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Chief

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... be paged by nursing regarding patient issues ... Geriatrics E-team Jeopardy Elective ... has the day off Crucial for patient safety and care ... – PowerPoint PPT presentation

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Title: Chief


1
WELCOME!!
2
Chiefs Orientation
Scott Denstaedt Marty Tam Angel Qin Khanjan Shah
June 14th, 2012
3
Starting intern year
SUCCESS!
4
Overview
  • Introductions
  • Roles of Chiefs
  • UH Wards
  • VA Wards
  • Typical Day on the Wards
  • The Pager System
  • Other Rotations
  • Conferences
  • Misc
  • Ambulatory
  • Professionalism
  • Advice
  • Questions

5
Scott Denstaedt
  • Undergraduate University of Michigan
  • Med School Wayne State University
  • Hometown Clarkston, MI
  • Hobbies tasting exotic beers, Game of Thrones
  • Fun fact speaks Japanese

6
Marty Tam
  • Undergraduate University of Michigan
  • Med School Ohio State University
  • Hometown Sterling Heights, MI
  • Hobbies sports, travel, food, drink, life
  • Fun fact almost was killed by a lion during
    medical school

7
Angel Qin
  • Undergraduate Duke University
  • Med School Case Western Reserve University
  • Hometown Chengdu, China ? Chicago, IL
  • Hobbies cooking, trying new foods, travel
  • Fun fact danced ballet for 8 years

8
Khanjan Shah
  • Undergraduate Furman University
  • Med School University of South Carolina
  • Hometown Greenville, SC
  • Hobbies working out, reading, eating good food
  • Fun fact Aspired to be a pizza delivery girl for
    most of my childhood

9
Roles of the Chiefs
  • Rotate every 3 months
  • UH Chief 31250 Marty Tam
  • Office in Lakeside 3
  • VA Chief 31533 Angel Qin
  • Office on 4th floor VA
  • Ambulatory Chief 31529 Scott Denstaedt
  • Office on 4th Floor VA
  • Quality Pt. Safety Chief 36644 Khanjan Shah
  • Office on 4th Floor VA/Lakeside 3

10
Roles of the Chiefs
  • We are the advocates for the residents
  • Call us with problems or issues that arise
  • Timely and specific pleasewe cant help you if
    you dont let us know.
  • We are your mentors
  • We provide support for your professional
    develoPMent, education, and your psycho-social
    well-being
  • We have candy!

11
UHUH Campus
Lerner Tower
Lakeside
ED
Seidman
12
Louis Stokes Veterans Administration Medical
Center
13
UH Ward Teams
Naff Wearn
Carpenter Dworken
Weisman Ratnoff
Hellerstein Eckel
Sister teams alternate long call days Each team
has 2 interns ? Q4 long call Hellerstein and
Eckel do not have sister teams
14
UH Ward Teams
  • Hellerstein (Cardiology)
  • Team room on Lerner Tower 5
  • 2 senior residents, 4 interns, sometimes a fellow
  • Eckel (Nephrology)
  • Team room on Lakeside 5 (between 50 and 55)
  • 2 senior residents, 4 interns

15
UH Ward Teams
  • Naff and Wearn (General medicine)
  • Team rooms on Lakeside 20
  • 1 senior resident, 2 interns
  • Carpenter (Infectious disease, HIV patients)
  • Team room on Lerner Tower 8
  • 1 senior resident, 2 interns

16
UH Ward Teams
  • Dworken (Gastroenterology, Hepatology)
  • Team room on Lakeside 55
  • 1 senior, 2 interns
  • Round separately with the Liver attending
  • Weisman and Ratnoff (Heme/Onc)
  • Weisman on Seidman 4 (hospitalist)
  • Ratnoff on Seidman 3 (oncologist)
  • 1 senior, 2 interns

17
UH ICUs
  • MICU
  • Lerner Tower 3
  • 5 seniors (4 on days, 1 on nights) 4 interns
  • Interns take call with their seniors Q4 seniors
    stay overnight
  • 1-2 attendings, 2 fellows, 2 teams
  • CICU
  • Lerner Tower 3
  • 5 seniors, 2 interns, 1 fellow
  • Interns do 1 week of days, 1 week of nights

18
VA Ward Teams
  • Four general medicine teams
  • Blue and Green are sister teams
  • White and Orange are sister teams
  • 1 senior, 2 intern teams
  • Q4 long call
  • Team rooms on 4th floor

19
VA MICU
  • Two seniors (one on days and one on nights)
  • Three interns, Q3 call
  • Admit from 7 AM to 8 PM
  • Leave by 10 PM
  • Day off is pre call day Friday through Sunday

20
LOGISTICS of Calls...
  • Long call 3 patients by 7 PM
  • Only 1 after 6 PM, 2 after 5 PM
  • Medium call 2 patients by 4 PM
  • Short Call
  • UH 2 Patients (nightfloat admission or ICU
    transfer)
  • VA 2 Patients (nightfloat, transfer, or NEW)
  • Cycle Long? Medium? Short? HAPPY!

21
LOGISTICS Team Caps
  • 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)
  • VA
  • Cap 8 all the time
  • Caps increase if you have acting interns

22
Days OFF
  • Dworken, Carpenter, Wearn, Naff,
  • Ratnoff, Weisman, and VA Wards
  • Short or Happy days that fall
  • on Saturday or Sunday
  • Golden both weekend days off
  • Black work both weekend days
  • Silver either Sat or Sun off
  • Eckel or Hellerstein
  • 1 day off per week Happy day Friday through
    Monday

23
Days OFF
  • Night Floats
  • UH 3 interns are scheduled but only 2 are on
    each night work out days off with each other!
  • Send schedule to chiefs if you are going to a
    ward rotation, you should not work the last
    Sunday
  • VA Saturday night is off
  • UH MICU
  • Helper day off Friday through Monday

24
Typical Ward Day
  • 7 AM to 745 AM
  • Pick up signouts from night float team on Lerner
    Tower 5 at UH and blue team room at the VA
  • Pre-round
  • 745-8 AM Be in your team room to discuss
    changes overnight and the days plan with your
    senior
  • 8 AM to 10 AM (VA) or 1030 AM (UH)
  • Rounds with attending
  • New patients present HP
  • 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
  • Your A/P may be right or wrong but the best way
    to learn is to take a shot dont just present
    the data and then look at your attending and
    resident and wait for them to tell you what to do
  • Be organizedhave a system

25
After Rounds
  • C Call your consults
  • Consultants will appreciate the early call
  • O Order Entry
  • Enter any orders that were not entered on rounds
  • L Labs
  • Run your labs
  • D Discharges
  • Get them out
  • Should have daily note on the day of discharge as
    well (very brief)
  • N Notes
  • Dont start your notes until the rest of the work
    is finished

26
Typical Ward Day
  • 1030-1130 AM (UH) or 10-11 AM(VA)
  • Resident AM report (M/W/F at UH, T/W/F at VA)
  • Thursday morning Intern AM report Tuesday at
    UH
  • Noon-1 PM daily conference
  • Afternoon for notes, procedures, teaching rounds,
    contacting families, following up studies, etc
  • Short call interns and happy interns can
    signout to their co-interns when their work is
    done
  • Medium call signs out to night float at 7 PM
  • Long call signs out to night float at 9 PM

27
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!

28
The night float team
29
The NIGHTFLOAT TEAM
30
Intern Role on Nightfloat
  • The night float intern comes in at 7 PM and
    receives the pagers from the non-call teams
  • The night float intern can receive the pagers
    from the long call intern at 9 PM and must
    receive the pager by 11 PM
  • Please be pro-active and help your co-intern out
    if theyre still in the hospital late

31
Night Float Duties
  • Follow-up on unfinished tasks
  • You may be asked to go evaluate a patient if you
    do, please write a brief Clinical Event Note
  • If there are any questions/concerns, please ask
    your seniors and NACR
  • A senior should go with you to every CODE WHITE
    during the first 6 months

32
Duty Hours
  • On long call, sign out at 9 PM, MUST be out by
    11PM
  • On medium call, signout at 7 PM
  • UH Lerner Tower 5
  • VA VA Blue room
  • Duty hours not to exceed 80 hours/week

33
Call and Continuity Clinic
  • No Clinic on Long or Medium call.
  • No short call patients assigned on your clinic
    day.

34
Team Pagers
  • Each team will have a pager held by one of
    interns on the team and then signed out to
    nightfloat in the evening
  • Will mostly be paged by nursing regarding patient
    issues
  • Team pagers are also code pagers long call
    interns should go to all codes (Code Blue)
  • Team pager numbers are listed on the pager card

35
How to send a page!
  • UH
  • Dial 222 ? type pager number ? beep beep beep ?
    your call back numberyour pager number
  • VA
  • For UH Pagers, dial 9-207-7244 ? type pager
    number ? beepbeepbeep ? you call back
    numberyour pager number
  • For VA pagers, dial 9-440-562-xxxx (pager number)
    ? beep beep beep ? your call back numberyour
    pager number

36
Other Rotations
  • Geriatrics
  • E-team
  • Jeopardy
  • Elective
  • UCC

37
Geriatrics
  • New this year 4 week block
  • 3 interns Geriatrics attending
  • 2 interns on wards, one intern at the VA
  • Other health care settings such as skilled
    nursing facilities, home calls

38
E-team
  • Only during the busiest months at UH
  • One intern hospitalist attending
  • 8 patient cap, off on Sundays
  • Lots of independence

39
  • Pager must be on 24/7
  • No pay back as it is an official rotation
  • Called to cover for inpatient and outpatient
  • Weekends are off

40
Urgent Care Center (UCC)
  • The VA Emergency Room
  • Staffed by at least 3 residents
  • One or two attending physicians
  • Hours are 8 AM 6 PM

41
Electives
  • There will be continuity clinics once a week
    during your electives
  • This is the time to explore your academic
    interests (get involved in research, participate
    on different consult services)
  • On elective, you are also backup jeopardy, so
    please keep your pagers on!
  • You are expected to attend Grand Rounds and MMs
  • If you do research, you are expected to present a
    poster at the Department of Medicine Research Day
    held every May

42
Example Elective Tracking
43
DISCHARGE SUMMARIES
  • DISCHARGE SUMMARY do 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
  • Crucial for patient safety and care

44
Conferences - UH
  • Intern Morning Reports Residents hold the
    pagers!!
  • Tuesday AM report from 1030 11 AM
  • Thursday 1030 AM 1130 AM
  • Grand Rounds
  • Tuesday 12-1 PM
  • Morbidity Mortality (MM)
  • Friday 12-1 PM
  • Agre Society
  • Monthly, Wednesday evenings more info to come
  • Noon Conference
  • Monday, Wednesday and Thursday 12-1 PM (with food)

45
Conferences - VA
  • Monday Noon conference
  • Tuesday Grand Rounds televised from UH at noon
  • Wednesday MM at noon
  • Thursday Intern Morning Report _at_ 10-11 AM
  • Your resident will take your pager
  • Be on time!!
  • Friday Noon-conference

46
UH Miscellaneous
  • GME Housestaff Lounge!!
  • Located on Lakeside 6th floor, next to GME office
  • Has coffee, bathrooms, TV, foosball table,
    computers, food on Sunday nights

47
VA Lounge and Call Rooms
  • Located on the 2nd floor
  • Fridge frozen dinners, ice cream, sorbet, string
    cheese, muffins, fruit, yogurt, milk, etc
  • Coffee machine
  • Cabinets all sorts of snacks

48
Intern Saturday Coverage
On Saturday nights when on ambulatory, UCC, or
elective, you will be asked to cover from
Saturday 7 PM to Sunday 8 AM for the VA intern
nightfloat to get a night off
49
VA Miscellaneous
  • Garage parking is free! Just need to get a
    parking pass from VA police department (bring
    license, insurance, registration)
  • VPN access for home CPRS access
  • Codes at VA are called Dr. Heart and are called
    overhead

50
Ambulatory Medicine
  • Continuity Clinic
  • Urgent Care Center
  • Primary Care Block
  • Clinical Skills Block (CSB)

51
Continuity Clinic
  • One afternoon/week either at the VA or at the
    Douglas Moore Clinic at UH
  • No clinic when
  • Medium call or on long call days
  • Vacation
  • Holidays
  • ICUs
  • Night Float
  • You DO have clinic when on Elective
  • To main continuity, you cannot switch clinics
    amongst yourselves all schedule changes need to
    be approved by ambulatory chief resident

52
Urgent Care (UCC)
  • Emergency room experience at the VA
  • You will either do it as a rotation or during
    ambulatory
  • If you are there as a rotation, you are expected
    to be there from 8 AM to 6 PM

53
Primary Care Block
  • Introduction to Outpatient Primary Care
  • Introduction to DMC and the VA continuity clinics
  • Morning Clinical Conferences 8 AM daily

54
Clinical Skills Block
  • 2-week outpatient rotation
  • Hands on activities
  • Simulation models at the simulation skill center
    (next to the VA)
  • Humanities in medicine
  • End of life care
  • Cultural competencies

55
Professionalism
56
Professionalism Attire
  • Men
  • Shirts and ties
  • Women
  • Professional
  • Keep white coats clean
  • No denim
  • Do not show up to Morning Report looking sloppy

57
Professionalism Absences
  • If you have to call in sick gt 1 day, you will
    need a doctors note from the Bolwell Family
    Practice clinic
  • You will be able to get a same-day appointment
  • If you are sick for gt 2 days and do not have a
    doctors note, you will be assigned extra weekend
    coverage and/or weekend jeopardy
  • Call-offs You must PAGE 31529 the Ambulatory
    Chief
  • DO NOT EMAIL
  • DO NOT TEXT PAGE
  • DO NOT CALL THE CELL PHONE OF THE CHIEF YOU KNOW

58
Professionalism Electives
  • Attend all Grand Rounds and MMs
  • You are back up jeopardy!! pager on
  • If you are going out of town for the weekend, as
    a courtesy please notify the ambulatory chief
    prior to leaving
  • Elective is not vacation
  • Please email Barb 2 weeks prior to starting your
    electives Quality chief will be keeping track of
    electives
  • Research for more than 2 weeks present at
    Research Day

59
Professionalism Conference Attendance
  • Please be on time our speakers usually have
    prepared a well thought out talk/powerpoint, so
    please be respectful of the time they spent
  • Noon conference
  • UH Mon-Wed-Thurs
  • VA Mon-Thurs-Fri
  • Grand Rounds on Tuesday UH VA
  • MM Fridays _at_UH, Wednesdays _at_VA
  • Conference attendance is part of your ACGME
    graduation requirements

60
Some friendly words of advice
  • Catch up on sleep when you can!
  • Talk to a chief resident/APD/KBA before a
    personal problem gets out of hand someone is
    always here!
  • Please support each other intern year is tough,
    but also fun!
  • Maintain personal and family relationships
    outside of the hospital make new friends while
    youre here
  • Take care of yourself its the only way you will
    be able to provide good care to your patients
  • LOVE what you do

61
Things to do in the CLE
  • Sports
  • The Cavaliers, the Browns, the Indians, the Lake
    Erie Monsters
  • SO MUCH GOOD FOOD
  • Lola/Lolita/B-spot, Superior Pho, Wonton Gourmet,
    Bangkok Thai, the Harp, Momochos, Fire, Sasa,
    Luxe, Southside, Parallax, Dante Gingko, the
    Black Pig, Soho, etc etc
  • AND SO MUCH GOOD DRINKS
  • Fairmount martini bar, Great Lakes brewery,
    Market Garden, Town Hall, Nanobrew
  • Beautiful scenery
  • Cleveland Metroparks
  • Edgewater Park
  • Mentor on the Lake
  • Summer festivals galore
  • CEDAR POINT!!

62
And so much more
  • http//www.clevescene.com/

63
QUESTIONS??
64
We are looking forward to a great year
together!!! -SMAK
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