Ward Night Team

Rotation Director:

Name: Sarah Green

Email: greensh@ohsu.edu

Office: CDRC 1240

Phone: 503-494-1170

Pager: 14161

Overview:

This is an inpatient rotation where residents will provide direct clinical care for hospitalized pediatric patients on both general and subspecialty services.

Rotation goals and objectives:

• 1. Residents will actively care for patients on the wards, including admitting new patients, moving forward care plans, addressing new clinical issues and concerns, and anticipating and preparing discharges

  2. Residents will be able to have effective team communication and interprofessional collaboration. This includes communicating with one another (ie senior aware of intern activities, intern knows senior expectations and triage, interns communicate to share admit workload), with nursing, and with attendings as indicated (ex with questions, alerting when there are big clinical changes)

Prior to the start of the rotation:

• • Residents should come prepared with their pager, PALS card, and emergency card

First night of the rotation:

• • During the weekdays, sign-out starts at 5:30pm in the resident lounge. Both interns are expected to arrive for sign-out each day at 5:30pm, regardless of which team signs out first that day. (Please see below for full sign-out schedule)

• During the weekends, sign-out starts at 5:30pm in the Hood workroom

  • Each intern will take two of the four inpatient teams. Either Hood/SSB or Coast/SSA

  • Helpful things the 2nd intern can do (while the other is getting sign-out):

    • Change first call

    • Listen to sign-out and help change any orders that come up. Be sure to close the loop with the day and night team regarding any changes made

    • Help answer any pages that come up during sign-out

    • Begin seeing sick patients or new admissions as needed

Resident Expectations:

Intern Expectations:

• • Provide family-centered patient care for patients with common pediatric signs, symptoms, and diagnoses requiring hospitalization:

    • See and examine new admissions, “watchers”, and patients with clinical status changes as needed throughout the night

    • Complete I-PASS action items and address new questions and concerns raised by all care team members and families overnight

    • Develop plan of care for new admissions

  • As time permits, anticipate discharges and help initiate discharge instructions and summary for patients likely to be discharged the next day

  • For new admissions:

    • Prepare patients and families for family centered rounds. Keep the family informed of changes in clinical status or in plan of care

    • Write H&P including problem based plan

    • Conduct an admission huddle with admitting RN to review care plan, address any concerns, answer questions

  • For known patients, residents should write a concise progress note for any significant overnight events or changes, emphasizing your medical decision making and plan of care

  • During sign-out in the morning, communicate key medical information including overnight events, clinical status changes, any immediate follow-up action items

Senior Expectations:

• • Provide leadership and organization to the inpatient teams:

    • Assigning admissions to interns, leading multidisciplinary midnight rounds (residents touch base with nurses on each floor for every patient), help coordinate communication between subspecialty attendings and team, maintaining I-PASS sign-out list, and assistant with discharge prep

    • When busy, helping maintain night flow including doing admissions independently if needed

  • Serve as the principal educator for the team:

    • Scheduling teaching time as able

    • Demonstrating physical exam findings and clinical pearls

    • Providing student and interns with direct, constructive feedback

  • Supervise the clinical care provided by interns and students:

    • Directly oversee all clinical care (including co-signing notes and orders for sub-interns – please note that sub-interns H&P notes and discharge summaries CANNOT be billed off of and thus new admissions or discharges will need a separate H&P or discharge summary)

    • Providing oversight, leadership, and support to interns including reviewing care plan and orders on all new admissions, supervising admission huddles, and helping interns develop time efficient strategies for completing clinical work

  • All residents are expected to respond to Pediatric Code Blues, including at Shriners and Casey Eye Institute

General Schedule:

• • Interns: Work Monday-Friday nights. Please note that your Senior resident will be different on Friday night. This will be a daytime ward senior on a 24 hour shift

  • Seniors: Work Sunday-Thursday nights

Evening Sign-out schedule: