Current Environment:


The Pediatric General Surgery Service is divided into two separate teams, the Gross and Ladd services, in order to group patients according to their primary disease process (e.g. short bowel syndrome, transplant, esophageal atresia). There is a chief pediatric surgery fellow assigned to each service.

The two-service-team approach allows us to more evenly distribute the number of inpatients that are cared for by the fellows, residents, interns, and nurse practitioners.

The team includes:

  • general surgery senior residents (2 to 4 residents a month) who rotate from area hospitals, including Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Boston Medical Center, Lahey Hospital & Medical Center, St. Elizabeth Medical Center, and Tufts Medical Center
  • two to three general surgery interns
  • a large group of more than a dozen nurse practitioners who cover the service 24/7
  • one to three critical care surgical fellows assigned to the NICU/MSICU
  • eight to 10 surgical research fellows who assist with call coverage at night


Morning rounds


  • Each team is composed of one fellow, one senior resident, one intern, and two nurse practitioners, and either the surgeon of the week (SOW) or senior fellow (+/- additional senior/intern residents).
  • Lee Ranstrom, senior nurse practitioner, will round with the non-SOW team.

5:45 a.m.: Overnight sign out

  • The overnight resident will make brief presentations on the patients who were admitted to the hospital overnight.
  • The overnight nurse practitioner will discuss any issues from overnight.
  • We will discuss any anticipated staffing/OR coverage issues.

6:00 a.m.: Floor rounds begin

  • The intern or nurse practitioner will present the patients (overnight events, vitals, I/Os).
  • Either the fellow or senior resident will examine the patient.
  • Plans will be outlined for the day.

6:45 a.m.: ICU rounds begin

  • Ladd chief rounds
  • Gross chief rounds
  • SOW will go at 6:45 a.m. and round in the NICU

7:15 a.m.: Chiefs, SOW, and surgeon of the day (SOD) meet for sign out

Evening sign-out

  • Both services will sign out at the same time (around 5:30 p.m.).
  • Written sign-out is also provided by the NPs/interns covering the floors.

Overnight call

  • In conjunction with the resident/moonlighter on call, the on-call nurse practitioner is responsible for sending a sign-out email with patients assigned to either the Gross or Ladd service. New patients who are added to the census list will be assigned a service according to their primary attending. If there is any question regarding which service a patient should be assigned, please discuss with the overnight SOD (the on-call fellow can also be contacted if there are any questions).
  • A fellow is on call in the hospital one to two times per week acting as a pre-attending.
  • Fellows are on call from home available for urgent inpatient concerns or fellow level OR cases at their discretion.