WELCOME!!

Chiefs’ Orientation Dana Angelini Hiloni Bhavsar Brandon Kellie Morgan Oberle Gigi Gaudiano (Med/Peds) June 14 th, 2012

Topics: Introductions….. Who we are Roles of Chiefs UH Wards VA Wards A Typical Day on the Wards Ambulatory The Pager System Advice

Dana Angelini Undergraduate: University of Dayton Med School: Wright State University Home Town: Clinton Township, MI Talent/Hobby: Baking

Hiloni Bhavsar Undergraduate: Wright State University Med School: Wright State University Home Town: Dayton, Ohio  Really...born in India, moved to Dayton '94 Talent/Hobbies: Throwing dinner parties & cooking!

Brandon Kellie Undergraduate: University of Louisville (GO Cards!) Med School: University of Louisville Home Town: Murray, KY Talent/Hobby: can BBQ and speak southern

Morgan Oberle Undergraduate: University of Evansville Med School: Indiana University Home Town: Paoli, IN Talent/Hobby: running/working out

Gigi Gaudiano Undergraduate: University of Virginia Med School: University of Virginia Home Town: Great Falls, Virginia Talent/Hobby: Cooking, chasing around Domenic

Roles of the Chiefs Medicine Chief Residents:  Rotate every three months UH Chief #31250 – Morgan Oberle  Office in Lakeside 3 VA Chief #31533 – Brandon Kellie  Office on 4th floor VA Ambulatory Chief #31529 – Hiloni Bhavsar  Office on 4th Floor VA Quality & Pt. Safety Chief #36644 – Dana Angelini  Office on 4 th Floor VA/Lakeside 3 Med-Peds Chief #37297 – Gigi Gaudiano  Office in Lakeside 3

Roles of the Chiefs We are the advocates for the residents  Call us with problems or issues that arise  Timely and specific please…we can’t help you if you don’t let us know. We are your mentors  We provide support for your professional development, education, and your psycho- social well-being We have candy! (Morgan may have granola bars or celery! )

UHUH Campus

UH Wards 8 Medicine Teams Wearn – General Medicine Naff – General Medicine Dworkin – Gastroenterology Carpenter – Infectious Disease, General Medicine Eckel – Nephrology and HTN Hellerstein – Cardiology Ratnoff – Hematology and Oncology Weisman – Hematology and Oncology 2 ICU's MICU & CICU

UH Wards – Sister Teams Naff Wearn Carpenter Dworkin Weisman Ratnoff Sister teams alternate long call days; each team has 2 interns  leading to Q4 “long” call

UH WARDS Hellerstein Eckel Each team has 4 interns rotating on Q 4 “long” call No “sister” team

UH WARDS UH MICU o 2 teams with 2 attendings and 2 fellows; each team with 2 residents and 2 interns o Q 4 long call for interns and seniors (seniors take overnight call) o “Helper” day is your seniors post call day (will sign out to you around 10 AM UH CICU o Act as “helper” can follow and admit patients o No formal call Night Float o 3 interns scheduled; 2 present each night; cover the 8 inpatient UH teams

Other UH Rotations Neurology  2 week rotation on the Neurology consult service GI-Jeopardy Rotate on GI consult service but are on call for back up for any absence on UH or VA wards/clincs MUST have pager on and answered 24/7

LOGISTICS of Calls... Long call – 3 patients by 7pm Only 1 patient after 6 pm Medium call – 2 patients by 4pm Short Call:  UH: 2 Patients (nightfloat admit or unit transfer)  VA: 2 Patients (nightfloat, transfer or NEW) Long  Medium  Short  HAPPY!

LOGISTICS: No. of Patients UH:  10 patient cap on all UH ward rotations EXCEPT Ratnoff and Weisman which will cap at 8 (rolling cap)  Your short call day will also cap at 8 (based on number of patients you start with in AM; not rolling) At VA:  Cap=8 all the time

cCall and continuity clinic No Clinic on Long or Medium call. No short call patients assigned on your clinic day.

Days OFF Dworkin, Carpenter, Wearn, Naff, Ratnoff, Weisman, and VA Wards o Short or Happy days that fall on Saturday or Sunday o “Golden” = both weekend days off o “Black” = work both weekend days o Either Sat or Sun off Eckel or Hellerstein o 1 day off per week: “Happy day” Friday through Monday

Days OFF Night Floats o UH: 3 interns are scheduled but only 2 are on each night; work out days off with each other! o VA: Saturday night is off UH MICU o Short call day off Friday through Monday

UH Team Pagers Each team (Eckel, Wearn…) will have a pager held by the on call and nightfloat interns Will mostly be paged by nursing regarding patient issues; not sure the answer???? Just ask your senior!! Team pagers are also code pagers – on call interns should go to all codes (‘Code Blue’) Team pager numbers are listed on the pager card in your bags.

Meet the DACR/NACR/MAN… Day Acting Chief Resident/Night Acting Chief Resident/Medical Admitting Nurse Role is to distribute admissions, run codes and overall monitor the daily flow of the internal medicine inpatient service Available 24 hours/day at pager to answer questions or provide assistance!

Conferences - UH Intern Morning Reports – Residents hold the pagers!! Tuesday AM report from 10:30 – 11am! ** NEW ** Thursday 10:30am-11:30am Grand Rounds  Tuesday 12-1pm Morbidity & Mortality (M&M)  Friday 12-1pm Agre Soceity  Monthly, Wednesday evenings – more info to come Noon Conference  Monday, Wednesday and Thursday 12-1pm (with food)

UH Miscellaneous Dictating – Interns must dictate discharge summary for each patient discharged on the DAY OF DISCHARGE Day of Discharge note = progress note + discharge summary  Dictation number must be written in the chart on the day of discharge Do them as soon as you write the discharge order Residents must do Discharge summaries when Intern has the day off

UH Miscellaneous GME Housestaff Lounge!!  Located on Lakeside 6 th floor, next to GME office  Has coffee, bathrooms, T.V., foosball table, computers, food on Sunday nights THE P.I.T. Fitness Center  Basement of Lakeside  Free card entry, TV's, towel service, open 24/7!

Duty Hours etc. 16: 80: 4 Rule!  16 hours per long call  80 hours per week  4 days off every month  Long call every fourth day  3 admissions by 7 PM, out by 9 PM, must be out by 11PM  Medium Call – 2 admissions by 4 pm, stay and signout team to intern nightfloat at 7pm

UH Resources The Chief Resident Your Senior Resident The DACR/NACR Other Residents The Night Floats

Louis Stokes Veterans Administration Medical Center

VA Wards Four General Medicine Teams  Blue, White, Green & Orange 1 resident + 2 interns per team – may have acting interns/medical students Ward 4A: Orange/White (sisters) Ward 4B: Blue/Green (sisters) PCU: telemetry 2 nd floor

VA Lounge and Call Rooms Located on the 2 nd floor Four call rooms (bunk bed room for AIs) Fridge: frozen dinners, ice cream, sorbet, string cheese, muffins, fruit, yogurt, milk, PBJ un-crustables Coffee machine Cabinets have: Trail mix, gold fish, peanut butter crackers, pretzels!

The VA MICU 2 resident (day and night), 3 intern team Q3 call  Admit from 7am to 8pm  Leave by 10 pm  No overnight here either!  Day off is “pre call” day Friday through Sunday

Urgent Care Center (UCC) The VA “Emergency Room” Staffed by at least 5 residents  One or two attending physicians  Hours are 9-6 with “on-call” resident to arrive at 0800 (you will not be the “on-call” resident this year)  Fast track: sees low acuity issues, med refills….

Intern Saturday Coverage One or 2 Saturday Nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7pm to Sunday 8am for the VA intern nightfloat to get a night off.

VA Conferences Monday: Noon conference Tuesday: Grand Rounds televised from UH at noon Wednesday: M&M at noon Thursday: Intern Morning 10am- 11am!  Your resident will take your pager  Be on time!! Friday: Noon-conference

VA Miscellaneous Garage parking is free! Just need to get a parking pass from VA police dept VPN access for home CPRS access Codes at VA are called ‘Dr. Heart’

A typical day on the wards 7am to 7:45am:  Pick up signouts in KACR (at UH – Tower 5) or from intern nightfloat team (at VA you will meet up with VA nightloat intern)  Pre-round 7:45-8am: Be in your team room to discuss changes overnight and the day’s plan with your senior 8am to 10:00am (VA) or 10:30am (UH): Rounds with attending  New patients – present H&P Present the pertinent data, remember you only have 2 hrs for rounds  Old patients – present new data, events overnight and then your assessment and plan Your A/P may be right or wrong but the best way to learn is to take a shot – don’t just present the data and then look at your attending and resident and wait for them to tell you what to do Be organized—”have a system”

10:00-12:00: Time to get C.O.L.D. C: Call your consults  The later you call, the more angry the consultant will be O: Order Entry  Enter any orders that were not entered on rounds L: Labs  Run your labs! D: Discharges  Get them out!  At UH, dictate your day of discharge note in your discharge summary  At the VA, type the discharge summary on the day of discharge

A typical day on the wards (cont) 10: :30 (UH) or 10: :00 (VA)  Resident AM report (M/W/F at UH, T/W/F at VA)  Thursday morning: Intern AM report Noon-1PM: conference Afternoon reserved for notes, procedures, teaching rounds, contacting families, following up studies short call should sign out to their co-intern who is long at 5pm medium call signs out to nightfloat at 7pm Long call signs out to nightfloat at 9pm

Ambulatory Medicine Continuity Clinic Urgent Care Center/Firm Urgent Primary Care Block Clinical Skills Block (CSB)

Continuity Clinic One afternoon per week at either the VA or the Douglas Moore Center at UH.  During ambulatory or elective, up to 2 clinics per week Always the same day each week and with the same attending preceptors You will develop a set of patients that you follow over 3 years Clinic cannot be canceled by anyone except the Ambulatory Chief Resident

Continuity Clinic Rules No clinic when  Medium call or on long call days  Vacation  Holidays  ICU’s  Night Float You DO have clinic when on Elective!!! Cannot switch clinics amongst yourselves; all schedule changes need to be approved by ambulatory chief resident

Primary Care Block Introduction to Outpatient Primary Care Introduction to DMC and the Firm Continuity Clinics Morning Clinical Conferences: 8am Daily 8:45-12:00: Clinics VA Firm A & B Mon – Thurs  Rheumatology  Diabetes, Renal, HTN  Endocrinology  Dermatology  Women’s Health Friday AM – Introduction to Quality & Pt. Safety Curriculum

Primary Care Block (cont.) Afternoon Didactic Sessions  Quality and Systems  Cardiovascular Health  Obesity  Managing Difficult Patients  Patient Safety  Professionalism and Writing  Physical Diagnosis  Common Ambulatory Disease Presentations

Clinical Skills Block 2-week outpatient rotation Hands on activities Simulation models at the simulation skill center Humanities in Medicine End of life care Cultural Competencies

The NIGHTFLOAT TEAM

NACR Nightfloat Resident Nightfloat Intern NIGHTFLOAT TEAM

The Nightfloat intern The Nightfloat Intern comes in at 7pm receives the pagers from the non-call teams The Nightfloat Intern can receive the pagers from the on-call intern at 9pm and must receive the pager by 11:00 pm

Night Float Duties Follow up on unfinished tasks Answer pages See patients when necessary (must document brief note in chart when you see a patient) Admit up to 2 patients from 8 pm – 5:30 am If you have questions – please please ask your nightfloat resident or NACR!!! Call senior for every CODE WHITE

Electives You have continuity clinic during elective Your should be answering your pager from 8 to 6 (M-F), no exceptions (unless on approved away elective) Must attend all conferences (GR, M&M, noon conferences at the VA) Otherwise, you can choose to do research, a clinical elective on a consult service, or even an ICU rotation. You have to inform Barb before starting what you will be doing on your elective time. If you do research or away elective, you need to identify a faculty mentor and should present your work at the Department of Medicine Research Day at the end of the year.

The Pager System UH: 1. Dial Wait for beep 3. Enter pager number 4. Wait for 3 beeps 5. Enter your phone number, then TAG the page (press star, then your own pager number) From the outside, dial (216) , then enter the pager number and follow remainder of protocol

The Pager System (cont.) Text paging:  Go to hospital directory website and select send a text-page from the menu on the left hand side of the screen (also possible to access remotely through physician portal or amion) VA: 1. Dial Follow the UH protocol

Professionalism Policy For call-offs of more than 2 consecutive days or more than 2 days in an academic year you will be required to have a physician’s note. You can be seen by an attending physician same day in the Family Medicine Bolwell clinic. Any call offs > 2 days, you will get extra weekend jeopardy or coverage

Friendly Advice Catch up on your sleep when you have a chance Talk to a chief or program director before personal problems get out of hand – we are here for you! SUPPORT EACH OTHER!

Friendly Advice Maintain personal and family relationships outside of the hospital; make new friends while you’re here Take care of yourself; it’s the only way you will be able to provide good care to your patients

Things to do in Cleveland Indians Cavs Browns Lake Erie Monsters East 4th West 6 th West Side Market Little Italy Art Museum Bodies Exhibit Edgewater Park Metroparks Zoo Goodtime 3 Wineries Great Lakes Brewery Larchmere Shaker Square Chagrin Falls Lakeview Cemetery Rock and Roll Hall of Fame Cleveland Orchestra Blossom Music Festival Lola Winking Lizard Panini's Cain Park Luna Bakery Playhouse Square Aurora Outlets Cedar Park Kalahari Water Park Put n Bay Kelley’s Island Air show Rib Festival Etc Etc

Final Thoughts SCHEDULES!

GOOD LUCK! Please call us if you need us, we are here to help!!!!!