Chief

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WELCOME!!
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Chiefs Orientation
Dana Angelini Hiloni Bhavsar Brandon
Kellie Morgan Oberle Gigi Gaudiano (Med/Peds)
June 14th, 2012
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Topics

• Introductions..
• Who we are
• Roles of Chiefs
• UH Wards
• VA Wards
• A Typical Day on the Wards
• Ambulatory
• The Pager System
• Advice

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Dana Angelini

• Undergraduate University of Dayton
• Med School Wright State University
• Home Town Clinton Township, MI
• Talent/Hobby Baking

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Hiloni Bhavsar

• Undergraduate Wright State University
• Med School Wright State University
• Home Town Dayton, Ohio
• Really...born in India, moved to Dayton '94
• Talent/Hobbies Throwing dinner parties
  cooking!

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Brandon Kellie

• Undergraduate University of Louisville (GO
  Cards!)
• Med School University of Louisville
• Home Town Murray, KY
• Talent/Hobby can BBQ and speak southern

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Morgan Oberle

• Undergraduate University of Evansville
• Med School Indiana University
• Home Town Paoli, IN
• Talent/Hobby running/working out

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Gigi Gaudiano

• Undergraduate University of Virginia
• Med School University of Virginia
• Home Town Great Falls, Virginia
• Talent/Hobby Cooking, chasing around Domenic

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Roles of the Chiefs

• Medicine Chief Residents
• Rotate every three months
• UH Chief 31250 Morgan Oberle
• Office in Lakeside 3
• VA Chief 31533 Brandon Kellie
• Office on 4th floor VA
• Ambulatory Chief 31529 Hiloni Bhavsar
• Office on 4th Floor VA
• Quality Pt. Safety Chief 36644 Dana Angelini
• Office on 4th Floor VA/Lakeside 3
• Med-Peds Chief 37297 Gigi Gaudiano
• Office in Lakeside 3

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Roles of the Chiefs

• We are the advocates for the residents
• Call us with problems or issues that arise
• Timely and specific pleasewe cant help you if
  you dont let us know.
• We are your mentors
• We provide support for your professional
  development, education, and your psycho-social
  well-being
• We have candy! (Morgan may have granola bars or
  celery! )

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UHUH Campus
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UH Wards

• 8 Medicine Teams
• Wearn General Medicine
• Naff General Medicine
• Dworkin Gastroenterology
• Carpenter Infectious Disease, General Medicine
• Eckel Nephrology and HTN
• Hellerstein Cardiology
• Ratnoff Hematology and Oncology
• Weisman Hematology and Oncology
• 2 ICU's
• MICU CICU

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UH Wards Sister Teams
Naff Wearn
Carpenter Dworkin
Weisman Ratnoff
Sister teams alternate long call days each team
has 2 interns ? leading to Q4 long call
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• UH WARDS
• Hellerstein
• Eckel
• Each team has 4 interns rotating on Q 4 long
  call
• No sister team

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• UH WARDS
• UH MICU
• 2 teams with 2 attendings and 2 fellows each
  team with 2 residents and 2 interns
• Q 4 long call for interns and seniors (seniors
  take overnight call)
• Helper day is your seniors post call day (will
  sign out to you around 10 AM
• UH CICU
• Act as helper can follow and admit patients
• No formal call
• Night Float
• 3 interns scheduled 2 present each night cover
  the 8 inpatient UH teams

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Other UH Rotations

• Neurology
• 2 week rotation on the Neurology consult service
• GI-Jeopardy
• Rotate on GI consult service but are on call for
  back up for any absence on UH or VA wards/clincs
• MUST have pager on and answered 24/7

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LOGISTICS of Calls...

• Long call 3 patients by 7pm
• Only 1 patient after 6 pm
• Medium call 2 patients by 4pm
• Short Call
• UH 2 Patients (nightfloat admit or unit
  transfer)
• VA 2 Patients (nightfloat, transfer or NEW)
• Long? Medium? Short? HAPPY!

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LOGISTICS No. of Patients

• UH
• 10 patient cap on all UH ward rotations EXCEPT
  Ratnoff and Weisman which will cap at 8 (rolling
  cap)
• Your short call day will also cap at 8 (based on
  number of patients you start with in AM not
  rolling)
• At VA
• Cap8 all the time

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cCall and continuity clinic

• No Clinic on Long or Medium call.
• No short call patients assigned on your clinic
  day.

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Days OFF

• Dworkin, Carpenter, Wearn, Naff,
• Ratnoff, Weisman, and VA Wards
• Short or Happy days that fall
• on Saturday or Sunday
• Golden both weekend days off
• Black work both weekend days
• Either Sat or Sun off
• Eckel or Hellerstein
• 1 day off per week
• Happy day Friday through Monday

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• Days OFF
• Night Floats
• UH 3 interns are scheduled but
• only 2 are on each night work
• out days off with each other!
• VA Saturday night is off
• UH MICU
• Short call day off Friday through Monday

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UH Team Pagers

• Each team (Eckel, Wearn) will have a pager held
  by the on call and nightfloat interns
• Will mostly be paged by nursing regarding patient
  issues not sure the answer???? Just ask your
  senior!!
• Team pagers are also code pagers on call
  interns should go to all codes (Code Blue)
• Team pager numbers are listed on the pager card
  in your bags.

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Meet the DACR/NACR/MAN

• Day Acting Chief Resident/Night Acting Chief
  Resident/Medical Admitting Nurse
• Role is to distribute admissions, run codes and
  overall monitor the daily flow of the internal
  medicine inpatient service
• Available 24 hours/day at pager 30512 to answer
  questions or provide assistance!

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Conferences - UH

• Intern Morning Reports Residents hold the
  pagers!!
• Tuesday AM report from 1030 11am! NEW
• Thursday 1030am-1130am
• Grand Rounds
• Tuesday 12-1pm
• Morbidity Mortality (MM)
• Friday 12-1pm
• Agre Soceity
• Monthly, Wednesday evenings more info to come
• Noon Conference
• Monday, Wednesday and Thursday 12-1pm (with food)

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UH Miscellaneous

• Dictating Interns must dictate discharge
  summary for each patient discharged on the DAY OF
  DISCHARGE
• Day of Discharge note progress note discharge
  summary
• Dictation number must be written in the chart on
  the day of discharge
• Do them as soon as you write the discharge order
• Residents must do Discharge summaries when Intern
  has the day off

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UH Miscellaneous

• GME Housestaff Lounge!!
• Located on Lakeside 6th floor, next to GME office
• Has coffee, bathrooms, T.V., foosball table,
  computers, food on Sunday nights
• THE P.I.T. Fitness Center
• Basement of Lakeside
• Free card entry, TV's, towel service, open 24/7!

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• Duty Hours etc.
• 16 80 4 Rule!
• 16 hours per long call
• 80 hours per week
• 4 days off every month

• Long call every fourth day
• 3 admissions by 7 PM, out by 9 PM, must be out by
  11PM
• Medium Call 2 admissions by 4 pm, stay and
  signout team to intern nightfloat at 7pm

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UH Resources

• The Chief Resident
• Your Senior Resident
• The DACR/NACR
• Other Residents
• The Night Floats

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Louis Stokes Veterans Administration Medical
Center
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VA Wards

• Four General Medicine Teams
• Blue, White, Green Orange
• 1 resident 2 interns per team may have acting
  interns/medical students
• Ward 4A Orange/White (sisters)
• Ward 4B Blue/Green (sisters)
• PCU telemetry 2nd floor

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VA Lounge and Call Rooms

• Located on the 2nd floor
• Four call rooms (bunk bed room for AIs)
• Fridge frozen dinners, ice cream, sorbet, string
  cheese, muffins, fruit, yogurt, milk, PBJ
  un-crustables
• Coffee machine
• Cabinets have Trail mix, gold fish, peanut
  butter crackers, pretzels!

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The VA MICU

• 2 resident (day and night), 3 intern team
• Q3 call
• Admit from 7am to 8pm
• Leave by 10 pm
• No overnight here either!
• Day off is pre call day Friday through Sunday

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Urgent Care Center (UCC)

• The VA Emergency Room
• Staffed by at least 5 residents
• One or two attending physicians
• Hours are 9-6 with on-call resident to arrive
  at 0800 (you will not be the on-call resident
  this year)
• Fast track sees low acuity issues, med refills.

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Intern Saturday Coverage

• One or 2 Saturday Nights when on ambulatory, UCC,
  or elective, you will be asked to cover from
  Saturday 7pm to Sunday 8am for the VA intern
  nightfloat to get a night off.

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VA Conferences

• Monday Noon conference
• Tuesday Grand Rounds televised from UH at noon
• Wednesday MM at noon
• Thursday Intern Morning Report _at_ 10am-11am!
• Your resident will take your pager
• Be on time!!
• Friday Noon-conference

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VA Miscellaneous

• Garage parking is free! Just need to get a
  parking pass from VA police dept
• VPN access for home CPRS access
• Codes at VA are called Dr. Heart

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A typical day on the wards

• 7am to 745am
• Pick up signouts in KACR (at UH Tower 5) or
  from intern nightfloat team (at VA you will meet
  up with VA nightloat intern)
• Pre-round
• 745-8am Be in your team room to discuss changes
  overnight and the days plan with your senior
• 8am to 1000am (VA) or 1030am (UH) Rounds with
  attending
• New patients present HP
• Present the pertinent data, remember you only
  have 2 hrs for rounds
• Old patients present new data, events overnight
  and then your assessment and plan
• Your A/P may be right or wrong but the best way
  to learn is to take a shot dont just present
  the data and then look at your attending and
  resident and wait for them to tell you what to do
• Be organizedhave a system

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1000-1200 Time to get C.O.L.D.

• C Call your consults
• The later you call, the more angry the consultant
  will be
• O Order Entry
• Enter any orders that were not entered on rounds
• L Labs
• Run your labs!
• D Discharges
• Get them out!
• At UH, dictate your day of discharge note in your
  discharge summary
• At the VA, type the discharge summary on the day
  of discharge

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A typical day on the wards (cont)

• 1030 - 1130 (UH) or 1000 - 1100 (VA)
• Resident AM report (M/W/F at UH, T/W/F at VA)
• Thursday morning Intern AM report
• Noon-1PM conference
• Afternoon reserved for notes, procedures,
  teaching rounds, contacting families, following
  up studies
• short call should sign out to their co-intern who
  is long at 5pm
• medium call signs out to nightfloat at 7pm
• Long call signs out to nightfloat at 9pm

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Ambulatory Medicine

• Continuity Clinic
• Urgent Care Center/Firm Urgent
• Primary Care Block
• Clinical Skills Block (CSB)

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Continuity Clinic

• One afternoon per week at either the VA or the
  Douglas Moore Center at UH.
• During ambulatory or elective, up to 2 clinics
  per week
• Always the same day each week and with the same
  attending preceptors
• You will develop a set of patients that you
  follow over 3 years
• Clinic cannot be canceled by anyone except the
  Ambulatory Chief Resident

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Continuity Clinic Rules

• No clinic when
• Medium call or on long call days
• Vacation
• Holidays
• ICUs
• Night Float
• You DO have clinic when on Elective!!!
• Cannot switch clinics amongst yourselves all
  schedule changes need to be approved by
  ambulatory chief resident

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Primary Care Block

• Introduction to Outpatient Primary Care
• Introduction to DMC and the Firm Continuity
  Clinics
• Morning Clinical Conferences 8am Daily
• 845-1200 Clinics VA Firm A B Mon Thurs
• Rheumatology
• Diabetes, Renal, HTN
• Endocrinology
• Dermatology
• Womens Health
• Friday AM Introduction to Quality Pt. Safety
  Curriculum

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Primary Care Block (cont.)

• Afternoon Didactic Sessions
• Quality and Systems
• Cardiovascular Health
• Obesity
• Managing Difficult Patients
• Patient Safety
• Professionalism and Writing
• Physical Diagnosis
• Common Ambulatory Disease Presentations

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Clinical Skills Block

• 2-week outpatient rotation
• Hands on activities
• Simulation models at the simulation skill center
• Humanities in Medicine
• End of life care
• Cultural Competencies

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The NIGHTFLOAT TEAM
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The NIGHTFLOAT TEAM
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The Nightfloat intern

• The Nightfloat Intern comes in at 7pm receives
  the pagers from the non-call teams
• The Nightfloat Intern can receive the pagers from
  the on-call intern at 9pm and must receive the
  pager by 1100 pm

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Night Float Duties

• Follow up on unfinished tasks
• Answer pages
• See patients when necessary (must document brief
  note in chart when you see a patient)
• Admit up to 2 patients from 8 pm 530 am
• If you have questions please please ask your
  nightfloat resident or NACR!!!
• Call senior for every CODE WHITE

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Electives

• You have continuity clinic during elective
• Your should be answering your pager from 8 to 6
  (M-F), no exceptions (unless on approved away
  elective)
• Must attend all conferences (GR, MM, noon
  conferences at the VA)
• Otherwise, you can choose to do research, a
  clinical elective on a consult service, or even
  an ICU rotation.
• You have to inform Barb before starting what you
  will be doing on your elective time .
• If you do research or away elective, you need to
  identify a faculty mentor and should present your
  work at the Department of Medicine Research Day
  at the end of the year.

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The Pager System

• UH
• 1. Dial 222
• 2. Wait for beep
• 3. Enter pager number
• 4. Wait for 3 beeps
• 5. Enter your phone number, then TAG the page
  (press star, then your own pager number)
• From the outside, dial [phone], then enter
  the pager number and follow remainder of protocol

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The Pager System (cont.)

• Text paging
• Go to hospital directory website and select send
  a text-page from the menu on the left hand side
  of the screen (also possible to access remotely
  through physician portal or amion)
• VA
• 1. Dial 9-207-7244
• 2. Follow the UH protocol

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Professionalism Policy

• For call-offs of more than 2 consecutive days or
  more than 2 days in an academic year you will be
  required to have a physicians note. You can be
  seen by an attending physician same day in the
  Family Medicine Bolwell clinic.
• Any call offs gt 2 days, you will get extra
  weekend jeopardy or coverage

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Friendly Advice

• Catch up on your sleep when you have a chance
• Talk to a chief or program director before
  personal problems get out of hand we are here
  for you!
• SUPPORT EACH OTHER!

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Friendly Advice

• Maintain personal and family relationships
  outside of the hospital make new friends while
  youre here
• Take care of yourself its the only way you will
  be able to provide good care to your patients

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Things to do in Cleveland

• Goodtime 3
• Wineries
• Great Lakes Brewery
• Larchmere
• Shaker Square
• Chagrin Falls
• Lakeview Cemetery
• Rock and Roll Hall of Fame
• Cleveland Orchestra
• Blossom Music Festival
• Lola

• Winking Lizard
• Panini's
• Cain Park
• Luna Bakery
• Playhouse Square
• Aurora Outlets
• Cedar Park
• Kalahari Water Park
• Put n Bay
• Kelleys Island
• Air show
• Rib Festival
• Etc Etc

• Indians
• Cavs
• Browns
• Lake Erie Monsters
• East 4th
• West 6th
• West Side Market
• Little Italy
• Art Museum
• Bodies Exhibit
• Edgewater Park
• Metroparks
• Zoo
• www.clevelandindependents.com
• www.coolcleveland.com

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Final Thoughts

• SCHEDULES!

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GOOD LUCK! Please call us if you need us, we
are here to help!!!!!