1. Structural Changes in the Program Department of Medicine University Hospitals of Cleveland Case Western Reserve University Bronson Day, May 2002 Presented by: Keith Armitage Jay Finigan Noah Jones Keith Petras

2. Outline Medical service changes General Reminders Clinics Miscellaneous

3. Current Medical Services Eckel (Blue/Renal) Carpenter (Purple/ID) Ratnoff (HemeOnc) Hellerstein (Green/CHF) Wiggers (Telemetry) Weisman (Red/Gen Med) Naff (Orange/Gen Med) Wearn (White/Gen Med)

4. Changes Wiggers GONE HellersteinCHF/TELE (Cards) WeismanPulmonary Short call Naff & Wearn Reduced work-hour servicesNaff, Wearn, and Ratnoff All admissions end at 1100pm Signout rounds with the chief resident

5. New Medical Services Eckel (Renal) Carpenter (ID) Ratnoff (HemeOnc) Hellerstein (CHF/Tele) Weisman (Pulm) Naff (Gen Med) Wearn (Gen Med)

6. Medical Services: Nuts & Bolts Service Resident InternsCall Misc. Eckel13Q6,Q3 No changes Carpenter13Q6,Q3 No changes Weisman13Q6,Q3 Intern added Ratnoff*14Q4 No changes Hellerstein14Q4,Q2 Supershort: 1 till 1pm Naff*12Q4,Q2 Short: 2 till 1pm Wearn*12Q4,Q2 Short: 2 till 1pm * Reduced Work-hour Services

7. Weisman Service Pulmonary & Gen Med Pulmonary/Critical care attendings 1 resident, 3 interns Takes call like Eckel and Carpenter Q6 long & Q3 short long call = 5 admissions till 1100pm Short call = 3 admission till 600pm

8. Hellerstein Service CHF and Telemetry General and CHF cardiology attendings 1 resident, 4 interns Q4 long & Q2 supershort Long = 5 admissions till 1100pm Supershort = 1 admission till 100pm

9. Hellerstein Call Schedule Q4 Long / Q2 Supershort 123412341123412341 (1)Long Call(1)Supershort (1)Long Call (2)Long Call (2)Supershor t Days (3)Long Call(3)Supershort (2)Long Call (4)Long Call(4)Supershort (1)Supershort (3)Long call (2)Supershort (4)Long call (1)Long call

10. Naff and Wearn Service No major changes except Short Call Long call = Q4 Short call = 2 admits till 100pm = 1 admit till Noon (clinic day)

11. Reduced Work-hour Services Naff/Wearn/Ratnoff Admissions stop at 1100pm (all services) Interns can signout and hand pagers to cross cover at 100am Two cross cover interns per night (sometimes three) Interns must remain in the hospital

12. Morning Signout Rounds with UH Chief Resident Department of Medicine Conf Room Intern - Cross cover exchange (700-730am) NACR - DACR exchange (800am) Residents welcomed Inappropriate signouts Overnight problems Assignment of nightfloat admissions

13. General Reminders Schedule Changes Jeopardy Weekend Coverage responsibilities Screening/Ambulatory/Elective/Geriatrics Disciplinary actions Evaluations

14. Schedule Changes No changes can be made unless the chief resident is notified All schedule changes must be in writing (email) and given to the chief resident

15. Jeopardy All junior residents take jeopardy call during elective A minimum of three junior residents per month Weekend jeopardy call is assigned Weekday jeopardy call is random You cannot leave town during the week and during your assigned weekend. You can arrange with each other to take jeopardy call

16. Weekend Coverage Responsibilities Weekend coverage to ward residents is provided by residents on ambulatory, elective, and geriatrics Residents on ambulatory are pulled first to cover A list of coverage responsibilities will be provided Adherence to coverage responsibilities will be strictly enforced

17. Screening/Ambulatory/Elective /Geriatrics Under certain circumstances residents on these services may be pulled to cover any service

18. Disciplinary Actions for repeated infractions 1/2 day of Screening 1 day of Screening 1 week of Screening Formal letter placed in permanent file Review by the recommendation promotions com.

19. Evaluations Attending evaluations Evaluations of colleagues

20. Clinics Re-establish continuity UH CICU: residents/interns will have clinic on their non-call days (no clinics on call days) VA ICU: residents/interns will have clinic once during the month. On their good day

21. Chief Residents Always accessible “open door” policy Advocates for the housestaff Periodic rounding with teams “Pizza/cookie” rounds at night Mentorship meetings with the chiefs Q3 month housestaff meetings