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UK | UK Email UK Teams UK DHM Meeting UK Med Grand Rounds UK Pharm GrandRnds Renal (WR 12pm, F8am) | ProviderOnCall Careweb LinkBlue | LB IRB CCTS | KASPER | ||||
Calculators | FENa FEUrea | MELD Maddrey | CHADSVasc Has-BLED | FreeWater Duke | ||||
Watch | MIT 6.036 MIT Opencourseware CMU DeepLearning Google Python | KDFC WCRB WQXR Dead | Bloomberg Live Bloomberg Close Bloomberg Europe Bloomberg Surv Schwab Techpod GamersNexus PCWorld NextLander DarkNet Diaries IntelTechniques | Grand Rounds UW UMich (Fri, noon, live) Stanford CU CU Live UL Renal | ||||
Diagnoses to not forget:
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Things on Discharge to not forget:
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============================================================== Swing-2 Guidelines ============================================================== ======================== 1pm-4pm ======================== 1. Residents Give 2hrs per patient. 1a. On call team 1b. Pre-Pre call team (before 4pm) 1c. Post Call team 1d. Pre-call team 2. MCH-14 - M-F only, if their census is < 12 3. MCH 8 and 9 attending - M-F only, if their census is lower than other teams 4. MCH 15 APP - M-F only, if their census is < 15 5. Swing 1 up to 6pm 6. APP Swing ======================== 4-6pm ======================== 1. On call residents (until 6:30) 2. Swing 1 up to 6pm 3. APP Swing ======================== 6-7PM ======================== 1. APP Swing 2. Swing 2 ======================== 7-8PM ======================== 1. APP Swing 2. Night Resident Team 3. Night APP Crosscover ======================== 8-9:30PM ======================== 1. APP Swing 2. Night Resident Team 3. Night APP2 ======================== 9:30-10PM ======================== 1. APP Swing 2. Night Resident Team 3. Night APP2 4. Night APP21 Family Medicine Any Family Med patient in the past 3 years (Turfland, Georgetown, Hazard, Hindman, Wilmore) Not Fountain court or Turfland UTC Transplant Kidney or liver - within 1 years Heart (Cardiology) and Lung (Thoracic) any year Cardiology Heart Transplant STEMI Neurology Primary Neuro Problem: Seizure, Stroke, Parkinsons, ALS, GBS UNLESS, these go to DHM: Meningitis, DKA, Cirrhosis (MELD > 24 or Pugh > 9) Sepsis with end organ damage (except neuro), Dialysis, Plasmex, Chemo Trauma Gallbladder - Cholangitis due to stone, Gallstones, Gallstone Panc Fall greater than standing or bed or wheelchair Injury to head, spine, chest, abdomen, pelvis, face, eye Hip injury under age 65yo Extremity other than hip with no significant medical problems So, DHM takes hip injuries with age >= 65 and isolated extremity injury with significant comorbidity Ob/Gyn/GynOnc if pregnant > 22wks DHM takes Ophtho ============================================================== ATP Guidelines ============================================================== 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.