structural changes in the program department of medicine university hospitals of cleveland case...
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Structural Changes in the Program
Department of MedicineUniversity Hospitals of ClevelandCase Western Reserve University
Bronson Day, May 2002Presented by:
Keith ArmitageJay FiniganNoah JonesKeith Petras
Current Medical Services
• Eckel (Blue/Renal)
• Carpenter (Purple/ID)
• Ratnoff (HemeOnc)
• Hellerstein (Green/CHF)
• Wiggers (Telemetry)
• Weisman (Red/Gen Med)
• Naff (Orange/Gen Med)
• Wearn (White/Gen Med)
Changes
• Wiggers GONE
• HellersteinCHF/TELE (Cards)
• Weisman Pulmonary
• Short call Naff & Wearn
• Reduced work-hour services Naff, Wearn, and Ratnoff
• All admissions end at 1100pm
• Signout rounds with the chief resident
New Medical Services
• Eckel (Renal)
• Carpenter (ID)
• Ratnoff (HemeOnc)
• Hellerstein (CHF/Tele)
• Weisman (Pulm)
• Naff (Gen Med)
• Wearn (Gen Med)
Medical Services: Nuts & Bolts
Service Resident Interns Call Misc.Eckel 1 3 Q6,Q3 No changesCarpenter 1 3 Q6,Q3 No changesWeisman 1 3 Q6,Q3 Intern addedRatnoff* 1 4 Q4 No changesHellerstein 1 4 Q4,Q2 Supershort: 1 till 1pm Naff* 1 2 Q4,Q2 Short: 2 till 1pmWearn* 1 2 Q4,Q2 Short: 2 till 1pm
* Reduced Work-hour Services
Weisman Service
• Pulmonary & Gen Med
• Pulmonary/Critical care attendings
• 1 resident, 3 interns
• Takes call like Eckel and Carpenter
• Q6 long & Q3 short
• long call = 5 admissions till 1100pm
• Short call = 3 admission till 600pm
Hellerstein Service
• CHF and Telemetry
• General and CHF cardiology attendings
• 1 resident, 4 interns
• Q4 long & Q2 supershort
• Long = 5 admissions till 1100pm
• Supershort = 1 admission till 100pm
Hellerstein Call ScheduleQ4 Long / Q2 Supershort
1 2 3 4 1 2 3 4 1
(1)Long Call (1)Supershort (1)Long Call
(2)Long Call (2)Supershort
Days
(3)Long Call (3)Supershort
(2)Long Call
(4)Long Call (4)Supershort
(1)Supershort
(3)Long call
(2)Supershort
(4)Long call
(1)Long call
Naff and Wearn Service
• No major changes except Short Call
• Long call = Q4
• Short call = 2 admits till 100pm = 1 admit till Noon (clinic day)
Reduced Work-hour ServicesNaff/Wearn/Ratnoff
• Admissions stop at 1100pm (all services)
• Interns can signout and hand pagers to cross cover at 100am
• Two cross cover interns per night (sometimes three)
• Interns must remain in the hospital
Morning Signout Rounds with UH Chief Resident
Department of Medicine Conf Room
• Intern - Cross cover exchange (700-730am)
• NACR - DACR exchange (800am)
• Residents welcomed
• Inappropriate signouts
• Overnight problems
• Assignment of nightfloat admissions
General Reminders
• Schedule Changes
• Jeopardy
• Weekend Coverage responsibilities
• Screening/Ambulatory/Elective/Geriatrics
• Disciplinary actions
• Evaluations
Schedule Changes
• No changes can be made unless the chief resident is notified
• All schedule changes must be in writing (email) and given to the chief resident
Jeopardy
• All junior residents take jeopardy call during elective
• A minimum of three junior residents per month
• Weekend jeopardy call is assigned
• Weekday jeopardy call is random
• You cannot leave town during the week and during your assigned weekend.
• You can arrange with each other to take jeopardy call
Weekend Coverage Responsibilities
• Weekend coverage to ward residents is provided by residents on ambulatory, elective, and geriatrics
• Residents on ambulatory are pulled first to cover
• A list of coverage responsibilities will be provided
• Adherence to coverage responsibilities will be strictly enforced
Screening/Ambulatory/Elective/Geriatrics
• Under certain circumstances residents on these services may be pulled to cover any service
Disciplinary Actionsfor repeated infractions
1/2 day of Screening
1 day of Screening
1 week of Screening
Formal letter placed in permanent file
Review by the recommendation promotions com.
Clinics
• Re-establish continuity
• UH CICU: residents/interns will have clinic on their non-call days (no clinics on call days)
• VA ICU: residents/interns will have clinic once during the month. On their good day