Harbor:Administrative resident - Revision history

Rossdonaldson1: /* See Also */

2019-12-30T16:59:23Z

Bchap23: /* Patient Safety */

2019-06-05T23:42:54Z

Patient Safety

← Older revision		Revision as of 23:42, 5 June 2019
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	==Patient Safety==		==Patient Safety==
	*Your most important job is to make sure that all patients in emergency department have at least been eyeballed, and if needed have orders written~~, especially for pain medicine~~. Although each team is responsible for screening its own patients, you may have to screen the opposite team’s patients while they are in rounds.		*Your most important job is to make sure that all patients in emergency department have at least been eyeballed, and if needed have orders written. Although each team is responsible for screening its own patients, you may have to screen the opposite team’s patients while they are in rounds.
	*Ambulance patients are the responsibility of the Team A Resident to screen. Usually, the charge RN will overhead page you to go see the patient. Sometimes, they will call your phone (x23204). Patients will show up on the trackboard under ATri (on the 'Acute, Trauma, RME HAR track)		*If you notice an ambulance triage patient has been on the board for >30 min, please check with the AED Charge RN for team assignment.
	**[[Harbor:_Triaging_Ambulance_Runs\|Triaging Ambulance Runs]]		**As a general rule, you (or the other R3 if you designate them) should screen all ED Traumas to make sure they do not meet higher level Trauma criteria. Look at the trauma criteria card!
	*Another problem with ambulance patients in the middle of the room is that sometimes they sit there a long time with no care whatsoever, either waiting for the nurse to screen them, or waiting for an ED bed after the nurse has screened them. It's your responsibility to keep an eye on all these patients. If you notice an ambulance patient has been ~~sitting awhile and no one has begun caring for the patient, screen the patient and find out what's going~~ on ~~from~~ the ~~charge nurse. If the patient is to stay in the treatment area~~, ~~make sure a team gets assigned by~~ the ~~charge nurse and someone starts caring~~ for ~~the patient.~~
	*In general, all patients should be screened within approximately 20 minutes. If you're getting really behind, talk to your attending to get some assistance.
	**If the patient you've screened requires immediate attention, make sure a physician starts seeing them right away if you cannot. All the members on your team ~~work for you, and it is your prerogative to reprioritize them to a higher priority task when you need them to!~~
	**When you screen a patient, you can indicate this on FirstNet by completing the 'MSE' note. Not only does this count for measuring the “time to first provider”, but it also keeps any one else from duplicating your effort.
	**As a general rule, you (or the other R3 if you designate them) should screen all ED Traumas to make sure they do not meet higher level Trauma criteria. Look at the card!

	==Patient Flow==		==Patient Flow==

Bchap23: /* Background */

2019-06-05T23:38:14Z

Background

← Older revision		Revision as of 23:38, 5 June 2019
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	~~==Background==~~
	~~ED Administrative Resident Orientation (Team A Resident)~~

	First and foremost, the point of having R2s begin performing the administrative resident role in the emergency department before the end of the year, is so you can ask questions of the current senior residents about how to do things. Many of the finer points of being the administrative resident are not known to the attending physicians. Ask the senior residents lots of questions!

	==Things to Do Before Starting Rounds==		==Things to Do Before Starting Rounds==
	#Get everyone together to do [[Harbor:5S\|5S]] for a strict 5 minutes. Document on the 5S sheet.		#Get everyone together to do [[Harbor:5S\|5S]] for a strict 5 minutes. Document on the 5S sheet.

Bchap23: /* Acting Senior (R2) Roles */

2019-06-05T23:37:50Z

Acting Senior (R2) Roles

← Older revision		Revision as of 23:37, 5 June 2019
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	~~==Acting Senior (R2) Roles==~~
	*Lead rounds
	*Take follows
	*Take intern presentations
	*Senior resident phone (once keys applied to all phones)
	*Continue junior 5S duties

	==Background==		==Background==
	ED Administrative Resident Orientation (Team A Resident)		ED Administrative Resident Orientation (Team A Resident)

Tomfadial: /* Acting Senior (R2) Roles */

2017-04-10T04:31:54Z

Acting Senior (R2) Roles

← Older revision		Revision as of 04:31, 10 April 2017
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	==Acting Senior (R2) Roles==		==Acting Senior (R2) Roles==
	~~•Lead~~ rounds		*Lead rounds
	*Take follows		*Take follows
	*Take intern presentations		*Take intern presentations

Tomfadial: Summarized acting senior roles

2017-04-10T04:31:44Z

Summarized acting senior roles

← Older revision		Revision as of 04:31, 10 April 2017
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			==Acting Senior (R2) Roles==
			•Lead rounds
			*Take follows
			*Take intern presentations
			*Senior resident phone (once keys applied to all phones)
			*Continue junior 5S duties

	==Background==		==Background==
	ED Administrative Resident Orientation (Team A Resident)		ED Administrative Resident Orientation (Team A Resident)

Tomfadial: /* Patient Flow */

2017-04-07T22:24:41Z

Patient Flow

← Older revision		Revision as of 22:24, 7 April 2017
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	***Sometimes the actual insurance is different from the original registration info, and many times patients who are 'OOP' can still be admitted at Harbor.		***Sometimes the actual insurance is different from the original registration info, and many times patients who are 'OOP' can still be admitted at Harbor.
	***Depending on who is working in UR, they may not start running interqual until there is a 'discharge' diagnosis in Orchid		***Depending on who is working in UR, they may not start running interqual until there is a 'discharge' diagnosis in Orchid
	**~~Short Call - Get admits in before 11~~:30 or ~~so to make sure we do not miss using all the medicine short call spots! Similarly, one long call resident finishes admitting at 6 PM so these spots should be used before they are lost if possible~~.		**Admissions: enter admissions and observations on their respective clipboards and call the teams as soon as the decision is made. This helps to avoid missed inpatient or observation slots.
	**Help your team to avoid time-consuming activities:		**Help your team to avoid time-consuming activities:
	***Consults - consults often take several hours. Do you really need that consult? Would a clinic visit suffice?		***Consults - consults often take several hours. Do you really need that consult? Would a clinic visit suffice?

Tomfadial: /* Patient Flow */

2017-04-07T22:22:33Z

Patient Flow

← Older revision		Revision as of 22:22, 7 April 2017
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	==Patient Flow==		==Patient Flow==
	*Keep an eye on overall flow in the department. The better the flow, the safer the emergency department is and more patients get seen. There are several ways you can do this:		*Keep an eye on overall flow in the department. The better the flow, the safer the emergency department is and more patients get seen. There are several ways you can do this:
	**Orders: make sure orders are being written in timely fashion for patients who are admitted or on observation. Holding orders can be written for all Non-ICU patients when 2 hours have elapsed after the order ~~“Admit to inpatient”, “Observation Status in ED” or “Core Status”~~ has been entered in FirstNet, and you have notified the admitting team you are writing the orders. ~~(Update 5/2015: Eventually we will have an 'ED holding orders' order set in FirstNet)~~		**Orders: make sure orders are being written in timely fashion for patients who are admitted or on observation. Holding orders can be written for all Non-ICU patients when 2 hours have elapsed after the order “Request for Admit” has been entered in FirstNet, and you have notified the admitting team you are writing the orders.
	**Consults: Keep an eye on how long consults are taking. If you think the consult is taking too long, ask your attending for assistance. Always ask a consultant for an estimated time of arrival, so you know if they are overdue.		**Consults: Keep an eye on how long consults are taking. If you think the consult is taking too long, ask your attending for assistance. Always ask a consultant for an estimated time of arrival, so you know if they are overdue.
	**Downgrades – One of the best ways to move patients along is to get boarders downgraded as soon as possible. Whenever getting signout on a “follow”, know the (usually) single reason why that patient needs the PCU or ICU bed, and an idea of when that requirement will go away. When possible, discuss this directly with the admitting resident.		**Downgrades – One of the best ways to move patients along is to get boarders downgraded as soon as possible. Whenever getting signout on a “follow”, know the (usually) single reason why that patient needs the PCU or ICU bed, and an idea of when that requirement will go away. When possible, discuss this directly with the admitting resident.

Tomfadial: /* Background */

2017-04-07T22:20:37Z

Background

← Older revision		Revision as of 22:20, 7 April 2017
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	ED Administrative Resident Orientation (Team A Resident)		ED Administrative Resident Orientation (Team A Resident)

	First and foremost, the point of having R2s begin performing the administrative resident role in the emergency department before the end of the year, is so you can ask questions of the current ~~R3s~~ about how to do things. Many of the finer points of being the administrative resident are not known to the attending physicians. Ask the ~~R3s~~ lots of questions!		First and foremost, the point of having R2s begin performing the administrative resident role in the emergency department before the end of the year, is so you can ask questions of the current senior residents about how to do things. Many of the finer points of being the administrative resident are not known to the attending physicians. Ask the senior residents lots of questions!

	==Things to Do Before Starting Rounds==		==Things to Do Before Starting Rounds==

Tomfadial: Formatting (blockquote) and bullets

2017-04-07T21:51:29Z

Formatting (blockquote) and bullets

← Older revision		Revision as of 21:51, 7 April 2017
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	**Perform medical clearance when needed urgently on any ED patients (e.g. for surgery)		**Perform medical clearance when needed urgently on any ED patients (e.g. for surgery)
	*Working with Nursing		*Working with Nursing
	**This cannot be stated better than Stephanie Donald, a past resident, did:		**This cannot be stated better than Stephanie Donald, a past resident, did: <blockquote>“Emphasize that they [the residents]should actively work on their leadership skills and establishing a positive working relationship with the charge nurse, and not be afraid to use the charge nurse to help facilitate patient safety and flow, and see themselves as 2 on the same team. Their goal is for the charge RN to see them as the leader of the department and one she/he can work with instead of just the triage person and she/he does their own thing in terms of flow, etc.”</blockquote>
	“Emphasize that they [the residents]should actively work on their leadership skills and establishing a positive working relationship with the charge nurse, and not be afraid to use the charge nurse to help facilitate patient safety and flow, and see themselves as 2 on the same team. Their goal is for the charge RN to see them as the leader of the department and one she/he can work with instead of just the triage person and she/he does their own thing in terms of flow, etc.”
	**Carry your phone and encourage nurses and clerks to contact you on it, as well as forward your calls to it. Have him or her call you to let you know when runs are on their way before the patient shows up		**Carry your phone and encourage nurses and clerks to contact you on it, as well as forward your calls to it. Have him or her call you to let you know when runs are on their way before the patient shows up
	**And finally – as the leader of the healthcare team in the ED, YOU set the tone for the department. Even if it doesn’t always seem like it, other housestaff, the nurses (most, anyway), clerks, nursing attendants, CT Techs, and even the housekeepers look up to you. If you are grumpy, everyone is, if you are positive and up beat, it’s contagious. “Do with a smile what you have to do anyway”		**And finally – as the leader of the healthcare team in the ED, YOU set the tone for the department. Even if it doesn’t always seem like it, other housestaff, the nurses (most, anyway), clerks, nursing attendants, CT Techs, and even the housekeepers look up to you. If you are grumpy, everyone is, if you are positive and up beat, it’s contagious. “Do with a smile what you have to do anyway”

← Older revision		Revision as of 16:59, 30 December 2019
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	==See Also==		==See Also==
	[[Harbor: ~~Harbor (~~Main)]]		[[Harbor:Main]]

	[[Category:Admin]]		[[Category:Admin]]