Chief Resident Overview - School of Medicine

Chief Resident Overview June 14, 2013

Welcome Interns!

Your Chiefs

Crystal Lantz-DeGeorge, M.D. • • • • •

Hometown: Tiffin OH Undergrad: The Ohio State University Med School: Wright State University Boonshoft SOM Professional Interest: Primary Care Mommy of identical twin 8 month olds

Sumit Bose, M.D. • • • • •

Hometown: Pittsford NY Undergrad: Johns Hopkins University Med School: GWU Professional Interest: Allergy/Immunology Can do an amazing dance with a wheeled walker

Kamal Shemisa, M.D. • • • • •

Hometown: Westlake OH Undergrad: Kent State University Med School: NEOMED Professional Interest: Cardiology Lover of cats and cardiology

Claire Sullivan, M.D. • • • • •

Hometown: Rocky River OH Undergrad: John Carroll Med School: University of Cincinnati Professional Interest: Cardiology Obsessed with Cleveland

Navin Vij, M.D. (Med/Peds) • • • • •

Hometown: Bloomington, MN College: Rice University Med School: Baylor Professional Interest: Health Policy Former professional Bhangra dancer

Roles of the Chiefs • Rotate every 3 months • UH Chief - #31250 – Claire Sullivan • Office in DOM 3rd floor

• VA Chief - #31533 – Kamal Shemisa • Office on VA 4th Floor

• Ambulatory Chief - #31529 – Sumit Bose • Office on VA 4th Floor

• Patient Safety & Chief - #36644 – Crystal Lantz-DeGeorge • Office in DOM 3rd floor

Roles of the Chiefs • We are your ADVOCATES • Call us with any problem or issue that arises in a TIMELY and SPECIFIC manner • We can’t help you if you don’t let us know the problem

• We are your MENTORS • We embrace the opportunity to provide support for you professionally, educationally and psychosocially

• We have been in your shoes! • We remember well the struggles of intern year and are here to help you in any way we possibly can

Block Zero • June 24th-June 30th • No days off • Many extra interns on teams to divide the work and admissions • Constant senior supervision due to rotating extra senior helpers who will work with non-call teams from 5pm-10pm • Ask questions!

UH Campus

UH teams • Ward Teams • 2 General Medicine • 6 Sub-Specialty

• MICU • CICU

• UH Nightfloat Team

Naff Gen Med

Wearn Gen Med

Carpenter ID

Dworkin GI

Weisman Heme/Onc

Ratnoff Heme/Onc

Eckel Nephrology

Hellerstein Cardiology

ICU Rotations • At UH • MICU • CICU

Other UH Rotations •

Geriatrics •

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2 week rotation

Jeopardy •

Rotate on a consult service while on back-up call for any absence on UH or VA wards/clinics

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MUST have pager on 24/7 including weekends

E Team •

Work 1:1 with hospitalist during winter months

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Back up Jeopardy

Team Caps • UH ward teams cap at 10 patients per intern except for the Seidman teams which cap at 8 • VA ward teams cap at 8 patients per intern • No short call on weekends • Intern + AI @ VA = 10; AI+AI paired together = 10 if one senior, 12 if two seniors • Intern + AI @ UH = 12 when 2 seniors; 10 when 1 senior

Intern Call/Duty Hours Call Schedule: Long  Medium  Short  Happy  • Long Call admits 3 patients - Last patient no later than 7:00 pm - Interns should be done staffing patients and sign out to NF by 9:00 PM - Must be out by 11:00 PM

Intern Call/Duty Hours • Medium call admits 2 patients - Last patient by 4:00 pm. - Holds the Team Pager until 7:00 pm - Signs out to NF at 7:00 pm.

Intern Call/Duty Hours • Short call admits 2 patients - By 12:00 PM at UH and 1:00 at the VA - MICU and Night float patients ONLY at UH - Can be new patients at VA - No patients on clinic days or if intern has 8 patients

- Signs out to Medium call intern as early as 4:00 pm

Call Sequence

UH MICU - 4 interns and 5 residents per rotation; Interns paired with resident for long call - Interns will get last admission by 7 pm, should leave by 9 pm, must leave by 11 pm

- Patients admitted by the NF will be distributed by the MICU fellow in AM to keep teams even and optimize work flow in the MICU - The post call resident will present and leave, sign out to the post call intern - The helper resident will supervise the post call intern and will help until the intern has completed their work, usually around 5pm

The New CICU for Interns • 2 interns scheduled in the CICU: -Day intern: works 7 AM-7 PM. May follow/admit one to two patients under supervision of senior resident. -Night intern: works 7 PM-7 AM. Helps with cross-cover, gains valuable night ICU experience including procedures, and possibly allows for on-call resident to take a nap. • Interns will do one week of nights and one week of days during two week rotation • Both interns have Sunday off (accommodate switch days and transition from nights to days)

Intern Call/Duty Hours • All teams will have double seniors until block 3-4 • Orphan coverage: When you are on call and your team senior isn’t • On Call interns will be covered by the assigned orphan resident • Ask your seniors how to look this up • Always page the senior as soon as you get an admission to speed up the process

Typical Day • 6:45-7:00: Get sign out from NF on Tower 5 • 7:00-7:45: Pre-round on your patients • Get patient assignments from NF seniors

• 7:45-8:00: Run overnight events with senior resident Address any major issues before rounds • 8:00-10:30: Rounds with attending • 10:30-11:30 : MR for residents (MWF) and interns (T/Th) • 12:00-1:00: Noon Conference

10:30-12:00: Time to get C.O.L.D. •

C: Call your consults • The later you call, the more angry the consultant will be • Ask your senior for advice on how to call the best consult before your first one

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O: Order Entry • Enter any orders that were not entered on rounds

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L: Labs • Run your labs!

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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

Conferences - UH • Intern Morning Reports – Residents hold the pagers!! • Tuesday AM report from 10:30 – 11am! ** NEW ** • Thursday 10:30am-11:30am • •

Noon Conference • Monday, Wednesday and Thursday 12-1pm (with food) Grand Rounds •

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Morbidity & Mortality (M&M) •

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Tuesday 12-1pm Friday 12-1pm

Agre Society •

Occur monthly on Wednesdays

Typical Day • Afternoon: Follow-up on studies, consults • Sign out to co-intern/resident and attend clinic on clinic days • Admit new patients and staff with team resident or on call resident • On long call day sign out between 9-11pm • On medium call day sign out at 7pm • On short/happy day leave as early as 4pm

Sign Out • Sign out is an exchange of information to ensure excellent patient care • As an intern sign out • What is important? • • • •

FU CT PE  If positive, start heparin FU ECG and troponins  If troponin positive, treat for ACS FU I/O’s, goal 1L negative  If not at goal, give 80 IV Lasix FU H&H  If Hb