Transcript Chief’s Orientation - Case Western Reserve University

WELCOME!!
Chiefs’ Orientation
Dana Angelini
th,
June
14
Hiloni Bhavsar
Brandon Kellie
Morgan Oberle
Gigi Gaudiano (Med/Peds)
2012
Topics:
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Introductions…..
Who we are
Roles of Chiefs
UH Wards
VA Wards
A Typical Day on the Wards
Ambulatory
The Pager System
Advice
Dana Angelini
Undergraduate: University of Dayton
 Med School: Wright State University
 Home Town: Clinton Township, MI
 Talent/Hobby: Baking
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Hiloni Bhavsar
Undergraduate: Wright State University
 Med School: Wright State University
 Home Town: Dayton, Ohio
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 Really...born
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in India, moved to Dayton '94
Talent/Hobbies: Throwing dinner parties &
cooking!
Brandon Kellie
Undergraduate: University of Louisville
(GO Cards!)
 Med School: University of Louisville
 Home Town: Murray, KY
 Talent/Hobby: can BBQ and speak
southern
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Morgan Oberle
Undergraduate: University of Evansville
 Med School: Indiana University
 Home Town: Paoli, IN
 Talent/Hobby: running/working out
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Gigi Gaudiano
Undergraduate: University of Virginia
 Med School: University of Virginia
 Home Town: Great Falls, Virginia
 Talent/Hobby: Cooking, chasing around
Domenic
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Roles of the Chiefs
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Medicine Chief Residents:
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UH Chief #31250 – Morgan Oberle
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Office on 4th Floor VA
Quality & Pt. Safety Chief #36644 – Dana Angelini
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Office on 4th floor VA
Ambulatory Chief #31529 – Hiloni Bhavsar
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Office in Lakeside 3
VA Chief #31533 – Brandon Kellie
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Rotate every three months
Office on 4th Floor VA/Lakeside 3
Med-Peds Chief #37297 – Gigi Gaudiano
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Office in Lakeside 3
Roles of the Chiefs
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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.
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We are your mentors
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We provide support for your professional
development, education, and your psychosocial well-being
We have candy! (Morgan may have
granola bars or celery! )
UHUH Campus
UH Wards
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8 Medicine Teams
Wearn – General Medicine
Naff – General Medicine
Dworkin – Gastroenterology
Carpenter – Infectious Disease, General Medicine
Eckel – Nephrology and HTN
Hellerstein – Cardiology
Ratnoff – Hematology and Oncology
Weisman – Hematology and Oncology
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2 ICU's
MICU & CICU
UH Wards – Sister Teams
Naff
Wearn
Carpenter
Dworkin
Weisman
Ratnoff
Sister teams alternate long call days; each team has 2 interns
 leading to Q4 “long” call
UH WARDS
• Hellerstein
• Eckel
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Each team has 4 interns rotating
on Q 4 “long” call
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No “sister” team
UH WARDS
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UH MICU
o 2 teams with 2 attendings and 2 fellows; each team
with 2 residents and 2 interns
o Q 4 long call for interns and seniors (seniors take
overnight call)
o “Helper” day is your seniors post call day (will sign
out to you around 10 AM
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UH CICU
o Act as “helper” can follow and admit patients
o No formal call
•
Night Float
o 3 interns scheduled; 2 present each night; cover
the 8 inpatient UH teams
Other UH Rotations
Neurology
 2 week rotation on the Neurology
consult service
 GI-Jeopardy
 Rotate on GI consult service but are on
call for back up for any absence on UH
or VA wards/clincs
 MUST have pager on and answered
24/7
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LOGISTICS of Calls...
Long call – 3 patients by 7pm
 Only 1 patient after 6 pm
 Medium call – 2 patients by 4pm
 Short Call:
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 UH:
2 Patients (nightfloat admit or unit transfer)
 VA: 2 Patients (nightfloat, transfer or NEW)
Long Medium Short HAPPY!
LOGISTICS: No. of Patients
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UH:
 10
patient cap on all UH ward rotations
EXCEPT Ratnoff 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)
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At VA:
 Cap=8
all the time
cCall and continuity clinic
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No Clinic on Long or Medium call.
No short call patients assigned on
your clinic day.
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Days OFF
• Dworkin, Carpenter, Wearn, Naff,
Ratnoff, Weisman, and VA Wards
o Short or Happy days that fall
on Saturday or Sunday
o “Golden” = both weekend days off
o “Black” = work both weekend days
o Either Sat or Sun off
• Eckel or Hellerstein
o 1 day off per week:
“Happy day” Friday through Monday
Days OFF
• Night Floats
o UH: 3 interns are scheduled but
only 2 are on each night; work
out days off with each other!
o VA: Saturday night is off
• UH MICU
o Short call day off Friday through Monday
UH Team Pagers
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Each team (Eckel, Wearn…) will have a pager held by
the on call and nightfloat interns
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Will mostly be paged by nursing regarding patient
issues; not sure the answer???? Just ask your senior!!
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Team pagers are also code pagers – on call interns
should go to all codes (‘Code Blue’)
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Team pager numbers are listed on the pager card in your
bags.
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!
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Conferences - UH
Intern Morning Reports – Residents hold the pagers!!
• Tuesday AM report from 10:30 – 11am! ** NEW **
• Thursday 10:30am-11:30am
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Grand Rounds
 Tuesday 12-1pm
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Morbidity & Mortality (M&M)
 Friday 12-1pm
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Agre Soceity
 Monthly, Wednesday evenings – more info to come
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Noon Conference
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Monday, Wednesday and Thursday 12-1pm (with food)
UH Miscellaneous
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Dictating – Interns must dictate discharge
summary for each patient discharged on the
DAY OF DISCHARGE
Day of Discharge note = progress note +
discharge summary
 Dictation number must be written in the
chart 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
UH Miscellaneous
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GME Housestaff Lounge!!
on Lakeside 6th floor, next to GME office
 Has coffee, bathrooms, T.V., foosball table,
computers, food on Sunday nights
 Located
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THE P.I.T. Fitness Center
 Basement
of Lakeside
 Free card entry, TV's, towel service, open 24/7!
Duty Hours etc.
16:
80: 4 Rule!
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16 hours per long call
 80 hours per week
 4 days off every month
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Long call every fourth day
 3 admissions by 7 PM, out by 9 PM, must be out by
11PM
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Medium Call – 2 admissions by 4 pm, stay and signout team
to intern nightfloat at 7pm
UH Resources
 The
Chief Resident
 Your Senior Resident
 The DACR/NACR
 Other Residents
 The Night Floats
Louis Stokes Veterans
Administration Medical Center
VA Wards
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Four General Medicine Teams
 Blue, White, Green & Orange
1 resident + 2 interns per team – may have
acting interns/medical students
Ward 4A: Orange/White (sisters)
Ward 4B: Blue/Green (sisters)
PCU: telemetry 2nd floor
VA Lounge and Call Rooms
Located on the 2nd floor
 Four call rooms (bunk bed room for AIs)
 Fridge: frozen dinners, ice cream, sorbet,
string cheese, muffins, fruit, yogurt, milk,
PBJ un-crustables
 Coffee machine
 Cabinets have: Trail mix, gold fish, peanut
butter crackers, pretzels!
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The VA MICU
2 resident (day and night), 3 intern team
 Q3 call
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 Admit
from 7am to 8pm
 Leave by 10 pm
 No overnight here either!
 Day off is “pre call” day Friday through
Sunday
Urgent Care Center (UCC)
The VA “Emergency Room”
 Staffed by at least 5 residents
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 One
or two attending physicians
 Hours are 9-6 with “on-call” resident to arrive
at 0800 (you will not be the “on-call” resident
this year)
 Fast track: sees low acuity issues, med
refills….
Intern Saturday Coverage
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One or 2 Saturday Nights when on
ambulatory, UCC, or elective, you will be
asked to cover from Saturday 7pm to
Sunday 8am for the VA intern nightfloat to
get a night off.
VA Conferences
Monday: Noon conference
 Tuesday: Grand Rounds televised from
UH at noon
 Wednesday: M&M at noon
 Thursday: Intern Morning Report @ 10am11am!
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 Your
resident will take your pager
 Be on time!!
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Friday: Noon-conference
VA Miscellaneous
Garage parking is free! Just need to get a
parking pass from VA police dept
 VPN access for home CPRS access
 Codes at VA are called ‘Dr. Heart’
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A typical day on the wards
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7am to 7:45am:
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Pick up signouts in KACR (at UH – Tower 5) or from intern
nightfloat team (at VA you will meet up with VA nightloat intern)
Pre-round
7:45-8am: Be in your team room to discuss changes
overnight and the day’s plan with your senior
8am to 10:00am (VA) or 10:30am (UH): Rounds with
attending
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New patients – present H&P
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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
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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”
10:00-12:00: Time to get C.O.L.D.
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C: Call your consults
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O: Order Entry
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Enter any orders that were not entered on rounds
L: Labs
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The later you call, the more angry the consultant will be
Run your labs!
D: Discharges
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Get them out!
At UH, dictate your day of discharge note in your discharge
summary
At the VA, type the discharge summary on the day of
discharge
A typical day on the wards
(cont)
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10:30 - 11:30 (UH) or 10:00 - 11:00 (VA)
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Resident AM report (M/W/F at UH, T/W/F at VA)
 Thursday morning: Intern AM report
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Noon-1PM: conference
Afternoon reserved for notes, procedures,
teaching rounds, contacting families, following
up studies
short call should sign out to their co-intern who is
long at 5pm
medium call signs out to nightfloat at 7pm
Long call signs out to nightfloat at 9pm
Ambulatory Medicine
 Continuity
Clinic
 Urgent Care Center/Firm Urgent
 Primary Care Block
 Clinical Skills Block (CSB)
Continuity Clinic
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One afternoon per week at either the VA or the Douglas
Moore Center at UH.
 During ambulatory or elective, up to 2 clinics per
week
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Always the same day each week and with the same
attending preceptors
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You will develop a set of patients that you follow over 3
years
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Clinic cannot be canceled by anyone except the
Ambulatory Chief Resident
Continuity Clinic Rules
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No clinic when
 Medium call or on long call days
 Vacation
 Holidays
 ICU’s
 Night Float
You DO have clinic when on Elective!!!
Cannot switch clinics amongst yourselves; all
schedule changes need to be approved by
ambulatory chief resident
Primary Care Block
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Introduction to Outpatient Primary Care
Introduction to DMC and the Firm Continuity
Clinics
Morning Clinical Conferences: 8am Daily
8:45-12:00: Clinics VA Firm A & B Mon – Thurs
 Rheumatology
 Diabetes,
Renal, HTN
 Endocrinology
 Dermatology
 Women’s Health
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Friday AM – Introduction to Quality & Pt. Safety
Curriculum
Primary Care Block (cont.)
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Afternoon Didactic Sessions
 Quality
and Systems
 Cardiovascular Health
 Obesity
 Managing Difficult Patients
 Patient Safety
 Professionalism and Writing
 Physical Diagnosis
 Common Ambulatory Disease Presentations
Clinical Skills Block
2-week outpatient rotation
 Hands on activities
 Simulation models at the simulation skill
center
 Humanities in Medicine
 End of life care
 Cultural Competencies
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The NIGHTFLOAT TEAM
The NIGHTFLOAT TEAM
NACR
Nightfloat Resident
Nightfloat Resident
Nightfloat Intern
Nightfloat Intern
NIGHTFLOAT TEAM
The Nightfloat intern
The Nightfloat Intern comes in at 7pm
receives the pagers from the non-call
teams
 The Nightfloat Intern can receive the
pagers from the on-call intern at 9pm and
must receive the pager by 11:00 pm
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Night Float Duties
Follow up on unfinished tasks
Answer pages
 See patients when necessary (must
document brief note in chart when you see
a patient)
 Admit up to 2 patients from 8 pm – 5:30
am
 If you have questions – please please ask
your nightfloat resident or NACR!!!
 Call senior for every CODE WHITE
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Electives
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You have continuity clinic during elective
Your should be answering your pager from 8 to 6 (M-F),
no exceptions (unless on approved away elective)
Must attend all conferences (GR, M&M, noon
conferences at the VA)
Otherwise, you can choose to do research, a clinical
elective on a consult service, or even an ICU rotation.
You have to inform Barb before starting what you will be
doing on your elective time .
If you do research or away elective, you need to identify
a faculty mentor and should present your work at the
Department of Medicine Research Day at the end of the
year.
The Pager System
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UH:
1. Dial 222
2. Wait for beep
3. Enter pager number
4. Wait for 3 beeps
5. Enter your phone number, then TAG the page (press
star, then your own pager number)
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From the outside, dial (216) 207-7244, then
enter the pager number and follow remainder of
protocol
The Pager System (cont.)
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Text paging:
 Go
to hospital directory website and select send a
text-page from the menu on the left hand side of the
screen (also possible to access remotely through
physician portal or amion)
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VA:
1. Dial 9-207-7244
2. Follow the UH protocol
Professionalism Policy
For call-offs of more than 2 consecutive
days or more than 2 days in an academic
year you will be required to have a
physician’s note. You can be seen by an
attending physician same day in the
Family Medicine Bolwell clinic.
 Any call offs > 2 days, you will get extra
weekend jeopardy or coverage
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Friendly Advice
Catch up on your sleep when you have a
chance
 Talk to a chief or program director before
personal problems get out of hand – we
are here for you!
 SUPPORT EACH OTHER!
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Friendly Advice
Maintain personal and family relationships
outside of the hospital; make new friends
while you’re here
 Take care of yourself; it’s the only way you
will be able to provide good care to your
patients
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Things to do in Cleveland
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Indians
Cavs
Browns
Lake Erie Monsters
East 4th
West 6th
West Side Market
Little Italy
Art Museum
Bodies Exhibit
Edgewater Park
Metroparks
Zoo
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Goodtime 3
Wineries
Great Lakes Brewery
Larchmere
Shaker Square
Chagrin Falls
Lakeview Cemetery
Rock and Roll Hall of
Fame
Cleveland Orchestra
Blossom Music
Festival
Lola
www.clevelandindependents.com
www.coolcleveland.com
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Winking Lizard
Panini's
Cain Park
Luna Bakery
Playhouse Square
Aurora Outlets
Cedar Park
Kalahari Water Park
Put n Bay
Kelley’s Island
Air show
Rib Festival
Etc Etc
Final Thoughts
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SCHEDULES!
GOOD LUCK!
Please call us if you need us,
we are here to help!!!!!