“Need to Know” Information

Katherine Tatar, MD Chief Resident

Office: 330-375-3735

Pager: 330-971-2607

Cell 330-559-2735

chiefsumma@yahoo.com

Schedules, schedules, schedules

Master rotation schedule

Monthly “call schedule”

Med team schedules

ICU schedule

CCU schedule

Check regularly…I will let you know about updates

Changes had to be made this past week to the July med team and

call schedules--- PLEASE CHECK TODAY to confirm what day you

start

www.imsumma.org

Viewing your master schedule

Master Schedule

Monthly “Call Schedule”

Residents

Interns

Interns on

Electives Interns on

Med Teams

(A,B,C,D)

Interns on

ICU or CCU

Call:

Overnight

shifts

(admitting or

“night float”

AI2/AI3)

Day Pager:

7AM-6:30PM

-Carry AI2/AI3

pager

Med Team Schedule

Night admitting: 7:30PM-approx 11AM

July is ONLY month where you will also do at least

1 night as AI2 or AI3 (night float) instead of admit to

get experience (STARTS at 6:30PM-7:30AM)

AI2/3 “Day Pager”

-usually do 2 days

throughout month

on med team

-7:00AM – 6:30PM

-Respond to Code

Blues/Stroke

Teams IN

ADDITION to

normal med team

responsibilities

Admitting

- 4 Med Teams

(A,B,C,D)

-each team admits

every 4th day

(24hours)

-either day or night

admitting

-day: 7AM to ~7PM

-Night: 7:30PM-

11AM (round with

team in AM)

-Look for dates

with your med

team letter under it

Night Admitting

Day Admitting

ICU Schedule

Nights: 5PM-5AM

Night

Shift

Med Team Admitting

Day AI-1 “Admitting Intern” 7AM to ~7PM

Work with AR-1

Carries their personal pager only

Respond to ER and Floor Medicine consults

Respond to pages regarding your team’s patients on the floor

AR-1 (Admitting Resident) will receive pages about consults first, and then will notify you of the consult

Night AI-1 7:30PM to ~11AM

Admissions over night with the night AR1

In AM: write notes and round with day team on patients seen or admitted overnight

Day Pager & Night Float

Respond to all floor pages

Work with AR2 “Floor Resident”

Code Blue and Stroke Teams/Neurology Teams

Back up for AI-1

Daytime: Hold both, AI2/3 Pick up in Cafeteria at 7am

Code Blues (except in ICU/CCU)

Stroke Teams/Neurology Teams

Sign out at 6:30pm

Nighttime: 2 interns Resident’s Lounge 6:30pm

ALL Code Blues, Stroke Teams/Neurology Teams, RAPID RESPONSES

Morning report at 7AM weekdays

• AI-2 “Floor Intern”

• Pager 4574

• 3 West, 4, 7

• AI-3 “Floor Intern”

• Pager 3976

• 5, 6, PACU

ICU Responsibilities

ICU Intern

Pager 4726

Respond to ALL Code Blue pages

Daytime: Arrive 5:00am for sign out at the T-3 “Fishbowl”

Write progress notes with other interns, daily ICU activities

Answer pages on “teaching” ICU patients

Answer emergent pages on “non-Teaching” patients

Sign out to night team at 5:00pm in T-3 “Fishbowl”

Nighttime:

Follow up on any outstanding issues the day team signed out

Answer pages on “teaching” ICU and emergent issues on “non-teaching” ICU patients

Assist ICU resident with new admissions if time permits

CCU Responsibilities

CCU Intern Pager 4614

Arrive for sign out at 6:00am in CCU fishbowl

Respond to ALL Code Blues

Write progress notes with other interns and other daily CCU activities

Answer all pages regarding CCU patients

Sign out to night team at 6:00pm in CCU fishbowl

Nighttime: follow up on any outstanding issues the day team signed out, answer pages regarding CCU patients, respond to ALL Code Blue pages

Most months, CCU night intern only on Fri/Sat/Sun nights

Assists CCU resident with Code STEMI’s/new admissions if able

Responsibilities

So… What are my hours?

Day AI-1(Admitting) 7AM-7:30 PM

Day AI-2/3 (“Day Pager”) 7 AM- 6:30 PM

Night AI-1 (Admitting) 7:30 PM- 11:00 AM

Night AI-2 6:30 PM- 7AM(morning report)

Night AI-3 6:30 PM- 7AM(morning report)

Night ICU-I 5 PM- 5 AM

Night CCU-I 6 PM- 6 AM

Putting it all together

Med Team

7AM (cafeteria) to 5PM on weekdays

Your team admits every 4th day

Look for your med team letter under each date

Day AI1: 7AM to 7:30PM

Night AI1: 7:30 PM to 11:00 AM

Will hold “day pager” (AI2/3) periodically (7 AM-6:30 PM)

Electives

Discuss hours and weekends with senior, attending

Will hold “day pager” (AI2/3) periodically (7 AM-6:30 PM)

“Cross-coverage” (XCVR)

2 weekends per month

Can be AI1, AI2, or AI3

Always, always check the call schedule

Putting it all together

ICU

Daytime: 5 AM to 5 PM

Periodically hold the ICU intern pager during the day (respond to ALL Code Blues)

Nighttime: 5 PM to 5 AM

Only ICU intern at night (Mon-Sun)

Carry personal pager AND ICU intern pager

Respond to ALL Code Blue Pages

CCU

Daytime: 6 AM to 6 PM

Periodically hold the CCU intern pager during the day (respond to ALL Code Blues)

Nighttime: 6 AM to 6 PM

Only CCU intern at night (Most Months: Fri/Sat/Sun nights only, no CCU intern Mon-

Thurs night)

Carry personal pager AND CCU intern pager

Respond to ALL Code Blue Pages

What about time to recharge? Vacation

A total of 3 weeks throughout the year

Submit all vacation requests as soon as possible

Forms are always in my office and my office is always open

MUST USE 1 week before January 1st

Must take 5 consecutive weekdays (i.e. Monday-Friday)

You will either get the weekend before or after off as well

NO VACATIONS in July, December or June

NO VACATIONS during ICU, CCU, or Night Float months

Transitional/Preliminary residents: Must use 1 week for the last week of June

No Guarantees, Plan Ahead!

Vacation Request Deadlines

August and September schedules already completed, will be uploaded

to the website soon

Ideally, will be making the schedules several months in advance

Remember, at least 1 week MUST be taken before January 1st

DEADLINE FOR OCTOBER & NOVEMBER REQUESTS:

Friday July 14th

DEADLINE FOR JANUARY-MAY REQUESTS:

Friday September 15th

Vacation Request Deadlines

August & September schedules are already completed

Will be posted to the website next week

At this point:

I have only TWO interns who have given me specific vacation requests

for August & September (Ahmed & Tatineni)

Several of you may not be able to take vacation in October & November

(eg if you’re on NF/CCU/ICU both months)

PLEASE LOOK AT YOUR MASTER ROTATION SCHEDULE TODAY

Get back to me by MONDAY (July 3rd) if you forgot to turn in a

request for August or September

As this will require me to modify the current schedules (not always easy)

Remember to fill out a vacation request form (located in my office)

Off Call Requests

Off Call Requests

Use these for important events Weddings, graduations

Allowed one request per month…1-2 days (Saturday/Sunday)

If you request a weekday, you are still expected to work your usual shift but I will

not assign you “call” (i.e day pager)

Will NOT be accepted on ICU or CCU months Unless extenuating circumstances arise, which may lead to master rotation schedule

changes

Try to turn in along with vacation requests but if something comes up later

than that come see me

Call Changes

MUST be approved by me

can NOT violate duty hours

USMLE STEP 3

Categoricals

Needs to be done before the end of PGY2

Prelim/transitionals

SCHEDULE ON AN ELECTIVE MONTH

Conferences

July: 12:00 conference, core series of lectures

ICU/CCU Interns excused

All other interns expected to attend

Typical noon conference

MANDATORY (unless on CCU/ICU/Nights/Post-call)

12:00 – 12:15 Patient Care Conference

12:15 – 1:00 Lecture, board review, grand rounds, etc.

Located in the PCS Basement Auditorium (55 Arch St)

Reminder page sent out usually around 11:00AM

Grand Rounds

Every Wednesday of every month at 12:00

Usually in Firestone Auditorium

Conferences

Conferences

IMC Didactics

For all interns/residents during their IMC rotation

Every Tuesday and Thursday from 8-8:30AM

You will receive an IMC month schedule from Cindy Hanna

One assigned presenter per session but all residents should

come prepared to discuss the case

www.summalearner.com

IMC Didactics

IMC Didactics

Video Tutorials

A series of 6 tutorials designed to help address some

common scenarios encountered while on call

General Overview of taking Call

Chest Pain

Hypertension

Hypotension

Shortness of Breath

Abdominal Pain

On Call Videos

Username: imc

Password: bullpen

What about the Boards?

Medical Knowledge Quality Improvement Project

-For Categoricals

MKSAP Quizzes-Proctored in Dept of Medicine

-30 Question Quizzes required in each subspecialty (while on the

rotation).

-Must get 80%. If lower, must retake and pass.

-2 random 60 question quizzes each year. First must be taken by the

end of November.

Procedure Policy

Full Policy Listed in the Graduate Medical Education Procedures/Policy Manual

Information also found on IM Summa on Conference Calendar

Applies to: Central Line (Internal Jugular, Subclavian, Femoral)

Endotracheal intubation

Chest Tube (tube thoracostomy)

Arterial Line

Paracentesis

Thoracentesis

Lumbar puncture

Procedure Policy

MUST be credentialed for intubations and central lines PRIOR to their

ICU or CCU rotation

Step 1

Resident has completed didactic test on indications, contraindications, and

troubleshooting strategies associated with the procedures.

Step 2

Resident has completed procedure under supervision of an attending (in

person) with a high-fidelity simulator and performed all critical actions

DONE IN THE SIM LAB

Resident is now able to perform the procedure under supervision of a

credentialed *attending physician.

*Senior residents and fellows are not permitted to supervise any PGY1 or other resident doing an invasive

procedure. An attending must be scrubbed in.

Procedure Policy

Step 3 (Applies to Senior Residents only)

Resident has completed the pre-determined number of

procedures under the supervision of a fully credentialed

physician and is now credentialed to perform the procedure

independently (with approval of the attending/credentialed

physician).

Procedure Policy

Take Home: PGY1s are NEVER to perform a

Med Ed identified invasive procedure without a certified

Attending physician physically in the room and

scrubbed with them

Procedures

We will try to get you into the sim lab before your ICU month to

be Step 2 Certified in Central Lines and Endotracheal Intubation.

Typically we have the Sim Lab on the 2nd and 4th Fridays of the

month.

Procedure Credentialing

Duty Hours

Log Procedures

Request Evaluations

New Innovations

Logging Duty Hours

MUST LOG DURING:

July

ICU/CCU Months

February

Procedure Logging Sim Lab also has log requirement for Categoricals who will

eventually progress to Step 3. Yes, you should log both in New

Innovations and on their form!

Med Team Workflow / Teamwork • A day in the life…..

– 7:00 AM: Standard start time; typically print a list, meet your team for sign-out, eat breakfast, etc. Then start writing your assigned notes.

– 9:00 AM: Begin rounding with attending and rest of the team. This

time varies depending on the med team or specialty, but you should aim to have all your notes completed prior to 9:00 AM unless you’re told otherwise. • Caveat: 7:00 am start time is optional. If you cannot complete your

notes prior to rounds you can come in earlier. You must have 10 hours out of the hospital between shifts however.

– 12:00pm- 1:00pm: Patient Care Conf. / Noon Conf. • Beginning in August each Med Team and some subspecialties will give

20min case presentations at the patient care conf. Check the CALENDAR for the Conf. Schedule!

Workflow / Teamwork

A day in the life….. 1- 5:00pm

Finish rounding, complete epic sign out, floor work, order AM

labs on all your patients, discharges, discharge summaries.

Sign out in person to the floor intern if there are pressing issues

that may come up for them or need checked on. Ex: follow up troponin, CXR, H/H, etc.

Check Epic/IMC mailbox and complete all telephone encounters

or documents.

ALWAYS check with your senior resident before leaving.

Help your fellow interns. Never watch someone else

work…pitch in.

Knowledge Base

Study…. Don’t forget how to do it!

Read…every night, even if its not very much

MKSAP will be provided for you (Categoricals).

There are copies of MedStudy and MKSAP in the Chief’s office

Copy them but leave the originals!

Try and read the sections related to your electives

First Day

Med Team Interns:

Regular day or AI2/3: 7AM in the Cafeteria

Night admitting: 7:30PM in ED consult room or Resident’s lounge

(page your senior)

First Day

ICU Interns:

Day shift: 5AM in the T3 ICU fish-bowl

Night shift: 5PM in the T3 ICU fish-bowl

ICU Team should meet in T3 fish-bowl tonight for sign-out

CCU Interns:

Day shift: 6AM in the CCU (T1) fish-bowl

Night shift: 6PM in the CCU (T1) fish-bowl

CCU Team should meet in the CCU (T1) fish-bowl tonight for sign-out

First Day

Electives:

Typically work Monday through Friday with 1-2 weekends of “cross

cover” throughout the month (either night float or admitting intern)

Check CALL SCHEDULE to make sure you aren’t cross covering

this weekend

Usually begin at 7AM unless told otherwise

Try paging your senior later today

Call/e-mail me with questions

MOST IMPORTANTLY…

When in doubt– CALL YOUR SENIOR

Your priority is the patient

Your seniors WANT you to call them with questions or concerns

At some point, you will inevitably feel as though you’re “nagging”

people to do what’s best for your patient (eg calling down to radiology

to get your patient with a STAT CT down as soon as possible, or

following up with a nurse to make sure a medication was given)

Be nice and considerate

Help when you can (within your capabilities)

Focus on your primary goal: doing what’s best for the patient

If you’re not sure about something– ALWAYS ASK

Your senior, your attending, the chief (me), our faculty

Someone is ALWAYS here to help you

Remember: These are YOUR patients now

Take ownership and responsibility

Advocate for them

Don’t let stress or fatigue allow you to forget why you’re here

Double and triple check your work

Before submitting an order– confirm it’s on the right patient and that it’s the right order

Make sure you know the risks and indications of whatever medication/procedure/test you are ordering and always keep that in mind

Make checklists!!!!

Make a list for each patient– things to do/order/follow-up on/change

Cross things out as you go

Do NOT rely on memory alone--- these are people’s lives

When you are stress or tired or distracted you WILL forget– so write everything down

MOST IMPORTANTLY…

Have fun!

Work as a TEAM

Always keep in mind-- your actions will impact not only your patients’

lives but their families

Remember– it is a PRIVILEGE to have a job that pays you to serve

others

So be kind and work hard– the rest will fall into place

MOST IMPORTANTLY…

Chief Resident

Katie Tatar, MD chiefsumma@yahoo.com

Pager: 330-971-2607

Office: 330-375-3735

Cell: 330-559-2735