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General Hospitalist Agreements

Page history last edited by Sepehr Khashaei 8 years, 5 months ago
  • If the last day of a ward service is falling on the day call day, who staffs the patients with the residents, the attending on service or the attending coming on the next day on service?
    • Generally speaking our goal is to have every patient staffed the day they come in.  
    • Patients who are admitted when you are on Day call late in the day always present a dilemma. Staying to here formal presentations may delay both your and residents going home by 9 (which may impact the start of rounds the next day). Also, it is not clear that staying around the extra 2 hours or so to hear formal presentations - which could be given in 15 minutes the next day - is an efficient use of time.  For the most part we have left it to the discretion of the attending how they handle these admission - again recognizing that the general guiding principle should be that all patients are staffed on the day they come in if possible. (Many of us will see the patients and go over them briefly with the resident, waiting for the formal presentation the following day..unless the patient's status warrants more immediate attention.)
    • We discussed this during our hospitalist work-group meeting on 8/23 and feel it is acceptable to leave up to 2 formal presentations of patients admitted on the last day of service for the next day if that next day is to be a transition day (in other words, you are on day call on the last day of service).  The attending on day call should see all the patients and get formal presentations on as many as the team can have ready (this is the standard we should all follow).  But, if there are late admissions which the team is not able to have ready for presentation by 5 PM on that last day of the attending's block, the attending may choose to leave the formal presentations to the new attending.  But, this is not to exceed 2 patient presentations. 

 

  • How many patients should an intern or a resdient see on a one-intern or one-resident day?
    • On any day that there is only an attending and an intern or an attending and a resident, the intern should see 8 patients, a second year resident 9 patients, and a third year resident 10 patients and the rest of the patients should be seen by the attending.
    • It does not matter if the patients are the residents patients or the interns patients, the above still applies.  The intern can also follow up on the consults as the eight patients that he/she has to see.
    • It is important that we all stick to this rule in order not to create a good guy and bad guy situation and to keep the resident/interns expectations the same.

 

  • Students' Notes: 
    • The students should put their note in Powerchart as a separate note to the intern or resident (or attending, if the attending is writing the note on that day).  The attending will then write an addendum to their note as follows:  "Note:  I have reviewed the medical student note above for Date.  This note is for teaching purposes only.  Please see intern/resident's note from this stated date for pertinent information about the care of this patient.  SKH (attending's initial)"
    •  It is up to the attending to edit the student notes or not. 

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