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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

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  1. WELCOME!!

  2. Chiefs’ Orientation Scott Denstaedt Marty Tam Angel Qin Khanjan Shah June 14th, 2012

  3. Starting intern year… SUCCESS!

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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!

  11. UHUH Campus Lerner Tower Lakeside ED Seidman

  12. Louis Stokes Veterans Administration Medical Center

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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!

  21. 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

  22. 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

  23. 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

  24. 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”

  25. 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

  26. 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

  27. 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!

  28. The night float team

  29. NACR Night float Resident Night float Resident Night float Intern Night float Intern The NIGHTFLOAT TEAM

  30. 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

  31. 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

  32. 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

  33. Call and Continuity Clinic • No Clinic on Long or Medium call. • No short call patients assigned on your clinic day.

  34. 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

  35. 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#

  36. Other Rotations • Geriatrics • E-team • Jeopardy • Elective • UCC

  37. 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

  38. E-team • Only during the busiest months at UH • One intern + hospitalist attending • 8 patient cap, off on Sundays • Lots of independence

  39. 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

  40. 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

  41. 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

  42. Example Elective Tracking

  43. 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

  44. 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)

  45. 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

  46. 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

  47. 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

  48. 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

  49. 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

  50. Ambulatory Medicine • Continuity Clinic • Urgent Care Center • Primary Care Block • Clinical Skills Block (CSB)

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