Orientation
to Medicine and Subspecialty Rotations at LBJGH
(Revised January 7, 2008)
Table of Contents
- Signing In
- Internal Medicine Office
- Conferences
- Dr Fred Rounds
- General Medicine Service
- Chart Stickers
- Float Resident
- Students
- General Medicine Consults
- CCU/Cards Consults
- MICU
- Float Intern
- Renal Team
- Hematology/Oncology Team
- ER
- Surgical Consults
- Psychiatry Consults
- GI Consults
- Meal Tickets/Dictations
- Post-Call
- Educational Materials/Resources
- Routine Patient Care
- Social Work, Counseling, and Psychiatric Services
- Discharge Planning Meeting
- Rapid Access to Radiology Reports
- Policy for Housestaff Needlesticks and other exposures to Body Fluids
- Problems/Complaints
- Internal Medicine Call Room Assignments
- Pronouncement of Death
- Ready Reserve
- Official UT Holidays
Call
room key: Next, go to the Physician Services Administration
office, located across from the Pediatric EC to obtain provider number if you
don’t already have one and a call room
key ($15.00 deposit).
ID
Badge: Then go to the HCHD Security Office at the Kelley
Street Entrance to get an ID Badge if you don’t already have one.
Parking Sticker: Parking is free at LBJ, but you must have a parking
decal. Obtain your parking decal in the
HCHD Security Office. The first decal is
free. If you lose it, a 2nd decal will be supplied at no cost.
However, if you loose it again, there is a $15 replacement fee for the 3rd
decal.
The Internal Medicine office
is located on the 4th floor, west hall, near ward 4B. The main phone number is (713) 566-4550. Fax number is (713) 566-5025. Kimberley Concepcion is the Residency
Training Coordinator. Drs. Patel,
Smythe, Gardiner, Bhattacharjee, Fred, Cid, and Mehta have offices here.
There is a copier, which the residents may use. (use your assigned UT copy
code). There is a computer with internet
access for your use. Attending mailboxes
are here. Resident mailboxes are here.
The ACS Office is also
in the Medicine office. The number is (713) 566-6199. You should contact the administrative ACS at
this number for issues relating to LBJ rotations during business hours. Contact the Float ACS if you are sick or have
an emergency and cannot report for work. Float ACS pager # 22001. The float ACS pager is also on AMION under
Ward Attendings.
Attendance is REQUIRED by
all residents, interns, and students assigned to LBJ. You
are responsible for signing in before conference begins. Please
consult your schedule on a daily basis as to where conferences are held. The location CHANGES DAILY. The MICU
house-staff are required to attend all of the educational conferences provided
at LBJ, during the noon hour. They
are excused on post call days, days off, and are not required to attend morning
report.
Dr. Orlander has requested
that he be notified if any individual’s attendance is low. IF YOU HAVE LESS THAN 70% ATTENDANCE FOR THE MONTH, YOU WILL BE ASSIGNED
AN EIGHT HOUR EMERGENCY ROOM SHIFT (likely on a Saturday afternoon during the
next consult, or non-call month), YOU WILL BE REQUIRED TO MEET PERSONALLY WITH
DR. ORLANDER, AND A LETTER WILL BE PLACED IN YOUR FILE. Please be on time and turn you
pagers and cell phones to silent during conferences.
If you have greater than 90% attendance, a letter of
commendation will be placed in your file and you may be eligible for a book
give away, if books become available to the Chief’s Office.
You must sign the roster to get credit for attendance. You must sign in no later than 8am for MR or 12pm for Noon Conferences. Being one minute late will result in no credit. Dr. Orlander has mandated all residents be released at 11:45, so that they can be on time for conference. This includes Ambulatory clinic Residents and Interns. If you have morning continuity clinic, go to morning report, sign in, see the first case, and leave at 8:30. You are excused from noon conference if you have morning continuity clinic on that day; however, if you finish early and come to noon conference on time, you will earn an extra credit. Furthermore, you are excused from both MR and NC if you must travel to another hospital to conduct an AM continuity clinic. You are also excused from noon conference if you must travel to another hospital to conduct a PM continuity clinic. Unfortunately, the LBJ office of the Chief of Service insists that we are not allowed to eat or drink in the Annex Auditorium.
We
will have daily morning reports for all residents, interns, and students. All morning
reports, with the exception of Dr. Fred’s morning report, will include two cases presented by the on-call interns. The presenting intern should bring relevant
chest x-ray images to morning report. It
is important to be on time, such that two cases can be discussed adequately. Please participate and contribute to the
discussion. The presenting intern will
also be asked to bring follow-up or additional information to add to the case
discussion.
OBTAINING RADIOGRAPHIC IMAGES FOR CONFERENCES:
The hospital no longer prints
copies of X-Rays as all the current imaging studies are now available online
via the PACS system. Every computer on
the wards is equipped with the ability to pull up the image on the screen as
well as the PowerPoint program.
If
you do not have a memory stick to plug into the USB connection, ask one of the
chiefs, and they may loan you one for the conference.
Dr. Mehta’s morning report on Tuesdays (8:45am – 9:45am) is for interns only, or students
only on Fridays at 1pm. One intern
needs to prepare a case you would like to discuss with Dr. Mehta. The patient must be present in the hospital
because you will examine the patient together as a group. You will meet in 3C at 8:45 AM, or 1:00 PM
for the students. Usually the on-call team presents unless the team on call
happens to be Dr. Mehta’s team. In that
case, the pre-call team should prepare a case. This should be discussed ahead of time to give the intern or student
time to prepare the case. Please have
the radiographic images pulled up on computer and all pertinent records
available (e.g. old EKGs, laboratory information, etc.) Post call interns do
not attend these rounds.
Med-Radiology will
be held every month. Every resident is
responsible for submitting to Dr. Fred for approval. Once approved by Dr Fred, the resident will
communicate the cases to the administrative chief with the final diagnosis and
finding that would be beneficial for learning. These must be submitted at least one week prior to the conference. The resident is required to be at the conference to give a history and answer any
questions. A maximum of 8 cases will be
discussed. Dr. Fred will assign the
resident a learning topic and the resident will give a 2 minute oral
presentation on that day. If the
resident has continuity clinic in the afternoon that day, they will present
first. Another alternative would be to
move the clinic day for that week—with permission the clinic coordinator, at
least two weeks in advance. Dr. Fred will facilitate discussion along with Dr.
Guthrie. See document posted on the
Chief’s corner under Dr. Fred Morning Report.
Med-Pathology Same rules as above, but with a maximum of 4 cases. Dr. Fred will also help facilitate this
conference.
FOR UPPER LEVEL WARD
RESIDENTS:
You
will be expected to be prompt, well prepared, and eager to learn. Enthusiastic participation is encouraged for all
residents. Residents will also be
expected to provide follow-up on patients presented at morning report. Dr. Fred will evaluate each resident at the
end of the month, and this evaluation will be included in the final monthly
evaluation to go in each resident’s permanent file.
Dr. Fred Morning
Report (8am): on Monday and Tuesday mornings for ward residents
only. Post-call residents will
present. Please see the attached schedule
for the room reservation. DO NOT BE LATE. Residents are expected to read and
familiarize themselves with Fred packets prior to their first Fred MR. Copies
of the 3 articles that are required
reading are available online at the “Resident Information Page” in the section
“Chiefs Corner,” as well as in the Internal Medicine office at LBJ. The articles are entitled: “Morning Report Card,” “Tenets for Physicians
in the New Millennium,” and “These are the Days.” If your continuity clinic (LBJ) is on a
morning when we have Dr. Fred morning report, notify your clinic a month in
advance to schedule your first patient at 9:30am so that you can attend Dr
Fred’s morning report. If you have
clinic at
Dr. Herbert L. Fred Rounds (See Schedule)
-Be prepared at 1:30 P.M. on Wednesdays and Thursdays (for whichever
time your team is allotted).
-Only the resident presents, unless pre-arranged with Dr. Fred.
-All team members should help in preparing the cases. All residents, interns, and students
directly involved in the care of the patient presented are required to attend
– you cannot have your day off on this day.
- **Residents are required to have one case each, ready to present. Dr Fred will choose which case he will discuss and willl likely discuss both cases. If only one resident is present, then he or she need not prepare two cases. However, every resident should have a back-up case ready, in the event the patient that they intend to present dies, leaves AMA, gets discharged without the resident knowing, etc.... .
-Case presentation: Use “The
Card” as a starting point.
-Consult the conference
calendar for the official location.
ALL RECORDS
from ALL past admissions from
whatever hospital (call long distance, if needed, through the page operator)
should be obtained and prepared for review.
-All x-rays/imaging must be
available.
-Chest x-rays on the computer
screen.
-You may try to “stump” Dr.
Fred if you wish.
-Patient preparation: Pupils
dilated, please. You may use
neosynephrine or Midriacyl ophthalmic drops.
-Bring functioning and fully
charged ophthalmoscope, please!
-Patient in one gown only,
open to the back.
-Bed elevated to its highest
level (this is done when you enter the room to examine the patient).
-Please explain to the
patients that Dr. Fred will be coming to examine them.
-Make sure the patients will
be in their room, and not sent for a diagnostic study or procedure.
-At least 3 articles on
the particular subject/diagnosis are mandatory and should be in the conference
room.
-Don’t hesitate to take notes, as he will ask what you have learned
from the meeting.
-Ask questions!
Dr. Fred Physical Diagnosis Rounds
Ward team residents need to
choose 3 patients between them with physical exam findings. 4-5 residents
should attend. As long as there are at least 4 residents, the postcall team
does not have to attend. Have enough pairs of large gloves available for Dr.
Fred. Prepare the patient for his arrival. If the patient has cardiac findings,
make sure all leads are off, the EKG is bedside, and the CXR can be readily
pulled up. Use three drops of dilating per eye if you plan for him to do a
fundoscopic exam.
The 3 cases should be
determined the day before. If there are “no cases”, the postcall team should be
prepared to present at the classic postcall morning report as described above.
General
Internal Medicine Service
There is an on-call pager (713)687-0124
which must be passed between teams. This
is how the ER will contact you. You must
have the call pager and have received checkout from the ER by 6:45 am on your
call day. If you are carrying the admit pager, take down the patient's information, and then find the appropriate resident to take the admission, even if you are capped. You must then give the check-out to the resident who is actually taking admissions (be that the next day on call team or the float) and hand them the pager. The resident to which you transfer the patient's care can always call the EC for more information, if needed. The admitting physician should not have to
page 2-3 different people to hand off an admission to the Internal Medicine
service.
Once a patient is admitted to
you, the RESIDENT should write cover
orders within 30 minutes, at which time the team sticker should be placed on
these orders. The team should make sure the team sticker is on the front of the
chart once the patient arrives to the floor.
It is your responsibility to
call & cancel your continuity clinic on days your team will be post-call. This should be done as far in advance as
possible so patients can be re-scheduled. (at least 1 month ahead of time)
Call
is every 4 days. Call team takes admissions from 6:45am-2:00am. Each resident has a cap of 10 new
patients. Each intern has a cap of 5 new
patients. New patients include all MICU
transfers, admits, and “bounce-backs”. Admissions
after 2AM or after the team caps will seen by the float resident. Please call the float resident yourself with
the info from the ER– do not expect the EC physician to figure out who to call.
Bouncebacks - Patients who are under the care of a General Medicine team from the 3rd of the month until the 2nd of the following month and require readmission to a medicine service during that time, will be readmitted to that same General Medicine team that originally discharged the patient. If the Readmission occurs when that team is post call, then the On Call Medicine team will take the admission and pass it back to the primary care team the next day. If the primary team is not post call, then they will take the readmission that day up until 4pm on weekdays and noon on weekends. However, if the upper level resident is off or otherwise unavailable on the day of readmission, then the Attending physician of the primary team will decide who takes the patient for that day.
Team
structure is as follows. Teams are
A,B,C,D. Each lettered team is made up
by 2 subteams composed of 1resident/2intern pairs. On each call day, the cap is 20 total
patients.
Upper level residents are to be in the hospital by
6:45am to see and examine every patient on the team each day prior to attending
rounds (this means that interns and students will likely need to be here even
earlier). There needs to be a note by
the upper level resident for each admission. If there is an intern note on a patient, this
may be a brief addendum stated that you have seen & examined the patient
with emphasis on assessment & plan. This includes MICU admissions. Again, this may be a brief note focusing on assessment & plan if an
intern note is on the chart.
The MICU team is allowed to transfer patients out of
the unit 24 hours a day. If you get a transfer before 2am, the patient
is yours. After 2am, the all transfers
will be managed by the float resident.
If IR is doing an outpatient
procedure ordered by a medicine service or clinic, and the patient has any
medical issues after the procedure, it is the responsibility of the IR
attending to determine if the patient should be admitted, since they are
responsible for the patient. If the IR attending decides to admit the patient,
the Admit team takes the patient (unless they are capped ; then it’s the float
resident). If the IR attending is not in-house, the IR resident should make the
decision to admit. If neither the IR attending or resident is available, the
resident should go assess the patient, admit the patient, or contact the
on-call medicine attending if the resident is unsure.
If you are post call on your
continuity clinic day, you will need to call your clinic coordinator and have
your clinic rescheduled within the same
week. The coordinators will need at
least 3 weeks notice.
Every house officer is required to take an average of one day off in seven, or four days per month. Upper-level residents must not take a day off on the 1st, 2nd, or 3rd of the month. The staggered switch of interns and residents on the 1st and 3rd, respectively, is designed to provide continuity of care for the patients. This continuity is interrupted by the resident taking off on the 1st or 2nd. furthermore, days off should be coordinated such that there is at least one upper-level resident in the hospital on any given day.
Each Ward team will be assigned
a set of chart stickers, displaying the team name, team members, pagers, and
post call cover. You are REQUIRED to put
a sticker on the outside, upper-right hand corner of every chart. Also, put a smaller sticker on the admission
orders. The stickers will be provided by
the Internal Medicine office.
Monday through Friday: After 4 pm, the Float Resident will be responsible for taking medicine admissions after the team caps, emergent cardiology consults, geriatrics consults, renal consults, and renal admissions.
Saturday and Sunday: After noon, the float resident will be responsible for taking medicine admissions after the team caps, emergent cardiology consults, geriatrics consults, renal consults, and renal admissions.
Every night: From 2am to 7am, the Float Resident will take Medicine admissions and Medicine consults, and hand them off to the appropriate team by 7am.
Medicine consults Monday through Thursday: After 4pm, Float Resident will see medicine consults and will hand off the patient to the Medicine Consult Team at 7am the next morning.
Medicine consults Friday after 1 pm until Sunday at noon: Medicine consults will be seen by the on-call team (the float resident would only take medicine consults from 2am to 7am, or if the team caps). The on-call team will be responsible for the patient over the weekend, and hand them off to the Medicine consult resident Monday morning.
The Float Resident will also provide help to the float intern. The float will be limited to a total of 10 patients. After the float has 10 patients, any other patients to be admitted from the ER will need to remain in the ER until 6:45am (even if there are open beds).
Students will be assigned to
each ward team. You are expected to
educate them. They will evaluate you at
the end of each month.
-no more than 3 new admissions per student per
night
-no more than 5 active
patients per student
-Their month ends on
Saturday, not the last Friday of the month.
-They are excused from all
duties Thursday prior to their exam and have no call on the Wednesday before
the exam
-They must have on average 1
day off per week on the weekend.
- MS 4’s doing acting
internships on a team should follow patients with the upper level resident, not
the intern. Every day the upper level
resident must write a full note on all the AI’s patients.
-Due to a shortage of call
rooms, only two of the four students on call will stay in house overnight. The others will go home at around 7pm, or
sundown, and return the next morning to pre-round on their new patients prior
to attending rounds. They rotate this
way for the month.
All general medicine consults will be done by the pulmonary resident from 7am to 4pm Monday through Thursday. The pulmonary resident will take consults on Fridays from 7am to 1pm.
After 4pm on Monday through Thursday, the Float Resident will see Medicine consults and hand off the patient to the Medicine Consult Service at 7am the following day. After 1pm on Friday until noon on Sunday, the Medicine team on-call will see Medicine consults, continue to follow the patient through the weekend, and hand off the patient to the Medicine Consult Service Monday at 7 am.
Consults do not contribute to the 12 bed cap. Residents must see the patient whether or not it is an “emergency.” Please notify the requesting service of any recommendations. All medicine consults must be staffed by an attending within 24 hours. During the week, the Medicine Consult attending will be responsible. During the weekends, the on-call medicine attending is responsible for staffing all new medicine consults, as described above and in the Float Resident Section.
Patients with primary orthopedic problems and uncomplicated medicine problems get admitted to orthopedics with a medicine consult. These patients are checked out to the medicine float intern at 4pm. If these patients either become complicated or have more serious acute issues arise, the float resident will be called to re-consult on the patient (this will count as an overnight consult). These patients need to then be signed out to the appropriate resident in the morning. The team on-call on Saturday will cover these ortho patients over the weekend. A progress note is required on both Saturday and Sunday, and the medicine attending is required to write a note on one of the two weekend days.
**If someone calls you with a consult, regardless if you are the correct person to see it, you must take the information and give it to the correct resident. You will be responsible for either seeing the patient or finding the appropriate resident to see the patient. Do not make other services page many different people looking for the correct resident. If in doubt, take the patient and then page the chief to see who is responsible.
CCU/Cards residents do not
take call. The team is composed of an
attending, fellow, and at least 2 residents. They sign out their CCU patients to the MICU resident on call.
Team consists of an
attending, fellow, at least 3 residents, and at least 3 interns. Call will be either q4 or q3 depending on the
number of residents and interns. They
must have ONLY 4 days off in
a given month, regardless of the number of interns/residents. Rounds usually start at 8am. Post-call team
leaves by
MICU Transfers should be
called through the medicine on-call pager only, not through individual resident
pagers.
The Float Intern provides cross coverage for the general internal medicine, inpatient nephrology, inpatient geriatrics, and inpatient hepatology team. Each day, a member of all internal medicine inpatient teams, including the post-call cover resident on weekdays, will provide both a written and verbal checkout of their respective patients. Checkouts that are given over the phone or by simply pushing a checkout sheet under the door to the Float’s call room is unacceptable and will not be tolerated.
The medicine consult resident will be checking out the orthopedic patients he or she is following to the float intern. These patients should have uncomplicated medicine problems i.e. HTN, DM. On Fridays, keep the checkout from the Medicine Consult Resident so these patients can be followed over the weekend if need be. The on-call residents will take medicine consults over the weekend and check out to the float intern if necessary. Please see any of these patients if an acute issue arises. If these patients become more complicated they need to be either transferred to the medicine service or reevaluated by the on-call medicine resident or float resident (they can count it as a consult).
Each weekday shift starts at 4pm and ends at 7am. Weekend and holiday shifts start at noon and end at 7am. The official UT holidays are in the Hermann online orientation packet. You have a co-intern, and you should come up with a schedule you are happy with, as long as all the shifts are covered. Please email your planned schedule in advance so the chiefs can fax it to the pager operators. Let the chiefs know if you are leaving town during the month.
You are required to do all 4 continuity clinics this month. If you need to, you can contact your clinic coordinator to reschedule some of your clinic days but they must all be in 4 separate weeks (for example, you can’t have 2 clinics in the same week).
HOW TO TRANSFER A PATIENT TO THE MICU
Additional Tips
You have backup!
The
renal team consists of at least one fellow, one resident, and at least two
interns. They will take consults and
admit the following patients:
1) ESRD patients being
admitted for HD only, with the approval of the Renal fellow. Any other medical
issues such as pneumonia, line sepsis, osteo etc would make it a medicine admission.
2) All patients admitted
directly from renal clinic
3) All patients admitted only
for renal biopsies.
3) Any other patient with
primary renal issues that the Renal fellow wants to admit to their service (for
example, acute renal failure).
The ER needs to call the
renal fellow for all admissions so that patients can be appropriately triaged. If
the float resident or admit resident is called before the renal fellow, then
he/she should contact the renal fellow to decide which service the patient will
go to. The Renal fellow makes
the ultimate decision as to which service a patient is triaged to. They may
occasionally admit a patient after 5 pm during the week and after noon on the
weekends, at which time the Float resident must come in to see the patient.
The Heme/Onc team consists of
one intern, one resident, and one MD Anderson oncology fellow. They will share the service and take either
type of consult. Rounds will be conducted
by separate attending for Heme and Onc, but rounds will be coordinated by the
fellow to allow time to see old patients and new consults. There will be Oncology clinic two times a
week and Heme clinic once a week. Details will be explained in the MDACC orientation. Attendance will be subject to consult service
requirements. Both house staff will be
required to attend orientation at MDACC, to get computer access and badges for
overnight call responsibilities. Overnight
cross cover call will be held q 5 at MDACC, again details will be given at the
orientation. However, you will not be
expected to drive back to LBJ post call for clinic or to round on
patients. You will leave from MDACC and
go home.
Dr. Phong Nguyen is in charge
of the ER rotation. If you have any special schedule requests (such as a
wedding, longstanding doctor’s appointment, etc.), he must be informed via
email at least 6 weeks before the start
of the rotation. Email him at Phong.H.Nguyen@uth.tmc.edu.
Internal Medicine conference attendance during ER is not required. However, you
are to attend ER didactic lectures every Wednesday from 7 am until noon in MSB
3.001. Report back to LBJ by 1 pm. You are not required to go to the didactic
lectures if it is your day off or you worked the night before.
The upper level Internal
Medicine resident will see the Shock Room patients. However, if interns are
interested and have time, they are welcome to go as well.
When giving checkout, give
the kind of checkout you would want to receive if you were admitting. This
means have the chart in front of you, know pertinent labs, patient location, and
indication for the admission. After giving report, protect yourself and the
patient by documenting WHO accepted
the patient and the TIME it was
accepted. Emergent and urgent procedures should be done in the ER; this month
is a great time for you to fill your log book if you put forth the interest.
It is IMPERATIVE that you briefly review the Encounters tab and Discharge
Summaries on Epicweb. Do this before you call report on an admission to make sure the patient is not a “bounce back”
to an Internal Medicine, Family Practice, or other team. It is part of your job
to review any recent discharge summaries as you work up the patient anyway.
Please also review the criteria for ICU/IMU admission when calling for a bed.
Please note that the first
two admissions of the day go to the Family Practice service if they are not
capped. You need to call the on-call Family Practice resident before calling the Medicine team for
admissions. The Family Practice admission guidelines are available on the
Chief’s Corner.
Call 713-566-5095 (Tanya or Monique) for all surgical consultations
between
After 5PM, weekends, or
holidays, junior in-house surgical resident should be paged. If after 15
minutes no response is obtained, the PM consult surgical faculty should be
paged.
Please enter an accompanying
pager number after the call back number so that the surgery on call resident
can page back if they cannot return the call immediately. Also please ask
them to document their name, pager number, and team color clearly in the chart
so we can contact them if necessary.
Please see Kim Concepcion in
the medicine office. She distributes meal tickets.
Incomplete medical records
are a chronic problem. The upper level
resident is responsible ensuring that the discharge summary is dictated. Several mechanisms address this problem:
The hospital requires that you
specifically write the following words “d/c patient home” and “d/c IV”. Also, you must complete a triplicate “final
progress note” which combines discharge orders, final progress note, and
prescriptions. You also need to co-sign every single note made by medical students. Here are a few tips for dictating charts:
a.
Dictate charts at
the time of the discharge no matter how late it is or how tired you are. Please
be sure that you note the dictation confirmation number in the chart upon
completion. Evaluations will be
withheld or withdrawn if medical records are not complete. Ultimately, you will be suspended from
clinical services if medical records are not completed.
b.
The discharge
summary is not a detailed account of every single event that took place in the
hospital, but a useful document for the next physician taking care of the
patient. The most important information,
therefore, refers to the patient’s condition at discharge rather than on
presentation and includes every thing on the “final progress note”:
·
discharge
diagnoses
·
cause of death if
applicable (Do not say “cardiopulmonary arrest”)
·
results of major
diagnostic tests and brief hospital course
·
discharge
medications (in detail)
·
activity on
discharge
·
condition on
discharge
·
diet on discharge
·
follow-up
arrangements
You must be leaving by 1:00PM
without exceptions. If you are violating
the 1:00 sign out time, both you and your attending will be contacted. The post
call cover resident is there to help you with any of your work, including
procedures
Educational Materials and
Resources
Current textbooks are
available in the Residents Lounge, the ICU, and during business hours in the
Internal Medicine office. In addition,
the hospital library (located in the east hall on the 4th floor) is
accessible with your I.D. badge.
Many computers are connected
to the UT network and the internet from which you can conduct literature
searches at any time. (library on 4th floor, computer lab next to
the dialysis suite). There is also a computer lab in the Annex.
The Resident Lounge is
located in 3C. There is a TV/VCR,
microwave and a computer for internet access. Please keep this room clean.
Admit patients to an attending
physician. Specify your attending physician on the order or
requisitions when ordering all diagnostic tests that require another
physician’s interpretation, e.g. radiologic, cardiologic, pulmonary, cytologic,
or surgical pathology. This is a
requirement by insurance and the federal government.
Select the most appropriate
clinic for follow-up.
The community clinic:
Send patients to the community clinic if they have stable
problems or a primary care physician at the community clinic. Please send a copy of the “final progress
note” with the patient to the primary physician
LBJGH Medicine Clinic: 6-4465. This is a Primary Care Clinic – this is a
clinic for patients in the Hospital District with insurance, Medicare or
Medicaid
Resident panel clinic at LBJGH: 6-5205 (requires agreement by attending or resident)
If you take care of patients
who are followed by a resident in the panel clinic (actually you should do this
with all PCPs), please inform that resident promptly of the patient’s admission
and arrange with him or her the appropriate follow-up at discharge.
If you believe that a patient
is appropriate as a new patient in the Panel Clinic, fill out a referral form
and contact the resident of that panel clinic.
Subspecialty Clinic.
Complete a referral
form. You may be able to contact the
fellow of a particular specialty to get an appointment quicker. They may refuse.
Coumadin Clinic
Many patients with
cardiovascular, renal or hematologic diseases need anticoagulation. A nurse managed “Coumadin Clinic” at LBJGH is
available, although the majority of patients have their prothrombin time
checked in the community clinics. Be
sure an specify on the referral sheet the exact indication for coumadin, their
current dose, and their last INR.
“Coumadin Patient Educator”
is available in-house during regular hours to teach your patients about food
and drug interactions with coumadin. Call the LBJ Pharmacy at (713) 566-4613. Need 24-hour notice.
Social workers: Numbers you can never seem to find:
|
Social
Worker
|
Tanya
Lattimore
|
6-5555
281-952-4634
|
|
Social
Worker
|
Deveeta
Porter
|
6-5579
281-952-4495
|
|
Social
Worker
|
Paul
Lyons
|
6-5556
281-952-4633
|
|
Social
Worker,
Affairs
of the Kidney
|
Brenda
Watkins
|
6-5559
281-952-4639
|
|
Clinics
|
Margaret
Tanyingu
|
6-5557
281-952-4635
|
|
Diabetic
Educators
|
Karen LaCour
(call in request
6-5314)
|
6-5177,
281-952-3898
|
|
Discharge
Planning
|
Perrie
Wilson
|
6-5953
281-952-5360
|
|
Discharge
Planning
|
Sandra
Henry
|
6-5020
281-952-7122
|
|
Physical
Therapy
Occupational
Therapy
|
|
6-5570
|
|
Psychiatrist
|
Dr
David
|
6-5964
|
|
Psychiatric
Commitment, (also adoption, CPS)
|
Juana
Amaya (Operations Mgr for Business Services)
|
6-5400
|
|
Pts
with HIV
|
Ruben
Ceron
|
6-5562
281-952-4034
|
|
Pts
with TB
|
TB
Control
|
713-278-6600
|
|
Substance
Abuse
|
Kim
Jackson
|
6-5763
281-952-4632
|
You should arrange a daily time to meet
with your case manager/social worker to discuss patients and discharge needs.
Home IV therapy is arranged by Ms. Henry, discharge planner, at
281-963-7126.
Rapid Access to Radiology
Reports
Procedure:
1)
From any phone,
call 566-5543.
2)
Enter 362867
(DOCTOR) when prompted for USER ID.
3)
Enter 362867
(DOCTOR) when prompted for STAFF ID.
4)
Enter #1 to enter
review mode.
5)
Enter 1 to review
by MEDICAL RECORD #
6)
Skip to next
report, touch 5 or Touch 9 to disconnect the system.
*** It is important that you
touch 9 to disconnect the system.
Failure
to do this will cause the system to shut-down.
7)
PLEASE DO NOT CALL THE LBJ TRANSCRIPTION
OFFICE. If you are unable to get the
x-ray report or need assistance, call 566-5447.
Policy for Housestaff Needlesticks and Other Exposures to Body Fluids
***If
you sustain a needlestick or other body fluid exposure, page the UTHSC Exposure
Hotline at (713) 951-8013 24 hours a day 7 days a week. The UTHSC Exposure Coordinator will instruct
you as to the course of immediate action depending upon the type of exposure
you have had.
There are times when problems arise regarding
ancillary services ranging from social workers to the laboratory. If you have a complaint, you are encouraged
to place a 4x6 inch card, the patient involved medical record number, date, and
the specific events regarding the problem and give this card to one of the
chief medical residents. These cards
will be brought to the attention of Dr. Finkel and any necessary action will
follow. Often time, complaints are
brought up but nothing can be substantiated because specific events are not
available. Specific DETAILS are needed in order to pursue any solution.
Internal Medicine Call Room Assignments
Location Room Number Room
Assignment
Back Hall 4SP70002 Float Team
Front Hall 4SP30014 Ward Team
Front Hall 4SP30005 Ward Team
Back Hall 4SP90002 Ward Team
Back Hall 4SP90004 Ward Students
MICU 3IC61003 MICU
Entitle note “Pronouncement
of Death”
Information note needs to contain:
(1)
Called
to see patient re: (cyanotic: no respiration, pulse, etc.)
(2)
Physical
exam: pulse 0 and BP 0
HEENT:
Pupils fixed and dilated
Chest:
no spontaneous respirations
CV:
No heart sounds
Neuro:
Unresponsive to deep pain
(3) Patient
pronounced dead at: (give time, date).
-(Specific family member) notified via
(phone or in person).
-Dr. (Attending) notified. (County coroner notified as needed).
-(Family refused or agreed to) (full
or limited) autopsy.
-Patient (is or is not) candidate for
organ donation.
-Funeral arrangements (have been or are)
being made for (funeral home).
Everyone on Ambulatory or Geriatrics will be
on ready reserve. When you are on ready
reserve, you are expected to be reachable 24 hours/ day, every day that month
(unless on vacation). It is your
responsibility to always have your pagers on and with you. Please leave cell phone numbers and home
numbers with the administrative chief at the beginning of the month. If you need to leave town, you must clear
this with the chief at the beginning of the month. You must answer your pages
in a timely manner (within 15 minutes).
Failure to do so will result in additional months of ready reserve and
possible other disciplinary actions by the department.
Abuse of the system will result in
disciplinary action, including not meeting your graduation date and having to
remediate certain medicine months. The
ready reserve is set up to help those who truly have emergencies. Let’s all try to help one another, as we will
all need some help at some time.
On
these days, both the Float Intern and the Float Resident will report for duty
come at noon:
Ø
July
4, 2007 – Independence Day
Ø
Sept
3, 2007 – Labor Day
Ø
Nov
22, 23 2007 – Thanksgiving
Ø
Dec
24, 25, 26 2007 – Christmas