uams internal medicine intern_orientation

Welcome to Little Rock!

2014-2015 ChiefsNick Gowen

Intern Core Lectures NNGowen@uams.edu 501-831-0036

Sandra Susanibar Intern Morning Report SPSusanibaradaniya@uams.edu 501-258-4092

Heather Moore Schedule HCDelahuntMoore@uams.edu 501-605-7541

Chief OfficeShorey 3rd Floor Office phone: 686-7088Chief Phone: 291-3246

Office Hours0800-1600Usually one of us is here by 0730Can always contact by phone

Pinnacle Mountain State Park11901 Pinnacle Valley Rd, Roland, AR 72135

Need-to-Know: UAMS

Housestaff Office 3rd Floor Shorey BuildingLinda Lindsey, Sheila Rupley, Melissa Clapp Phone Number and FAX Number on card

Respond PROMPTLY to all emails from these ladies.

Need-to-Know: UAMS

Resident Lounge/ Call Rooms –A3Secured with badge accessDoor codes on cardMAILBOX

E4 Call RoomsNo computers

F6 WorkroomSleep couch, TV, computers

Need-to-Know: UAMS Team 1 Cardiology/CCU: F8 Workroom/

H4

Team 2A/2B Heme-Onc: H7 Workroom

Team 3A/3B Gen Med: F6 Workroom

Abernathy ID Team (6): F6 Workroom

UAMS MICU: E4 Workroom

Need-to-Know: VA Medicine Office: 6A

Gen Med 1-2: 6D workrooms

Gen Med 3-4: 4B workrooms

Team 7/ CCU: 5E workroom

MICU: 1F workroom CCU: 5D SICU: 2C

Need-to-Know: VA

Workroom codes: 5123# If you don’t want it stolen, hide it or keep

it on your person.

Need-to-Know: VA

Call rooms: 1F Door code: Press 2/4, then 3 Call rooms: 7B

5123#Phone, TV, BedsDon’t leave pt information in these roomsPull the door closed

Need-to-Know: VA

To get into the MICU at the VANeed a PIV badgeTake it OUT of the holderHold up to the card scanner

Need-to-Know: VA

Need-to-Know: Clinics

VA – Ft Roots campus, NLRUAMS- 2nd floor, Outpatient center

Need-to-Know: Food Resident Noon Conference

Lunch provided all days but ThursdayWarm Lunch Wednesday

VA OptionsCafeteria, boxed lunches on the ground floor

UAMS OptionsCafeteria: Ground floor, Central Building

Not open on weekends, holidaysLobby Café—First floor, Main Hospital

open on holidays/weekendsDoc Java, The Gathering

June 28

Be sure to come to Dr. Marsh’s reception.

Have a good time. Remember a designated driver.

June 30 Make sure you have a white coat, stethoscope,

penlight, pens, etc. Go see the intern on service. Get hand-off on the

patients you will see in the morning. Ask questions. If on an elective, call the fellow to ask where and when

you need to be on Jul 1. Log into the computer. Make sure your passwords

work. (Do this early in the day.) If you are at the VA, you will need to get your DEA

number (details to follow). Make sure you know where to park (and have your

parking decals).

UAMS

July 1

For MICU and wards, show up at 0530-0600

For electives, show up at the time your fellow stated.

Find night team for hand-off Pre-round, Round, Consults, Orders,

Discharges, Notes Go home and get some sleep.

Petit Jean State Park-Morrilton, AR -approx 1 hour from UAMS-multiple hiking trails-camping

Wards: Pre-rounding

1. Arrive from 0530-0630. NO LATER THAN 0650.

2. Find night float interns for hand-off. Take pagers if you are on call. Discuss pt assignment with resident.

3. Review notes, nursing notes, vitals, labs, imaging, cultures.

4. Interview and examine your assigned patients. 5. Review any pressing issues/questions with

your resident prior to rounds.

Wards: Pre-rounding

6. Correct electrolytes, order blood products, etc.

7. Enter and call expected consultations (discuss with resident)

8. Start on discharges and progress notes if you have time

9. Rounds start at 0800-0830 at UAMS, 0900 at VA

Wards: Rounding

Things to know for rounds:Vital signs trend, I/OsAntibiotics (day/reason), IVFCentral lines, PICCs, NGTs, PEG/G-tube,

Foleys, O2 (how many liters)Skin breakdown—ask nurseDiet/TF/TPN—swallow exam?Baseline functioning—PT/OT needed?Daily labs – can we stop?

Wards: Rounding Two important questions:

Why is this patient in the hospital?What is going to keep him/her in the hospital?

Barriers to discharge:Family support, safe housing, rehabHHA, HHPT, Hospice, Home IV abxMake social workers your friend. Talk to them

early about barriers.

Wards: Rounding Take ownership of your assigned patients.

Pay attention. Know about the basic plan on all of the patients on your team.

When your resident is off, you are in charge. Rise to the challenge.

Rounds is not a competition. Don’t be a jerk.

Don’t bulldoze the medical student presentations.

Wards: Post-Rounds

BEFORE Noon Conference: Call consultants WITH A QUESTIONDischarge plans/orders Daily ordersProceduresTalk with patient familiesDaily notes

Rounds should end by 1100 to allow for time before conference.

Wards: End of the Day

Update hand-off lists. Hand-off to on-call intern may start at 1600 Do not “hand-off” procedures. Direct admissions that arrive before 1600 are

the responsibility of the day team. If it is really important, check it yourself.

MICU

Similar expectations as for wards Rounds start at 0800 on both sides Patients are more complex Don’t forget about pressors and vent

settings KNOW YOUR ABG Residents, fellows, nurses are your

resources

Eureka SpringsApprox 3 hours

to the northArtistic CenterOutdoor and

indoor activities

Call: UAMS Short Call: M-F 1600-1900; 1200-1900 on

weekends, holidaysCover 1: F6, H7, F9, H9

○ Holds the Code pager○ Answer pages, follow up on recs, help with

admissions○ “That’s not my patient” is never a good answer.

There is always something you can do to help.

Call: VA VA short call:

○ M-Th 1600-1900○ F 1600-2200 ○ Sa 1200-2200 ○ Su 1200-1900

Cover 1: GM1, GM2, Team 7 A-LCover 2: GM3, GM4, Team 7 M-ZBoth should respond to codesSame responsibilities

Call: VA

Swing ShiftOn FRIDAY and SATURDAYCome in at 0600, round on no more than 4

patients, leave by 1100Return at 2150 for hand-off, take pagers by

2200Leave at 0700 the next morningYou do NOT round on your post-call

morning

Swing Shift Example Nick is on swing shift cover 1 on Friday He comes in at 0600, pre-rounds on 4

patients. Rounds start at 0900. He presents his patients first, excuses himself from rounds, finishes his orders and notes. He leaves the hospital by 1100.

He comes back at 2150, gets handoff from Cover 1 short call intern.

At 0700 on Saturday, he hands-off to the day team, gives his pagers to the Cover 1 intern. He then goes home. Comes back to work on Sunday unless he is off.

Call Responsibilities Summary of responsibilities posted in all

workrooms Mobile phone numbers of your team Text paging: www.teletouchpaging.com Potential Danger Zones

Patient movement (changes floors, comes up from the ED, moves to or from the MICU/CCU)

Sick patientsDocumentation

Call Responsiblities Admissions

H&P and admission orders○ Be sure all of the criteria are met○ PMH, PSH, FH, SH, Allergies, Meds, ROS of 10-14

systems○ Let the EMR help you

Follow up!

Call Responsibilities

Direct AdmissionsH&P and Orders

ER AdmissionsReview documentation, orders. Follow up.

MICU Transfers/ Transfers from other servicesAccept Note

Night Float: UAMS Rotating interns:

1900-0700—show up no later than 1850 for hand-off

Cover 1 and Cover 2 (F4, A7, E7, F8, H8)Same responsibilities as short callWatch for patient movement. Be proactive.When things are quiet, catch up on reading,

MKSAP, etc. When you are rotating off nights, your Resident

may ask you to round. No more than 4 patients. Leave by 1100.

Night Float: VA Two designated interns

1900-0700 SUNDAY through THURSDAYTHIS SCHEDULE IS DIFFERENT FROM THE

RESIDENT NIGHT FLOAT!Same responsibilities as short call.Be proactive!

Hand-Off

Three Essentials:Face-to-FacePertinent information/Potential issuesAccurate List with expected patients

○ VA Med$ Drive○ UAMS H-Drive

When your Resident is off, it is YOUR responsibility to hand-off to everyone, including the Ward resident

Answering pages

“This is Dr. _____ with Medicine returning a page.”

Be professional at all times. Nurses write down EVERYTHING in the chart. If you get paged more than twice on a patient, go

see the patient.Think before you order. Look at the bigger

picture. If you can’t do something, briefly explain. Report inappropriate interactions to the Chiefs.

Documentation

Daily progress notes EVERY daySOAP NoteCannot steal/addend the med student noteProblem-based plan EXCEPT in MICUDocument any barriers to discharge

Attestation: “Pt discussed with Dr. Attending, 3B

attending of record, who formulated the plan of care.”

Documentation

Discharge summariesDue on the day of dischargeBrief hospital coursePlan for follow up, treatment, etc—very

important for cardiology patients!

Document facts, not opinions. No chart wars.

Do not disparage anyone in the chart.

Documentation

If it isn’t documented, it didn’t happen.Procedure notes with Time OutOn call notes when pt is crashing

Arkansas Symphony OrchestraDiscounted

Tickets for UAMS

Pops and Chamber Series

Broadway shows

Clinics: UAMS Internal Medicine North

Go to clinic on your scheduled day for orientationNotes MUST be completed and signed within

24hrsCheck your in-basket REGULARLY (at least once

a week) Contacts:

○ Dr. Alice Alexander, MD and Heather Thomason, RN

Clinics: Med-Peds

½ UAMS, ½ ACH Circle of FriendsTake drive time into considerationFinish notes on timeDon’t forget to check EPIC when you are at

ACH. Your patients still exist at UAMS!

Clinics: VA

Fort Roots, North Little Rock Assigned to an Attending’s team Contact: Dr. Shagufta Siddiqui or your

attending Finish notes in a timely fashion Take drive time into consideration

To UAMSRiver

Consults Find the right fellow

Where to be, when to roundHow to write your notesMobile phone number

Clinic responsibilities New Consult notes = focused H&P Daily follow up notes = focused SOAP notes Talk to your fellow BEFORE leaving Talk to your fellow about weekends

Clinical DesktopIcon (Stethoscope):

Scroll down to UAMS ON CALL

1. Select date

2. Select Service.

GMC “Essential” consult service 0700-1600 Pre-op clinic Tues and Wed in IM North Usually Thurs PM clinic with Dr Lavender As the intern, you do not accept transfer from

any service without an ATTENDING staffing the patient. Be sure to hand-off to our medicine teams if pt is transferred.

No weekend duties

Geriatrics/ Neurology

Month is split to accommodate both You can take vacation during the

Geriatrics portion (not preferred) on your non-clinic week

Please let us know if you are being used for scut work

Be professional.

Emergency Medicine

12-hr Shifts Should honor 1-in-7 rule Good time to learn procedures Good time to learn Women’s health if

you have VA clinic Good time to make friends with the ED

attendings and residents

Crystal Bridges Museum of American Art600 Museum Way, Bentonville, AR

-Approx 3 hours from UAMS to the northwest-General admission is free-Admission charge for rotating exhibits-Amazing landscaping with walking paths

Jeopardy

5-6 days during elective months (not ED) NOT OPTIONAL AVAILABILITY---need to be able to come to the

hospital immediately if called Payback: educational leave, non-emergent issues

Calling Jeopardy

Call the “Admin” Chief ASAP The Golden Rule. Acceptable reasons:

Acute illness (fever, vomiting, diarrhea, surgery, bleeding, loss of limb)—NOT head cold, allergies, menstrual cycle, HA

Death/Critical Illness of a family member (1st degree + grandparents)—everything else needs approval

Birth of YOUR child

Calling Jeopardy

Unacceptable reasons:“I missed my flight.”

○ Rental car/ Greyhound

“My car won’t start.”○ Phone a friend

“My child is sick”○ with few exceptions

“I don’t feel well.” ○ Take some tylenol.

Calling Jeopardy

Unacceptable reasons:“I overslept.”

○ Then you better hustle!

“It’s snowing/ icing/ raining/ stormy.”○ STAY at the hospital. Pack a winter bag.

“I’m going to a wedding/ party/ shower.”○ Shaking mad

“But I’m having an elective procedure.”○ My ulcer just perforated.

Calling Jeopardy

Unacceptable reasons“I didn’t get the day off I wanted.”

○ The Chief just had a stroke.

Garvan Woodland Gardens540 Arkridge Rd, Hot Springs, AR

-Botanical Garden-Christmas Lights-Admission Fee-Approx 1 hour from UAMS

Expectations of Chiefs

Listen to your concerns Advocate on your behalf Provide correction when required Provide education Follow ACGME

ACGME Guidelines 16 hours (+ 2 hours for handoff) with 8-10

hours in between shifts No more than 10 patient assignments AVERAGE 1-in-7 days off over a month Admissions supervised by Resident When post-nights, leave by 1100 PATIENT CARE COMES FIRST! Let the Chiefs know if you are having

problems.

Conferences Daily Noon Conference

MANDATORY portion of your EducationExcused when on nights, post-nightsExcused for urgent patient care issuesCanceled on holidays and weekends

Monday: Core curriculum (UAMS)

Tuesday: Med-Path Conference (7E, VA)

Wednesday: Board Review/ Core curriculum (UAMS)

Thursday: Grand Rounds (G141, UAMS)

Friday: Resident Presentations/ Journal Club (UAMS)

Conferences

Morning Report

Mandatory for all interns on wards (unless holding code pager at VA)

Off-service interns should attend Ward Resident or Chiefs hold pagers Rotating interns present to Attendings or

Chiefs

M&M Conference

Last Thursday of the month0730 in G137, UAMSALL residents are expected to attend ON

TIMEClosed conference—no students or off-

service

Intern Core Lecture Series

Start the second week in July Attendance is MANDATORY unless you

are off or on nights

Evaluations

Complete on new innovation for every rotation

Check the anonymous click box if you want

ALL attending evaluations are anonymous and pooled together for 6 month blocks

Complete promptly and honestly

Core Competencies 1. Patient Care –

Provide compassionate, appropriate, and effective treatment for all patients

2. Medical Knowledge –Understand biomedical, clinical, and socio-

behavioral knowledge about patient care

3. Practice-Based learning and ImprovementInvestigate, evaluate, and improve patient care

practices

Core Competencies 4. Interpersonal and Communication Skills

Effectively communicate with patients, families, and other healthcare professionals

5. ProfessionalismCarry out responsibilities in a professional

manner

6. Systems-Based PracticeUnderstand and access the systems based

practice of medicine as it applies to UAMS, CAVHS, and the community

Leave

Other than scheduled days off, ALL leave has to go through the schedule chief and Sheila in the housestaff officeStep 3VacationsSick leaveConferences (only if you are a presenter)

Email

UAMS: Check daily VA: Access by starting Outlook after

logging into VA computer You are responsible for information in

both email accounts

Dress Code

Women:Dress clothes on wards, consults, clinicClosed-toed shoes in patient care areasScrubs for call, weekendsKeep in mind that you need to bend over a

lot

Men: Shirts and Ties on Wards, consults, clinicScrubs for call, weekends

VA DEA

2C 155 Write it down and keep it with you. EVERYONE needs to do this once you

have VA Access