1. Harper University Hospital Orientation
Hala Nas

2. New to Harper… Pager/sign-outs at 7 AM and 3 PM, no excuses
On Thursday, admission cutoff is 3 PM, however sign-out to long-call team is at 5 PM. No seniors or interns should be leaving before 5 PM
No Observation admissions, however if Med B contacts us for an upgrade we take the patient

3. Responsibilities towards medical students
Please make sure you get in touch early on with your medical students. MS3 can carry 2-3 patients and Sub-Is can carry 3-4 patients
Please allow time for your medical student to see the patient, staff with them and allow them to fully present to attending without interruptions.
Your medical students should be writing daily notes, and signing them to team senior for corrections

4. Team structure
HUH A1
Resident
Intern A2

5. Team caps Intern cap: 10 patients (all encounters)
Intern new admission cap: 5 patients in a 24 hour call
Total team cap: 20 patients

6. Hitting caps If the on-call team caps…
Before 6:30 pm  page Dr. Safwan Saker 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
At 8 PM the night float team arrives, transfers the admission pager to themselves and will admit patients to the other team
After 6:30 pm  on-call senior admits patients to the other 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 capped > admissions go to Dr. Safwan Saker

7. Call days (Q2)
Days where you admit patients. Admission cut-off is 3 PM always
Short call (3 PM) and long call (8 PM)
Admission pager carried by short call senior until 3 PM, then carried by long call senior until 8 PM
3 PM: Teams sign out to on-call team for cross coverage. On Thursday sign-out is at 5 PM

8. Night float and night admissions
Cap overnight to call team: 10 patients
Intern cap in a regular non 24 hour day: 3 new patients. 10 total patients
5 nights: NF senior and NF intern
Fridays and Saturdays: NF senior and on-call floor intern

9. Admission cut-offs
Admissions 6:30 PM to 8 PM to be evaluated by on-call senior (admission and basic orders), H&P to be completed by night float team
Admissions 6 AM to 7 AM to be evaluated by NF senior (admission and basic orders), on-call team to complete H&P
Admission to short team: 3 PM

10. Non-call days No new admissions
Finish up your work and sign-out at 3 PM to on-call team
Sign-out is at 5 PM on Thursday. No exemptions

11. Admissions

12. From ED On-Call Senior will carry the admission pager (0092)
When the ED calls for an admission take sign-out, briefly review the chart, ask the ED physician any questions you might have, provide the attendings name and go evaluate the patient immediately or at least within 15 minutes
Place the following orders:
Covering physician order
Basic orders until the primary team evaluates the patient (which should be after morning report)
Patient presence in ED doesn’t stop you from managing/ordering
Always evaluate the acuity of your patient’s illness; determine if they are stable for the floor or need evaluation by the ICU
Admissions can not be refused. If you believe the patient does not need admission, call your attending

13. From MICU Take sign-out from resident or fellow
Cannot place orders on the patient until they physically have left the unit
Communicate with MICU team if you’d like something done/cancelled
Place covering physician order so that nurses page you once patient is on the floor
Do not round on patients if still physically in MICU

14. From other services
Patients transferred to your team from another service if you have not taken care of that patient before.
The Medicine Consult service must first evaluate to approve this transfer, pager 5501.

15. Direct admissions and facility transfers
Admissions from the clinic/outside
If you accept an admission from the clinics, it is your responsibility to check which floor the patient is going to be admitted to. Bed assignment 51387
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.

16. Transfers to MICU
If you feel your patient needs a higher level of care, page MICU fellow at 6428 and consult
If accepted to MICU, fellow calls bed control for an MICU bed. Either you or MICU team place transfer orders

17. Bounce backs
Bounce backs are admitted by the on-call team (regardless of who the bounced patient belongs to).
The next morning, the team staffs the patient with the attending, writes a progress note, and signs out the patient to the team that the patient belongs to originally
If the patient is being discharged on the next day, the discharge will be done by the team that admitted the patient.
No bounce backs on the first and last days of the rotation

18. Discharges Discharge process starts on day of admission 
If patient to be discharged later in the day, make sure discharge meds, appointments, ambulance forms and order is placed by primary team

19. Medicine consults
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:
Evaluate STAT medicine consults
Conduct pre-op assessment on a patient
Staff over the phone with the DRH UPG Medicine Hospitalist (pager 5755)
Write a brief incident note (SOAP format)
Add patient to Medicine Consult list and page the team the next morning, give them a brief signout and they will do the full consult note
These DO NOT count as hits

20. Who counts as hit?
Patients seen, staffed and directly discharged from the ED
BUT MUST BE STAFFED WITH ATTENDING FIRST
Completed H&P but patient ends up going to a different service
Patients admitted to your team who you will be following on a daily basis
Patients transferred to your team from another service if you have not taken care of that patient before.

21. Codes On-call team responds to codes in Harper
Do not respond to Karmanos codes

22. Days off Each resident must take 1 day off in each 7 days
All team members must be here on call days
Obviously, can’t have your assigned MR day off 
Seniors should avoid taking post-long call days off as much as possible

23. Morning report Morning Report- combined at DRH
Morning report will start promptly at 11:00 am. No excuses to skip
All residents are expected to attend MR except the senior who is on short call
1 case per day
Case presentation slides to be covered by the intern
Senior is responsible for case oversight and educational slides
Review the MR schedule
Complete your case slides 48 hrs in advance and to CMRs.
Late cases < 48 hrs will be moderated by senior

24. Have fun!