Welcome to Jacobi Wards

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Jacobi Medical Center
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Medicine Service

• New Building (Building 6)?
• 4A General Medicine/Surgery
• MSOU (Special Observation Unit)
• 4B ICU
• 5A General Medicine Telemetry
• 5B CCU
• 5D Oncology
• 6A General Medicine
• Old Building (Building 1)?
• 3 North Medicine Department and Library.
• 5 South General Medicine

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Welcome to Jacobi Wards

• Day Structure
• -Interns arrive 630-700 AM
• -Retrieve Sign-out from Night Float
• (4A Conference Room, New Building)?
• -General medicine residents report (PGY2-3) to
  intake rounds 715 AM in the 3 North, Medicine
• Library (old building).
• -Pre-Round on all pts 7-8 AM (Vital signs,
  Exam)?
• -Work Rounds with Resident 8-915 AM
• (you must SEE all the new patients and the
  sickest)?
• -Attending Rounds 900-11 AM
• (Will discuss all new admits, old patients,
  radiology rounds, SW
• rounds, didactics, presentations,
  discuss chart documentation.)?

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Jacobi Wards

• Intern Work Completion 11-1230
• Learn how to prioritize work to be done. (This
  is a critical time period)?
• -call consults early!
• -review morning labs
• -order and arrange all diagnostic
  tests
• -discharge pts scheduled to go
  home
• -start daily progress notes if not
  started already!
• Resident Report (PGY2-3)1100-1200
• (3 North Medicine Library, Old Building)?
• All medicine residents must attend!

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Noon Conference 1230--100

• 3 North Medicine Library, Old Building

Your attendance at Noon Conference is
MANDATORY, unless you have an emergency or are
scheduled for clinic. Attendance will be taken.
Program directors will be officially notified if
anyone is routinely absent from conference.
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Jacobi Wards

• Complete all work 130-500 PM
• Finish all work for the day
• Make sure you see your pts at least one more
  time
• prior to leaving for the day
• Attend Clinic (your responsible for
  knowing your clinic day)?
• Follow-up to make certain all procedures are
  completed
• Check the chart for notes from attendings,
  consults
• Complete progress notes, print, and place in
  chart.
• Order labs and other test for the next day.
• Admit if you are on call
• Sign-out 5 pm (when done)?
• On holidays and weekends not earlier
• than 3 pm (when not on call)

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Jacobi Wards

• Resident Responsibilities (PGY2-3)
• The SUB-Intern
• Work Rounds see and examine all pts
• Attend Morning Report
• Facilitate and help organize the interns day
• Answer all questions
• Help call consults, CT scan, MRI
• Have a general working knowledge of what is
  going on
• with all the pts
• Replete lytes, optimize BP, blood glucose,
  review meds
• Take the initiative to manage pts when necessary
  

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Jacobi Wards

• Additional Intern Responsibilities
• Perform Complete Work-ups
• -Include old info/baselines
• -Formulate a complete differential
• -Explain all abnormal data and
  
  construct a plan
• Be the Doctor -Constantly review meds
• -Know what is going into and
  coming out of your pt
• -Be proactive, attempt to predict
• adverse situations and have a
  
• 
  plan to combat
  them

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Jacobi Wards

• Additional Intern Responsibilities contd
• -Case-based reading
• -Consult the literature when questions arise
• -Primary goal to recognize sick or unstable
  pts.
• When uncertain about something, Ask!!!!!!!
• (There are no stupid
  questions. Period.)?

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Jacobi Wards

• MS III Medical Students
• Read! Read! Read
• Study for Shelf Exam
• Follow 2-3 pts
• Shadow your intern
• Help as much as possible
• Write daily notes
• Your note does not replace interns note
• Presentations
• Bring in pertinent articles to share with the
  team
• We are hands on at Jacobi learn your
  procedures here!!!

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Call

• -Once the ER decides to admit a patient to the
  medical service, they contact the SMR (Senior
  Medical Resident i.e. MAR).
• -SMR contacts both the admitting resident and
  intern/sub-I.

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General Medical Service Call

• Residents, Interns, Sub-Is are on-call every 4th
  day. Sabbath observers (Residents, Interns,
  Sub-Is) will occasionally have Q2 call
  alternating with Q6 call. They are not on call
  on Friday nights and/or Saturday.
• Short Hits These are additional admissions
  given on the second day after call (middle-day).
  Usually worked up by resident only. You can get
  up to 2 pts.
• Pick-ups Occur on call day. Usually, these
  are patients admitted overnight that have already
  been worked up by overnight residents and
  interns. These count as admissions for the day.

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Call

• Very Important
• Back Admissions Occurs occasionally on
  weekends and rarely during the week. If
  interns/sub-Is do not max by the end of their
  call, they may receive the remainder of their
  admission the next morning.
• These pts are worked up by residents and an
  overnight intern.

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Call Times

• -General Medicine and Specialty Service
  Residents 8 AM 8 PM (last admission 7 PM).
  Must stay until 8 PM even if finished with
  admissions before 7 PM.
• -General Medicine Interns and Sub-interns 7 AM
  930 PM (last admission 8 PM). Sign-out 930 PM
  10 PM.
• - Night Float Residents 8 PM 8 AM (last
  admission at 530 AM).
• -Night Float Interns 930 PM -11 AM (last
  admission at 530 AM).

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Call Times

• Subspecialty teams
• On call every other day. Between short-call and
  long call
• -ACS/Onc Shot-call (Q4) Intern 7 AM 5 PM (7
  days a week).
• Last admission 4 PM and must stay until 5 PM.
• - ACS/Onc Long call Intern (Q4) 7 AM 930 PM.
  Admissions for both ACS and Onc starting at 4
  PM. Last admission at 7 PM. Cover until 930
  10 PM.
• -Pulmonary Service (Q2) 7 AM 8 PM. Last
  admission at 7 PM. Sign-out to ACS/Onc Intern at
  8 PM.
• Note 1) Onc admissions need to be approved by
  the on-call fellow
• 2) Pulmonary service do not admit from 8 AM
  Saturday until 8 AM Sunday
• 3) ACS sometimes admits every day and requires
  attending approval (check
• with the attending on
  service)

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Call How many admissions?

• General Medicine Interns (including pick-ups)
• If on-call with sub-I 4 but up to 6 if the
  last are unit transfers.
• If alone 5 but up to 7 if the last are
  unit transfers.
• Sub-interns 3 admissions
• Pulmonary Interns total of 4 admissions in a 24
  hrs if 2 interns on team.
• ACS/Onc as per SMR/Attending.

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Intern Coverage

• -Long call intern covers their team and sister
  team from 5 PM until 930 10 PM. At that
  time, day intern will sign-out to the designated
  night float intern (see intern coverage grid).
• -Sub-interns cover themselves when on call.

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Resident Coverage

• -Residents job is to assist in coverage!
• -Residents must discuss cases with
  interns/sub-Is.
• -On weekends, pick ups are presented to the
  intern by the admitting resident.
• -It is both the admitting resident and on-call
  intern responsibility to discuss new admissions.

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Weekends

• -Residents have one weekend day off per week. No
  gold weekends.
• -Floor interns are usually scheduled for one
  gold-weekend per month. Specialty team interns
  are not scheduled for gold weekends a/p the
  official schedule. However, team interns may
  decide to cover each other for a weekend in order
  to allow for a weekend off. This is allowed only
  if 1.) the interns formally request this in
  advance by emailing the chiefs 2.) It occurs no
  more then once per month per intern.
• -If a resident was on-call Saturday he does not
  come in on Sunday. The SMR will present the case
  during intake rounds on Sunday AM.
• -Interns are to come to intake rounds (730 AM, 3
  North Medicine Library) on the weekends. This is
  so the interns can hear about their new admission
  and discuss the case management with the covering
  day resident.

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Intern/Sub-intern Limits

• Interns 12 patients
• Sub-interns 7 patients
• Residents are encourage to re-distribute patients
  if approaching maximum.

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General Policy

• -Bounce back 7 days
• -Unit transfers 48 hrs
• -SMR should be notified of any specialty team
  direct
• admissions.
• -All transfers require both an intern and
  resident note.
• -Document everything. Use event note function in
  Mysis.
• -Use Nextels (when available). No excuses.
• -Problem with the computers
• Call the help desk (3-HELP)?
• -Intern/Sub-Is must review sign out with team
  resident.
• -Intern/Subintern ? Team/Covering Resident ?
• SMR ? 405 Attending or Service Attending.

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General Policy

• Code CAC During the day, code team and anyone
  in the vicinity. At night, everyone should
  respond. Dial the operator.
• RRT Rapid Response Team A team of
  clinicians (SMR, Critical Care Nurse, Resp.
  Therapist) who respond to critically ill patients
  on the floor (i.e. The CRASHING PATIENT)
• Dial 3-5110

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Weekly Medicine Conference Schedule

• Resident Report (Medical Residents)Every weekday
• at 1100 AM, except Thursday in the Medicine
  Library (3N, old building).
• Clinical Question/Journal Club (Mondays Resident
  Report)1100 AM, Mondays in the Medicine
  Library,
• (3N, old building).
• Noon Conference..Every weekday at 1230 PM in
  the Medicine Library (3N, old building).
• Intern Report (Sub-Is and MSIII too).
  Wednesdays at 1230 PM in the Medicine Library
  (3N, old building).

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Weekly Medicine Conference Schedule (contd)

• Chief-of-Service Rounds (Noon conference)..Every
  Thursday at 1230 PM in the Medicine Library
  (3N, old building).
• Medicine Grand Rounds (All medical house staff).
• Fridays at 1230 PM in the 4th floor
  Auditorium, Building 1 (old building).
• Renal Grand RoundsTuesdays, 1230 PM in the 4th
  Floor Auditorium, Building 1 (old building).
• Cardiology Imaging ConferenceTuesdays, 4 PM,
  Building 1(old building), RM 1N-48.
• Tumor Board Thursdays, 12 PM, Building 1 (old
  building), RM 1N-48.

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Jacobi Wards
Welcome!
CHIEF RESIDENTS
Eric Barna, M.D. 917-
Manuela Calvo, M.D. 917-
Michael Grushko, M.D. 917-
Dave Sohal, M.D. 917-