Jacobi Medical Center Medicine Service New Building Building

Jacobi Medical Center

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

Welcome to Jacobi Wards Ø Day Structure -Interns arrive ~6: 30 -7: 00 AM -Retrieve Sign-out from Night Float (4 A Conference Room, New Building) -General medicine residents report (PGY 2 -3) to intake rounds 7: 15 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 -9: 15 AM (you must SEE all the new patients and the sickest) -Attending Rounds 9: 00 -11 AM (Will discuss all new admits, old patients, radiology rounds, SW rounds, didactics, presentations, discuss chart documentation. )

Jacobi Wards Intern Work Completion 11 -12: 30 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 (PGY 2 -3)11: 00 -12: 00 (3 North Medicine Library, Old Building) All medicine residents must attend!

Noon Conference 12: 30 --1: 00 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.

Jacobi Wards Complete all work 1: 30 -5: 00 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)

Jacobi Wards Resident Responsibilities (PGY 2 -3) q q q q q 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

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

Jacobi Wards Additional Intern Responsibilities cont’d -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. )

Jacobi Wards MS III Medical Students 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!!!

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.

General Medical Service Call - Residents, Interns, Sub-Is are on-call every 4 th day. Sabbath observers (Residents, Interns, Sub-Is) will occasionally have Q 2 call alternating with Q 6 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.

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.

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 – 9: 30 PM (last admission 8 PM). Sign-out 9: 30 PM – 10 PM. - Night Float Residents: 8 PM – 8 AM (last admission at 5: 30 AM). -Night Float Interns: 9: 30 PM -11 AM (last admission at 5: 30 AM).

Call Times Subspecialty teams: On call every other day. Between short-call and long call -ACS/Onc Shot-call (Q 4) Intern: 7 AM – 5 PM (7 days a week). Last admission 4 PM and must stay until 5 PM. - ACS/Onc Long call Intern (Q 4): 7 AM – 9: 30 PM. Admissions for both ACS and Onc starting at 4 PM. Last admission at 7 PM. Cover until 9: 30 – 10 PM. -Pulmonary Service (Q 2): 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)

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.

Intern Coverage -Long call intern covers their team and “sister team” from 5 PM until 9: 30 – 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.

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.

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 (7: 30 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.

Intern/Sub-intern Limits Interns: 12 patients Sub-interns: 7 patients Residents are encourage to re-distribute patients if approaching maximum.

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.

General Policy Ø Ø 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

Weekly Medicine Conference Schedule: Ø Resident Report (Medical Residents)…Every weekday at 11: 00 AM, except Thursday in the Medicine Library (3 N, old building). Ø Clinical Question/Journal Club (Monday’s Resident Report)…… 11: 00 AM, Mondays in the Medicine Library, (3 N, old building). Ø Noon Conference…. . ……Every weekday at 12: 30 PM in the Medicine Library (3 N, old building). Ø Intern Report (Sub-Is and MSIII too)………. Wednesdays at 12: 30 PM in the Medicine Library (3 N, old building).

Weekly Medicine Conference Schedule (cont’d): Ø Chief-of-Service Rounds (Noon conference)…. . Every Thursday at 12: 30 PM in the Medicine Library (3 N, old building). Ø Medicine Grand Rounds (All medical house staff)…. Fridays at 12: 30 PM in the 4 th floor Auditorium, Building 1 (old building). Ø Renal Grand Rounds…Tuesdays, 12: 30 PM in the 4 th Floor Auditorium, Building 1 (old building). Ø Cardiology Imaging Conference……Tuesdays, 4 PM, Building 1(old building), RM 1 N-48. Ø Tumor Board…… Thursdays, 12 PM, Building 1 (old building), RM 1 N-48.

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