Taking Signout #
- It is good practice to arrive to your shift a bit early (10-15 min); this let’s the off going person sign out to you and leave on time (you would want the same!)
- When you take sign out on boarding patients, write a clinical update in your note once per shift.
- Obviously, if any events occur, you should be writing this in a note, but at the very least you should write an update stating they remain clinically stable and (if applicable) are awaiting transfer
Consults and Consulting Services #
- DO NOT consult a service before seeing the patient
- The “heads up” Tigertext is not helpful, they would rather wait for a full/proper consult before getting a message or call from us
- How to consult a service
Discharging a Patient #
Special Circumstances #
Psychiatric Holds #
- Use the “ED Mental Health Hold Request” – this is a new order that we should be using for our FD-12 psych patients once we have confirmed that they are indeed under FD-12
- Make sure to communicate to the team that the patient is under psychiatric hold, this includes the bedside RN, the charge RN, the senior, and the attending
My Patient Doesn’t Speak English #
The End of the Shift #
- The general expectation is you see patients UP TO 30 MIN before the end of an 8 hour shift, and UP TO 1 HOUR before the end of a 12 hour shift
- Your seniors are aware of this policy and should be assigning patients as such, but when volumes are high, not seeing patients in a timely manner can introduce significant delays in patient care
- This does not apply to critically ill/sick patients/answering the radio – in these cases, another service may be able to help you offload, but otherwise, please do not delay patient care
- DO NOT SIGN OUT PROCEDURES: This includes especially sensitive exams like pelvic and rectal exams, both for your patients’ and colleagues’ sake. If you think you may have to do a procedure and it is coming to the end of your shift, talk to your senior to figure out time to do it. They need to be done before sign out or completed by you after you have signed out on time.
End of Shift To-Dos #
- [ ] Ask for feedback from your senior/attendings (if they are busy – try asking for text feedback later)
- [ ] Start a note on every patient that you saw
- [ ] Finish your notes
- [ ] Pull in clinical data including LABS, IMAGING
- [ ] Write EKG interpretations
- [ ] Write a sign out addendum to the oncoming provider
- [ ] Complete any uploaded QPath for point-of-care ultrasound images (these may take time to upload)
- [ ] These must be done in 7 days; if images are not uploading – reach out to the ultrasound team
- [ ] Complete an end of shift evaluation/request feedback from an attending
- [ ] A reminder that you should be completing end of shift self evaluations as much as possible! Your CCC comments are heavily based on this, and leadership relies upon these to evaluate each resident and track clinical progress. It is also useful to initiate evaluations of your attendings, as these are required for their yearly evaluations. Both positive comments and constructive criticism that may help them grow as attendings and educators are useful! These can be initiated in Medhub.