2018 RESIDENT GUIDELINES FOR MARYBRIDGE ED ROTATION
EDUCATIONAL RESOURCES:
1) MBED PEM Education Website (https://sites.google.com/site/marybridgeed/home): Contains the resident schedule, required reading list and some presentations. Here is a link to the site: PEM Reading List - Mary Bridge Children's Hospital - Pediatric Emergency Medicine (PEM)
2) MBED Clinical Guideline Folder: This folder contains our collection of practice guidelines. Every desktop our department has a shortcut to this folder and it is labeled "Algorithm and Standardized Processes - All Documents." The "MBED pathways" folder is ours. The "MB inpatient" folder is where the pediatric hospitalists (inpatient pediatric specialists, IPS) stores theirs. Our folder has been updated and contains guidelines that are relevant to the care of patients in our department. Some of them are MBED specific, while others have gone through multidisciplinary approval processes and apply more broadly to pediatric care in all of Mary Bridge Children’s Hospital (MBCH) or Multicare Health System (MHS). Lastly, a few national guidelines (or those from other institutions) that have been endorsed by our group have also been included.
ATTENDANCE
RESIDENTS ARE EXPECTED TO BE ON TIME FOR ALL SHIFTS AND STAY UNTIL THE SHIFT IS COMPLETED, UNLESS EXCUSED BY THE ATTENDING PHYSICIAN. RESIDENTS SHOULD CALL TO THE ED 253-403-1418 AND SPEAK DIRECTLY TO THE ATTNDING ON IF THEY WILL BE LATE.
EACH SHIFT WILL BE 9 HOURS, WITH THE LAST HOUR SET ASIDE TO WRAP UP PATIENT CARE AND CHARTING.
THE SHIFT WILL 7 AM-4 PM, 3 PM-12 AM, 5 PM – 2 AM, 11 PM-8 AM. ADDITIONAL SHIFTS FOR BUSIER TIMES WILL BE 9 AM-6 PM AND 3 PM-12 AM
ABSENCES
ABSENCES WITHOUT PERMISSION WILL BE GROUNDS FOR ROTATION FAILURE AND IMMEDIATE COMMUNICATION WITH THE RESIDENT’S PROGRAM DIRECTOR. SHIFTS MAY BE TRADED WITH OTHER RESIDENTS, BUT MUST BE DONE PRIOR TO THE SHIFT AND HAVE APPROVAL. ONE SICK CALL SHALL BE PERMITTED; ADDITIONAL SICK CALLS MUST BE RESCHEDULED FROM THE AVAILABLE SHIFTS AND THE PROGRAM DIRECTOR WILL BE NOTIFIED.
SCHEDULING
SPECIFIC SCHEDULE REQUEST MUST BE 2 MONTHS IN ADVANCE OF THEIR ROTATION. OTHERWISE, THEY MUST MAKE ARRANGEMNTS FOR COVERAGE FOR THEIR SHIFT OR MAKE UP THE SHIFT FROM AVAILABLE REMAINING SHIFTS THAT MONTH.
TEAM ASSIGNMENT
RESIDENTS WILL REMAIN ON THEIR ASSIGNED TEAM, UNLESS DIRECTED TO CROSS COVER BY THE ATTENDING PHYSICIAN.
PATIENT SELECTION
PATIENTS WILL BE SEEN IN ORDER BY TIME OF PRESENTATION WITHOUT EXCEPTION, UNLESS THE ATTENDING PHYSICIAN DIRECTS OTHERWISE. IF THERE IS A PARTICULAR PATIENT THAT WILL FULFIL A KNOWLEDGE DEFECIT FOR YOU PLEASE LET US KNOW AND WE CAN ORGANIZE THAT YOU SEE THAT PATIENT OUT OF ORDER. RESIDENTS WILL SIGN UP ELECTRONICALLY PRIOR TO ENTERING THE PATIENT ROOM. WHEN YOU ENTER THE PATIENT ROOM, MAKE SURE TO WASH YOUR HANDS, INTRODUCE YOURSELF, APOLOGIZE FOR THEIR WAIT TIME, ALWAYS USE A CHAPERONE FOR SENSITIVE EXAMS, BE CULTURALLY RESPECTFUL, DO NOT DISCUSS A PLAN UNTIL YOUR ATTENDING AGREES WITH IT.
PATIENT CARE
PLEASE MAKE SURE YOUR NAME IS WRITTEN ON WHITE BOARD IN PATIENT ROOMS AND THE MAIN WHITE BOARD NEAR THE CHARGE NURSE STATION.
WE STRONGLY ENCOURAGE THE RESIDENTS TO SEE THE PATIENT WITH THE NURSE AT THE INITIAL INTAKE AS PART OF THE TEAM APPROACH. THE NURSES ASK THAT THE PHYSICIANS ALLOW THEM TO DO THEIR INTAKE TRIAGE BEFORE THE PHYSICIAN STARTS THEIR EVALUATION IN ORDER TO MINIMIZE A DISRUPTION IN THEIR FLOW PROCESS. MOST OF THE INFORMATION THE NURSES GET IS INFORMATION THE PHYSICIAN ALSO NEEDS, SO ENTERING AS A TEAM MINIMIZES THE REPEATED QUESTIONING. IN SOME SITUATIONS, THE EXAMINATION CAN BE STARTED AS LONG AS IT DOES NOT DISRUPT THE INTAKE PROCESS.
WE ALSO STRONGLY ENCOURAGE VERBAL COMMUNICATION WITH NURSING ABOUT PATIENT CARE AND PLAN AND WE WILL ENCOURAGE NURSING TO SPEAK WITH THE RESIDENT ABOUT ISSUES REGARDING THEIR PATIENTS.
AIDET
THE DEPARTMENT IS COMMITTED TO PATIENT SERVICE. WE FOLLOW THE “AIDET” ACRONYM.
ACKNOWLEGE
GREET PEOPLE WITH A SMILE, MAINTAIN APPROPRIATE EYE CONTACT, AND DEMONSTRATE A WARM, RECEPTIVE ATTITUDE WITH EVERYONE YOU COME IN CONTACT WITH
INTRODUCE
OFFER YOUR NAME, YOUR ROLE IN THE PATIENT’S CARE AND COMMUNICATE YOUR ABILITY AND DESIRE TO HELP – THIS REQUIRES YOUR FULL ATTENTION TO THE OTHER PERSON. RESIDENTS WILL WRITE THEIR NAME ON THE WHITE BOARD FOR EVERY PATIENT THEY SEE UNDER THE ATTENDING NAME. RESIDENTS WILL INTRODUCE THEMSELVES TO FAMILIES, SHAKE HANDS AND TAKE THE HISTORY WHILE SEATED, IF POSSIBLE.
DURATION
EXPLAIN HOW LONG A PROCEDURE WILL TAKE, HOW LONG THE PAITENT MAY HAVE TO WAIT
EXPLANATION
PROVIDE DETAILED INFORMATION ABOUT A TEST OR PROCEDURE, SUCH AS WHY IT IS BEING PERFORMED, WHO WILL PERFORM IT, WHETHER THERE IS PAIN OR DISCOMFORT, AND WHAT WILL HAPPEN AFTERWARD. BE SURE TO ANSWER THE PATIENT’S OR FAMILY MEMBERS QUESTIONS.
THANK YOU
SINCERELY THANK THE PATIENT OR VISITOR FOR CHOOSING THE HOSPITAL AND FOR TRUSTING YOU TO PROVIDE CARE
PLACING ORDERS
THE RESIDENTS WILL BE PLACING ORDERS FOR THEIR PATIENTS. BEFORE DOING SO, THEY NEED TO DISCUSS THE CASE AND PLAN WITH THE ATTENDING. ORDERS WILL BE ENTERED FROM THE EPIC ED ORDER SET.
DOCUMENTATION
RESIDENTS WILL DOCUMENT THEIR NOTE USING AN EPIC TEMPLATE. THE NOTE SHOULD INCLUDE HISTORY, PHYSICAL EXAM, IMPRESSION AND PLAN FOR ALL PATIENTS. THERE SHOULD BE NO ABBREVIATIONS IN THE EPIC NOTE.
REMEMBER THAT TIMELY PATIENT CARE ALWAYS PRECEDS CHARTING.
ALL NOTES ARE TO BE FINALIZED AND SHARED WITH ATTENDING PRIOR TO THE END OF THE SHIFT.
PATIENT RESPONSIBILITIES
RESIDENTS WILL BE RESPONSIBLE FOR CONTINUOUSLY RECHECKING PATIENT STATUS AS INDICATED AND FOLLOWING UP ON ANY LABWORK OR RADIOLOGY STUDIES, AND SHOULD UPDATE THE ATTENDING PHYSICIAN AND PATIENT WITH ANY PERTINENT CHANGES. IT IS THE RESIDENT’S RESPONSIBILITY TO FREQUENTLY REASSESS THE PATIENT AND WHEN THE NURSE CHANGES THE STATUS COLOR IN EPIC TO YELLOW (RECHECK REQUESTED)
THEY ARE ALSO RESPONSIBLE FOR DISCUSSING THE DISPOSITION WITH THE FAMILY PRIOR TO HAVING THE NURSE GIVE DISCHARGE INSTRUCTIONS.
SIGN OUT
RESIDENTS WILL SIGN OUT AT THE END OF THEIR SHIFTS, HANDING OFF THE PATIENTS TO THE NEXT RESIDENT AND/OR THE ATTENDING PHYSICIAN. RESIDENTS WILL NOTIFY THE ATTENDING PRIOR TO LEAVING THE EMERGENCY DEPARTMENT.
EVALUATIONS
RESIDENTS SHOULD GIVE THEIR EVALUATION CARD TO THE ATTENDINGS PRIOR TO LEAVING THEIR SHIFT. FEEDBACK AT THAT TIME CAN ALSO BE DISCUSSED.
PRESENTATIONS
RESIDENTS WILL BE EXPECTED TO MAKE 3-5 MINUTE PRESENTATIONS DURING UNIT HUDDLES AT 7 AM AND 3 PM. A LIST OF TOPICS WILL BE AVAILABE FOR THEM.