1. SMH Psychiatry: Intro to Call, Notes & Orders
Magdalena Casagrande
2014

2. SMH Psychiatry
Introductions
Attendings and rotations

3. Safety Panic buttons on units Ekahau tags in ER
Nursing/Security to be present when entering security room

4. Psych Call 4 evening calls & 1 weekend call
Your attending & resident will be in house with you
Exchange cell phone numbers / pagers
Weekdays
5pm - 11pm (in-house)
Weekends
8 or 9 am until the work is done (in-house)
Your responsibility to ensure coverage – can switch with same level for same type of call

5. Psych Call Weekday call = new assessments
Weekend call = new assessments & follow ups
Assessments = admit or not
Do not see patients on your own before first discussing with your staff
Safety – MCFD, driving, work
Present patient to attending

6. Inpatient Units: 4E, 4W & PAU Team rounds vary depending on attending
Usually in morning, once weekly
Room across from Pat McColgan’s office
Nursing staff, SW, Pharmacist, Neuropsychologist, Occupational therapy

7. Inpatient Daily assessments SOAP notes Review nursing notes
Review use of prn medications
S/R over last 24 hours
Any messages on psychiatrist clip-board?
SOAP notes
See example

8. Dictations Dictation systems & codes Outpatient: d/w Dr. Smit
Personal dictation ID
Facility code = 17
Work type = 104 (consult), 107 (discharge)
Outpatient: d/w Dr. Smit
Inpatient: discharges
Psych ER: consultation & discharges

9. Dictation Headings: Consultation
Identification
Chief complaint
HPI
Past psych hx
1st contact
Hospitalizations
Past medical hx
TBI / seizures / thyroid
Meds / All
Family psych hx
Substance use hx
Forensic hx
Personal / social hx
Investigations
MSE
Impression
Plan
Certifiable or not
Further investigations / assessments

10. Dictation Headings: Discharge Summary
Discharge dx
Discharge meds
Identification
HPI
“For details, refer to consultation by Dr. X, dated July 4, 2014”
Presenting MSE
Past history
Check with attending
Course in hospital
Behaviour on unit
Any issues, passes
Medication changes
MSE on discharge
Discharge plan
Accommodations/housing
Psych & GP f/u
Medications & Rx
Special instructions (driving, work)

11. Orders Admitting orders On unit Psych ER Orders sheet AD-DAVID
Don’t forget nicotine replacement therapy
Consulting other services
On unit
Levels of observation
Day passes – specify accompanied or not
Overnight or weekend passes – write “with meds”
Consult SW / OT etc. – write reason for consultation in orders

12. Expectations Know & utilize Meditech
Utilize various sources of collateral information
Family, police (ER)
GP or community psychiatrist
Prior consultations
Professionalism
Check with Attendings/residents
Remind them of your scheduled teachings, half-days

13. Teaching Schedule Monday, Wednesday, Friday 8am Friday 9 – 10 am
MSI teaching various topics
Friday 9 – 10 am
Journal club 1st week
Psychopharmacology rounds 2nd week
Grand rounds 3rd week
Friday 11:45am
OSCE rounds
Jeopardy August 8th

14. MSI Teaching Mon / Wed / Fri 8 – 9 am: core psychiatry lectures
Psychiatric assessment & MSE
Emergency psychiatry
Psychotic disorders & mood disorders including ECT
Personality disorders, anxiety & sleep disorders
Crash courses x 2 in psychopharmacology
Geriatric psychiatry including dementia & delirium
EPS & AIMS assessment demo
Various child psychiatry topics (week 4)
Addiction psychiatry
CL psychiatry
CRE practice, feedback, Q&A
AM lectures at SC4 Conference room
Psychotherapy teachings SC7 Solarium