R2 Orientation

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R2 Orientation
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Congratulations!
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PGY2 YEAR

• YOUR NEW ROLE
• IN A FAMILIAR
• PLACE

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Resident Survival Calculator

• Upper year resident exposure
• Floor months Unit Months / Electives
• In service exam score
• Astrological sign
• Score on economic survey
• Gender
• Low, Intermediate, High Termination Risk

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Here to help

• Education
• Autonomy
• Morale

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Leadership

• Some men are born great, some achieve greatness,
  and some have greatness thrust upon them.

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Floors

• There is always a backup system in place
• Activate this system if you are in over your head
• Attendings on the floors should be available
  whenever you have a question
• Call the house chief BEFORE the patient crashes

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Floors continued

• Temple floor services (Q5, Q4 winter)
• Sub-I services (Q10 or Q8 winter)
• 3 teams on call each night with 3 shifts
• (10p-1a, 1a-4a, 4a-7a) with assignments
• to be determined by each floor team,
• (Schnook has priority in choosing his/her shift)

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Breaking Shift

• If you are overwhelmed and unable to
  appropriately evaluate and admit pts in a timely
  manner you should
• Contact the other residents on-call to
  determine a strategy collectively
• Contact the extra
• Contact the House Chief
• Call us to call in the reserve

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Attending Notification Policy

• Call the Attending within 2 hours of seeing the
  patient
• Call the Attending with any significant changes
  in Pt status (deteriorating condition, code,
  death, RICU transfers, etc) or if you have
  management questions
• Fellows are extensions of their
  Attendings (except in cases of death)

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Signout

• Signout sick patients to the Housechief
• Teach your intern how to signout appropriately,
  adequately, and efficiently
• Signout with your intern for the first few blocks
• Tie up and finish end of day work as a team

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Weekend Rounds

• EVERYONE must come in the first weekend of the
  year both SATURDAY and SUNDAY
• Plan ahead with your intern for days off
• Sub-I sister teams cover each other on weekends
  (work this our with your partner)

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Specialty Services

• Four services One upper year, one intern, one
  fellow, and one attending
• CHF/Cardiology Medicine Red
• Pulmonary Medicine Blue
• Renal Medicine Yellow
• GI Medicine Brown
• ON-CALL Q8 only for UPPER YEARS
• CAP 16 patients (CHF 10)

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Specialty Services

• Similar daily schedule to regular floor blocks
• Resident rounds
• Attending rounds (will include teaching)
• Admissions
• During the day until 4pm (post-call, the intern
  will admit with the fellows help)
• Redistributions Monday through Friday (admissions
  done by the Extra overnight)
• Fellows expected to be more involved

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Specialty Services

• UPPER YEAR ON-CALL RESPONSIBILITIES
• Cover his/her service and admit to that service
  (no more than 5 admissions)
• Upper year resident in the CCU
• Will have the help of the Extra for admissions

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PNH

• Newton/Burden attending of record
• Admit to TUH Hospitalist Group only
• Hospitalist attending dictates all
  management and discharge decisions.

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RICU

• Q4 call
• Short call days
• post post-call day admit from 7a-1130a
• pre-call day admit from 1130p-4p
• On call team admits 4pm-7am
• Weekends
• On call team covers their sister team on the call
  and post call days
• PAC will be expected to round with the post-call
  team help the post-call team with notes,
  procedures, etc.

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RICU PAC

• Weekdays 5pm-7am
• Cross cover the other teams and help with
  procedures/admissions
• VRU admissions
• Weekends
• VRU admissions
• 7am-7pm
• Round with team, procedures, notes, etc.
• 7pm-7am
• Cross cover, procedures, etc.

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RICU continued

• Attending must approve all ED admissions
• All night time transfers require a call to the
  fellow on-call
• Discuss significant clinical changes with fellow
  and/or attending
• Call attending when patients pass away
• All non-medicine service transfers should be
  approved attending to attending

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CCU

• Two residents and two interns covering the unit.
• Q4 call schedule (with Specialty upper year when
  interns on call)
• Post-call CCU resident will sign out to the
  sister residents by 1 pm.
• Weekends on call and post call intern/residents
  divide notes

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Extra 10am-8am

• 10am-3pm
• Help post-call teams get out on time
• Help with RICU post-call procedures
• Primary backup for intern on call covering
  post-call teams
• 3pm-6pm
• Take signout from non-post call teams
• Hand off signout to night floats _at_ 6pm
• 7pm-8am
• Night float backup
• Help Housechief with codes
• Sub-specialty admissions (5 max)
• Sign out admissions directly to teams, after
  discussing with Housechief (who will assign teams)

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Friday Saturday Guest Extra

• Saturday 10am-7am
• Friday 6pm-7am
• Call team back up admissions only
• Patients still belong to admitting team
• Responsible for cross-covering non-post call
  teams until the night floats arrive
• Help out the post call teams

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SchnookingGame on!

• After 3pm and on weekends, the upper year on call
  will be schnooking
• (this is you)
• 3 teams on call from 3pm- 7am
• Decide who will snook before 3pm 7am
• Treat the Extra fairly

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Schnooking Rules

• GIM GIM attending, Chief service, GIM
  Hospitalist
• PNH TUH Hospitalist
• Tedaldi Ward service with Tedaldi as an
  attending (Private)
• Esperanza Ward service with their own attendings
  (Private)
• EPED admissions accepted by Transfer Center
  attending. You need to assign team/attending
• Transfers from OSH need to be accepted by CDU
  attending

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Episcopal ED / Transfers

• Do not give the shift info to Transfer Center
• Schnook contacted by Transfer Center with
  patients name, bed assignment, accepting
  attending and ETA
• Schnook responsible for calling Episcopal ED _at_
  2-0800 and talk to the ED attending
• Direct admission, CALL THE FELLOW and/or
  ATTENDING
• RN notifies Schnook when patient arrives
• Schnook notifies the team on shift , see pt ASAP

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New role, new places
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Fox Chase Cancer Center

• Q4 call
• 2 residents to a team, 1 team with each attending
• 1 SubI with each resident (sometimes)
• Arrive no later than 8am
• Short-call admits until 400 pm
• Post call signout at 1pm to on-call team
• On-call resident schnooks holds CODE BEEPER
• Saturday on call resident covers teammate on
  Saturday
• and Sunday
• Friday on call resident will cover teammate on
  Saturday
• Sunday on call resident will cover teammate on
  Sunday

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FCCC continued

• Codes
• You are the code chief (ACLS certification)
• Jeanes hospital anesthesia intubates
• Familiarize yourself with the code cart/AED
• Follow patients into the unit (open unit)
• ICU attending will automatically follow

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Abington Memorial Hospital
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Abington Memorial Hospital

• 2 Temple Teams TUH resident, Abington intern, 2
  SubIs on each
• Teach Sub-I and supervise their work
• Take advantage of the formal educational aspects
  of their training program
• Go to case conferences and speak up. This
  reflects well on Temple Medicine and you.

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Abington, Cont.

• You have to dictate discharge summaries only on
  patients A-L (split evenly with your intern)
• 1 morning report per block
• You must round every Saturday.
• Take admissions until 12pm (usually
  redistributions)
• No Sunday rounds

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Abington Daily Schedule

• Temple teams will alternate days of taking 2
  redistributions in the am with taking up to 3 new
  admissions during the day
• You still have weekly clinic
• Pick up sign out with your SubIs each day at 7am
• Take admissions until 4pm
• One of the Temple residents must stay until 5
• A Temple Chief will be out there with you

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Duty Hours

• 80 hrs/wk
• Consecutive hrs
• lt 30 hrs
• No admissions after 24 hrs
• Log your hours on New Innovations
• Report problems (with details) to Chiefs

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Days Off

• Average 4 days off in a period of 28 days
• This requires some foresight and planning on your
  part.
• Decide days off for the block with your intern on
  the first day of the rotation

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Schedules

• ALL scheduling changes need to be approved by the
  chief residents occur in writing
• You should receive written confirmation (email)
  of approved schedule changes and you should
  confirm changes on Amion
• Any resulting schedule conflicts (post call
  clinic, guest floats, reserve, etc) are your
  responsibility

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Schedules

• AWAY ELECTIVES Require approval in advance by
  Dr. Moyer
• RESEARCH BLOCKS Require approval by Dr. Moyer
  via email Faculty preceptor, project goals.
  Expected to present at the annual Research Forum.
• READING DAYS Only 1st day of elective if coming
  off service, except if you have clinic

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Emergent Scheduling Changes

• We will arrange coverage (via the reserve) in
  cases of illness and emergency
• In cases of emergency, the chief resident may be
  contacted via the long range pager (215- 363-4232)

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Reserve Duty

• Be available by pager phone at all times
• If you are going to be out of pager range, you
  are responsible for providing updated contact
  info to the chiefs
• Arrive within 90 minutes
• Do not agree to schedule changes that overlap
  your reserve duty

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BackPac

• Non-optional, assigned RICU reserve
• Help the admitting RICU team
• Admissions, Cross-cover, Lines, etc.
• 6pm 7am
• Pager Call (like reserve)
• Get to hospital within 60 minutes
• Paid!
• 10/hour if not called in
• 65/hour if called in
• Must email to get paid Nathaniel.Marchetti_at_tuhs.t
  emple.edu
• Email time/date called-in immediately (within 1
  day of pull)
• Separate paycheck

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PAC

• 50 / hour
• Need to fill out form at GME office (we have it)
• No medical record deficiencies
• Only residents on Elective non-call months, NOT
  during reserve
• Counts toward weekly duty hours
• You are there to help out everyone else

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Dictations

• Your responsibility.
• Try to dictate as you discharge patients.
• If you get suspended, you cannot use another
  residents MIS code
• Reserve will be pulled (with pay back).
• Will go into your file.

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Clinic

• Anticipate morning clinic on elective
• Check your schedule in advance
• Minimize switching clinics
• Submit clinic switch proposals to Larry Ward
  (Lawrence.Ward_at_tuhs.temple.edu) at least one
  month in advance
• Hold interns pager while theyre in clinic

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Shameless Primary Care Plug
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Sharpen The Saw

• Mental
• Physical
• Social
• Spiritual

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We need your help

• Education
• Autonomy
• Moral

• Set the tone
• Lead by example
• Think solutions, not problems
• Complain up
• Whats in me for it?

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Good Luck!!!