Your Chiefs Located across the corridor in Evans 116 (8-7253) Also an office on the 6th floor HAC (4-5642) VA Chief – Anju at the moment 5222 – the oncall pager Stop us in the hallway, at conference, in clinic etc. – we’re here to help you
Pre-rounding 7am pick up sign-out (9am on Sundays @BMC): ENC 8 th floor work room HAC one of two 6 th floor conference rooms VA 2-South conference room Pre-round on patients – collect vitals, assess any patients active overnight, ins and outs, weights... Don’t forget the Telemetry (upcoming intern conference session) Check stability of any new Short Call “holdovers” ICU pre-rounds are a little more involved
Ward rounds and presentations Usually start 7.30am, Attdg present alternate days 24hr events, any new tests and results, morning vitals See the patient with your team – interns lead at the bedside! Then present your assessment and plan by problem (don’t forget to address FEN, Ppx, Dispo, and Code when relevant) Organize your ‘scut sheet’ Rounds complete by / pause @10am Morning Report
The superstar intern How old is the central line? Can any IV meds be changed to PO? Can they come off telemetry? Can the IVF be stopped? Will they need PT prior to discharge? Can you D/C the Foley catheter? Can you advance the diet? Are they moving their bowels? How close are we to discharge? Are the meds adjusted for renal/hepatic failure? Does the patient understand their care?
Putting in Orders Sunrise (SCM) order entry Phlebotomy draws are 7am, 10am, 1pm, 4pm, 7pm, 10pm, 1am, 4am. (AM draws usually 7am on the wards) If you can’t find it, try the % sign Call consults early please (the fellows will ♥ you) Radiology requests are a consult! Call down if its STAT Don’t forget to let the nurse know!
Progress notes Are now on SCM!!! Are required 7 days of the week
Attending rounds You should receive 3 attending round sessions per week You should also seek expectations / mid-way feedback / end of rotation feedback from Attdg and Resident
Noon conference Monday – HAC A/B Tuesday – Intern conf in Evans – compulsory! Wednesday – firm conf (11.30) or M&M Thursday – HAC A/B Friday – Emergency series / Grand Rounds You will be fed ☺ Attendance goal 80% We will hold your pagers 12 – 1pm
Afternoons Follow up results, consults, images Always update the patient! CLINIC Procedures – supervision, help Record temporarily by an SCM list or emails to self Teaching Calling a Code: 8-7777 or 4-7777
On call schedules Long call Max 5 for Early Long, 5+2 for Late Long Early call out by 9pm, Late is overnight Post call Short call Max 5 Early to 12, Late to 5pm (should be out by 7pm) Routine Or day off Units are q4 overnight Weekend coverage assignments
Survival tips If you’re standing, sit You’ll get out of this experience what you put into this experience Don’t assume anything… Use the resources around you: Resident, med students Chiefs, PDs RNs, pharmacists, PT/OT, case managers Subspecialty fellows BMC intranet Uptodate, online journals Each other
Admitting patients Resident will receive Admitting and ED pages IBEX is the ED board See the pt as soon as they arrive, at least to ‘eyeball’ and write holding orders Using the order sets – quality improvement H&P is online – every patient needs an intern or resident H&P Assigning a pager to the patient
Discharging patients The computerized Discharge Summary Can “copy forwards” from H&P – but check its relevant and accurate Discharge Medication Reconciliation in Logician – cut and paste the med list into the DSUMM Print out the Med Rec E-prescribe / Pharmacy arrange new meds Page One for services Discharge Order Follow-up appointments
Signout (after notes done, labs ordered, checked in w/ patients and resident) To Who? Long call <7pm NF junior >7pm Divert your pager! SBAR: Situation Background Assessment Recommendations