Welcome to your upcoming VA Bridge rotation!
Your primary role is acting as a combined AOD (in the morning) and bridge (throughout the day). You will admit patients to the early call team (and to the mid call team, if needed) while they are rounding. The Hospitalist MOD will contact you with a potential admission, after which you are expected to go and evaluate the patient in the ED and then contact UM and place admission orders to expedite their admission to the floor or step-down unit (see UM info below). You may also be expected to call consults if needed to help expedite care for the patients and to help the teams. You will also respond to any SWATs or codes throughout the day. Please let me know if you have any questions about your role!
Please be familiar with every step of the admissions process at the VA, as you will likely need to help a call team on their senior's day off at some point in time. You will be copied on the VA wards email with more information on this.
You will now carry a VA provided cell phone that will receive the alerts (RRT, code blue, stroke, etc.). Your phone number is: 352-740-0826. Additionally, we expect the teams to drop their phones off in the bridge room when they drop off sign out. You can silence the phones and do not need to carry them with you. It's just for safekeeping.
Please ensure your CPRS alerts are at zero (have cleared all your alerts) when you rotate off of your assigned VA Bridge Rotation. This is meant to prevent any adverse events for our patients. VA and Program leadership will be monitoring this and reaching out directly to residents who are negligent.
This rotation is 7a-7p Monday-Friday with weekends and holidays OFF. There is NO CONTINUITY CLINIC during this rotation. Please do not leave your shift UNTIL the night resident arrives. You are always expected to physically hand sign-out and the pager/phone to the night resident. Similarly, please arrive BY 7am (ideally 6:45am) so that the night resident can hand off everything to you and go home.
Medicine call room on 4 West (J413-1)
In the morning after receiving sign-out, you should check in with the teams to see if there are any teams with a senior resident that is off or will be out during the afternoon for clinic.
Additionally, in the morning you will be acting in a similar role to the Shands AOD. You will admit patients to the early call team (and to the mid call team, if needed) while they are rounding. The Hospitalist MOD will contact you with a potential admission, after which you are expected to go and evaluate the patient in the ED and then place admission orders to expedite their admission to the floor or step-down unit (see UM info below). You may also be expected to call consults if needed to help expedite care for the patients and to help the teams.
In the afternoons, you will be functioning similarly to the Shands Bridge. You will be helping teams whenever/wherever needed (i.e., resident’s day off, resident in clinic, etc.), receiving sign-out from the teams after 3pm, and covering the cross-cover phone/pager.
You will carry the RRT/Code phone and are responsible for responding to ALL RRTs and CODE BLUE/CODE ASSIST notifications. You do not need to write an RRT note (MICU nurse will write this note and may co-sign it to you but you are NOT the primary author of this note).
***TIP***
Keep a list of residents’ days off and always be willing to lend a helping hand when you can. This can include helping teams pre-round, joining in on daily rounds (highly encourage), extra teaching time for interns or students, doing procedures, etc.
Full orders and medication reconciliation may not happen in an hour, but our VA is requesting that Medicine Residents and Hospitalists place basic admission orders after discussion with the referring Emergency provider so that the search for a bed can begin within one hour. These are for patients who will be admitted without a doubt (i.e., sepsis, NSTEMI, GI bleed, etc.) to help expedite patient care. These orders should include:
Treating specialty and providers
Diagnosis
Level of care (acute, observation, step-down)
Telemetry (if needed)
Isolation orders and precautions, including 1:1 observation/sitter, etc. (if needed)
Additional orders can be included as well, but please ensure basic orders are entered once the discussion with the Emergency provider is complete.
Before placing initial admission orders, it is a requirement to call your team's assigned UM to discuss and ensure the appropriate level of care is selected. This should be a discussion between the admitting team and UM to identify the most likely initial admission diagnoses for the patient and the patient’s clinical status. Afterhours and on weekends, UM can be reached at 10-2177 . Please do not argue with the UM advisors. Their job is simply to recommend a level of care based on certain clinical criteria. If you feel a patient requires a higher/different level of care based on their clinical status and are at an impasse, simply admit the patient and you can escalate to the UM Manager Patty Davis at 10-1283.