1. A typical day on the inpatient Medicine team What do I need to know? Naseema B Merchant, MD, FCCP, FACP, FHM Department of Medicine Yale University School of Medicine VA CT Health Care System

2. Objectives Inpatient care Processes – Clinical Care – Patient and family communication – Electronic Health Records – Patient flow – Resource utilization

3. Balancing clinical responsibilities with education - Point of care learning - Managing time between patient work and scheduled educational activities Objectives (contd.)

4. Inpatient Care Processes Clinical Care Gathering patient data Physical exam (during admission and daily visits) Presenting on rounds Writing notes Patient admission process Patient discharge process Patient hand off

5. Clinical Care -Gathering patient data Communication with night float team Communication with the night nurse Reviewing notes from the previous 24 hours( nursing, allied services, consults etc.) Reviewing new orders entered on your patient ( while you were gone)

6. Clinical Care-Presenting on rounds Communicating with the team prior to presenting on rounds Presenting a new admission Presenting daily progress on an existing patient Use of templates for oral presentation

7. Clinical Care- Note writing Daily progress notes Admission note Discharge note

8. Clinical Care- Admission, rounding and discharge Admission checklist Daily rounding checklist Discharge checklist

9. Inpatient Care Checklist

10. Inpatient Care processes- Patient hand-off Admission team and ED Admission team and PCP Day team to night team and vice versa Weekday team to weekend team and vice versa Primary team to consult team and vice versa Primary team to patient and family DC handoff -Discharging team, patient, family and outpatient providers SBAR model

11. S- Situation B- Background A- Assessment R- Recommendation

12. Patient Care processes- Patient/family communication First meeting with the patient Follow up visits Use of the white board in the patient room Family communication ( timing and frequency)

13. Patient Care processes- Patient flow Definition Significance Physician role in patient flow

14. Inpatient Care processes-Resource utilization Definition Significance Role of the physician in the appropriate use of resources and limiting inpatient costs

15. Balancing clinical responsibilities with- educational activities Point of care learning Learning on the go! Managing time between patient work and scheduled clerkship learning activities ( case conferences, EKG sessions, radiology sessions etc.)

16. Care for your patient the way you want to be cared for Thank you