Harper University Hospital Orientation Hala Nas

New to Harper… Floor interns take 24 hour call on Fridays and Saturdays No more AMR No excuse for skipping morning report. Only team responding to codes should remain behind Pager/sign-outs at 7 AM, no excuses

Team structure HUH A1 Resident Intern A2

Team caps Intern cap: 10 patients (all encounters) Intern new admission cap: 5 patients in a 24 hour call Total team cap: 23 patients

Hitting caps If the on-call team caps… Before 6:30 pm  page Dr. Safwan Saker who will take over the admission pager until 8 PM YOU CANNOT LEAVE THE HOSPITAL! YOU MUST CONTINUE TO CROSS COVER PATIENTS, SIGN THEM OUT TO NIGHT FLOAT AND TELL NIGHT FLOAT TO TRANSFER THE PAGER AND ADMIT TO THE OTHER TEAM At 8 PM the night float team arrives, transfers the admission pager to themselves and will admit patients to the other team After 6:30 pm  on-call senior admits patients to the other team, places covering physician orders, evaluates the patient, places basic orders, signs the patient out to night float who will continue the workup and do the full H & P THE ON-CALL SENIOR MUST PLACE BASIC ORDERS ON THESE PATIENTS AND SIGN THEM OUT TO NIGHT FLOAT, LET THEM KNOW WHAT YOU’VE ALREADY DONE SO THEY CAN PICK UP WHERE YOU LEFT OFF If both teams capped > admissions go to Dr. Safwan Saker

Call days (Q2) Days where you admit patients Short call (3 PM) and long call (8 PM) Admission pager carried by short call senior until 3 PM, then carried by long call senior until 8 PM 3 PM: Teams sign out to on-call team for cross coverage

Night float and night admissions Cap overnight to call team: 10 patients Intern cap in a regular non 24 hour day: 3 new patients. 10 total patients 5 nights: NF senior and NF intern Fridays and Saturdays: NF senior and on-call floor intern

Admission cut-offs Admissions 6:30 PM to 8 PM to be evaluated by on-call senior (admission and basic orders), H&P to be completed by night float team Admissions 6 AM to 7 AM to be evaluated by NF senior (admission and basic orders), on-call team to complete H&P

Non-call days No new admissions Finish up your work and sign-out at 3 PM to on-call team

Admissions

From ED On-Call Senior will carry the admission pager (0092) When the ED calls for an admission take sign-out, briefly review the chart, ask the ED physician any questions you might have, provide the attendings name and go evaluate the patient immediately or at least within 15 minutes Place the following orders: Covering physician order Basic orders until the primary team evaluates the patient (which should be after morning report) Patient presence in ED doesn’t stop you from managing/ordering Always evaluate the acuity of your patient’s illness; determine if they are stable for the floor or need evaluation by the ICU Admissions can not be refused. If you believe the patient does not need admission, call your attending

From MICU Take sign-out from resident or fellow Cannot place orders on the patient until they physically have left the unit Communicate with MICU team if you’d like something done/cancelled Place covering physician order so that nurses page you once patient is on the floor Do not round on patients if still physically in MICU

From other services Patients transferred to your team from another service if you have not taken care of that patient before. The Medicine Consult service must first evaluate to approve this transfer, pager 5501.

Direct admissions and facility transfers Admissions from the clinic/outside If you accept an admission from the clinics, it is your responsibility to check which floor the patient is going to be admitted to. Bed assignment 51387 Your attending physician must accept transfers from outside hospitals first. If you are called to accept a transfer, talk to the transferring physician and obtain the following information provisional diagnosis history vital signs pertinent physical examination pertinent work-up reason for transfer phone number of transferring physician Make sure the patient is stable for transfer and management on the floor. Discuss this with your attending physician before accepting the transfer.

Transfers to MICU If you feel your patient needs a higher level of care, page MICU fellow at 6428 and consult If accepted to MICU, fellow calls bed control for an MICU bed. Either you or MICU team place transfer orders

Bounce backs Bounce backs are admitted by the on-call team (regardless of who the bounced patient belongs to). The next morning, the team staffs the patient with the attending, writes a progress note, and signs out the patient to the team that the patient belongs to originally If the patient is being discharged on the next day, the discharge will be done by the team that admitted the patient. No bounce backs on the first and last days of the rotation

Discharges Discharge process starts on day of admission  If patient to be discharged later in the day, make sure discharge meds, appointments, ambulance forms and order is placed by primary team

Medicine consults After 4 pm on the weekdays and 2 pm on the weekends the medicine consult pager will be forwarded to you and you may need to see a HUH/RIM patient SENIORS, after that time you must: Evaluate STAT medicine consults Conduct pre-op assessment on a patient Staff over the phone with the DRH UPG Medicine Hospitalist (pager 5755) Write a brief incident note (SOAP format) Add patient to Medicine Consult list and page the team the next morning, give them a brief signout and they will do the full consult note These DO NOT count as hits

Who counts as hit? Patients seen, staffed and directly discharged from the ED BUT MUST BE STAFFED WITH ATTENDING FIRST Completed H&P but patient ends up going to a different service Patients admitted to your team who you will be following on a daily basis Patients transferred to your team from another service if you have not taken care of that patient before.

Codes On-call team responds to codes in Harper Do not respond to Karmanos codes

Days off Each resident must take 1 day off in each 7 days All team members must be here on call days Obviously, can’t have your assigned MR day off  Seniors should avoid taking post-long call days off as much as possible

Morning report Morning Report- combined at DRH Morning report will start promptly at 11:00 am. No excuses to skip All residents are expected to attend MR except the senior who is on short call 1 case per day Case presentation and teaching slides to be covered by the intern Senior is responsible for case oversight and assisting intern Review the MR schedule Complete your case slides 48 hrs in advance and email to CMRs Late cases will be moderated by senior

Have fun!