greenbook

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UCH Medicine Wards ​

You will receive a very detailed email with expectations for the rotation as well as access to a folder with a bunch of additional orientation materials. If you haven’t received this email a week or so before the start of your rotation, email the IM chiefs. Also, if the timing of your block lines up with that of the IM residents, you will also get a detailed orientation during one of your first noon lectures.

Shifts ​

Expect to work 6 days a week. Your day off will be assigned to you, though there is some flexibility to switch your day off if you work out a swap with the other residents on your team or email the chiefs far enough in advance.

Day shifts 0600-1700 (sign-out times 6AM and 5PM, new admissions up to 3PM).

Swing admit shift 1400-1900 every day of the week. Interns arrive at 1330 (1:30PM) and meet the swing hospitalist on the 11th floor AIP1 (11.102) for education M-F. Cap is 6 admissions and you go home after you staff and when your work is done.

Night admits 2000-0700 (new admissions up to 0600), every day of the week.  Cap is 8 admissions, and you go home after signing out to day teams (6AM for teaching teams, 7AM for non-teaching teams).

Night XC is from 1700-0630, every day of the week and you go home after signing out to day teams.

Medicine teams and team rooms ​

Anesthesia interns tend to rotate on Med 2, which is a procedure team. The team cap on Med 2 is 10 patients as opposed to 12 and the team does 1-2 procedures in the afternoon (ie paracentesis, thoracentesis, LPs). You also generally get fewer admits than the other teams while on med 2.

Med 1: 9th floor AIP1 9.137B (Code 9137#) Med 2: 9th floor AIP1 9.137B (Code 9137#)   Med 3: 7th floor AIP2 North Pod or South Pod, feel free to store belongings in Med4 locked work room   Med 4: 7th floor AIP2 7.755 (Code 1816# or 84845#)   ACE: 12th floor AIP1 Middle Pod   Hep: 9th floor AIP2 9.758D

Food and Noon Conference

Food is provided at noon conference 12:00-1:00 Monday-Friday. These take place in Conference Room A down on the first flood.

General Expectations ​

Interns are expected to carry 8-10 patients. You’re typically expected to see all your patients before rounds.

Rounding typically starts around 8:30 and most attendings do bedside rounds. Rounds are supposed to end by 11:00 so you can get your orders in before noon conference.

Interns are expected to update handoffs for your patients and sign out all your people if not the whole team in the evening.

Pro-tip

Ask your senior and/or attending to help you set up your epic to optimize pre-rounding and chart checking

Cross cover ​

  • Cross cover is brutal. You respond to a bunch of epic chats and see patients with new changes in clinical status. It’s unlikely that you will get to sleep.

  • When in doubt, go see the patient.

  • Don’t hesitate to call a rapid response if you need more resources/help. A MICU fellow or attending comes to every rapid response which is a great lifeline.

  • If you need help, look for the senior residents on admits (swing from 2PM onwards, nights from 8PM onwards). If the senior is not available, ask the hospitalist for help (Swing Hospitalist until 7PM, Noc1 from 7PM onwards).

  • It’s good practice to save the phone numbers of your seniors and attendings at the beginning of every shift. You can find yourself in sticky situations and you don’t want to waste time having to look up these phone numbers. It can also be helpful to have the MICU resident’s phone number on hand for MICU upgrades.

  • Be sure you have quick access to amion throughout the shift so that you can quickly call emergent consults

INFO

The IM green book has a great section about cross cover that is worth reading and referring back