Medical Chief Residents' Intern Orientation 2009 “A Day in the Life of a BMC Intern”
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Transcript of Medical Chief Residents' Intern Orientation 2009 “A Day in the Life of a BMC Intern”
Your Chiefs
Located across the corridor in Evans 116 (8-7253)
Also an office on the 6th floor HAC (4-5642)
VA Chief – Anju at the moment
5222 – the oncall pager
Stop us in the hallway, at conference, in clinic etc. – we’re here to help you
Pre-rounding
7am pick up sign-out (9am on Sundays @BMC): ENC 8th floor work room HAC one of two 6th floor conference rooms VA 2-South conference room
Pre-round on patients – collect vitals, assess any patients active overnight, ins and outs, weights...
Don’t forget the Telemetry (upcoming intern conference session)
Check stability of any new Short Call “holdovers”
ICU pre-rounds are a little more involved
Ward rounds and presentations
Usually start 7.30am, Attdg present alternate days
24hr events, any new tests and results, morning vitals
See the patient with your team – interns lead at the bedside!
Then present your assessment and plan by problem (don’t forget to address FEN, Ppx, Dispo, and Code when relevant)
Organize your ‘scut sheet’ Rounds complete by / pause @10am Morning
Report
The superstar intern
How old is the central line? Can any IV meds be changed to PO? Can they come off telemetry? Can the IVF be stopped? Will they need PT prior to discharge? Can you D/C the Foley catheter? Can you advance the diet? Are they moving their bowels? How close are we to discharge? Are the meds adjusted for renal/hepatic
failure? Does the patient understand their care?
Putting in Orders
Sunrise (SCM) order entry Phlebotomy draws are 7am, 10am, 1pm,
4pm, 7pm, 10pm, 1am, 4am. (AM draws usually 7am on the wards)
If you can’t find it, try the % sign
Call consults early please (the fellows will ♥ you)
Radiology requests are a consult! Call down if its STAT
Don’t forget to let the nurse know!
Attending rounds
You should receive 3 attending round sessions per week
You should also seek expectations / mid-way feedback / end of rotation feedback from Attdg and Resident
Noon conference
Monday – HAC A/B Tuesday – Intern conf in Evans – compulsory! Wednesday – firm conf (11.30) or M&M Thursday – HAC A/B Friday – Emergency series / Grand Rounds
You will be fed ☺ Attendance goal 80% We will hold your pagers 12 – 1pm
Afternoons
Follow up results, consults, images Always update the patient! CLINIC Procedures – supervision, help
Record temporarily by an SCM list or emails to self
Teaching
Calling a Code: 8-7777 or 4-7777
On call schedules Long call
Max 5 for Early Long, 5+2 for Late Long Early call out by 9pm, Late is overnight
Post call Short call
Max 5 Early to 12, Late to 5pm (should be out by 7pm)
Routine Or day off
Units are q4 overnight Weekend coverage assignments
Survival tips
If you’re standing, sit You’ll get out of this experience what you put
into this experience Don’t assume anything… Use the resources around you:
Resident, med students Chiefs, PDs RNs, pharmacists, PT/OT, case managers Subspecialty fellows BMC intranet Uptodate, online journals Each other
Admitting patients
Resident will receive Admitting and ED pages IBEX is the ED board
See the pt as soon as they arrive, at least to ‘eyeball’ and write holding orders
Using the order sets – quality improvement H&P is online – every patient needs an intern
or resident H&P Assigning a pager to the patient
Discharging patients
The computerized Discharge Summary Can “copy forwards” from H&P – but check its
relevant and accurate Discharge Medication Reconciliation in
Logician – cut and paste the med list into the DSUMM
Print out the Med Rec E-prescribe / Pharmacy arrange new meds Page One for services Discharge Order
Follow-up appointments
Signout (after notes done, labs ordered, checked in w/ patients and resident)
To Who? Long call <7pm NF junior >7pm
Divert your pager!
SBAR: Situation Background Assessment Recommendations