or swap shifts with your co-residents if you need to make an appointment on a certain day. The chiefs can help facilitate this.

Day 1 at CHCO: ​

Your first day will solely be orientation. You do not need to get oriented prior to this from other residents (as with most other rotations). This will include a morning of Epic training, badge collection and parking information and access. You will be required to either bring a copy of your car’s registration OR know your license plate number to obtain a parking pass. On the first day you may park in the visitor lot out the front of the hospital. On subsequent days (once you have a CHCO parking sticker on your car) you will be ticketed if you do not park in the assigned lot. Your badge will be your method of access to the parking lot, hospital and all departments and doors in the OR (includes the anesthesia work room.) After your Epic training, you will have a brief tour.

At completion of your tour please be sure to accomplish the following:

Check that Lindsay has your correct contact info, including your UCH email (very important that you confirm your email is included in daily case assignments and OR schedules), cell phone#, and obtain the attending cell phone roster, lecture and call schedules.

Check you have working Omnicell and Epic access.

Know where the items are on the list at the end of this document.

Obtain iStat training (Bryan King, NP does iSTAT training - can be on a later day)

Know how to access the resident SharePoint site.

Take a look at the OSA screening (STUBR) training on the resident SharePoint site.

Please read this manual as well as the orientation guidelines received this day and ask questions if anything doesn’t make sense.

Lindsay Baumgartner will assign lockers; depending on the number of residents, you may need to share.

Following orientation, start working on your pre-ops for the next day so that you may call your attending in a timely manner.

General Info: ​

Attendings will sometimes run their own room, sometimes work one on one with residents and other times have 2 residents and fellows to supervise.

For your first 5 days, you should be scheduled with an attending one-on-one.

There are also AAs and CRNAs working at Children’s. Be kind to them!

All patient information is on electronic boards in pre-op, post-op and ORs. Check this board before you set up anything as cases cancel/delay more often than at UCH.

Be sure to communicate with pre-op and OR nurses about pre-meds if you have ordered them (oral midazolam needs ~30 minutes to be effective so be proactive!)

Call room: located on the 2nd floor, past the bridge and Castle Peak conference room and through the double doors. Code 8-6-4-2. Our call room is labeled (#3) and the code is again 8-6-4-2.

Please know where the following items are prior to your first day: ​

  • Belmont infuser
  • Trauma line cart and central line omnicell
  • Emergency airway cart
  • Advanced airway tools
  • MH cart
  • Code carts for OR and PACU
  • Main omni (“Mommy Omni”)
  • 520 tube station
  • Main OR blood refrigerator

Weekday Daily Workflow: ​

Set up: ​

The next day schedule should be out by 2-4 pm by email. All names by initials (see Roster).

Do your pre-op H&Ps on Epic for outpatients coming into the hospital as completely as you can the night before. Mark note as “incomplete” until finalized (if you do not check the box at the top of the note that says “this note is incomplete” it may be deleted by Epic overnight!!!!!)

Contact your attending (early in the afternoon/evening if possible) to present your plan (and explain why) for your patients. Before 7 pm is typically better.

Give yourself 15 - 30 minutes to set-up your OR before any morning conferences (in Castle Peak conference room down hall from locker rooms 0630- 0700 Tues/Thurs)

Check the Epic status board before you set up since there may be last-minute changes!

Let the anesthesia techs know, in advance, if you need any special equipment for your case. Please (1) write it on the white board with room number and (2) speak with the tech (PST).

Please ask your attending to show you how to avoid iatrogenic contamination of your patients and keep lines air-free.

Generally speaking, do not place syringes that have touched the patient’s lines, dirty airway equipment, dirty fingers/gloves, or anything else “dirty” on or in the Omnicell. The anesthesia machine is generally considered a dirty area after the start of the case.

Pre-op: ​

Arrive in Pre-op by 7:00 (8:00 on Mondays) to see your patient. Our window is 07:00-07:10, but you can see them earlier if they are “ready” per the pre-op RN (purple on Epic status board).

To find your patient- check the electronic board showing name and room. Child may be in the play area; you will see a sign on/next to the door to their pre-op room.

Make sure you ID the child and find correct parent(s).

You can use the in-room computers to fill out your pre-op note.

Decide early on (ideally > 30 min prior to OR) if your patient needs pre-anesthesia PO midazolam (“pre med”) as it takes some time for the RN to administer and ~30min to reach clinical effect. The 2–4-year age group is most common. You will need to inform the pre-op RN directly for timely administration of the premed. If the patient has active or recent URI symptoms (last 2-4 weeks), speak with the attending before ordering any medications, as this may warrant case cancellation.

If you would like an IV placed in a patient (typically >12 yo), this order may be placed in EPIC the night before. Pre-op acetaminophen orders may be placed once the patient weight is verified; notify the RN that an order has been placed.

After you’ve evaluated the patient, complete your pre-op note and click “Ready for Procedure” before 7:20 (8:20 on Mondays). The patient cannot be brought back to the OR until this is done.

If doing an inhalation induction, you can ask the child to pick out a chapstick flavor to make the mask smell fun.

When done with pre-op, you may wait for the patient in the OR—nurses bring patients and parents back to OR.

Many times, you will need an interpreter—typically there is an in-person interpreter floating around pre-op for first case starts. If you need an interpreter for a case later in the day, you likely will need to use a translator phone or iPad.

First case start times may be a little more lax than at UCH, but it is always good practice to get your preop done and room ready—try not be the reason there is a delay.

Some attendings will pre-op the next patient while others will ask you to do so (communicate with them). Be prepared to drop a patient off in PACU, speak with that patient’s parents in the waiting area, and then go to pre-op to see your next patient, all prior to going back to the OR to get your room ready and waste your drugs for the next case.

Parents are almost never present at induction.

In the OR: ​

Go back to the room and do a final check while you wait for the child to come back to the OR with the circulating nurse (you do not bring the patient back, the circulator does unless you are giving IV midazolam).

Now is a good time to touch base with your attending and confirm the plan you discussed the previous night.

Before induction, follow the pre-induction “anesthesia time-in” checklist, line by line.

Be sure to introduce yourself clearly at timeouts and signouts in the PACU and ICU and to the colleagues you will be working with for the day.

Pay attention and avoid doing other tasks during this and during the time in and surgical time out.

SCDs must be on prior to induction, if indicated.

Use your skills (iPad) to keep the child engaged and happy while you give approximately 35 to 40% nitrous oxide in oxygen. Usually okay to turn on 8% sevoflurane for induction except for certain patients (ie, Trisomy 21).

Open communication and distraction with something interesting and enjoyable to the child is commonly preferred over repeated reassurances of “you’re ok” which are in stark contradiction to what the patient is experiencing.

N2O is an odorless way of getting the induction started though it is no longer available in the hospital gas supply, you must open the tanks on the back of the anesthesia machine if you want to use it.

NOTE

If the patient is a small baby and is asleep then leave the pacifier in and perform a “steal” induction without touching the baby and hopefully without waking them.

Some kids do better if sitting up on the OR bed or being - wrap a warm blanket around their shoulders and hug their arms to their sides as they drift off.

Once the kiddo is asleep, often the attending will take over the airway while you get IV access. This can sometimes be a challenge, especially in the chubby 2 yo child. You will quickly improve and learn to use the tools (WeeLight, snake light, wires, ultrasound) to help you. Saphenous sticks are common in babies and those getting caudal blocks for urological procedures.

Anesthesia techs place airway bags on anesthesia machine—be sure to correctly size tubes (cuffed and uncuffed) and blades (with working lights) are available in these bags.

Emergence, Post-op : ​

You will chart in EPIC similarly to at UCH, with a few minor changes.

PACU orders are done in EPIC, complete before leaving the OR.

For efficiency, orders may be filled out prior to the case start if the patient weight and allergies have been entered for that encounter.

You will frequently remove the patient’s ETT/LMA before awakening, aka “deep extubate.” However, there are a few medical/attending specific exceptions such as airway concerns, very large, very small, etc. Also be aware, for PICU bound patients, they will not receive the same airway attention that our PACU patients receive.

When traveling with your patient to PACU or the ICU, you must bring the patient’s facemask, O2 tank, and any additional airway equipment or emergency medication (propofol, sux) that may be required.

In PACU, do a verbal hand off by following step-by-step the blue handoff sheet.

Use the mobile laptop stations or the CHCO iPhone to mark your I/O totals as correct and hit “Handoff Complete” (these are in the post-Op tab of EPIC)

Also see PICU section below

For complex cases that stay >24-48 hrs (major trauma, major ortho, major neuro, index cases, etc.) a post op follow-up note should be placed as a matter of professionalism and for your education of typical post-op course but is not mandated.

Also see PICU/NICU section below for additional info

End of day: ​

Ask for feedback and with your attending before leaving on a daily basis. Please be proactive and help to facilitate this.

If you get out of the OR more than an hour before your colleagues, please work as a team and help your fellow resident with pre-ops if they are going to be stuck there late. You can either break them out or see their inpatients for them. This is especially helpful when a resident has a late case one day with a busy ENT/urology room the following day (sometimes up to 10 pre-ops).

Before going home, make sure all pre, intra, and post-op documentation for all your patients are complete.

Work on your pre-ops and see inpatients for the next day.

For adverse outcomes or near misses, use QSRS on Epic. Coordinate w/ your attending.

Discuss with your attending who will be responsible for completing the post op notes for your patients (typically the attending does these unless the patient is admitted postoperatively, in which case you are/may be expected to do it)

ICU (NICU and PICU): ​

For patients going to NICU or PICU, a member of the anesthesia team must call the ICU to give a brief report to the ICU attending or fellow/PA prior to leaving the OR. Usually within ~30 minutes of expected arrival time to ICU.

Typically, patients going to the ICU will go directly to the ICU without going to PACU first. Extubated patients should be managed so that little airway support is needed by the ICU staff. ICU has neither the same resources nor the experience in managing a heavily sedated patient’s airway as does our PACU.

There is a separate protocolized sign-out for the ICU that is done as a multi-disciplinary team after the first set of vital signs are obtained. Your OR RN will provide the template for you. Follow line by line.

For PICU bound patients you must chart your own handoff in this scenario.

Ask attending about how to appropriately document VS and transport events in Epic.

Drugs/Pharmacy: ​

Controlled drugs are in Omnicells in each OR

Omni by the main OR desk has additional meds (lovingly referred to as the “Mommy Omni”)

At CHC ephedrine is in your Pyxis machine and considered a monitored substance, and propofol must be accounted for, like other controlled substances.

At the end of each case, the unused/dirty medications need to be returned to the bin on the right side of the Omnicell before the next patient enters the room.

Please charge for all medications taken out of the Omnicell.

Our pharmacy is now adjacent to the ORs, by the locker rooms.

Pharmacy will make up drips and epidural infusions for you. Some cases will have order sets that make it extremely easy to order drips from pharmacy.

Main OR desk tube station is 520.

Epidural infusions, however, should be sent to the PACU and set up there on a pump and then brought into the OR.

Any infusions continued post op must be made up by the pharmacy. You can make up your own infusions if solely used in the OR (best to order from pharmacy).

Drug vials are treated as single dose only and have to be discarded before the next patient enters the room.

Get in the habit of calculating IM doses of sux/atropine for all patients—induction takes place prior to IV placement thus you may need to give meds IM in case of laryngospasm.

IV acetaminophen is available from the OR pharmacy—clarify with attending if okay to use since it is expensive.

Drugs given in the OR need to be charted on Epic by the time you sign out.

On Epic, there is a link to protocols and educational materials on sharepoint via the “Anes Sharepoint site.”

All drugs need to be labeled, including propofol. All ORs now have label printing machines, which print labels as well as charges for drugs. Be sure to double check concentrations as some drugs need to be diluted (ie, narcotics, ephedrine, epi).

Lectures ​

You are expected to attend all morning lectures Tues, Thurs at 6:30-07:00 (check your email for location/zoom links)

Mondays you will attend any CHC M&M or grand rounds. If there is no presentation at CHC, attend the CU grand rounds. You will not attend department staff meetings.

Acute Pain Service ​

Will give you sign out and their PCD on C1 Saturday overnight call.

When you come in, call the PCD at x75433 to meet up for sign out.

Keep track of any patients added overnight/changes made for AM sign-out.

Always see patients when an evaluation is needed.

Briefly document all significant changes in plan and all patient visits on Epic.

There is an APS attending on call every night, available by phone. Make sure you get their contact info at sign-out. Call for all updates and changes in pain management.

Ask plenty of questions at APS sign-out, especially about the plan for problems.

Give report to the pain service APN or fellow by 7am the next morning.

APS team will sign out to C2 fellow or mid-level on Sunday PM, so Sunday resident does NOT cover APS.

The C1 Saturday overnight resident is assigned to the Acute Pain Service (APS) on Friday before the C1 PM Saturday shift. This allows you to become familiar with the APS service on rounds, learn about acute pediatric pain medicine, and perform blocks prior to holding the APS pager overnight that weekend. Please reach out to the APS attending on Thursday before that shift to determine when and where to meet on Friday AM.

Codes: ​

Coordinate with your attending by phone or in person for all codes

Level One Trauma or Trauma Red – MUST attend STAT. Sign in when you arrive via access card reader

Level Two Trauma – do NOT need to attend.

Our responsibility is the airway. Once verified/secured, ask the code/trauma code leader (ICU, surgery, or ED attending/fellow) if you need to provide additional assistance, otherwise return to your other responsibilities.

When called to the ER, the ED fellow may ask to place the airway. Use your discretion and do what is best for the patient. You may respectfully decline if you do not feel comfortable with this. Please discuss with your attending, if possible.

They have a Glidescope, LMA’s, and standard intubation equipment available in the ED.

Emergency Medical Response/” Code Blue” – MUST attend. If in OR, call your attending immediately.

Stroke alert level 1 – heads-up. May require urgent imaging (typically MRI) under anesthesia. Begin to prepare and pre-op patient, if possible, coordinate with your attending

Stroke alert level 2 – Need to start scan now.

RRT – ICU team will respond to eval. Not required to attend, but 30% will become a code blue. Review prior anesthetic record, co-morbidies on Epic and be prepared for possible escalation.

Don’t forget to swipe your code access card when you exit the elevator to release it.

Airway Box - there is NO tackle box at CHC, but you may need to take a Glidescope if going to a difficult airway child. Also, no neonatal microcuff tubes or LMA’s on the units, so bring those with you if you know they are needed. Be sure to call your attending as soon as you get the code.

Discuss with your attending how to document all patient care delivered outside the OR, including procedures.

Blood ​

Please leave blood products in the OR refrigerator until you are going to transfuse them (except emergencies) to avoid temperature indicator color change.

Tips for success ​

CHCO is a place to let your inner type-A shine! Attendings appreciate attention to detail and cleanliness more than efficiency. You will notice that the entire OR works together to provide the safest, best care we can (i.e., the circulator will typically be near the head of the bed helping with induction, people with help you with IVs, etc). It is a very team-oriented, patient-focused learning site so enjoy!

You may find yourself being more closely supervised at CHC than other rotations, especially when you are new here. Do not take this personally. As we get to know you that will typically change.

We realize that taking care of very ill and traumatically injured children can be emotionally challenging. Please let us know if this is an issue so we can address it sooner rather than later. Good resources are Drs. Bielsky or Janosy, the CHCO Fellows, and the chiefs.

Spine fusions, acetabular osteotomy cases, VPS, ERAS, and transplant cases are complex and highly protocol driven. Please ensure you obtain a copy of the protocol from sharepoint (clinical section), discuss the case with your attending, and give yourself adequate time to set up. Always look to see if a protocol exists for major cases (or ask attending during pre-op discussion if one exists).

Please use the central line insertion kit for all central lines

Please wash, gown and glove for all catheter placements. Use a probe cover for all U/S blocks.

You will need to log out of the Omnicell and both computers when you leave the room and secure all medications.

Please refer to the CHC policies and procedures for additional information on topics such as: trauma codes, massive transfusion protocol, blood transfusions, admission following GA due to young age, and others. https://info.childrenscolorado.org/sites/search/Pages/results_policies.aspx?k=

There are now 2 computers screens in all OR’s. The one above the APL valve is a touch screen and automatically links to anesthesia machine (you must login on this computer in order for VS to automatically load into Epic); the regular computer is not linked to anesthesia machine (you must manually link it if you want it to record vitals).

Attendings here have trained in a variety of places—it is very common to do very similar cases and procedures one way with one attending and completely different another day with another attending. It can be extremely frustrating at first, so be very patient. Be sure to have a thorough and complete plan for your cases that day. In the end, it is good to see different ways of doing things so that you can adapt and develop your own practice based on what has worked for you.

Professionalism: ​

Please be helpful, respectful, and courteous to everyone you encounter at CHC. If you cannot address their concerns, or have issues, please contact your attending.

Be proactive in your communication at all times (from pre op planning, problems/concerns/questions, and your documentation responsibilities)

For complex cases and blocks, please make an effort to personally post-op patients that stay > 24 hrs inpatient. See (or call patients at home) that had nerve blocks to see how they did with any blocks you placed.

Resources ​

Protocols ​

CHCO has an internal sharepoint with protocols for a subset of the cases you might see. Access to this sharepoint may be restricted without a CHCO email address which residents rotating there won't have. The link below is a folder containing some of these that were shared by email.