Structural Changes in the Program

Department of MedicineUniversity Hospitals of ClevelandCase Western Reserve University

Bronson Day, May 2002Presented by:

Keith ArmitageJay FiniganNoah JonesKeith Petras

Outline

• Medical service changes

• General Reminders

• Clinics

• Miscellaneous

Current Medical Services

• Eckel (Blue/Renal)

• Carpenter (Purple/ID)

• Ratnoff (HemeOnc)

• Hellerstein (Green/CHF)

• Wiggers (Telemetry)

• Weisman (Red/Gen Med)

• Naff (Orange/Gen Med)

• Wearn (White/Gen Med)

Changes

• Wiggers GONE

• HellersteinCHF/TELE (Cards)

• Weisman Pulmonary

• Short call Naff & Wearn

• Reduced work-hour services Naff, Wearn, and Ratnoff

• All admissions end at 1100pm

• Signout rounds with the chief resident

New Medical Services

• Eckel (Renal)

• Carpenter (ID)

• Ratnoff (HemeOnc)

• Hellerstein (CHF/Tele)

• Weisman (Pulm)

• Naff (Gen Med)

• Wearn (Gen Med)

Medical Services: Nuts & Bolts

Service Resident Interns Call Misc.Eckel 1 3 Q6,Q3 No changesCarpenter 1 3 Q6,Q3 No changesWeisman 1 3 Q6,Q3 Intern addedRatnoff* 1 4 Q4 No changesHellerstein 1 4 Q4,Q2 Supershort: 1 till 1pm Naff* 1 2 Q4,Q2 Short: 2 till 1pmWearn* 1 2 Q4,Q2 Short: 2 till 1pm

* Reduced Work-hour Services

Weisman Service

• Pulmonary & Gen Med

• Pulmonary/Critical care attendings

• 1 resident, 3 interns

• Takes call like Eckel and Carpenter

• Q6 long & Q3 short

• long call = 5 admissions till 1100pm

• Short call = 3 admission till 600pm

Hellerstein Service

• CHF and Telemetry

• General and CHF cardiology attendings

• 1 resident, 4 interns

• Q4 long & Q2 supershort

• Long = 5 admissions till 1100pm

• Supershort = 1 admission till 100pm

Hellerstein Call ScheduleQ4 Long / Q2 Supershort

1 2 3 4 1 2 3 4 1

(1)Long Call (1)Supershort (1)Long Call

(2)Long Call (2)Supershort

Days

(3)Long Call (3)Supershort

(2)Long Call

(4)Long Call (4)Supershort

(1)Supershort

(3)Long call

(2)Supershort

(4)Long call

(1)Long call

Naff and Wearn Service

• No major changes except Short Call

• Long call = Q4

• Short call = 2 admits till 100pm = 1 admit till Noon (clinic day)

Reduced Work-hour ServicesNaff/Wearn/Ratnoff

• Admissions stop at 1100pm (all services)

• Interns can signout and hand pagers to cross cover at 100am

• Two cross cover interns per night (sometimes three)

• Interns must remain in the hospital

Morning Signout Rounds with UH Chief Resident

Department of Medicine Conf Room

• Intern - Cross cover exchange (700-730am)

• NACR - DACR exchange (800am)

• Residents welcomed

• Inappropriate signouts

• Overnight problems

• Assignment of nightfloat admissions

General Reminders

• Schedule Changes

• Jeopardy

• Weekend Coverage responsibilities

• Screening/Ambulatory/Elective/Geriatrics

• Disciplinary actions

• Evaluations

Schedule Changes

• No changes can be made unless the chief resident is notified

• All schedule changes must be in writing (email) and given to the chief resident

Jeopardy

• All junior residents take jeopardy call during elective

• A minimum of three junior residents per month

• Weekend jeopardy call is assigned

• Weekday jeopardy call is random

• You cannot leave town during the week and during your assigned weekend.

• You can arrange with each other to take jeopardy call

Weekend Coverage Responsibilities

• Weekend coverage to ward residents is provided by residents on ambulatory, elective, and geriatrics

• Residents on ambulatory are pulled first to cover

• A list of coverage responsibilities will be provided

• Adherence to coverage responsibilities will be strictly enforced

Screening/Ambulatory/Elective/Geriatrics

• Under certain circumstances residents on these services may be pulled to cover any service

Disciplinary Actionsfor repeated infractions

1/2 day of Screening

1 day of Screening

1 week of Screening

Formal letter placed in permanent file

Review by the recommendation promotions com.

Evaluations

• Attending evaluations

• Evaluations of colleagues

Clinics

• Re-establish continuity

• UH CICU: residents/interns will have clinic on their non-call days (no clinics on call days)

• VA ICU: residents/interns will have clinic once during the month. On their good day

Chief Residents

• Always accessible “open door” policy

• Advocates for the housestaff

• Periodic rounding with teams

• “Pizza/cookie” rounds at night

• Mentorship meetings with the chiefs

• Q3 month housestaff meetings