WELCOME Orientation to Harper University Hospital

In General: A Day on Harper Floors On-Call (Q2) 7 am Short call senior carries admission pager Floor residents get signout from night float/intern overnight (pager!) Evaluate your patients Pre-round with your senior Pre-round with students Round with your attending Attend morning report 3 pm Long call team begins admitting patients If your intern is on 24-hour call they should not cap with 5 new patients before night float senior arrives They should be given every-other patient between 3 and 8 pm (no more than three patients) so that they may help admit patients overnight 8 pm Night float team arrives to take sign-out (cross coverage) and begins admitting patient (pagers!)

In General: A Day on Harper Floors Non-Call (Q2) 7 am Round with night float 3 pm Sign out to long call 7 am next day Return to get sign-out about your patients (pagers!) You’re now on-call **YOU MAY ADMIT PATIENTS TO YOUR TEAM ON NON-CALL DAYS IF THE OTHER TEAM IS CAPPED!!**

AMR aka. ER/IM Sorry  No more AMR for HUH Short call senior: admissions, code blue  

Long Call Team Notes Cross-Coverage Long call team will cross cover the other teams’ patients from 3pm until 8 pm Stay and provide sign out to the night float team at 8 pm Don’t forget to forward your pager to the covering resident Long Call team accepts admissions and writes full H & P’s until 6:30 pm (unless capped) Admissions between 6:30 pm and 8:00 pm will evaluated by on call senior who will admit the patient, add the patient to the list, place a covering physician order and place basic orders Seniors must sign these patients out to night float!!! Full admission note to be done by the night float team Admissions from 6:00 am to 7:00 am will be evaluated by the night float senior who will admit the patient, add the patient to the list, place a covering physician order and place basic orders Patient sign out to upcoming short call senior  

Night Float and Intern 24 +4 Night call 8 pm - 7 am Patient cap to admit overnight is currently 10 patients Cross-coverage of patient continues; sign-out occurs at 7 am next morning 4 nights: Night Float intern + Night Float Senior 2 nights: Floor interns stay overnight (in-house from 7 am that morning until after round the next day) with Night Float Senior 24 + 4 hours Night float senior rounds with you too  

Team Cap EFFECTIVE IMMEDIATELY TEAM CAP IS 23 patients per team If the on-call team caps… Before 6:30 pm  page Dr. Saker, Safwan who will take over the admission pager until 8 pm YOU CANNOT LEAVE THE HOSPITAL! YOU MUST CONTINUE TO CROSS COVER PATIENTS, SIGN THEM OUT TO NIGHT FLOAT AND TELL NIGHT FLOAT TO TRANSFER THE PAGER AND ADMIT TO THE OTHER TEAM After 6:30 pm  on-call senior admits patients to the other call team, places covering physician orders, evaluates the patient, places basic orders, signs the patient out to night float who will continue the workup and do the full H & P THE ON-CALL SENIOR MUST PLACE BASIC ORDERS ON THESE PATIENTS AND SIGN THEM OUT TO NIGHT FLOAT, LET THEM KNOW WHAT YOU’VE ALREADY DONE SO THEY CAN PICK UP WHERE YOU LEFT OFF If both teams cap > admissions go to Dr. Saker, Safwan

Intern Cap INTERN CAP IS 10 patients TOTAL - 10 patients = (new and follow-ups) Interns should not admit more than 5 new patients on any call day If your intern is on 24-hour call they should not cap with 5 new patients before night float senior arrives They should be given every-other patient between 3 and 8 pm (no more than three patients) so that they may help admit patients overnight

A Few General Floor Notes You should be identifying patients for potential discharge at least the day before and completing paperwork early so that on rounds you can just place the discharge order Participate in the TEMPO boards on a daily basis and notify nurse daily and directly of patient plans/dispo plans

Days Off DECIDE TODAY!! No exceptions will be accepted if you postpone. Nobody can take long-call off… no exception Seniors try taking post short call off only. Avoid taking short-call and post-long call days off as much as possible Interns try taking short call or post short-call off. Avoid taking post long-call if possible.

Admissions Return pages promptly (within 10-15 min) Please do not review patient chart to decide if the patient needs to go to different attending before accepting new admission. Bounce back: admit and round the next day. If patient is expected to stay longer than a day then after you round and write your note and put your orders, give it back to the bounce back team. If during rounds you decide you can discharge the patient then do not give it to the other team, just put in the orders and discharge yourself.

Admissions From the ED Please do not wait for the patient to receive a bed on the floor to work them up. Evaluation and orders should begin in the ED.

Admission from DRH ED Once the DRH ED calls you to tell you about the patient, call the resident on call (or AMR) in DRH to evaluate the patient and place basic orders. Put a communication order to page you once transferred Keep patient on your list but realize that the FIN will change so keep checking. Once the new FIN is in, all orders must be put in again.

Non-ICU transfer to Medicine In House Transfers Floor to ICU The floor resident is responsible for calling the MICU/CCU fellow on call for any transfers to the critical care ICU, CCU, Cardiology to Floor Transfer order will be entered by MICU team Cannot place orders on the patient until they physically have left the unit Communicate with MICU team if you’d like something done/cancelled Non-ICU transfer to Medicine Patients transferred to your team from another service if you have not taken care of that patient before. The Medicine Consult service must FIRST to approve this transfer, pager 5501.

Direct Admission and Facility Transfer Admissions from the clinic/outside are direct admissions. If you accept an admission from the clinics, it is your responsibility to check which floor the patient is going to be admitted to. - Your attending physician must accept transfers from outside hospitals first. If you are called to accept a transfer, talk to the transferring physician and obtain the following information provisional diagnosis history vital signs pertinent physical examination pertinent work-up reason for transfer phone number of transferring physician Make sure the patient is stable for transfer and management on the floor. Discuss this with your attending physician before accepting the transfer. Bed assignment number: 51387

Medicine Consults These DO NOT count as hits After 4 pm on the weekdays and 2 pm on the weekends the medicine consult pager will be forwarded to you and you may need to see a HUH/RIM patient SENIORS, after that time you must… If STAT (check order) Evaluate, staff over the phone with the DRH UPG Medicine Hospitalist (pager 5755), write a brief incident note (SOAP format), add to Medicine Consult list If routine Just place on the Medicine Consult list These DO NOT count as hits

Discharges Remember that dc summaries count as progress notes Complete the discharge summary on the DAY of the discharge. Remember that dc summaries count as progress notes Must include Subjective, PE and vitals! New discharge template includes these

Discharges By Covering Teams/Night Float The covering/night float teams should confirm with the respective attending on the team before discharging any patients if asked to do so by the primary team Also, the primary team should complete the departure process/discharge plan before leaving including: Completing depart in computer Making all discharge appointments placing scripts in the chart arranging for transportation answering all patient/family/caregiver questions

Documentation Always document lines, ports, catheters Code status Family member/contact and RELATIONSHIP Diet Disposition (update DAILY!!) VTE/GI proph

Codes On-call team responds to codes and actively participates (Senior, intern, students) Other people/resources should be there too If they are not, ASK FOR THEM

Important Issues Continued Every cystic fibrosis patient needs a Pulmonary consult Notify Drs Kissner and Saydain when their pts are admitted. I&O’s and Daily weights when needed!! Tempo board Isolation orders: order with labs directly (e.g.: c diff pcr + contact isolation, influenza pcr + droplet isolation). DO NOT DELAY.

Telemetry Renew after 48 hrs. If not needed --> discontinue the order If pt can travel w/o tele, pt doesn’t need tele (order can be discontinued) If patient needs telemetry they cannot travel without it

Sepsis ADDRESS sepsis alerts (accept or reject) Utilize Sepsis PowerPlan

Education Morning Report- combined at DRH Morning report will start promptly at 11:00 am. All residents are expected to attend MR except the senior who is on short call 1 case per day case presentation and teaching slides to be covered by the intern Clinical quesiton, literature search and appraisal by the senior Senior is responsible for case oversight and assisting intern Review the MR schedule and guidelines on MR schedule