Resident Orientation

4/23/20
Outline
• Introduction
• Wards
• RITE Team
• UT Team
• Sub-specialty services
• Night float
• In house call
• Conclusion
Introduction
Chief Resident
• Mohita Singh
• Office – long hallway, fourth floor
• Contact information:
• Cell: (732) 778-1039
• Pager: (281) 567-1438
• Office: Ext. 27894
• mohitas@bcm.edu
Parking
• Apply for a parking pass (directions on blackboard)
• You will receive a confirmation e-mail the pass is
ready (sent to your VA outlook inbox)
• Bring the following to the security office (see next slide
for security office location, building 7):
• Drivers license
• Proof of insurance
• Vehicle registration
Door codes
• Ward rooms – 7291
• RITE – 7291#
• Morning report room - 729133
• ICU/CCU team rooms – 7291*
Pagers, ASCOMs, and WOWs
• Make sure your pagers are working and up to date!

• Need a new battery?

• Box on my office door
• Leave old batteries (so I can get new ones)

• Broken pagers:
• Enter a work notice using the “CA Help Desk Ticket”

• Broken ASCOM:
• Bring to me or Kari Booker
 Paging – How to?
• 4 digit pager #: Dial *5
• 10 digit pager #: Dial 9
• Paging from home:
• 713-794-7134
• Returning a page from
home:
• Call 713-791-1414, then
enter the extension
Needle Sticks MEDVAMC
• Notify me immediately!

• Wash area with soap and water and use povidone iodine (if not
allergic to it).
• With mucous membrane exposure, rinse with large amounts of
water.

• Go to the ER – Start the needle stick protocol

• Report the event to BCM OHP, (713) 798-7880

Needle Sticks MEDVAMC

Contact VA Employee Health, 4B 231, to get source patient test results. 713-794-7440
A BCM incident report needs to be filled out for exposures occurring at any institution.
ACGME Duty Hours
• PGY1: max shift = 16hrs
• Must have 8hrs in between shifts
• PGY2-4: max shift = 24+4
• Must have 8hrs between shifts
• Must have 14hrs between shifts after 24hr call
• UL can round on OLD patients post IH call
• Discuss duty hour violations with me early
Conferences
• Morning Report
• 8:30 AM – 9:30 AM
• Nov – Jan: 11:30 AM – 12:15 PM
• Email slides before

• Noon Conference
• 12:15 PM – 1:00 PM
• Grand Rounds – Monday (VA), Thursday (BCM)
Intern Morning Report
• Every Wednesday!
• 8:30 AM – 9:30 AM with Dr. Musher

• Room 4B-260
• End of the long hallway past blue elevators

• Bring two cases if you are post short call team

Step Down
• Available SD units:
• 3D – NP available, discuss with NP before transfer
• 5A – No NP coverage

• No Step Down Beds?

• Consult the MICU (ICU will be Primary as it is a closed unit)
• Never go down a level of care!

• Reassess SDU need daily, transfer from 3D/5A as soon as

medically appropriate
Telemetry
• Use the Clinical Access icon on your desktop

• If you don’t have access e-mail:

• Devang.Patel3@va.gov
• David.Anderson145250@va.gov

• Discontinue telemetry if you don’t need it anymore

Where is the House Staff Folder?
• Under the ‘S drive’

• Click on MEDVAMC

• E-mail Kari for access

Incident Reporting (ePER)
• Why?
• Labs wasn’t drawn
• Rx wasn’t administered
• Issues with the ER
• Any misses or near misses
• How?
• Click on the gold star icon
• Select HOU Shortcuts
MAR
• Go to: http://vaww.houston.va.gov/
• Select SharePoint Site
• Choose Medical Care Line under
Care Lines tab
• Click on Internal Medicine
Admission on the left
• MAR link:
https://vaww.visn16.portal.va.gov/sites/ho
u/MCL/IM/default.aspx
• E-mail Jung Park for access
Procedures
• Help available:
• Chief Resident
• VA Skills resident
• Attending, hospitalists, fellows, co-residents

• U/S machine – Dr. Von and Zaven’s offices

• Enter an invasive procedure note*

Wards
Ward Team
• 1 PGY2 + 2-3 PGY1’s
• Med/PA Studs – 2-3 core students +/- sub-intern
• Attendings:
• Team A + D – PC
• Team B – ID
• Team C – Endo, Renal
• Team E – Gen Med and CMR’s
• Team F, G, H – Hospitalist
 A Day in the Life
• 6:30 - 7am - Checkout from NF
• 7:00-8:30am – Pre-round
• 8:30-9:30am – Morning report
• 9:30am-12:15pm – Rounding
• 12:15-1:15pm – Noon conference #doallthet
h ings!

• 1:15pm-6pm – Notes, orders, follow up on patients

• 6pm – earliest possible sign out to NF
 D Off S Off N Off Off Off

Call Schedule
• Short call = 4+1, 7am-12pm

• Day call = 8+1, 7am-7pm

• Two TOTAL admissions after 5pm, 1 after 6pm

• Night call = 8, 5pm-7am

• UL arrives around 4:30pm
• Hospitalist support present from 7pm-7am
• Backup hospitalist always available until 7pm
Days Off! D Off S Off N Off Off Off

• Please arrange them with your team today

• One day off for every seven of service

• Three available days off:

• Pre-day call day – Upper level
• Day between day and short call – PGY1
• Post-post night call day – PGY1

• See me if you’re having trouble arranging days off

Pre-Night Call
• Hold the RRT/Code Blue pager
• Get the pagers from the NF by 7am
• Attend all RRT’s and Code Blues
• Handoff pagers to the NF at 6pm
• On the weekends:
• Take sign out from other teams at noon
• Cross-cover during the day
• In-House serves as your back-up
ER Orders and UM
• UM will recommend obs, admission, or step down

• ER MD will then:
• Call for admission
• Write admission, diet, and activity orders

• If you disagree with the ER’s assignment?

• Cancel the orders and enter new admission orders
ER Orders – DO NOT RE-WRITE!
Transfers
• ICU transfers:
• Usually one each to short and day teams
• Should be called by ICU UL before 12pm*

• Other services (IM sub-specialties, Surgery)

• If GM is following – transfers are per the GM
attending
Bounce Back Policy
• Criteria:
• Same Upper level
• Not hard capped
• Weekday before 5pm and weekend before 12pm
• Counts as an admission ONLY if during your call
hours
• What if UL is off?
• Can still accept the bounce back as long patient can be
staffed that day
Notes
• H&P – Required MCL H&P template
• Completed within 24hrs
• Day and short call written by PGY1’s
• Night call UL can write an H&P or admission note*

• Important:
• Do not remove any components
• “Non-contributory” is not an adequate family history
• Please document any changes to meds in the outpatient med
rec
Notes
• Admission notes – Brief, upper level note on all new
admits

• Progress notes – keep them concise and ensure your

updating anything you copy/paste

• DC Summaries (48 hours):

• PGY1: “MCL Discharge PN & Instructions”
• UL addends and enters note in the DC summary tab*
Contact Information in your notes
• Required to include your
team’s contact info at the
bottom of your notes
• Pager
• ASCOM
• Extension
Consults
• Consult etiquette – timely, thorough, respectful

• Prep MS before they call a consult

• STAT Orders/Consults – Need within 6hrs

• Not synonymous with “I want this done now”
• Never appropriate for PT, OT, Speech Path
• PLEASE do not order TTE’s STAT
 NOW Dose Orders - Communication

• MD must communicate
verbally with RN for all
now dose orders!
 PCP Follow Up
• Place order day prior to discharge
• Use the following order set:
• Medicine inpatient orders
• Select either:
• PC team unassigned
• PC team assigned
Interdisciplinary Huddle
• Who – Team, CM, SW, RN manager, RN
• Why – Improve communication
• When – Daily
Coding Huddle
• Two times per week with UM reviewers
• Help review your teams’ documentation
• Send one resident to attend
RITE + UT Teams
RITE Team
• 2-3 UL overseen by hospitalist without students

• Admit 7am-5pm on Mon, Tues, Thurs, and Fri

• Admit four patients on admitting days

• Longitudinal curriculum on billing, coding, QI

UT Team
• 1 UL and 2 PGY1’s with a hospitalist attending

• Admit 7am-5pm on Mon, Tues, Wed, Fri

• Take 4 admissions on those days

• Typically will not receive ICU transfers

Sub-specialty
Residents
General Guidelines
• Cannot refuse consults

• Notes – use the “[ ] Consult” note daily

• Sign out – checkout primary patients to the IH

• Days off – coordinate with your team

• May be asked to see old patients post call

Night Float
The Night Life
• Arrive by 6pm to get check out

• Responsibilities:
• Cover all non-step down patients
• Attend all RRT’s and code blues

• Teams pick up sign out at 7am

Cross Cover
• Responsible for all non-step down patients
• During sign out:
• Keep a running list of overnight “to-do” items
• Ask questions if anything is unclear
• Document on the team’s sign out sheet any calls or
orders you handled overnight
• Write brief notes in CPRS for any patient that
required bedside evaluation
RRT’s, Codes, Backup!
• RRT’s – run by IH resident
• Code blue – run by ICU resident
• Overnight backup
• In house resident
• ICU resident
• Hospitalist
In-House
Nightlife
• Pick up the RRT + code blue pager at 7am
• Attend all RRT’s and codes
• Get checkout on SD patients at 6pm
• See urgent GM consults overnight
• Back up the night float intern
RRT
• Attendees:
• IH – runs the RRT
• Daytime – pre-night interns
• Nightime – night float intern
• Nursing staff, respiratory therapy
• Two simultaneous RRT’s – ICU UL runs the 2nd RRT
Code Blue
• Attendees:
• ICU UL – runs the code
• IH – can run the code if desired
• Daytime – pre-night interns
• Nighttime – night float intern
• Two simultaneous codes – IH runs the 2nd code
Conclusions
Wellness
• To take care of others, you must care for yourself!

• Let me know of any issues over the month

• If you are interested in additional help:

• Dr. Heather Goodman
• (713)-798-4881
HAVE A GREAT MONTH!