Queens Medical Center Night Medicine Orientation Academic Year

Queen’s Medical Center Night Medicine Orientation Academic Year 2014 -2015 Dennis Bolger, MD (Assoc. Director of Med Ed) Chief Medical Resident: Masayuki Nogi, pager: 577 -2608 Revised Oct 2014

What you need to know as Cross covering intern

Beginning of shift 1. Arrive at 7 th Floor call room (code 4 -3 -5 -1) 2. Pick-up X-cover pager (#578 -8995) 3. Gather printed I-PASS hand-out per intern 4. Call ALL interns for verbal sign-out 5. Fill-in Transfer sheet census Saturday On , 2 -teams are OFF. Contact the attending via “physician exchange” 524 -2575

This is where you fill in

End of shift (Sunday morning) 1. Give verbal sign-out to ALL interns in the call-room (as they come) 1. 6: 45 am – page the UHS attending for OFF teams via physicians exchange. • Call MTC attending ONLY when significant overnight event 2. Hand X-cover pager to LATE CALL intern

Urgent consult * PE: physicians exchange 524 -2575 ICU transfer x 5391 MICU attending (cell) X-cover hospitalist 578 -8307 (pager) Gastroenterology PE* “on-call gastroenterologist for QMC” Cardiology fellow x 5541 (cell) / 578 -8065 (pager) Surgery QMC intranet “On-call physician (Surgery 1 st call)” Neurology PE* “on-call Neurologist for QMC” Nephrology PE* any one you like Urology PE* any one you like Other on-call physician try operator #0 or QMC intranet

Team structure Team member Attending UL UHS attending intern Sub. I Avg. 3 -5 pts intern Cap 8+1 MS 3 Cap 8+1 Max 18 pts MTC attendi ng Avg. 2 -4 pts • • Max 2 pts UHS: University Hospitalist Service MTC: Medical team care

I-PASS Handover Electronic Hand-over in Carelink, should be updated daily! IZ U Q What does I-PASS stand for?

The I-PASS Mnemonic I Illness Severity Stable, “watcher, ” unstable P Patient Summary statement; events leading up to admission; hospital course; ongoing assessment, plan A Action List To do list; timeline and ownership S Situation Awareness & Contingency Planning Know what’s going on; plan for what might happen S Synthesis by Receiver summarizes what was heard, asks questions; restates key action/to do items © 2013 I-PASS Study Group/Boston Children’s Hospital. All Rights Reserved. For Permissions contact ipass. study@childrens. harvard. edu

Cross Cover Tips Clarify & anticipate problems during hand-offs Answer each page ASAP. “This is Dr. _____ returning a cross cover page for medicine”. Identify the pt & team taking care of them Go to bedside for assessment! (if in doubt, or unstable) Short cross cover note (in carelink): for any bedside assessment or significant change. Ask help to ADM upper level resident for any unstable/difficult cases Death pronouncement interns can write Death summary only UL resident, dictation preferred

What you need to know as Admitting resident

Beginning of shift 1. Arrive at 7 th Floor call room (code 4 -3 -5 -1) 2. Pick-up MTC admission pager (#578 -8169) 3. Pick-up transfer sheet from Xcover resident 4. Count the Caps for tonight

End of shift 1. Fill-in Transfer sheet AM 2. Sign-out to interns (by 6 am) and Transfer team UL. • Day-shift UL will remove you from “treatment team” • Call UHS attending via Physician exchange if team is off 3. Hand MTC admission pager to Early call UL. 4. Leave transfer sheet in call room wall pocket

Patient Acquisition Schedule Overnight Transfer New ICU downgrade Late ⑦⑧ 12 pm-6 pm ①② AED − − − ①②③④ 6 am-12 pm − Early ⑤⑥ 6 am-12 pm − Short ①②③④ 6 -10 am − ⑤⑥ 10 am-6 pm ①② Transfer Lw if E team capped Admission CAPs for NF resident 6 UHS, 1 MTC and 3 QEC patients (max 10)

Unexpected Re-admissions AKA “Bounce backs” Patient will return to the previous team regardless of their shift schedule. If ANY note is filed from ANY of the current team member If team is OFF, contact attending. Team will acquire patient on the next day.

T!! N A ORT IMP Admission & transfer log Carelink Any transfer (night!) Drop into “Block. OO total NIGHT admission” list. Usually NF resident will do Please leave the transfer sheet in the call room! (CMR will collect)

Treatment team Day team UL resident will organize.

Problem Lists Need to be updated & accurate for all of your patients. This should be updated daily during the admission to add or take away current ACTIVE problems only

Summary of Admitting Resident Duties 1. ADMIT! Write a nice H&P (need to dictate if MTC admission) 2. Complete transfer sheet by 5 am & leave it in call room 1. 2. Add day team to Treatment team by 7 am Add all overnight admits to shared pt list “MTC/UHS total night time admission” in Carelink. 3. Signout in call room by 7 am 4. Give the MTC pager to the “Early” team UL

Conferences (refer to the Conference Schedule)

Resident Morning Report Mon/Wed/Thurs Every 7: 30 am – 8: 15 am @ Iolani 5 How to prepare? 1. Notify CMR one day prior (MRN) How to present? Case presentation 30 min – accurate content, confident delivery “Talk to the audience” – make it lively Night float resident will present at morning report! * No need for preparing didactic!

Miscellaneous

Pager rules Keep pager ON, and respond From 6 pm-7 am on regular work days Who carries MTC admission pager? NF E team UL L team UL NF How to change greeting message 1. 2. 3. 4. 5. 6. Who carries X-cover pager? NF L team intern NF *CMR can supple batteries for xcover or MTC admission pager Call your pager No. Hit * Enter PIN number Hit 3 -0 Record message Hit 1

Reminder about HIPAA: Health Insurance Portability and Accountability Act of 1996. first federal law aimed at protecting the privacy of health information. Be careful to protect Patient’s health information do not talk about patients in the elevators taking clinical pictures needs a consent do not take pictures or send information of patient’s information on personal phone or email Don’t lose/leave your papers in public areas

Miscellaneous 1. 2. 3. 4. 5. 6. Verbal Orders (In-Basket): 1. MUST be signed within 24 -48 hours Changing Code Status: 1. Only upper or attending Code Call room, Iolani 5: 4 -3 -5 -1 ER code: 2 -4 -6 -8 -* Meal Debit: $18/call 1. Meal card problems: call Stacey Teramae x 4381 Scrubs ok to wear daily except on Clinic days

Needlesticks/ occupational exposure QMC Blood/Body Fluid Exposure Policy 24 -hr confidential hotline: 6914004 Don’t wait! Obtain immediate care and follow-up Alternative = Call ER

Night medicine references Medicine on call & Washington manual(texts) Uptodate. com, Dynamed http: //medicine. ucsf. edu/education/resources/policies/ha ndbook. html Scroll down to the section on night float, also includes ICU tips. http: //info. med. yale. edu/intmed/cardio/imaging/content s. html Huge index of CXRs for reference.

TH IS IS JO KE A Chief Medical Resident Pager #577 -0984