Hospital Medicine Elective for IM Residents
UT Southwestern Hospital Medicine at Parkland
Over the past two decades, care of the hospitalized patient has increasingly shifted from the private physician to the professional hospitalist. The specialization of the hospitalist physician has allowed for increased efficiencies in the hospital environment, has improved quality and safety of health care institutions, and has provided tremendous opportunities for internists seeking the challenges of inpatient medicine. The Parkland Hospital Medicine elective allows residents the opportunity to participate in the hospitalist model, which provides direct attending level care and contrasts with a team-based patient care model. The resident will have the opportunity to work one-on-one with an experienced hospitalist physician and gain an understanding of the patient care challenges, system-based practices, and lifestyle of a full-time practicing hospitalist.
Inpatient Rotation Details
Admission/Team Caps:
You will inherit all of the patients that the resident before you managed. Admissions will be via a daily drip systems. Provided you have room in your cap, you will admit daily with a maximum of two new admissions per day. Most of these daily admissions will be from overnight admissions to hospital medicine. However, you will also likely admit new patients that come in between 5-7am and have not yet been formally admitted ("unseen" patients). You do not need to absorb old patients to fill your cap and should only be accepting new admissions unless you would like additional patients from a learning perspective. There is a hard cap of 8 patients per resident.
Work Days and Hours:
The rotation starts Saturday and ends on Friday; You will be working every day of the 1-week rotation. Work hours are 7:00 am-6 pm every day. You will sign out electronically to the overnight hospitalist cross cover team (see below).
Rounds:
Please contact your attending to discuss when and where you will round each day. The cell phone number for your attending should have been signed out to you by the offgoing resident.
Communication:
Please download Engage. You will be expected to use Engage as your primary method of communication.
Notes:
All notes should include the barriers to disposition (included in the templates below). This assists the physician taking over your service identify the barriers to discharge quickly, and it also helps case managers, social workers, and nurses identify how they can help avoid disposition delays.
Recommended note templates:
.IMHP
.IMPROGRESS
.IMDCSUMMARY
Nightly Signout
From 6pm-7am, all patients are covered by the Hospitalist cross cover team. Typically there is no verbal handoff with the cross cover team. However, if you have a patient at high risk for decompensation, if a death is possible overnight, or if you have outlined a very specific management plan (for example, a sick patient with very complicated goals of care), please find the covering Hospitalist APP starting at 6pm in the 13-400 area.
Electronic signout is used to communicate any overnight plans or contingencies with the Hospitalist cross cover team. Open the Handoff tool in Epic under the Internal Medicine context.
The Hospitalist cross cover signout differs from the signout process that we use on wards teams in a couple of key ways:
- In general, the hospitalists do not sign out anything to the cross cover team that they are able to do from home (electrolytes, CBC, etc unless it's scheduled for 2am). Because of the high number of patients that the cross covering team is managing, following up routine labs on each patient is not feasible.
- An attending hospitalist or experienced APP covers your patients at night. There is no need to write extensive summaries or contingencies on generic scenarios ("if fever, pan-culture and start vanc/zosyn...") for this overnight team.
- In general, the covering team does not look at your contingencies box unless they're called on a patient. Please only include concise and specific contingencies that differ from the standard of care here. This means that not all of your patients will have contingencies written- this is acceptable and expected.
- It is not necessary to update the "Primary Team Signout" box daily. This is ONLY used to transfer care of a patient when the provider switches over at the end of a 7 day work period.
Handoff to oncoming resident
On the Hospitalist teams, handoffs help oncoming teams triage who they need to see first during their first day on service and help them understand the disposition barriers clearly.
The outgoing resident on service will be responsible for sending handoff on their patients to the incoming resident. Please send a securemail email on Thursday night to the oncoming resident who will take over the clinical week. This email should detail the name and room number of the patients you have, the team you are on (ie Hospitalist Q), the name of the attending, and the attending's cell phone number. However, unlike on our wards services, this email should not contain the details of the patient handoff. Please remind the incoming resident to look at the Handoff tool for details about each patient.
Please use the handoff tool to hand off your patients to the oncoming resident. If absolutely necessary, you may also copy the information in this handoff tool in your email to the incoming resident. However, it is not recommended to duplicate your work by updating both areas. You must update the handoff tool, as this is how information is conveyed when attendings switch services.
- In the Handoff tool, open the "Internal Medicine" context.
- In the Primary Team Sign Out box, type ".hmhandoff" and complete the relevant sections. Please ask your attending for guidance if you're unsure what should be included.
- Keep this area concise and relevant. Avoid a copy/paste of the problem list from the note (as the oncoming resident/hospitalist is going to read your note anyway). The note is where details about patients go, whereas the handoff tool gives a broad overview of the patient and the reasons that they continue to remain hospitalized.
