WELCOME!!. Chiefs ’ Orientation. Scott Denstaedt Marty Tam Angel Qin Khanjan Shah. June 14 th , 2012. Starting intern year…. SUCCESS!. Overview. Introductions Roles of Chiefs UH Wards VA Wards Typical Day on the Wards The Pager System Other Rotations Conferences Misc Ambulatory
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Chiefs’ Orientation Scott Denstaedt Marty Tam Angel Qin Khanjan Shah June 14th, 2012
Starting intern year… SUCCESS!
Overview • Introductions • Roles of Chiefs • UH Wards • VA Wards • Typical Day on the Wards • The Pager System • Other Rotations • Conferences • Misc • Ambulatory • Professionalism • Advice • Questions
Scott Denstaedt • Undergraduate: University of Michigan • Med School: Wayne State University • Hometown: Clarkston, MI • Hobbies: tasting exotic beers, Game of Thrones • Fun fact: speaks Japanese
Marty Tam • Undergraduate: University of Michigan • Med School: Ohio State University • Hometown: Sterling Heights, MI • Hobbies: sports, travel, food, drink, life • Fun fact: almost was killed by a lion during medical school
Angel Qin • Undergraduate: Duke University • Med School: Case Western Reserve University • Hometown: Chengdu, China Chicago, IL • Hobbies: cooking, trying new foods, travel • Fun fact: danced ballet for 8 years
Khanjan Shah • Undergraduate: Furman University • Med School: University of South Carolina • Hometown: Greenville, SC • Hobbies: working out, reading, eating good food • Fun fact: Aspired to be a pizza delivery girl for most of my childhood
Roles of the Chiefs • Rotate every 3 months • UH Chief #31250 – Marty Tam • Office in Lakeside 3 • VA Chief #31533 – Angel Qin • Office on 4th floor VA • Ambulatory Chief #31529 – Scott Denstaedt • Office on 4th Floor VA • Quality & Pt. Safety Chief #36644 – Khanjan Shah • Office on 4th Floor VA/Lakeside 3
Roles of the Chiefs • We are the advocates for the residents • Call us with problems or issues that arise • Timely and specific please…we can’t help you if you don’t let us know. • We are your mentors • We provide support for your professional develoPMent, education, and your psycho-social well-being • We have candy!
UHUH Campus Lerner Tower Lakeside ED Seidman
UH Ward Teams Sister teams alternate “long” call days Each team has 2 interns Q4 “long” call Hellerstein and Eckel do not have sister teams
UH Ward Teams • Hellerstein (Cardiology) • Team room on Lerner Tower 5 • 2 senior residents, 4 interns, sometimes a fellow • Eckel (Nephrology) • Team room on Lakeside 5 (between 50 and 55) • 2 senior residents, 4 interns
UH Ward Teams • Naff and Wearn (General medicine) • Team rooms on Lakeside 20 • 1 senior resident, 2 interns • Carpenter (Infectious disease, HIV patients) • Team room on Lerner Tower 8 • 1 senior resident, 2 interns
UH Ward Teams • Dworken (Gastroenterology, Hepatology) • Team room on Lakeside 55 • 1 senior, 2 interns • Round separately with the Liver attending • Weisman and Ratnoff (Heme/Onc) • Weisman on Seidman 4 (hospitalist) • Ratnoff on Seidman 3 (oncologist) • 1 senior, 2 interns
UH ICUs • MICU • Lerner Tower 3 • 5 seniors (4 on days, 1 on nights); 4 interns • Interns take call with their seniors Q4; seniors stay overnight • 1-2 attendings, 2 fellows, 2 teams • CICU • Lerner Tower 3 • 5 seniors, 2+ interns, 1 fellow • Interns do 1 week of days, 1 week of nights
VA Ward Teams • Four general medicine teams • Blue and Green are sister teams • White and Orange are sister teams • 1 senior, 2 intern teams • Q4 long call • Team rooms on 4th floor
VA MICU Two seniors (one on days and one on nights) Three interns, Q3 call Admit from 7 AM to 8 PM Leave by 10 PM Day off is “pre call” day Friday through Sunday
LOGISTICS of Calls... • Long call – 3 patients by 7 PM • Only 1 after 6 PM, 2 after 5 PM • Medium call – 2 patients by 4 PM • Short Call: • UH: 2 Patients (nightfloat admission or ICU transfer) • VA: 2 Patients (nightfloat, transfer, or NEW) • Cycle: Long Medium Short HAPPY!
LOGISTICS: Team Caps • UH: • 10 patient cap on all UH ward rotations EXCEPTRatnoff and Weisman which will cap at 8 (rolling cap) • Your short call day will also cap at 8 (based on number of patients you start with in AM; not rolling) • VA: • Cap = 8 all the time • Caps increase if you have acting interns
Days OFF • Dworken, Carpenter, Wearn, Naff, • Ratnoff, Weisman, and VA Wards • Short or Happy days that fall • on Saturday or Sunday • “Golden” = both weekend days off • “Black” = work both weekend days • “Silver” = either Sat or Sun off • Eckel or Hellerstein • 1 day off per week: “Happy day” Friday through Monday
Days OFF • Night Floats • UH: 3 interns are scheduled but only 2 are on each night; work out days off with each other! • Send schedule to chiefs; if you are going to a ward rotation, you should not work the last Sunday • VA: Saturday night is off • UH MICU • Helper day off Friday through Monday
Typical Ward Day • 7 AM to 7:45 AM • Pick up signouts from night float team on Lerner Tower 5 at UH and blue team room at the VA • Pre-round • 7:45-8 AM: Be in your team room to discuss changes overnight and the day’s plan with your senior • 8 AM to 10 AM (VA) or 10:30 AM (UH) • Rounds with attending • New patients – present H&P • Present the pertinent data, remember you only have 2 hrs for rounds • Old patients – present new data, events overnight and then your assessment and plan • Your A/P may be right or wrong but the best way to learn is to take a shot – don’t just present the data and then look at your attending and resident and wait for them to tell you what to do • Be organized—”have a system”
After Rounds • C: Call your consults • Consultants will appreciate the early call • O: Order Entry • Enter any orders that were not entered on rounds • L: Labs • Run your labs • D: Discharges • Get them out • Should have daily note on the day of discharge as well (very brief) • N:Notes • Don’t start your notes until the rest of the work is finished
Typical Ward Day • 10:30-11:30 AM (UH) or 10-11 AM(VA) • Resident AM report (M/W/F at UH, T/W/F at VA) • Thursday morning: Intern AM report + Tuesday at UH • Noon-1 PM: daily conference • Afternoon for notes, procedures, teaching rounds, contacting families, following up studies, etc • Short call interns and “happy” interns can signout to their co-interns when their work is done • Medium call signs out to night float at 7 PM • Long call signs out to night float at 9 PM
Meet the DACR/NACR/MAN… • Day Acting Chief Resident/Night Acting Chief Resident/Medical Admitting Nurse • Role is to distribute admissions, run codes, and overall monitor the daily flow of the internal medicine inpatient service • Available 24 hours/day at pager 30512 to answer questions or provide assistance!
NACR Night float Resident Night float Resident Night float Intern Night float Intern The NIGHTFLOAT TEAM
Intern Role on Nightfloat • The night float intern comes in at 7 PM and receives the pagers from the non-call teams • The night float intern can receive the pagers from the long call intern at 9 PM and must receive the pager by 11 PM • Please be pro-active and help your co-intern out if they’re still in the hospital late
Night Float Duties Follow-up on unfinished tasks You may be asked to go evaluate a patient; if you do, please write a brief Clinical Event Note If there are any questions/concerns, please ask your seniors and NACR A senior should go with you to every CODE WHITE during the first 6 months
Duty Hours • On long call, sign out at 9 PM, MUST be out by 11PM • On medium call, signout at 7 PM • UH: Lerner Tower 5 • VA: VA Blue room • Duty hours not to exceed 80 hours/week
Call and Continuity Clinic • No Clinic on Long or Medium call. • No short call patients assigned on your clinic day.
Team Pagers • Each team will have a pager held by one of interns on the team and then signed out to nightfloat in the evening • Will mostly be paged by nursing regarding patient issues • Team pagers are also code pagers – long call interns should go to all codes (‘Code Blue’) • Team pager numbers are listed on the pager card
How to send a page! • UH • Dial 222 type pager number *beep beep beep* your call back number*your pager number # • VA • For UH Pagers, dial 9-207-7244 type pager number *beepbeepbeep* you call back number*your pager number# • For VA pagers, dial 9-440-562-xxxx (pager number) *beep beep beep* your call back number*your pager number#
Other Rotations • Geriatrics • E-team • Jeopardy • Elective • UCC
Geriatrics • New this year; 4 week block • 3 interns + Geriatrics attending • 2 interns on wards, one intern at the VA • Other health care settings such as skilled nursing facilities, home calls
E-team • Only during the busiest months at UH • One intern + hospitalist attending • 8 patient cap, off on Sundays • Lots of independence
Pager must be on 24/7 • No pay back as it is an official rotation • Called to cover for inpatient and outpatient • Weekends are off
Urgent Care Center (UCC) • The VA Emergency Room • Staffed by at least 3 residents • One or two attending physicians • Hours are 8 AM – 6 PM
Electives • There will be continuity clinics once a week during your electives • This is the time to explore your academic interests (get involved in research, participate on different consult services) • On elective, you are also backup jeopardy, so please keep your pagers on! • You are expected to attend Grand Rounds and M&Ms • If you do research, you are expected to present a poster at the Department of Medicine Research Day held every May
DISCHARGE SUMMARIES • DISCHARGE SUMMARY: do on the day of discharge • Do them as soon as you write the discharge order • Residents must do discharge summaries when intern has the day off • Crucial for patient safety and care
Conferences - UH • Intern Morning Reports – Residents hold the pagers!! • Tuesday AM report from 10:30 – 11 AM • Thursday 10:30 AM – 11:30 AM • Grand Rounds • Tuesday 12-1 PM • Morbidity & Mortality (M&M) • Friday 12-1 PM • Agre Society • Monthly, Wednesday evenings – more info to come • Noon Conference • Monday, Wednesday and Thursday 12-1 PM (with food)
Conferences - VA • Monday: Noon conference • Tuesday: Grand Rounds televised from UH at noon • Wednesday: M&M at noon • Thursday: Intern Morning Report @ 10-11 AM • Your resident will take your pager • Be on time!! • Friday: Noon-conference
UH Miscellaneous • GME Housestaff Lounge!! • Located on Lakeside 6th floor, next to GME office • Has coffee, bathrooms, TV, foosball table, computers, food on Sunday nights
VA Lounge and Call Rooms • Located on the 2nd floor • Fridge: frozen dinners, ice cream, sorbet, string cheese, muffins, fruit, yogurt, milk, etc • Coffee machine • Cabinets: all sorts of snacks
Intern Saturday Coverage On Saturday nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7 PM to Sunday 8 AM for the VA intern nightfloat to get a night off
VA Miscellaneous • Garage parking is free! Just need to get a parking pass from VA police department (bring license, insurance, registration) • VPN access for home CPRS access • Codes at VA are called “Dr. Heart” and are called overhead
Ambulatory Medicine • Continuity Clinic • Urgent Care Center • Primary Care Block • Clinical Skills Block (CSB)