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Welcome to the ED. EM Chiefs. Welcome to Residency. We’re glad you are here This purpose of this presentation is to provide helpful information for your new role as an emergency medicine resident. Your Schedule. There is a list outside Laura’s door of everyone’s rotations by month
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Welcome to the ED EM Chiefs
Welcome to Residency • We’re glad you are here • This purpose of this presentation is to provide helpful information for your new role as an emergency medicine resident
Your Schedule • There is a list outside Laura’s door of everyone’s rotations by month • Your schedule is available in Tangier (www.tangierweb.com) • You can click on location schedule to find out who you will be working with
Shifts/Scheduling: • Each intern will work 18 shifts in the one month period • Interns with scheduled vacation will work 14 shifts • We will typically make the schedule 3 weeks to 1 month in advance and will email the schedule out
When should I be there? • AM shifts: Be there by checkout, 6:45am • PM shifts: Be there by checkout, 6:45 p, • Mid shifts: Show up at noon, be available for checkout, try to dispo each of your patients by midnight
Shifts/Scheduling: • Notes about trading shifts after the schedule is published: • You MAY trade a shift for a shift with another intern if they agree • The preference is for switches with another EM intern • Ask one of the chiefs if you want to switch with an off service • If you are sick, injured, etc, let someone know immediately
Check OUT: • Checkout is in the South (front) fish bowl each day at 6:45 am and 6:45 pm. All residents working are expected to be present. • If you are working the Noon to Midnight (mid) shift, please be available at the 6:45pm check out to update the team on your patient’s status and treatment plan • The check out presentation should include a brief/succint summary of presenting complaint and findings, pertinent labs/study findings and planned disposition • Prior to leaving, (ffs) be sure that your documentation is complete
Check Out Presentation • Example: • Mr. Smith is a 67 year old male with h/o diabetes, hypertension, and smoking with no past cardiac workup who presented complaining of chest pain that was relieved by nitroglycerin x 3. His labs, including cardiac biomarkers, are all normal and there are some lateral T wave changes on his EKG. He has received an aspirin. He will be admitted to the medicine team for further workup. I have already spoken to the admitting team. He is still chest pain free and there should be nothing else to do or check.”
Check Out Presentation • Example • Ms. Johnson is a 36 y/o woman whose pelvic exam is consistent with PID. I have just ordered Rocephin IM and she can leave as soon as she receives it. Her discharge instructions and antibiotics are on the chart.
Seeing Patients: • You may see patients on either the North (back) or South (front) section • Feel free to bounce back and forth as needed • Patients should be seen in the order the charts are placed in the chart regardless of chief complaint (unless someone is critically ill) • Patients are triaged by their level of illness (1-5) • Feel free to pick up sick patients (level 2), but if you walk into a room and notice that someone appears ill, grab your attending or an upper level resident prior to performing a history and physical. The patient may require time-critical interventions!
Documentation: • All documentation in the ED is done on pre-made T-sheets. • The T-sheets are listed by chief complaint and are located just outside the front and back fish bowls. • If you cannot find a T-sheet that properly matches the complaint, a “General Medicine” T-sheet is available. • All portions of the T-sheet should be completed, including filling in labs and xray results. • Be sure to sign the T-sheet legibly. • (Be sure your attending signs it too)
Procedures: • Get as many procedures as you can • See as many new procedures as you can • For now, talk to the attending before doing a procedure. • A procedure note should be written for any procedure performed, there are specific procedure notes in the T-sheet racks. • Don’t forget to log your procedures http://www.new-innov.com
Presenting to the Attending: • If you see a patient that you are concerned about, let the attending know right away. If you can’t find an attending, notify an upper level for help until the attending is available. • Each attending has a different personality and different preferences. Talk with the upper levels when you arrive about tips for presenting to the attending for that day/night. • There are typically two attendings on each day. One takes the front section, the other takes the back. Present to the attending who is covering the section your patient is roomed in.
A Note on Safety • Illness and injury do not discriminate on the basis of mental stability or desire to obey the laws of society • Please be cognizant of your personal safety at all times • If you ever feel uncomfortable or threatened, remove yourself immediately from the situation • Security and LRPD are always available and can be called for assistance
Conferences: • Conferences are on Thursday from 7am to Noon. You are required to have at least 70% attendance. • You are only excused if you are working the night before and after. • If you are one an off service rotation, you should be allowed to go to conference • If you are scheduled from 7a-7p on Thursday, you had better be at conference. • The money shift: AM shift on a conference day • The shaft: Conference then a mid shift; we will try not to do this to you.
Other important Dates • 7/12/12: Cadaver Lab • 7/19/12: Splint Lab • 2/21/13: In Service Review • 3/28/13: Cadaver Lab
Other Helpful Hints: • Communication with the nursing staff will get you very far. Most of our nurses are very experienced and want to help you if you will allow them. • You must call radiology for US at night and on weekends (681-1812). • Radiology will put prelim reads in for CTs, these are available on PACS. • Discuss plain film x-rays with the attending prior to acting on them and prior to patient discharge. • If you have any questions or concerns, just ask! We are happy to help however we can.
Helpful Hints for Sunrise: • When you pick up a patient chart, place your name in the resident box on the ED dashboard. • For lab orders, if you type “ed.superset” you will have a order set with many typical ED stat orders. • When you consult another service, type “ed.consults” and select the service. • Make sure all orders are STAT
