1. Intern Orientation Sign Outs
UCI Department of Internal Medicine

2. Objectives Help interns feel more comfortable with the sign out sheet
Walk through a sample patient sign out

3. How to get to the sign out page
AT UCI:
Medicine Home Page:
Click on Residency Portal and log in
 “Shared Documents” (Column on left hand side)
 Your Team and log in again. An excel sheet will open up
AT VA:
Through CPRS: Click on Options  Handoff Tools
No need to read through this. This slide is for interns to do on their own or you can show them where to find it.

4. Tips for Sign-Out
Keep in mind that nightfloat residents are covering >30 patients per night and are busy. It takes time to learn on what to include in the sign out
If the service isn’t too busy, try to quickly review the sign out with your senior resident so no tasks are overlooked.
Do not wait until the last minute to update the sign out list!

5. Tips for Sign-Out
EVERY patient should have last name, first initial, location, and MRN listed
Write a one liner about the patient
List an ACTIVE problem list and whether the patient is stable or unstable from that standpoint
To Dos: Next slide
ALWAYS write the CODE STATUS of every patient

6. Tips for Sign-Out
To Dos for nightfloat: What to include? What to exclude?
List tasks for nightfloat to follow up on (labs, imaging, etc) and instructions on what to do with those results (transfuse, replete lytes, etc.)
Anticipate what night float will get called on follow up labs, imaging, Is/Os
Include FYI notes: if patient may decompensate, pass away, consultant recs, etc.
DO NOT sign out procedures! They should be completed before going home

7. Example
Your patient on the wards: She is a 64yo F with pmhx of CHF (EF 35%), HTN, HLD, DM s/p right toe amputation, and breast CA in remission who was admitted for DOE and LE swelling. She hasn’t been compliant with her medications and the team deemed her to be in CHF exacerbation. The patient was started on IV lasix BID and resumed on her home meds. You also noticed her right foot had a diabetic ulcer concerning for osteomyelitis. She has a leukocytosis of 18,000 and spiked a fever after being admitted. Ortho was consulted.
After reading through the case, ask the interns how they would approach signing out this patient.

8. Example (cont’d)
She was pancultured at the time and started on vanco, & zosyn. A nuclear scan (creatinine 1.7) was ordered earlier and still has not been performed. Her breast cancer has been in remission for 5y and her heme/onc doctor is an out of UCI network. Her daughter, Susie, is very involved in her care and requested to be called if there are any updates with her mom. Patient is stable. She is full code.
How would you write the sign out on this patient?

9. List all pertinent meds
Sample sign out
Patient
Problem
Meds
To DO
Code Status
Doe, S
T5B1
MRN
64yo F w/pmhx CHF (EF 25%), HTN, and DM s/p right toe amputation admitted for CHF exacerbation 2/2 med noncompliance and possible osteomyelitis.
#CHF exacerbation: Resumed on ASA, ACE, bB and started in IV lasix BID. Breathing comfortable on room air.
# Diabetic ulcer: Leukocytosis, febrile. On vanc, zosyn. Awaiting nuclear scan. Ortho aware.
#DM: On RISS
List all pertinent meds
[ ] Check K and Mg at midnight and replete
[ ] If febrile, do not reculture or change abx.
FYI: If decompensates, transfer to CCU for lasix gtt.
FYI: For major overnight events, call daughter: Susie (xxx)xxx-xxxx
FULL CODE
No need to mention HLD or breast ca since it’s in remission and not an active issue. Although the patient was stable when you left, but since patients can decompensate unexpectedly, should FYI nightfloat. Always include family member’s phone number if needed.

10. Summary Be concise and include pertinent info on the sign out
Anticipate events that may occur with your patients and notify nightfloat