WELCOME!!

Chiefs’ OrientationScott DenstaedtMarty TamAngel QinKhanjan Shah

June 14th, 2012

• Introductions• Roles of Chiefs• UH Wards• VA Wards• Typical Day on the Wards• The Pager System• Other Rotations• Conferences• Misc• Ambulatory• Professionalism• Advice• Questions

Overview

Scott Denstaedt

• Undergraduate: University of Michigan• Med School: Wayne State University• Hometown: Clarkston, MI• Hobbies: tasting exotic beers, Game of

Thrones• Fun fact: speaks Japanese

Marty Tam

• Undergraduate: University of Michigan• Med School: Ohio State University• Hometown: Sterling Heights, MI• Hobbies: sports, travel, food, drink, life• Fun fact: almost was killed by a lion during

medical school

Angel Qin

• Undergraduate: Duke University• Med School: Case Western Reserve University• Hometown: Chengdu, China Chicago, IL• Hobbies: cooking, trying new foods, travel• Fun fact: danced ballet for 8 years

Khanjan Shah

• Undergraduate: Furman University• Med School: University of South Carolina• Hometown: Greenville, SC• Hobbies: working out, reading, eating good

food• Fun fact: Aspired to be a pizza delivery girl for

most of my childhood

Roles of the Chiefs• Rotate every 3 months• UH Chief #31250 – Marty Tam

• Office in Lakeside 3• VA Chief #31533 – Angel Qin

• Office on 4th floor VA• Ambulatory Chief #31529 – Scott Denstaedt

• Office on 4th Floor VA• Quality & Pt. Safety Chief #36644 – Khanjan Shah

• Office on 4th Floor VA/Lakeside 3

Roles of the Chiefs• We are the advocates for the residents

• Call us with problems or issues that arise• Timely and specific please…we can’t help you if

you don’t let us know.

• We are your mentors• We provide support for your professional

develoPMent, education, and your psycho-social well-being

• We have candy!

UHUH Campus

Lakeside

Lerner Tower

SeidmanED

Louis Stokes Veterans Administration Medical Center

Naff Wearn

Carpenter Dworken

Weisman Ratnoff

Hellerstein Eckel

Sister teams alternate “long” call daysEach team has 2 interns Q4 “long” callHellerstein and Eckel do not have sister teams

UH Ward Teams

UH Ward Teams

• Hellerstein (Cardiology)– Team room on Lerner Tower 5– 2 senior residents, 4 interns, sometimes a fellow

• Eckel (Nephrology)– Team room on Lakeside 5 (between 50 and 55)– 2 senior residents, 4 interns

UH Ward Teams

• Naff and Wearn (General medicine)– Team rooms on Lakeside 20– 1 senior resident, 2 interns

• Carpenter (Infectious disease, HIV patients)– Team room on Lerner Tower 8– 1 senior resident, 2 interns

UH Ward Teams

• Dworken (Gastroenterology, Hepatology)– Team room on Lakeside 55– 1 senior, 2 interns– Round separately with the Liver attending

• Weisman and Ratnoff (Heme/Onc)– Weisman on Seidman 4 (hospitalist)– Ratnoff on Seidman 3 (oncologist)– 1 senior, 2 interns

UH ICUs• MICU

– Lerner Tower 3– 5 seniors (4 on days, 1 on nights); 4 interns– Interns take call with their seniors Q4; seniors stay

overnight– 1-2 attendings, 2 fellows, 2 teams

• CICU– Lerner Tower 3– 5 seniors, 2+ interns, 1 fellow– Interns do 1 week of days, 1 week of nights

VA Ward Teams

• Four general medicine teams• Blue and Green are sister teams• White and Orange are sister teams• 1 senior, 2 intern teams• Q4 long call• Team rooms on 4th floor

VA MICU• Two seniors (one on days and one on nights)• Three interns, Q3 call• Admit from 7 AM to 8 PM• Leave by 10 PM• Day off is “pre call” day Friday through Sunday

LOGISTICS of Calls... • Long call – 3 patients by 7 PM

• Only 1 after 6 PM, 2 after 5 PM• Medium call – 2 patients by 4 PM• Short Call:

• UH: 2 Patients (nightfloat admission or ICU transfer)

• VA: 2 Patients (nightfloat, transfer, or NEW)• Cycle: Long Medium Short HAPPY!

• 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)

• VA: • Cap = 8 all the time

• Caps increase if you have acting interns

LOGISTICS: Team Caps

Days OFF• Dworken, Carpenter, Wearn, Naff, Ratnoff, Weisman, and VA Wards

o Short or Happy days that fall on Saturday or Sundayo “Golden” = both weekend days offo “Black” = work both weekend dayso “Silver” = either Sat or Sun off

• Eckel or Hellersteino 1 day off per week: “Happy day” Friday

through Monday

•Night Floats• UH: 3 interns are scheduled but only

2 are on each night; work out days off with each other!

• Send schedule to chiefs; if you are going to a ward rotation, you should not work the last Sunday

• VA: Saturday night is off

•UH MICU• Helper day off Friday through

Monday

Days OFF

Typical Ward Day• 7 AM to 7:45 AM

• Pick up signouts from night float team on Lerner Tower 5 at UH and blue team room at the VA

• Pre-round• 7:45-8 AM: Be in your team room to discuss changes overnight and the

day’s plan with your senior• 8 AM to 10 AM (VA) or 10:30 AM (UH)

– Rounds with attending• New patients – present H&P

• 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 – don’t just present the data and then look at your attending and resident and wait for them to tell you what to do

• Be organized—”have a system”

After Rounds

• C: Call your consults• Consultants will appreciate the early call

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

• L: Labs• Run your labs

• D: Discharges• Get them out• Should have daily note on the day of discharge as well (very brief)

• N: Notes• Don’t start your notes until the rest of the work is finished

• 10:30-11:30 AM (UH) or 10-11 AM(VA)• Resident AM report (M/W/F at UH, T/W/F at VA)• Thursday morning: Intern AM report + Tuesday at UH

• Noon-1 PM: daily conference• Afternoon for notes, procedures, teaching rounds,

contacting families, following up studies, etc• Short call interns and “happy” interns can signout to

their co-interns when their work is done• Medium call signs out to night float at 7 PM• Long call signs out to night float at 9 PM

Typical Ward Day

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!

The night float team

The NIGHTFLOAT TEAM

NACR

Night float Resident Night float Resident

Night float Intern Night float Intern

Intern Role on Nightfloat

• The night float intern comes in at 7 PM and receives the pagers from the non-call teams

• The night float intern can receive the pagers from the long call intern at 9 PM and must receive the pager by 11 PM

• Please be pro-active and help your co-intern out if they’re still in the hospital late

Night Float Duties

• Follow-up on unfinished tasks• You may be asked to go evaluate a patient; if

you do, please write a brief Clinical Event Note

• If there are any questions/concerns, please ask your seniors and NACR

• A senior should go with you to every CODE WHITE during the first 6 months

Duty Hours

• On long call, sign out at 9 PM, MUST be out by 11PM

• On medium call, signout at 7 PM• UH: Lerner Tower 5• VA: VA Blue room• Duty hours not to exceed 80 hours/week

• No Clinic on Long or Medium call.

• No short call patients assigned on your clinic day.

Call and Continuity Clinic

Team Pagers

• Each team will have a pager held by one of interns on the team and then signed out to nightfloat in the evening

• Will mostly be paged by nursing regarding patient issues

• Team pagers are also code pagers – long call interns should go to all codes (‘Code Blue’)

• Team pager numbers are listed on the pager card

How to send a page!

• UH– Dial 222 type pager number *beep beep beep*

your call back number*your pager number #

• VA– For UH Pagers, dial 9-207-7244 type pager number

*beepbeepbeep* you call back number*your pager number#

– For VA pagers, dial 9-440-562-xxxx (pager number) *beep beep beep* your call back number*your pager number#

Other Rotations

• Geriatrics• E-team• Jeopardy• Elective• UCC

Geriatrics

• New this year; 4 week block• 3 interns + Geriatrics attending• 2 interns on wards, one intern at the VA• Other health care settings such as skilled

nursing facilities, home calls

E-team

• Only during the busiest months at UH• One intern + hospitalist attending• 8 patient cap, off on Sundays• Lots of independence

• Pager must be on 24/7• No pay back as it is an official rotation• Called to cover for inpatient and outpatient• Weekends are off

Urgent Care Center (UCC)

• The VA Emergency Room• Staffed by at least 3 residents

• One or two attending physicians• Hours are 8 AM – 6 PM

Electives• There will be continuity clinics once a week during your

electives • This is the time to explore your academic interests (get

involved in research, participate on different consult services)

• On elective, you are also backup jeopardy, so please keep your pagers on!

• You are expected to attend Grand Rounds and M&Ms• If you do research, you are expected to present a poster at

the Department of Medicine Research Day held every May

Example Elective Tracking

• DISCHARGE SUMMARY: do 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

• Crucial for patient safety and care

DISCHARGE SUMMARIES

Conferences - UH• Intern Morning Reports – Residents hold the pagers!!

– Tuesday AM report from 10:30 – 11 AM– Thursday 10:30 AM – 11:30 AM

• Grand Rounds• Tuesday 12-1 PM

• Morbidity & Mortality (M&M)• Friday 12-1 PM

• Agre Society• Monthly, Wednesday evenings – more info to come

• Noon Conference• Monday, Wednesday and Thursday 12-1 PM (with food)

Conferences - VA• Monday: Noon conference• Tuesday: Grand Rounds televised from UH at

noon• Wednesday: M&M at noon• Thursday: Intern Morning Report @ 10-11

AM• Your resident will take your pager• Be on time!!

• Friday: Noon-conference

• GME Housestaff Lounge!!• Located on Lakeside 6th floor, next to GME office• Has coffee, bathrooms, TV, foosball table, computers,

food on Sunday nights

UH Miscellaneous

VA Lounge and Call Rooms

• Located on the 2nd floor• Fridge: frozen dinners, ice cream, sorbet, string

cheese, muffins, fruit, yogurt, milk, etc• Coffee machine• Cabinets: all sorts of snacks

Intern Saturday Coverage

On Saturday nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7 PM to Sunday 8 AM for the VA intern nightfloat to get a night off

VA Miscellaneous

• Garage parking is free! Just need to get a parking pass from VA police department (bring license, insurance, registration)

• VPN access for home CPRS access• Codes at VA are called “Dr. Heart” and are

called overhead

Ambulatory Medicine

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

Continuity Clinic• One afternoon/week either at the VA or at the Douglas Moore

Clinic at UH• No clinic when

• Medium call or on long call days• Vacation• Holidays• ICU’s• Night Float

• You DO have clinic when on Elective• To main continuity, you cannot switch clinics amongst yourselves;

all schedule changes need to be approved by ambulatory chief resident

Urgent Care (UCC)

• Emergency room experience; at the VA• You will either do it as a rotation or during

ambulatory• If you are there as a rotation, you are

expected to be there from 8 AM to 6 PM

Primary Care Block• Introduction to Outpatient Primary Care• Introduction to DMC and the VA continuity clinics• Morning Clinical Conferences: 8 AM daily

Clinical Skills Block

• 2-week outpatient rotation• Hands on activities• Simulation models at the simulation skill

center (next to the VA)• Humanities in medicine• End of life care• Cultural competencies

Professionalism

Professionalism: Attire

•Men• Shirts and ties

•Women• Professional

•Keep white coats clean•No denim•Do not show up to Morning Report looking sloppy

Professionalism: Absences

• If you have to call in sick > 1 day, you will need a doctor’s note from the Bolwell Family Practice clinic • You will be able to get a same-day appointment

• If you are sick for > 2 days and do not have a doctor’s note, you will be assigned extra weekend coverage and/or weekend jeopardy

• Call-offs: You must PAGE 31529 the Ambulatory Chief• DO NOT EMAIL• DO NOT TEXT PAGE• DO NOT CALL THE CELL PHONE OF THE CHIEF YOU KNOW

Professionalism: Electives• Attend all Grand Rounds and M&M’s• You are back up jeopardy!! = pager on• If you are going out of town for the weekend, as a

courtesy please notify the ambulatory chief prior to leaving

• Elective is not vacation• Please email Barb 2 weeks prior to starting your

electives; Quality chief will be keeping track of electives• Research for more than 2 weeks = present at Research

Day

Professionalism: Conference Attendance

• Please be on time; our speakers usually have prepared a well thought out talk/powerpoint, so please be respectful of the time they spent

• Noon conference: • UH: Mon-Wed-Thurs • VA: Mon-Thurs-Fri

• Grand Rounds on Tuesday: UH & VA• M&M Fridays @UH, Wednesdays @VA• Conference attendance is part of your ACGME

graduation requirements

Some friendly words of advice…

• Catch up on sleep when you can!• Talk to a chief resident/APD/KBA before a personal problem

gets out of hand – someone is always here!• Please support each other – intern year is tough, but also fun!• Maintain personal and family relationships outside of the

hospital; make new friends while you’re here• Take care of yourself; it’s the only way you will be able to

provide good care to your patients• LOVE what you do

Things to do in the CLE

• Sports– The Cavaliers, the Browns,

the Indians, the Lake Erie Monsters

• SO MUCH GOOD FOOD– Lola/Lolita/B-spot,

Superior Pho, Wonton Gourmet, Bangkok Thai, the Harp, Momochos, Fire, Sasa, Luxe, Southside, Parallax, Dante + Gingko, the Black Pig, Soho, etc etc

• AND SO MUCH GOOD DRINKS– Fairmount martini bar, Great

Lakes brewery, Market Garden, Town Hall, Nanobrew…

• Beautiful scenery– Cleveland Metroparks– Edgewater Park– Mentor on the Lake

• Summer festivals galore• CEDAR POINT!!

And so much more

• http://www.clevescene.com/

QUESTIONS??

We are looking forward to a great year together!!!

-SMAK