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Structural Changes in the Program

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. Outline. Medical service changes General Reminders Clinics Miscellaneous.

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Structural Changes in the Program

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  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 • Hellerstein CHF/TELE (Cards) • Weisman Pulmonary • Short call Naff & Wearn • Reduced work-hour services Naff, 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 Interns Call Misc. Eckel 1 3 Q6,Q3 No changes Carpenter 1 3 Q6,Q3 No changes Weisman 1 3 Q6,Q3 Intern added Ratnoff* 1 4 Q4 No changes Hellerstein 1 4 Q4,Q2 Supershort: 1 till 1pm Naff* 1 2 Q4,Q2 Short: 2 till 1pm Wearn* 1 2 Q4,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 ScheduleQ4 Long / Q2 Supershort Days 1 2 3 4 1 2 3 4 1 (1)Long Call (1)Supershort (1)Long call (1)Long Call (1)Supershort (2)Supershort (2)Long Call (2)Long Call (2)Supershort (3)Long Call (3)Supershort (3)Long call (4)Long Call (4)Supershort (4)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 ServicesNaff/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 ResidentDepartment 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 Actionsfor repeated infractions 1/2 day of Screening Review by the recommendation promotions com. 1 day of Screening 1 week of Screening Formal letter placed in permanent file

  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

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