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Team Expectations

"You're throwing fastballs at a catcher with no mitt"

Use of ABCD:

  • A: Pts who are acutely ill or worsening quickly, “watcher” status, or never seen together as a team
  • B: Pts responding to therapies but still require updates to care and ongoing hospitalization
  • C: Pts pending discharge that are not able to be discharged for some defined reason (i.e., EOT for antibiotics, HD chair, placement)
  • D: Pts anticipated for discharge

Team responsibilities

  • A/B/C/D should be set prior to rounds by intern/resident and determines presentation:
    • A/B: team dependent (full, focused problem, etc.)
    • C: brief update
    • D: DDEMAP
  • Attending rounds typically run from 9-11:30a on weekdays, team responsibility to troubleshoot difficulties with this
  • See all A (including new to team) and definitive D patients in person (non-primary intern can be excused if busy). Primary presenter for patient should lead patient discussion.
  • Interns can be split for rounds to get work done
  • All team members should be prepared for rounds
  • Use of AIDET, communication with patients or surrogate decision makers and appropriate use of
  • interpreter services (as well as correct documentation where appropriate)
  • A note should be completed each day (H&P – overnight team H&P counts if completed after midnight, progress or transfer note, or discharge/transfer summary). Team should be clear about who is responsible for note (i.e. typically student, intern, or resident)

Attending responsibilities

  • See all patients every day. D patients should be seen prior to 12:30 to allow for discharges.
  • Coordinate teaching
  • Ensure CM rounds are running appropriately (providing resident and CM team with feedback)
  • Be available to help team members throughout the day
  • Supply feedback on patient care, presentations, cache, and documentation
  • Help in resolving conflicts between services
  • Be available to staff all new admissions with primary intern/resident by 4pm on short call days and by 6pm on long call days
  • Cover pager during Afternoon Report and non-Long Call/Short Call days Thursday Schools Resident responsibilities
  • Resident should review plans for patients with team members (medical students and interns) from 8:30-9a so that plans are prepared for attending rounds
  • Complete chart rounds prior to attending rounds on all patients every day and have a plan for every patient
  • See all A and D patients prior to attending rounds, prioritize active B patients and patients with new overnight issues

Senior responsibilities

  • Ensure days off are scheduled for the team and that patients are distributed appropriately each day, including who will see new admissions, who will see patients when people on the team have days off, and a reasonable distribution of the work
  • Supervise and run team rounds and CM rounds with attending support
  • Run list and ensure orders, consults, and discharges mostly done by 1pm
  • Ensure interns are completing all assigned duties and aid with intern direct care duties (i.e., calling
  • consults, arranging transitions, updating cache)
  • Perform sign out on long call days
  • Assist with teaching the medical student(s) and/or making time in the day for teaching
  • Ensure all notes and tasks are completed by 6pm on non-long call/8pm on long call, and help to alert attending if this is not happening
  • Ensure patients that need to be admitted are assigned and seen within 2 hours

Intern responsibilities

  • Be the primary intern for up to 8 patients at a time and perform admissions with the team
  • See all OWN patients every day, prior to rounds
  • Be prepared to present on all own patients, review main plan with resident prior to rounds
  • Prepare DDEMAP on discharges prior to rounds including medication reconciliation with knowledge of home medications
  • Write notes on all patients or attest student notes
  • Update cache daily
  • Split up between the two interns: pager/tiger connect duties during rounds, afternoon/evening pager duty (the resident and other intern, if not off that day, should be available for support and to answer questions), perform sign out on non-long call days
  • Pager coverage is not expected to be in-house but the intern on pager duty is expected to return to the hospital if acute issues arise and to know the other intern’s patients well enough to respond and appropriately cross cover until 7 and to give sign out to night cross cover resident.

Phase II Medical student responsibilities

  • See patients you are assigned and prepare presentations for them, review main plan with resident prior to rounds
  • Up to 3 notes/day with resident/intern verification/attestation
  • Should be present for all of rounds
  • Help with patient care duties on their patients (i.e., calling consults, helping with follow-ups, depart summary, patient education, family updates, cache updates)
  • Place basic medical orders on patients if they can be co-signed by physician at appropriate intervals
  • Predominantly see and present patients with A/B/D status. For C patients, if the student still follows, the intern/resident may present for efficiency.

Phase III (Sub-intern) Medical student responsibilities

  • See patients you are assigned and prepare presentations for them, review main plan with resident prior to rounds
  • Write H&P, progress note, and discharge summaries on all patents you see
  • Attending attestation/verification for progress notes/discharge summaries
  • Resident attestation/verification for H&P
  • Should be present for all of rounds
  • Perform all patient care duties on their patients (i.e., calling consults, requesting follow-ups, depart summary, patient education, family updates, cache updates)
  • Place basic medical orders on patients and requesting co-signature at appropriate interval

  • Day-to-Day for Interns:

    1. Checkout from Night Team
      • Senior to determine each intern’s patients for the day
        • Let your senior know if you have afternoon clinic
      • Morning Labs/Follow-up items
        • Check Morning Labs as well as any follow up items from the day prior
          • Start “Lab” & ”Box” System if desired; See Staying Organized
        • Replace relevant electrolytes/start new meds as needed
    2. Pre-Rounds
    3. Morning Report
    4. Rounds
    5. Lunch
    6. Didactics
    7. Post-Didactics
    8. Handoffs
      1. Please try your hardest to update hospital courses I. This is especially important for discharges, end of the rotation handoff, and patients in the hospital longer than one week
  • References