Medical Chief Residents' Intern Orientation 2009 “A Day in the Life of a BMC Intern”

Your Chiefs Located across the corridor in Evans 116 (8-7253) Also an office on the 6th floor HAC (4-5642) VA Chief – Anju at the moment 5222 – the oncall pager Stop us in the hallway, at conference, in clinic etc. – we’re here to help you

Pre-rounding 7am pick up sign-out (9am on ENC 8 th floor work room HAC one of two 6 th floor conference rooms VA 2-South conference room Pre-round on patients – collect vitals, assess any patients active overnight, ins and outs, weights... Don’t forget the Telemetry (upcoming intern conference session) Check stability of any new Short Call “holdovers” ICU pre-rounds are a little more involved

Ward rounds and presentations Usually start 7.30am, Attdg present alternate days 24hr events, any new tests and results, morning vitals See the patient with your team – interns lead at the bedside! Then present your assessment and plan by problem (don’t forget to address FEN, Ppx, Dispo, and Code when relevant) Organize your ‘scut sheet’ Rounds complete by / Morning Report

The superstar intern How old is the central line? Can any IV meds be changed to PO? Can they come off telemetry? Can the IVF be stopped? Will they need PT prior to discharge? Can you D/C the Foley catheter? Can you advance the diet? Are they moving their bowels? How close are we to discharge? Are the meds adjusted for renal/hepatic failure? Does the patient understand their care?

Putting in Orders Sunrise (SCM) order entry Phlebotomy draws are 7am, 10am, 1pm, 4pm, 7pm, 10pm, 1am, 4am. (AM draws usually 7am on the wards) If you can’t find it, try the % sign Call consults early please (the fellows will ♥ you) Radiology requests are a consult! Call down if its STAT Don’t forget to let the nurse know!

Progress notes Are now on SCM!!! Are required 7 days of the week

Attending rounds You should receive 3 attending round sessions per week You should also seek expectations / mid-way feedback / end of rotation feedback from Attdg and Resident

Noon conference Monday – HAC A/B Tuesday – Intern conf in Evans – compulsory! Wednesday – firm conf (11.30) or M&M Thursday – HAC A/B Friday – Emergency series / Grand Rounds You will be fed ☺ Attendance goal 80% We will hold your pagers 12 – 1pm

Afternoons Follow up results, consults, images Always update the patient! CLINIC Procedures – supervision, help Record temporarily by an SCM list or s to self Teaching Calling a Code: or

On call schedules Long call Max 5 for Early Long, 5+2 for Late Long Early call out by 9pm, Late is overnight Post call Short call Max 5 Early to 12, Late to 5pm (should be out by 7pm) Routine Or day off Units are q4 overnight Weekend coverage assignments

Survival tips If you’re standing, sit You’ll get out of this experience what you put into this experience Don’t assume anything… Use the resources around you: Resident, med students Chiefs, PDs RNs, pharmacists, PT/OT, case managers Subspecialty fellows BMC intranet Uptodate, online journals Each other

Admitting patients Resident will receive Admitting and ED pages IBEX is the ED board See the pt as soon as they arrive, at least to ‘eyeball’ and write holding orders Using the order sets – quality improvement H&P is online – every patient needs an intern or resident H&P Assigning a pager to the patient

SCM documents

Medication Reconciliation

Discharging patients The computerized Discharge Summary Can “copy forwards” from H&P – but check its relevant and accurate Discharge Medication Reconciliation in Logician – cut and paste the med list into the DSUMM Print out the Med Rec E-prescribe / Pharmacy arrange new meds Page One for services Discharge Order Follow-up appointments

Signout (after notes done, labs ordered, checked in w/ patients and resident) To Who? Long call <7pm NF junior >7pm Divert your pager! SBAR: Situation Background Assessment Recommendations

Pager etiquette

Ambulatory curriculum

The Medicine Residency Website Feedback appreciated! Jason is website lead

The West Roxbury VA

Location of WXVA Orange line to Forest Hills, then 36 bus

Y OU SURVIVED THE WHALEWATCH, YOU ’ LL SURVIVE BMC INTERNSHIP !