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Chief Resident Overview

Chief Resident Overview. June 14, 2013. Welcome Interns!. Your Chiefs. Crystal Lantz- DeGeorge , M.D. Hometown: Tiffin OH Undergrad: The Ohio State University Med School: Wright State University Boonshoft SOM Professional Interest: Primary Care Mommy of identical twin 8 month olds .

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Chief Resident Overview

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  1. Chief Resident Overview June 14, 2013

  2. Welcome Interns!

  3. Your Chiefs

  4. Crystal Lantz-DeGeorge, M.D. • Hometown: Tiffin OH • Undergrad: The Ohio State University • Med School: Wright State University Boonshoft SOM • Professional Interest: Primary Care • Mommy of identical twin 8 month olds

  5. Sumit Bose, M.D. • Hometown: Pittsford NY • Undergrad: Johns Hopkins University • Med School: GWU • Professional Interest: Allergy/Immunology • Can do an amazing dance with a wheeled walker

  6. KamalShemisa, M.D. • Hometown: Westlake OH • Undergrad: Kent State University • Med School: NEOMED • Professional Interest: Cardiology • Lover of cats and cardiology

  7. Claire Sullivan, M.D. • Hometown: Rocky River OH • Undergrad: John Carroll • Med School: University of Cincinnati • Professional Interest: Cardiology • Obsessed with Cleveland

  8. NavinVij, M.D. (Med/Peds) • Hometown: Bloomington, MN • College: Rice University • Med School: Baylor • Professional Interest: Health Policy • Former professional Bhangra dancer

  9. Roles of the Chiefs • Rotate every 3 months • UH Chief - #31250 – Claire Sullivan • Office in DOM 3rd floor • VA Chief - #31533 – Kamal Shemisa • Office on VA 4th Floor • Ambulatory Chief - #31529 – Sumit Bose • Office on VA 4th Floor • Patient Safety & Chief - #36644 – Crystal Lantz-DeGeorge • Office in DOM 3rd floor

  10. Roles of the Chiefs • We are your ADVOCATES • Call us with any problem or issue that arises in a TIMELY and SPECIFIC manner • We can’t help you if you don’t let us know the problem • We are your MENTORS • We embrace the opportunity to provide support for you - professionally, educationally and psychosocially • We have been in your shoes! • We remember well the struggles of intern year and are here to help you in any way we possibly can

  11. Block Zero • June 24th-June 30th • No days off • Many extra interns on teams to divide the work and admissions • Constant senior supervision due to rotating extra senior helpers who will work with non-call teams from 5pm-10pm • Ask questions!

  12. UHCampus

  13. UH teams • Ward Teams • 2 General Medicine • 6 Sub-Specialty • MICU • CICU • UH Nightfloat Team

  14. ICU Rotations • At UH • MICU • CICU

  15. Other UH Rotations • Geriatrics • 2 week rotation • Jeopardy • Rotate on a consult service while on back-up call for any absence on UH or VA wards/clinics • MUST have pager on 24/7 including weekends • E Team • Work 1:1 with hospitalist during winter months • Back up Jeopardy

  16. Team Caps • UH ward teams cap at 10 patients per intern except for the Seidman teams which cap at 8 • VA ward teams cap at 8 patients per intern • No short call on weekends • Intern + AI @ VA = 10; AI+AI paired together = 10 if one senior, 12 if two seniors • Intern + AI @ UH = 12 when 2 seniors; 10 when 1 senior

  17. Intern Call/Duty Hours Call Schedule: Long  Medium  Short  Happy  • Long Call admits 3 patients • Last patient no later than 7:00 pm • Interns should be done staffing patients and sign out to NF by 9:00 PM • Must be out by 11:00 PM

  18. Intern Call/Duty Hours • Medium call admits 2 patients • Last patient by 4:00 pm. • Holds the Team Pager until 7:00 pm • Signs out to NF at 7:00 pm.

  19. Intern Call/Duty Hours • Short call admits 2 patients - By 12:00 PM at UH and 1:00 at the VA • MICU and Night float patients ONLY at UH • Can be new patients at VA • No patients on clinic days or if intern has 8 patients • Signs out to Medium call intern as early as 4:00 pm

  20. Call Sequence

  21. UH MICU • 4 interns and 5 residents per rotation; Interns paired with resident for long call • Interns will get last admission by 7 pm, should leave by 9 pm, must leave by 11 pm • Patients admitted by the NF will be distributed by the MICU fellow in AM to keep teams even and optimize work flow in the MICU • The post call resident will present and leave, sign out to the post call intern • The helper resident will supervise the post call intern and will help until the intern has completed their work, usually around 5pm

  22. The New CICU for Interns • 2 interns scheduled in the CICU: -Day intern: works 7 AM-7 PM. May follow/admit one to two patients under supervision of senior resident. -Night intern: works 7 PM-7 AM. Helps with cross-cover, gains valuable night ICU experience including procedures, and possibly allows for on-call resident to take a nap. • Interns will do one week of nights and one week of days during two week rotation • Both interns have Sunday off (accommodate switch days and transition from nights to days)

  23. Intern Call/Duty Hours • All teams will have double seniors until block 3-4 • Orphan coverage: When you are on call and your team senior isn’t • On Call interns will be covered by the assigned orphan resident • Ask your seniors how to look this up • Always page the senior as soon as you get an admission to speed up the process

  24. Typical Day • 6:45-7:00: Get sign out from NF on Tower 5 • 7:00-7:45: Pre-round on your patients • Get patient assignments from NF seniors • 7:45-8:00: Run overnight events with senior resident Address any major issues before rounds • 8:00-10:30: Rounds with attending • 10:30-11:30 : MR for residents (MWF) and interns (T/Th) • 12:00-1:00: Noon Conference

  25. 10:30-12:00: Time to get C.O.L.D. • C: Call your consults • The later you call, the more angry the consultant will be • Ask your senior for advice on how to call the best consult before your first one • O: Order Entry • Enter any orders that were not entered on rounds • L: Labs • Run your labs! • D: Discharges • 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

  26. Conferences - UH • Intern Morning Reports – Residents hold the pagers!! • Tuesday AM report from 10:30 – 11am! ** NEW ** • Thursday 10:30am-11:30am • Noon Conference • Monday, Wednesday and Thursday 12-1pm (with food) • Grand Rounds • Tuesday 12-1pm • Morbidity & Mortality (M&M) • Friday 12-1pm • Agre Society • Occur monthly on Wednesdays

  27. Typical Day • Afternoon: Follow-up on studies, consults • Sign out to co-intern/resident and attend clinic on clinic days • Admit new patients and staff with team resident or on call resident • On long call day sign out between 9-11pm • On medium call day sign out at 7pm • On short/happy day leave as early as 4pm

  28. Sign Out • Sign out is an exchange of information to ensure excellent patient care • As an intern sign out • What is important? • FU CT PE  If positive, start heparin • FU ECG and troponins  If troponin positive, treat for ACS • FU I/O’s, goal 1L negative  If not at goal, give 80 IV Lasix • FU H&H  If Hb <7, transfuse 2U PRBCs • What is not important? Avoid having the NF do your work • FU Nutrition recs • FU CT A/P done for cancer staging • FU ANA • ANYTHING THAT WILL NOT CHANGE OVERNIGHT MGMT

  29. Intern Expectations • Interns have primary care responsibility for all patients assigned. These responsibilities include: • performing a complete admission history and physical • formulating a diagnostic and therapeutic plan with the resident and attending • When surveyed, patients almost always identify the INTERN as their primary provider while they were hospitalized

  30. Intern Expectations • The admission history and physical must be on the patient’s chart within 24 hours of admission. • The Intern is responsible for all day-to day management issues, which must be reflected in a daily Intern progress note (limit copy pasting)

  31. Intern Expectations • All patients assigned to the intern are • to be examined by the Intern every day • Interns have primary responsibility for discharge summaries, but this should also be shared with the resident depending on work load and workflow • If the intern is off, the discharge summary must be done by the covering resident, or the attending

  32. Intern Expectations • Interns should report any significant change in status of patients under their care to the supervising resident • These include significant • change in vital signs • change in mental status • change in status requiring a rapid response team (=code white) • Interns have 24/7 in house supervision by residents, fellows, or attendings

  33. InternExpectations • Discharges are the primary responsibility of the intern, but residents frequently help, especially early on • DAY OF DISCHARGE dictations – ask your seniors for help • Do not hesitate to ask your senior especially early on

  34. InternExpectations • ANESTHESIA INTERNS MUST LEAVE BY 9 PM IF ON CALL!!! • ACGME rules for anesthesia are different from those for categorical and preliminary medicine interns

  35. ResidentOn-Call • Are responsible to staff their own teams if the patient is available prior to 4:00 pm. • On call residents stay until at least 9:00 PM • Weekend team covering resident staffs until at least 1:00 PM On call senior will staff “orphan” interns after 4:00 PM during the week and after 1:00 PM on weekends

  36. Days OFF! • Dworkin, Carpenter, Wearn, Naff, Ratnoff, Weisman, and VA Wards • Short And/Or Happy Days on Saturday or Sunday • In a 4 week block, 4 days off: • 1 “Golden” – Sat AND Sun off • 2 “Silvers” – Either Sat OR Sun off • 1 “Black” – No weekend days off • Eckel and Hellerstein • Happy Day Friday through Monday • 1 Day off per week

  37. Days OFF! • Night Floats • UH: 3 interns are scheduled but only 2 are on each night; work out days off with each other! • Email your days off schedule to ambulatory chief • VA: Saturday night is off • UH MICU • Short call day off Friday through Monday

  38. UH Team Pagers • Each team (Eckel, Wearn…) has a team pager • Held by medium call until 7 pm • Pager signed out to NF Intern at 7 pm • Long call intern signs out their patients at 9 pm • Held by intern nightfloat 7pm-7am • Team pagers are also code pagers – on-call interns should go to all codes (‘Code Blue’) • Team pager numbers are listed on the pager card in your bags

  39. Meet the DACR/NACR/Admissions Coordinators… • DACR = Day Acting Chief Resident • NACR = Night Acting Chief Resident • PGY3 helps admit and triage new admissions, runs codes, manages medicine consults • Admissions Coordinators = Toni, Lisa, Kathy • Direct phone 67121 • Pager 30512 • Work Room 42508 • Distribute admissions to you during the day • Be nice to them!

  40. UH Miscellaneous • GME Housestaff Lounge • Located on Lakeside 6th floor, next to GME office • ID Badge required for entry • Has coffee, bathrooms, T.V., foosball table, computers • THE P.I.T. Fitness Center • Basement of Lakeside • Free card entry, TV's, towel service, open 24/7!

  41. UH Resources • Your Senior Resident • The DACR/NACR • Other Residents • The Night Floats • The Chief Resident

  42. Louis Stokes Veterans Administration Medical Center

  43. VAteams • 4 General Medicine Teams • VA Orange • VA White • VA Blue • VA Green • VA MICU • VA Nightfloat Team

  44. VA Wards • 1 resident + 2 interns per team – may have acting interns/medical students • Ward 4A: Orange/White (sister teams) • Ward 4B: Blue/Green (sister teams) • PCU: telemetry 2nd floor

  45. VA Lounge • Located on the 2nd floor • Fridge: frozen dinners, ice cream, sorbet, string cheese, muffins, fruit, yogurt, milk, PBJ uncrustables • Coffee machine • Cabinets: Trail mix, gold fish, peanut butter crackers, pretzels!

  46. VA Conferences • Monday: Noon conference • Tuesday: Grand Rounds televised from UH at noon • Wednesday: M&M at noon • Thursday: Intern Morning Report @ 10am-11am! • Your resident will take your pager • Be on time!! • Friday: Noon conference

  47. VA Miscellaneous • Garage parking is free! Just need to get a parking sticker from VA police dept • VPN access for home CPRS access • Codes at VA are called ‘Dr. Heart’

  48. VA MICU • 3 interns and 2 residents per rotation • Interns are q3 call. • Day senior 8a-8p • Night senior: 8p-8a • Interns will get last admission by 7 pm, should leave by 9 pm, must leave by 11 pm • Sign out to night senior • Patients admitted by the night senior go to the intern on call the next morning

  49. Nightfloat Rotations

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