Harbor:Administrative resident

1. Make sure everyone in the ED is seen in expediently
   1. Screen patients---eyeball and maybe write orders as not everyone comes via MSE or may speed pass MSE without orders because they are too sick. Also N.B. patients sent from clinic will have nothing ordered, and on top of that, you will not have screened as those that come via BLS
      1. BBN or beds 1-3-- ASAP
      2. Beds 4-13 or RUSH within about 15 minutes, if possible
      3. Otherwise within 30-45 minutes
      4. Possible critical complaints you should also eyeball: low BP, CP, LN (=?stroke), K+, VB +preg, GIB, SB in a monitored bed.
   2. Assigning patients
      1. if it's been >30min, try to see the pt yourself OR assign the pt to a co-worker
      2. DO NOT try to see everyone yourself. You will need to be available to run the board, move pts around, triage the BLS runs
      3. Don't get stuck in the hallways doing pelvics, or in the suture room doing I&D's and lacs
      4. BE AWARE of all the Tiers that come and assign someone. Often, the nurses do not tell you directly. Keep your eye on the board and listen for the pager to go off.
   3. Any trauma patient in Peds needs a senior (you guys for now!) resident for intubations, so again, assign someone.
   4. Be wary of the intern/med student who has not presented in 1 hour+ -- Actually, as you are busy running the board, it may be easier to take presentations from them, rather than see pt's primarily -- Good trick: assign a student/intern to I&D/lac/easy dispo you have eyeballed
2. Opening up beds (esp monitored)
   1. One bed in bed 1-3 must be opened at all times
   2. After you get your long list of "follows" try to eyeball all your admitted patients as this will help you decide if they can be downgraded (you need to confirm with admitting team)
      1. Tele for r/o ACS patients who have stable vitals, one neg enzyme, and only need to monitor for arrythmias
      2. neg AFBs x 3 can get off ISO
   3. At night Ward Call is in charge of all boarded ED patients
   4. You can write holding orders for Fam Med or Med patients (not hospitalists), for WARD immediately, for PCU within 30 minutes

Source

Hsiao 10/09