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MICU + MAR + Triage Orientation

MICU + MAR + Triage Orientation. Survival Guide. MAR A. HUH MAR 1. 7 PM – 7 AM week days 8 PM – 8 AM weekends Carry Triage Book and 42900 Assign patients using HPF or ask patient. Admit patients with on-call Intern + Sub-I Resident note / H+P must be written

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MICU + MAR + Triage Orientation

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  1. MICU + MAR + TriageOrientation Survival Guide.

  2. MAR A

  3. HUH MAR 1 • 7 PM – 7 AM week days • 8 PM – 8 AM weekends • Carry Triage Book and 42900 • Assign patients using HPF or ask patient. • Admit patients with on-call Intern + Sub-I • Resident note / H+P must be written • Fill out Core Measures Progress sheet • Always discuss case with attending

  4. HUH MAR 1 • Document ALL patients admitted • Document AM Resident assignment • Tell the MAR 2 what team gets the patient goes in AM.

  5. HUH MAR 1 • Get Physician to accept • Call patient in to ER Charge Nurse • Continue to monitor all patients you admit • Help Night floats • Do urgent Medicine consults and discuss with attending on-call

  6. HUH MAR 2 • 7 PM – 7 AM • Carry Code Pager • Admit patients with on-call Intern + Sub-I • Resident note / H+P must be written • Fill out Core Measures Progress note • Always discuss case with attending • Keep a record of patients you admit

  7. HUH MAR 2 • Call patient in to ER Charge Nurse • Continue to monitor all patients you admit • Help Night floats • Do urgent Medicine consults and discuss with attending on-call

  8. Chest Pain Pathway • If patient already has a cardiologist, admit patient to that respective service • Use TIMI Risk score sheet in triage book to determine if patient is to be assigned to Cardiology vs DOD. • Chest pain pathway admissions alternate between Red Univ A and CCP B weekly.

  9. Other Causes of Chest pain • Remember that ACS is not the only cause of chest pain • Other causes like Aortic Dissection occur • Have you seen the CXR?

  10. Doc of the Day Green Medicine • All patients from 1427 • All patients from Drexel at Fairmount • Alternate all other patients per Doc of the Day list. • Patients from 219 Broad go to Green Medicine as private patients, they do not count as Doc of the Day.

  11. Blue Service • All HIV “Partnership” patients go to the Blue Medicine Hospitalist. • You will have to talk to the Blue attending on call (Matin, O’Connell or Mac Andrew) if it is after 5PM.

  12. Blue Service • Weekdays -for all Blue Medicine patients, contact the specific primary attending. • Weekends – contact the Blue Medicine Attending on call.

  13. AMH MAR 1 and 2 • 7 PM – 7 AM • MAR A1 carries triage book and 7619 • Document ALL patient admissions • Document morning Resident assignments • MAR A2 carries 7310 • SPLIT admissions EQUALLY • Help Night floats

  14. AMH MAR 1 and 2 • Admit patients with on-call Intern + Sub-I • Resident note / H+P must be written • Always discuss case with attending • Sign-out patients to post-8 PM call Residents of appropriate odd/even day

  15. HUH MAR MICU-PM • 7 PM - 7 AM • Assist Overnight Intern • Second call for floor evaluations and admissions • Assist with procedures

  16. MAR B

  17. MICU MAR-AM • 7 AM – 7 PM • Help post-call Intern/Resident leave by 12 Noon • Help teams with procedures • Address post-call team issues • Carry the code beeper till 12:00 and do all the admissions till 12:00.

  18. MICU MAR-AM • Carry Code Pager - 7 AM to 1 PM • Evaluate and admit patients • 1st call until 12:00 • 2nd call after 12:00

  19. Triage - HUH • 7 AM – 7 PM • Carry RRT Pager Please give the RRT pager to the moonlighter at 7:00 PM. • All admissions until 12 Noon • Sign-out admitted patients to on-call teams at 12 PM.

  20. Triage - HUH After 12 Noon • If attending is known write a brief Triage Note • Assign patient to on-call team • Admissions-(If pt has no known attending, i.e. DOD patients) • Full work-up • More extensive Triage note • Call DOD Attending • Call on-call team and discuss plan

  21. Triage - AMH • 7 AM – 7 PM. • All admissions until 12 PM • Sign-out admitted patients to on-call teams at 12 PM. • Contact local Chief Resident on 7636

  22. Triage - AMH Drexel Medicine Service • Weekday Cap of 33 • Weekend cap of 24 (with no DayLighter) ( 7 AM Friday to 1 PM Sunday). • Admission cap of 6 patients from Friday 5pm till Saturday 8AM. • 6 patients from Saturday 8AM till Sunday 8AM. • On weekends when there is a DayLighter Cap will be 33 and admission caps will be 9 new patients in the designated time periods.

  23. Triage - AMH • Drexel Teams – Cap at 16 • Drexel census cap is 115 for Common Pool. • Drexel total cap is 120. • Call chiefs when you hit a census of 120. • Abington total census is 90.

  24. Triage - AMH • Assign patients using Triage Worksheet • Alternate Drexel admissions • Teams 4, 8 and 10 alternate on even day • Teams 3, 7 and 9 alternate on odd day

  25. Triage - AMH • Common pool attending patients alternate between AMH residents and Drexel • Drexel accepts all common pool if AMH is capped. • AMS Cardiology patients alternate between AMH residents and Drexel

  26. Triage - AMH • Patients out of MICU should have an accepting physician. • Ask AO what physician has accepted the patients out of the units. • Pulmonary Critical Care no longer keeps patients that come out of the units.

  27. AMH Units • Transfer to the unit must be discussed with the attending • The Attending of Record must be identified at the point of transfer. • On Toll ICU we sometimes have “boarder patients”.A TOLL BOARDER IS ANY PATIENT WHO HAS BEEN ON THE TOLL ICU WHO IS NOW STABLE AND IDENTIFIED AS SUITABLE FOR FLOOR TRANSFER. OUR HOUSE STAFF WILL WRITE NOTES ON THIS PATIENTS.

  28. Warminster Effect • We accept al Drexel Family practice patients from Warminster • If the patient is a direct admit from the office you must speak to the Drexel Attending and call. • Do not forget to call2258/2249 (Admissions) and 7358 (Bed manager).

  29. Questions Good luck!

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