A typical day on the inpatient Medicine team What do I need to know?

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A typical day on the inpatient Medicine teamWhat
do I need to know?

• Naseema B Merchant, MD, FCCP, FACP, FHM
• Department of Medicine
• Yale University School of Medicine
• VA CT Health Care System

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Objectives

• Inpatient care Processes
• Clinical Care
• Patient and family communication
• Electronic Health Records
• Patient flow
• Resource utilization

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Objectives (contd.)

• Balancing clinical responsibilities with
  education
• - Point of care learning
• - Managing time between patient work and
  scheduled educational activities

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Inpatient Care ProcessesClinical Care

• Gathering patient data
• Physical exam (during admission and daily visits)
• Presenting on rounds
• Writing notes
• Patient admission process
• Patient discharge process
• Patient hand off

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Clinical Care -Gathering patient data

• Communication with night float team
• Communication with the night nurse
• Reviewing notes from the previous 24 hours(
  nursing , allied services, consults etc.)
• Reviewing new orders entered on your patient (
  while you were gone)

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Clinical Care-Presenting on rounds

• Communicating with the team prior to presenting
  on rounds
• Presenting a new admission
• Presenting daily progress on an existing patient
• Use of templates for oral presentation

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Clinical Care- Note writing

• Daily progress notes
• Admission note
• Discharge note

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Clinical Care- Admission, rounding and discharge

• Admission checklist
• Daily rounding checklist
• Discharge checklist

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Inpatient Care Checklist
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Inpatient Care processes-Patient hand-off

• Admission team and ED
• Admission team and PCP
• Day team to night team and vice versa
• Weekday team to weekend team and vice versa
• Primary team to consult team and vice versa
• Primary team to patient and family
• DC handoff -Discharging team , patient, family
  and outpatient providers
• SBAR model

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SBAR model

• S- Situation
• B- Background
• A- Assessment
• R- Recommendation

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Patient Care processes-Patient/family
communication

• First meeting with the patient
• Follow up visits
• Use of the white board in the patient room
• Family communication ( timing and frequency)

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Patient Care processes-Patient flow

• Definition
• Significance
• Physician role in patient flow

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Inpatient Care processes-Resource utilization

• Definition
• Significance
• Role of the physician in the appropriate use of
  resources and limiting inpatient costs

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Balancing clinical responsibilities with-
educational activities

• Point of care learning Learning on the go!
• Managing time between patient work and scheduled
  clerkship learning activities ( case conferences,
  EKG sessions, radiology sessions etc.)

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Care for your patient the way you want to be
cared for

• Thank you