R3 Orientation

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R3 Orientation
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YOUR LAST YEAR

• New year ? New role
• Senior resident in house
• Role model to students, interns, PGY2

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House Chief / Schnook

• 7am 7am every other day (Q2)
• Sun, Tu, Th or Mo, Wed, Fri
• Friday only until 3pm
• Schnook 7am 3pm
• House chief 6pm 7 am next morning

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Schnook

• RESPONSIBILITIES
• Distributing admissions
• Call Episcopal ED _at_ 2-0800 when notified by
  Transfer Center about patient being admitted
  talk to ED attending
• Evaluating patients in ED/gathering data
• Track census, caps, redistributions
• Fax to chiefs every morning (5978)

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Schnook

• RULES
• GIM GIM attending, Chief service, Hospitalist
• PNH TUH Hospitalists only!
• EPED admissions accepted by Transfer Center
  attending. You need to assign team/attending
• Transfers from OSH need to be accepted by an
  attending

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Schnook

• RULES
• AM admissions when upper year in clinic in the
  afternoon
• AM admissions or RICU transfers to pre-call teams
• Avoid admissions to Sub-I team when sister team
  is post-call

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Schnook

• Schnook List will be distributed monthly
• Also available on the web site

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House Chief

• Responsibilities
• Code / Rapid Responses6pm to 7am week days/all
  day weekend
• RICU transfers
• Medicine consults 6pm to 7am week days/all day
  weekend
• Night float back-up and educator
• Problem solver and consultant to other residents
  and interns
• Extra hand on very busy nights

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Codes

• Make sure you are ACLS certified before your HC
  block (also before FCCC rotation)/Review all
  protocols
• Go look at a code cart know how to
• Open it
• Turn on monitor
• Hook the paddles, where they plug in
• Change the voltage
• Use the defibrillator, buttons to push to shock
• Switch leads
• Pace

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Codes

• Dont run to a code
• Youll be out of breath
• You want to arrive once patient is already on the
  board and on the monitor
• During the walk to the code, review in your head
  the ABCs, the 5 Ts, the 5 Hs

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Codes

• When you get to a code
• Identify yourself as HC
• Check compressions, bagging with 100FIO2,
  primary ABC, patient hooked up to the monitor
• Assign/delegate work get patients chart, get
  most recent labs, info form NF/Primary team
• Check for a pulse
• Determine rhythm

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Codes

• Your job doesnt end when pulse is back !...

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House Chief

• RICU TRANSFERS
• Do not need approval after hours (6pm to 7am)
• Make sure attending or fellow is notified and
  plan is discussed
• Transfer note

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House Chief

• MEDICINE CONSULTS
• Call attending with questions and help,
  especially when doing pre-op evaluations for
  patients going to the OR early the following
  morning
• Consults need to be staffed within 24 hours
• Do not push after hours / weekend consults to the
  am consult resident

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House Chief

• NIGHT FLOATS
• Back-up for questions/help when Extra is busy
• Responsible for night float education on Mondays
  and Tuesdays from 730 am 8 am
• Always try to see/evaluate a patient presented to
  you by NF (or another upper year)
• If a patient was signed out to you, check patient
  once/twice. Get in touch with the NF covering
  that patient

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Guest House Chief

• While on elective blocks
• Friday 6pm - 8am
• Saturday 8am 8 am
• Round with consult attending
• Importance of Friday sign out from Medicine
  consults team
• Same other responsibilities than regular HC

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Medicine Consults

• 8am 6pm, Monday through Friday
• Two PGY3
• Morning HC and carry Code/RR beeper
• Consults from 8am to 6pm
• Packet sent to your email account
• TUH Hospitalists co-management
• Neurosurgery
• Ortho
• Podiatry

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Medicine Consults

• Who needs a daily note?
• Patients with active medical problems /-
  unstable
• Attending dependant
• Round daily with consult attending
• Consults need to be staffed within 24 hours
• Sign off when all medical issues resolved or
  stable
• Consider transfers to medical services

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Floors Reminders

• Take interns beeper during their MR (Thursdays),
  Clinic and Summer Conferences
• Evaluate your team regularly
• Feedback (both positive and negative)
• Medical students
• Interns responsible for dictations after
  September 1st
• No split for weekend rounds on the first weekend
  of the first 2 months (both Saturday and Sunday)

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Floors Reminders

• ATTENDING NOTIFICATION POLICY
• Call within 2 hours of seeing the patient
• Call with ANY significant changes in pt. Status
• (deteriorating condition, code, death, RICU
  transfers)
• Use the fellows if not able to communicate with
  attending. Document your conversation.

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Floors Reminders

• Plan ahead with your intern for days off
• Sub-I sister teams cover each other on weekends
• When calling a Consult also order on MIS system

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Teaching Resident

• Get teaching resident CD and package from Betty
  Anne
• Teach Monday to Thursday at 1pm 2pm
• Thursdays also at 9am (CXR, EKG, ABG,)
• Friday SIM center

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Schedule changes

• All scheduling changes need to be approved by the
  chief residents
• Official request via email is required
• You should receive written confirmation (email)
  of approved schedule changes and you should
  confirm the change on Amion
• Any resulting schedule conflicts (post call
  clinic, guest floats, reserve, etc.) are your
  responsibility

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Schedule changes

• EMERGENT SCHEDULING CHANGES
• We will arrange coverage (via the reserve) in
  cases of illness or emergency
• Do not abuse
• In cases of emergency, the chief resident may be
  contacted via the long range pager (215-
  363-4232).

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Reserve

• Be available by beeper
• If you are going to be out of beeper range, you
  are responsible for providing contact info to the
  chiefs
• Arrive within 90 minutes
• Dont agree to schedule changes that overlap your
  reserve duty

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Dictations
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A few new things

• New TEXT pagers ? use both pagers for the first 2
  weeks
• Extra starts to do admissions at 7pm
• New Innovation https//www.new-innov.com

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www.temple.edu/imreports
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Morning Report Part A

• Some changes
• Part A PICO format
• Patient, Population, Problem
• Intervention
• Comparison
• Outcome
• 2 Part A Ambulatory resident (R3) will present
  the 3rd Monday of each of the month

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What if your question isnt in the Cochrane
Database?

• Doesnt mean its a bad question!
• Continue to look at other sources of data
• Come to us if you need help finding
  studies/reviews

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Ending your Morning Report A

• Complete the clinical loop - Always end with your
  patient and explain why you would or would not
  pursue the proposed intervention based on your
  evidence.
• Remember - finish in 25 minutes in order to allow
  time for discussion.

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Morning Report Part B

• Monday 930am Multiple Choice Questions
• Tuesday 930am Interpretive Skills (Pilot
  project)

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Journal Club

• Every 1st and 3rd Wednesday
• Two residents one article
• Coordinated by Dr. Taqui
• Contact specialists soon after you know what
  article will be discussed
• Be proactive
• Bring topics you would like to cover

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Professor Rounds

• Monday, Thursday, Friday
• Only days on call
• 1100 am to 12 pm 6th floor conference room
• Residents bring a case

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Your Chiefs