Off Service Resident Schedules

Off Service Chief Resident: Lucy Hale- Lucy.hale@wright.edu

KMC ED: 937-395-8659

Welcome to Kettering Emergency Department!

There will be several off-service rotators through the Kettering B pod, including transitional year residents, internal medicine residents, and podiatry residents. This is a unique opportunity for you to get experience on the opposite side of your consults, admissions, etc. and learn about immediate stabilization of patients and appropriate dispositions. Emergency medicine is a 24-hour, 365-day specialty. If possible, a weekend and request date will be accommodated for you during your block, but be prepared to work all holidays and weekends. 

The number of shifts required for each resident will vary based on program requirements. There are two shifts, as outlined above. Each shift is 9 hours in duration, with the expectation that the resident will pick up patients for 8 hours with 1 hour of time to wrap up at the end. Log in under "KH EMERGENCY DEPT" and press "sign in" in the banner at the top. When a patient has a red room number background, they are ready to be seen by a provider. Right click on the patient's name and assign yourself to the treatment team. As soon as you finish your H&P, find the attending who is assigned with you and present. 

Go to the unit coordinator desk by room 10 and sign out the Pod A resident Vocera when you get there. Sign in as "pod A resident" so the nurses have a point of contact for you. These are sometimes in short supply, so it may not always be there. If not, that's okay, just be sure to introduce yourself to the nursing staff when you see them so they know who to go to when they have questions. 

Expectations are to manage at least 1 patient per hour to get appropriate learning during your ED shifts (total of at least 8 patients by the end of the shift). The best way to do this is to front-load so you can get as much time to wrap up your patient at the end as possible. The workup does not need to be complete prior to picking up another patient; a key component to your ED shifts will be multi-tasking. When you have enough of the workup completed, move on to establishing an appropriate disposition. 

You will be the primary provider responsible for patient and nursing questions, so make yourself available - limit food/personal breaks to no more than 15 minutes at a time. 

All notes should be completed prior to the end of your shift, particularly for those who are admitted. Get a template from your attending or from the A pod resident as needed. If you have any questions, the A pod resident can always help you out. 

If your patients still need major portions of their workup done that are required prior to their dispo, you may sign these out to the incoming resident. Try to sign them out to another TY/IM resident. If there is no TY/IM resident available, you may sign them out to the EM resident. Make sure they are "packaged up" nicely - there should be clear decision points left and the majority of the workup should be complete. Here are general guidelines on signouts - 

• DO have a clear path on what to do next

• DO make all necessary phone calls prior to your shift's end. You are more familiar with why you are calling the consultant and it makes it easier for everyone

• DO NOT sign out more than 25% of the patients that you have seen during the course of your shift

• DO NOT sign out procedures (including pelvic exams, rectal exams, lac repairs, etc.). 

• DO take advice and pointers of your oncoming team - questions and clarifications are a way to improve patient care

• A clear, concise signout would read something like this: "This is a 24-year-old male with right lower quadrant pain and vomiting x 1 day. He is mildly tender in the right lower quadrant but not peritoneal, he's been stable throughout his time in the ED. Testicular exam was normal. Has a mild leukocytosis, labs are otherwise normal. We are waiting on the CT - if positive, we can call surgery and have him admitted; if it's negative, he can go home with some Zofran and close outpatient follow-up. Any questions or suggestions before I leave?"

EM didactics are required for all off-service residents and take place from 8am-12pm on Tuesday mornings, located in Nelson Conference Room by the cafeteria in the basement level of the hospital. This is typically broken up in to 2 hours of small group and 2 hours of lecture-style learning. 

We hope you have a great time with us during your rotation! If you have any questions, please reach out to Lucy Hale, lucy.hale@wright.edu