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Diagnoses to not forget:
  • Patient with chronic disease, apathetic or socially isolated - Depression
  • African american with iron deficiency anemia - Thalassemia or sickle cell trait
  • Female with GI symptoms and Vit D and Fe deficiency - Celiac
  • Chest pain and hypoxia - PE
Things on Discharge to not forget:
  • For smokers 55-80yo who smoked heavily and have smoked within past 15yrs, low power chest CT
  • For diabetics: Empagliflozin (Jardiance)
  • For HFrEF: Sacubitril/Valsartan (ENTRESTO)

7am:
===============================
1. Sign in to Epic
    Team is "HM Chandler Hospitalist Admission"
    Role is "Consulting Physician" - not attending
    This will let ER residents know to contact me for admissions.

2. Pick up the 6951 pager

3. Call Bed Board - 32233
[ ] Find who is on capacity command
[ ] Find how many GS beds are available for new admissions

4. Find the on call resident team
    Lightning Bolt will list then as available until 7pm
[ ] Get name of upper level resident. This will be the person to notify for new admissions

5. Review the "HM Chandler Hospitalist Admission" team
    Move patients who were admitted yesterday to a team
Keep all 3 lists "clean".
- Remove new admissions assigned to a DHM team.
    Delete the consult order to remove them from the list.
- Kepp new patients for GME on the consult list




Who Can Admit
===============================
Flex APP (7am to 7pm)
APP Swing (after 1pm)
Resident Team
MT14 APP Resident
Swing 1 (1pt 1-3pm, 1pt 3-5pm, 1pt 5-7pm)
Swing 2 (1pt 1-3pm, 1pt 3-5pm)
BMT (7am-4pm)
HMC1 and HMC2 (if fewer than 7 pts)
Fragility Fracture



When I get an ER Consult for a New Admission
===============================
I should get a secure message from an ER resident.
ER resident should (but may not) place a consult order, which will place the patient on the team.
I cannot consult myself, so ask the resident to place the order

The patient should appear on one of the following 3 lists:
    HM Chandler Hospitalist Admission (this is the main list)
    HM Chandler Hospitalist Consult
    Hospital Medicine - New Consults Chandler

If the new patient is COVID or High Risk of COVID
    Call Capacity command and get a bed number
    Check the teams, make sure they are roughly balanced
    Try to assign to the team cohorted with that bed.
        COVID Team: 5, 6, 7, 8, 9, 10
    Ask an APP or Swing 1 or 2 to admit the patient (not residents, including not APP residents)
    I cross-cover

If the new patient is unknown COVID status
    Leave in ER until COVID status is cleared
    Assign to the team "HM Chandler Hospitalist Admission"
    If low risk for COVID, ask residents to admit these
        If they turn positive, will need to transfer to a COVID team
    Ask an APP to admit the patient (not residents, including not APP residents)
    I cross-cover

If the new patient is COVID negative
    Try to send to Good Sam
        Call Bed Board, see if there is an open bed
        Chat to GSH Admitting hospitalist
        APP admits patient and then places transfer order to GSH
        Place Transfer to GSH order under the Transfer tab
    Try to place in Pav H
        When there are acting interns, if their census was < 10 in morning,
            then they can admit to MT4 or MT13
        Otherwise, ask admitting resident team or APP or swing to admit
        Resident teams can take 1 or 2 patients at a time
        Allow 90 minutes per 1-2 patients

Once Patient has been Admitted
    d/c the Consult order
    Right click the patient
    Select Remove Teams
    Select the team "HM Chandler Hospitalist Admission"




When ICU or another service Calls to transfer a patient
===============================
If COVID Positive - go to a COVID Team: 5, 6, 7, 8, 9, 10
If COVID Negative, goes to 4, 12, 13, 14 or a COVID team
If Cancer - May go to 11, HMC1, HMC2
    Melanoma and neutropenic fever often go to general medicine team
    Active leukemia or lymphoma go to HMC team, unless they have had a
        BM transplant, then they go to BMT usually.
    Always ask the Heme/BMT fellow what team they want the patient to go.
    HMC team admits their own up until 4 as long as they have < 10 patients

Add the accepting attending to the message from ICU - that attending takes over and will do the transfer order and note and c ross coverage.



When Another Service Calls
===============================
Try to ask them use GME instead
If other team will not use GME, or if patient is unstable or really needs medicine
- Call Leadership or Romil
- Ask team to enter a bed request for a bed in a medicine area
The old team will keep the patient on their team until they get to a medicine bed.
- Put them on the Expect list (right click...add patient).
- Include the patient on your email checkout.
- Once they have a medicine bed, we take it like an ICU transfer




When If KCATS calls
===============================
KCATS will checkout to you once bed is assinged, patient is usually not here yet (unlesss coming from endoscopy or Pacu).

Add them to the "DHM CH Expected Patients" or "DHM GSH Expected Patients"
    (right click...add patient)
    Include patient in your email checkout.

This is a direct admit, give it to a team based on Cohort
    Ask APP or Swing or Resident to admit the patient
    Send a Chat message to the team who will accept the patient

There is a list "KCATS - All Active"
This is used by the KCATS team, I do not add or remove patients here
I can use this list to find the patient.