Moses

Transition

Please scroll down or click the "upcoming block" link above. In the transition tab of the sheet, you will see who you should be getting sign-out from and reach out to that person prior to the start of your floor block (if you start on days). Typically, the outgoing resident/intern will email the incoming resident/intern with relevant information (see below) and/or do this by phone. You may agree on whichever sign out methods that works for both of you. For the interns starting on the B block (seccond half of the month), please see who is in your scheduled slot in the A block for coordination of sign out.

Night teams do not receive sign-out ahead of time. You will receive sign out from the day team when you arrive for your first shift.

Signout Principles 

Sign out should include the following information for each patient:

• Name, MRN, age, and relevant PMH

• Presenting problem and reason for hospitalization

• Hospital course thus far, including treatment and progress on the presenting problem as well as other complications

• Pending tasks

• Disposition: When is their estimated discharge and to where?

A tip for the signout email...

If your written handoff is updated in Epic, you can print the handoff as a PDF and send that to the oncoming intern/resident!

All discharge summaries must be updated to reflect events through the last day of the block. Outgoing interns, please ask your residents to help you with this if needed.

Scheduling Tidbits

Daily Schedule

You will notice that there are three different kinds of shifts on the Daily Schedule tab in the sheets below

• 8pm admit day: 7am-8pm; alongside your resident you will admit any patients that come up to your floor before 5pm. These are the boxes shaded in dark gray.

• 5pm admit day: 7am- 5pm; alongside your resident you will admit any patients that come up to your floor before 5pm. Please note that it is expected that you stay as long as you need to finish an admission. However, your resident may wish to coordinate admissions so that you may try to leave on time on your short admit days. These are the boxes shaded in light blue.

• No admit day: 7am-5pm; you do not admit on these days. You may leave earlier if your work is done and if your resident/co-intern(s) are not overwhelmed. These are the boxes shaded in white.

• Night: 8pm-10am; Interns are responsible for responding to pages and completing overnight tasks for their assigned team(s) with assistance from their resident. You will then sign out the previously admitted patients to the day team at 7am and wait to present any new admissions or transfers at attending rounds at 8:30am. Interns will be expected to admit up to 4 patients and 2 transfers to no more than one team. If you are on Blue/White or Green/Violet, your resident will admit to the other team. All admissions should be done with supervision from your resident, who will walk you the process in detail.

NOTE: small teams alternate 8pm and 5pm days, with admitting determined based on your workload.

CAC Team

You will be on code team a few times each block (on your 8pm admit days or night shifts). Please check the "CAC" tab of the sheet below or on the chief's door at the beginning of each shift to determine whether you are on code team. You are expected to be at all "Rapid Responses" or “CACs.”

Responsibilities and Expectations

Interns

You will be first call for and write daily progress notes on all of your patients. Please see this PDF on progress notes for some guidance, if needed.

For new patient admissions/transfers, admission notes are required and will need to be presented to an attending during the next morning's rounds (or sooner if the attending prefers). Please read the oral presentation guideline for assistance, if needed.

MEDICATION RECONCILITATION MUST BE COMPLETED FOR EACH NEW ADMISSION/TRANSFER IN THE 'ADMISSIONS' TAB.

SIMPLY LISTING THE PATIENT'S OUTPATIENT MEDICATIONS IN A NOTE IS NOT SUFFICIENT 

Please ask your resident for assistance in this matter.

For discharges, an updated discharge summary and medical reconciliation is required. Your residents should guide you through this process. Be sure to use the .19dc dot-phrase at the top of all discharge summaries!

Residents

Resident/work rounds are an expectation and your time to use as you wish for teaching and to lay eyes on patients that may require your attention (gravely ill, interesting physical exam findings, slated for discharge that day, etc.) It is expected that residents will have seen all of the patients at some point each day. You are at liberty to determine a system with your team as to how you will supervise and check over the interns' work each day.

For new patient admissions, you must supervise the intern's admission and write an accompanying H&P. The point of this second H&P is to serve as testament and document that this supervision occurred. It need not be as detailed but between the intern's and resident's H&Ps, all relevant information for that admission is expected to be documented. Remember to call the ED within 20 mins of a patient being paged for handoff. Always check whether an admission has a private provider via the "Admit-To List" located on the Intranet, under "Clinical Communications." See the following Patient Allocation Manual for more guidance.

New transfers to the floor must also be supervised but do not require a separate note.

Weekend Coverage

• You should arrive at by 8pm for sign-out. 

• Weekend coverage night team can leave at 7:30am on Sunday and Monday morning if there are 4 or less admissions! Sign out will take place from 7 - 7:30am at bedside for new overnight admissions.  

  • If there are 5 or more admissions to be signed out to ONE day resident - then the night team will need to stay for rounds. 

  • **Example: if Resident A admits 1 patient to Red team and Resident B admits 4 patients to Yellow (assuming they are both res-interns), they will both need to stay for rounds since they cannot sign out 5 patients to the red/yellow resident on Sunday morning. This will be less of a problem on Monday morning since both day residents will be present. 

  • You CANNOT pass off admissions to an intern. Admissions can ONLY be signed out to RESIDENTS to present to the attending (4 or less per resident).

Other Reminders: 

• If there is an unstable patient, codes, unforeseen events from 7-7:30am, please stay to help the day team. Do not hand over sick/crashing patients to a cross-covering resident who may need extra help. 

• Please utilize the night captain system as equitably as possible!! This will ensure a safe distribution of patients and will help everyone to leave on time.

• Superficial admissions will not be accepted and should directly be escalated to your chiefs. 

• If you are on a big/small team (Blue/White, Green/Violet), please try to fill the small teams to at least 9 patients (cap = 10 patients).

• Preferentially assign anticipated long length of stay patients to the big team, when possible, think about which teams' patients are assigned to. (e.g., if two patients have cellulitis or two patients are septic/intubated, split them between two teams).

Conferences and Food

We have lectures (...and lunch!) at noon conference every day and an afternoon educational activity on some days. Please check out the chief’s door to see the schedule. The chief will be text-paging and/or texting you about these. Please be on time! Please also let the chief know if your attending rounds or other activities are preventing you from being there on time.

• Noon conferences: 

  • When: 12pm - 1pm

• • Where: NW5 conference room. (Virtual option is available if you are uncomfortable or unable to join in person. Zoom ID 235 840 7222

• Intern/resident reports: usually happen on Wednesday or Thursday afternoon. The chief will text-page details the day of

• Journal Club (residents): Thursdays at 3pm. The chiefs will assign one resident to pick up an article for discussion

• EKG/radiology rounds: usually held one afternoon per block. Interns and residents are expected to attend

• Breakfast and Lunch will be served on weekdays in the NW5 conference room. 

Useful Information

SW Directors' and Nurse Managers' contact info

Betsy (Elizabeth) Clarke is the Assistant Director for Social Work and is specifically assigned to the NW building. Betsy’s office is 2 doors down from the chief residents’ office on NW5.

• • O: (718) 920-7085

  • C: (347) 853-3486

Amy Klein is the Associate Network Director for Social Work. Amy’s office is next to the elevators on NW4.

• • O: (718) 920-8165

  • C: (347) 853-3274

Donna Robinson-Hampton is the Nurse Manager for NW4.

• • O: (718) 920-4669

  • C: (646) 872-4084

Obiageli Ubakanma is the Nurse Manager for NW5.

• • O: (718) 920-4515

  • C: (347) 880-1369

Mimoza Brahimi is the Nurse Manager of NW6.

• • O: (718) 920-4436

  • C: (201) 800-2679

ED Hospitalists' Numbers

Joan Medina 646-245-0404

Raquel Peralta 332-877-5886

Jonathan Daich 347-481-1033

Mohammed Hossain   646-477-9474

Raj Krishnan 646-872-1976

Appointments Scheduling Assistance

Email Everminia Coriano a list of patients on your team you anticipate may be discharged soon (the sooner, the better!). Include:

• Patient name, MRN, current bed

• Estimated date of discharge

• Specialist(s) needed and associated diagnoses

NOTE: For medicine subspecialties consulted on a patient's care, those services are expected to make their own outpatient follow-up appointments.

Access Codes

• NW1 call rooms: 1-2-5-enter

• NW3 conference room: 2-4-5-enter

• NW4 conference room: 2/4-3 (outer), 2-4-5-enter (inner)

• NW5 conference room: 2-4-5-enter

• NW6 conference room: A: turn handle counterclockwise, B: 1-3-5-enter

• NW5 coat closet: 4-3-1 enter

• Bathrooms: 2/4-3-enter

• Clean utility rooms: 2/4-3-enter

• Medication room (NW6): 5-3-1-enter

Ultrasound

Located in the NW5 coat closet (see access code above)

We have a rolling SonoSite machine and 3 Philips Lumify tablet devices (with both phased array and linear probes)

Please sign out and sign in the US before and after use!

PPE AND RADIATION PROTECTION 

Enhanced pandemic PPE means that in addition to masks, eye protection be used throughout all inpatient clinical units. This applies to patient rooms as well as the hallways and nursing stations of clinical units.

Remember SURGICAL MASK + EYE PROTECTION (GOGGLES or FACE SHIELDS) must be worn for all patient interactions unless the patient requires additional isolation/PPE precautions. This equipment can be found in the clean supply room on each floor (code is 2+4 together, then 3).

You should be wearing N95 + EYE PROTECTION + GOWN + GLOVES for all RAPIDS AND CACs (assume you are at risk of being exposed to an aerosol generating procedure or that the pt has recently had something aerosolizing done to them within the last 90 min)

For all AEROSOL GENERATING PROCEDURES (AGPs), you must wear N95 + EYE PROTECTION + GOWN + GLOVES ​​regardless of COVID status.

For any CACs or rapids called to IR or cath lab suites, PLEASE PUT ON A LEAD GOWN AND THYROID SHIELD BEFORE ENTERING THE LAB. Radiology and cath lab are expected to provide these for all members of the CAC team in the event of an emergency.

Upcoming Block

For Issues...

Please do not hesitate to contact the chiefs and Dr. Pacifico. Letting us know of issues in real time allow us to better address them and find solutions