The Department of Internal Medicine is located on the first floor of the medical school building, adjacent to the green corridor. The Chairman’s Office and the Kirkendall Library are located in MSB 1.150. The main telephone number for the department is (713) 500-6500.

The Program Director’s Office is in MSB 1.126. Dr. Farnie’s assistant is Dolores Castro; her number is 500-6528. The Residency Program House Staff Office is at MSB 1.134. Susan Jones, Phyllis Martin, and Charity Harbes are the administrative assistants. Their phone numbers are as follows: Susan Jones 500-6525; Phyllis 500-6526; Charity 500-6536. The Chief Medical Resident Office is at MSB 1.136. The office numbers are 500-6523 or 6524. After hours or if you are sick or have an emergency and cannot report for work, please notify the Float Chief Resident, who can be reached at pager number 22001. This pager is active twenty-four hours a day, seven days a week.

Conferences

Attendance is required of all house staff and students. Please sign in before the conference begins in order to receive credit for attendance. Required conferences for ward teams include morning report and all noon conferences. Required conferences for the MICU and CCU rotations include all noon lectures, but not Morning Report. Post-call residents are excused from Noon Conference and Morning Report. Consultation residents are welcome to attend subspecialty conferences that are sponsored by other divisions; please notify the Chief Resident via email that same day.

If you have continuity clinic in the morning, you are expected to attend morning report at that hospital. Stay for the first case and you may leave to go to your clinic at 8:30am. You are excused from noon conference if your continuity clinic runs long; however, you will get extra credit if you make it in time to noon conference. If you have continuity clinic at a location other than the hospital that you are currently rotating through, then you are excused from noon conference to account for travel time. You should attend morning report at that hospital if your patient census permits.

Please notify the Chief Resident so that your conference attendance can be adjusted accordingly.

Please be on time, and before each conference begins, set your pagers and cell phones to silent. Please answer only necessary pages. For every month an individual’s attendance is less than 70%, he or she will be required to do an eight-hour shift at the LBJ Emergency Room. ****

The combined Internal Medicine-Pathology Conference will be held on a monthly basis. Every ward team is responsible for submitting at least one case to the Chief Resident at least one week in advance of the conference. The Chief Resident will select four to five cases and submit them to our colleagues in the Pathology Department. For the case presentations, our house staff should prepare no more than six, labs The Pathology house staff will discuss the histology slides.

Post Call Morning Report is every Tuesday. Attendance is required for all housestaff and students who normally attend morning report. Dr. Orlander is the facilitator and the presenter is the post call resident who presents cases admitted overnight with the “card” system. Please refer to the article “The Morning Report Card,” located in the Chief’s Corner at http://www.uth.tmc.edu/schools/med/imed/residency/chiefscorner/FredReport.htm for more details.

The President of the UT Health Science Center, Dr. James T. Willerson, will conduct Morning Report on most Saturdays in the Kirkendall Library at 6:50 AM. The post-call resident will present one case. Attendance is mandatory. All house staff and students of all ward teams should be in attendance.

General Internal Medicine Service

The general internal medicine in-patient service at Hermann consists of four teams that take call every fourth night. Each team consists of one resident and two interns. The upper level resident must write an admission note on every new admission, which may be a brief addendum that focuses on the assessment and plan, provided that a full intern history & physical is on the chart.

Daily “pre-rounds” is required, regardless of the size of the service. The upper level residents should report for duty by 6:45 am at the latest. The upper level resident must see and examine every patient on the service daily prior to attending rounds. Although the upper level resident is not required to write a daily progress note, he/she must examine the patient and supervise the interns and students. As interns and students are still inexperienced, their history and physical examination skills may be incomplete. Ultimately, the upper level resident is accountable for all patients on the service.

Each day the team “cap” includes new admissions from the emergency room; direct admissions from a UT Clinic or outside hospital; MICU transfers (count as one-half an admission); patients admitted by the Float Resident overnight; and “bounce-backs.” The cap is ten new patients and two MICU transfers. The intern cap is five new patients and up to two in-house transfers. Note: your attending physician must approve direct admissions from an outside hospital. Patients younger than 18 are admitted to Pediatrics. Generally, pregnant patients before 20 weeks will be admitted to the Internal Medicine service if she has a primary medicine problem. Patients 20 weeks and beyond with a primary medicine problem will go to the Maternal Fetal Medicine service. There may be exceptions to this general policy, which may require a discussion between the respective attendings to determine the best service for the patient.

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.

All general medicine admissions should be handled exclusively through the general medicine admission pager (#24032) in order to avoid confusion over which resident is on call at any given time. The person who carries the admission pager must collect information about all admissions when paged. Do not ask the caller to page another resident. If for any reason you are paged directly on your personal pager for an admission, please accept the admission and politely direct the caller to the admission pager for subsequent admissions. The emergency room will call you for an admission only after the patient has been assigned a bed. In your professional judgment, if you believe the patient would receive more appropriate care on a different service, promptly notify your attending. Please, do not argue with the emergency room. You may begin seeing a patient in the ER while they are waiting for transport to their assigned bed. In teh event the ER "retracts" a patient after you have already spent time evaluating the patient, you still count that patient toward your total cap. In the event of an egregiously inappropriate admission, discuss the matter immediately with your attending, who can discuss the matter directly with the emergency room attending. In the event that patient care is compromised from inappropriate triage and/or assignment to your service, promptly notify the Chief Resident. Each morning at 2 am, ideally, the resident on call should pass off the admission pager to the Float Resident. Each morning at 7 am, the Float Resident, in turn, should pass off the admission pager to the next resident on call.

The MICU is allowed to transfer patients twenty-four hours a day. If the MICU notifies you of a transfer before 2 am, you must accept the patient. If your team is capped, or after 2 am, the Float Resident will accept the patient and assume care until the next day’s admission team is officially on duty at 7 am.

Interdisciplinary Rounds

Walking rounds daily, Monday through Friday as follows (meet on unit at nurse’s station) with (1) team member from each rounding team to 5W Jones , (1) to 5W Cullen and (1) 8N Jones as outlined below:

Team A           0930-0945
Team B           0945-1000
Team C           1000-1015
Team D           1015-1030
Renal Wards    1030-1045

MHH Case Managers/Social Workers

5W Jones (MSCU) 5 W Cullen/Signature Suites 8 Jones (CMCU)/SACU/TCF

Clinical Manager: Phyllis Bertash Carmelita McKnight Trina Allison Moss
Pager: 22982 Pager: 18487 Pager: 29617

Case Manager: Katherine Koger Renita Buckner Aileen Villaneuva (CMCU) Pager: 18954 Pager: 24551 Pager: 20196

Social Work:         Kim Easley             Debbie Brod                                                    Sherrie Hamilton (SACU)
                              Pager: 24553                      Pager: 29610                                                    Pager: 24139

                                                                                                                                                Kim Brown (TCF)
                                                                                                                                                Pager: 24725

                                                                                                                                                Kim Easley (CMCU)
                                                                                                                                                Pager: 24553

Director: Virginia Earley Tammy Campos Tammy Campos
Pager: 22642 Pager: 24362 Pager: 22642

Post-call Cover Resident

The post-call cover (PCC) resident is an upper-level resident who fulfills the duties of the resident & intern after rounds are completed on the post-call day. The PCC resident picks up the PCC pager in the float intern’s room the morning of duty. The PCC is expected to be on rounds with the team to become familiar with the patients. When the team members are prepared to go home for the day, the team resident and/or interns will check-out their patients to the PCC, who will care for the patients until 4 pm, at which time the PCC will check-out the patients to the Float Intern and drop off the PCC pager in the Float Intern’s room for the next day’s PCC resident.

The designated PCC should touch base with the team resident the day before to determine when and where the team will round. Typically, the assignment of post-call cover is given to upper level residents who are currently serving on consultation at Herman or outlying clinics. The post-call cover is excused from all other clinical duties that day. It is every resident’s responsibility to check on Amion.com (specifically, your block schedule) to determine which months and which days you will assume this assignment. In a given month, if a resident wants to switch post-call cover days with another resident, he/she must notify the Chief Resident no later than the day before the assignment. Note to the ward team: if the PCC fails to do an acceptable job, promptly notify the Chief Resident so that this unfortunate situation can be addressed.

Near the end of the month, residents and interns must take the responsibility to make an appointment with their attending discuss their performance evaluation. We would also encourage you (interns in particular) to request a mid-month evaluation in order to address any concerns about your performance and rectify any deficiency before the rotation concludes. At the end of the rotation, you must complete the GMEIS on-line evaluation of both the rotation and the attending physician.

Nephrology In-patient Service

The nephrology in-patient service admits weekdays from 7 am through 4 pm and weekends from 7am through noon. If you are aware that a patient will arrive soon (via the ER or from clinic) and it is 4 pm, you should wait to evaluate the patient.

Admission Criteria for Nephrology Ward Service

Creatinine greater than or equal to 2.5
Patients with ESRD and a UT Nephrologist
Patients with ESRD and are under the care of by a private nephrologist who does not have admitting privileges at Hermann (same caveats apply), unless that private physician has an arrangement with another private nephrologists who does have admitting privileges (for example, Dr. Cherem is in Dr. Esquenazi’s group and takes care of their patients).

Caveats:

If a patient was directly admitted to the MICU or CCU and is set to be transferred out, the ICU Nephrology Consult Attending will ultimately decide to which team that patient be will be transferred, irrespective of the current creatinine level.
Patients NOT admitted to UT Renal Wards - Patients with ESRD and are under the care of a private nephrologists who has, or whose practice group has, admitting privileges at Hermann. For example, Dr. Noor Raman.
If a private nephrologist who has, or whose practice group has, admitting privileges at Hermann refuses to admit one of his/her own patients, then promptly notify the Renal Fellow.

As on the general medicine service, the upper level renal ward resident should write an admission note on every new admission. Again, this may be a brief addendum that focuses on the assessment and plan, provided that a full intern note is on the chart. Prior to daily attending rounds, the upper level resident must see and examine every patient.

Cardiac Care Unit

The CCU residents and interns are referred to as the Orange Team. Short call is from 6 am to noon, or four admissions, whichever one comes first. Short call is 1 day prior to long call. Long call begins after short call is capped or at noon, whichever comes first. The resident cap is ten patients. Please note that the intern admission cap is five, meaning five patients for whom they perform a history and physical. Once the intern cap is reached, all other patients that the resident admits must still be followed by the intern. Thus, the interns must know all patients on the service. Interns are responsible for admitting and caring for patients in CCU and on the floor.

The house staff will not work up patients who are admitted for elective procedures, such as pacemaker and cardiac catheterization. The interventional cardiology or electrophysiology fellow must admit and care for these patients. The fellow may inform the residents about these patients for float type coverage overnight. If a procedure oriented admission is complicated and will require more than a forty-eight hour stay, then the interventional fellow must notify the on call team staff that this will be a full admission, which will count towards the team cap. If a floor patient from another hospital service is transferred to the CCU, that patient must be transferred back to the original primary team after all cardiology issues are resolved. The upper level resident must write an admission note on every new admit. Again, this may be a brief addendum that focuses on the assessment and plan, provided that a full intern note is on the chart. There is no continuity clinic during this month.

The White Team is composed of a cardiology fellow, nurse practitioners and physicians assistants. They follow the patients of the private attendings, please refer to the list entitled “Cardiology Active Attendings” on the Chief’s corner for the list of attendings. The White Team admits the private attendings’ patients Monday through Sunday during the day. In the evening, the Orange Team on call will admit those patients of the listed private attendings and pass them off to the White Team the next day. The Orange Team resident on call must also be aware of all patients in the CCU for cross coverage overnight.

There is no continuity clinic this month.

Geriatrics Inpatient Service and Consult Service (updated 5/16/08)

Consult service: The geriatrics team will provide consultative services on patients with dementia, delirium, dizziness, falls, failure to thrive, palliative care, or abuse/neglect.

Consult pager: (713) 506-0069.

Weekend consult pager: (713) 404-0101.

Inpatient service:

Each weekday, the Geriatrics team will accept appropriate admissions to their inpatient service between 7 am and 3 pm on weekdays. The patients must be 70 or older, and not be better served by being on a surgical or specialty service (i.e. hepatology, renal, cardiology, etc.).

Inpatient service pager: (713) 961-6001

Weekend on-call pager: (713) 404-0101

Outpatient services:

Drs. Dyer and Ahmed have ambulatory clinic at UT West Loop Clinic. Their clinic also has the capability to do home visits in certain situations. Please call 713-572-8122 for appointments.

Ambulatory, consultative, and inpatient geriatrics services are also available at LBJ Hospital . The LBJ Consult Pager is 281-952-3674.

Medical Intensive Care Unit

Call is every third or fourth night. The fellow is expected to come in for all patients (exceptions: stable ESRD or hypertensive patients). The post-call team will write notes on all patients. Rounds Typically start at 7:30 am, except on those days of Critical Care Morning Report and Pulmonary Grand Rounds (Fridays), when rounds will start at 9 am. If you are not post-call, you can typically get to the unit by 7:20 am each day. Each housestaff is to have FOUR days off in the month, no more no less. Noon conference attendance is required everyday, and the same rules apply in regards to reviving an ER shift if conference attendance is less than 70%. Excuse yourself from rounds at 11:45 am if you are not post-call. If a patient is acutely decompensating, and the fellow needs your assistance, you are excused, but you need to let the chief residents know so you aren't marked absent. There is no continuity clinic during this month.

The "short call" team includes everyone not on call, and this team should stay in the unit until at least 2:00 pm. Their role is to assist the on-call team in any way, primarily with old patients, including procedures, transfer notes and orders during rounds. When all of the work is completed, this team can check out to the on call team and the ICU fellow prior to leaving.

Please take time to write detailed transfer notes, and gather the chart and other data prior to calling report on a patient. Make sure you know who to transfer the patient to, whether it be a particular medicine team, a private physician, or other service.

Do not make ventilator changes without the respiratory therapist or the ICU fellow. Otherwise, simply write your vent orders and alert the RT.

Consult Residents

There is a single pager for each consult service. The resident or intern must leave the hospital no later than 7 pm. If the attending or consult fellow does not abide by this rule, promptly notify the Chief Resident. You are responsible for taking new consults from 7 am through 4 pm during the week and from 7 am through noon on weekends. The Float Resident will notify you in the morning of any consults that were seen overnight.

Educational Materials And Resources

The Kirkendall Library contains the most recent copies of journals and textbooks. There is also a computer with internet access that is reserved for use by the house staff. After hours, you may enter through the keypad on the doors. To gain entrance, press 1 and 4 simultaneously, then press 2. The Jesse Jones Medical Center Library is located adjacent to the Medical School , and you have a free membership with your ID badge. We encourage you to register for remote online access to the Jesse Jones Library so that you may have instant access to online journals and databases.

Meal Tickets, Parking And Dictations

Phyllis Martin in the House Staff Office distributes meal tickets for your call days at two-week intervals. Please note that in order to receive meal tickets, you must be up to date on your dictations. Dictations should be done on the day of discharge and must be completed before you leave the service at the end of the month. Here are a few suggestions that have helped achieve this goal:

The house staff who discharges is responsible for completing the discharge summary dictation. Please, upper level residents, help your intern; if you discharge on an intern’s day off, then you must personally complete the discharge dictations.

Discharge summaries are not narratives and should be brief. The prototypical summary includes the following information in the indicated order:

Ø Admitting date

Ø Discharge date

Ø Admitting diagnosis

Ø Discharge diagnosis

Ø Attending physician

Ø Consulting Services m.

Ø Diagnostic tests/Dates/Results

Ø Hospital course (only pertinent findings, not a full H&P)

Ø Condition

Ø Activity level

Ø Diet instructions

Ø Discharge medications (in detail)

Ø Follow up arrangements

Routine Patient Care

Please keep your pager on at all times. The post-call cover resident must address all questions concerning the post-call team’s patients after noon. The post-call cover schedule will be given to page operators and to the nursing units. This schedule is available on Amion.com.

For billing purposes, please specify an admitting attending physician on your admission orders, diagnostic imaging tests, and consultations. Please confirm with the unit clerk that the attending of record on the Electronic Medical Records (EMR) is correct.

Starting July 3^rd, 2007, we will implement a chart labeling system. Please refer to the bulletin that will be dispatched the last week of June. The Chief Residents will distribute pre-printed labels to the upper level residents to all ward teams, the CCU teams, and the Float Resident to place on the patient’s charts and order forms to identify the correct teams. The purpose of this system is to improve communication between nurses and unit clerks and physicians.

In general, the general internal medicine floors occupy the 3^rd, 4^th, and 5^th floors of the Cullen Pavilion with occasional overflow to the 5th floor of the Jones Pavilion. The nephrology service is located on the 5th floor of Jones Pavilion. Cardiac monitoring is available on the 3^rd, 4^th, 5^th floors of Cullen Pavilion and the 5^th floor of Jones. Cardiology patients typically remain on the 3^rd floor of Cullen for IMU status, then subsequently downgraded to the 4^th or 5^th floor of Cullen.

Call Rooms

There is a card system for entry into the call rooms - one card opens all the doors. These cards are available to the residents in the Physician Staff Services Office, which is located on the 1^st floor of the Cullen Pavilion. Please defer any questions or problems with these cards to this office. Please, DO NOT use any call room that is not assigned to you.

Ø Cullen 242: CCU resident & intern

Ø Cullen 244: MICU intern/Ward intern

Ø Cullen 246: MICU resident

Ø Robertson 539: Ward resident/intern

(From the Visitor elevators, take a left off the elevator, another left, and the room will be on your right.)

Ø Robertson 631: Ward resident/intern

(All the way down the hall, take a right past the double doors that are usually open. The call room will be the last door on the left.)

Ø Robertson 675: Float Resident

Ø Robertson 676: Float Intern

Float Intern

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.

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. Let the chiefs know if you are leaving town during the month.

HOW TO TRANSFER A PATIENT TO THE MICU

Inform the Medicine Float Resident that a patient on the floor needs to go to the MICU & he / she will help you with the transfer.
Call the MICU team on call and inform them of the patient being transferred and give them check out. Once they officially accept the patient, they will inform the MICU Charge Nurse that they need to prepare a bed for your patient.
Inform the Charge Nurse on your floor that the patient needs to go to the MICU. He / she will arrange for a bed in the MICU and tell you once the bed has been obtained.
Write Transfer Orders and a Transfer Note while waiting for the bed.
Accompany the patient to the MICU if you have time and follow up with the MICU team later regarding the patient’s status.
Inform the Primary Team that their patient went to the MICU the next morning.
Special Situations:

There are no beds in the MICU

The Floor Charge Nurse and OA on call will try to find another Intensive Care Bed for the patient to be transferred to (i.e. CCU, TSICU (Transplant ICU), STICU (Shock Trauma ICU), etc. . . ) until an MICU bed opens up.

You need to call and give checkout to the accepting critical care team, then follow steps 4-6.

Caveat – The TSICU does not have a designated critical care team 24 hours a day 7 days a week, so you have to call for a Pulmonary Consult to manage the patient in the TSICU. The Float Resident should help you with this.

Additional tips:

You have backup!

Hermann - The Float Resident is your first backup. The MICU & on-call residents may be able to help you if they aren’t busy, and there is always the CCU resident or fellow. The on-call UT General Medicine Attending is your official back up attending.
Don’t forget that the Float Chief Resident pager is 22001 and can also be paged through amion.com under “Ward Attending”.
You are welcome to call the team if you need help with management, especially if they have instructed you to page them with questions or if it’s early in the evening. However, keep this to a minimum so as to give them a break (remember what’s it’s like when you are on wards!)

Get here on time – There will be lots of people watching the clock and waiting on you at your call room (Robertson 676).
Sign all your verbal orders before you leave the hospital!
If a patient dies, you need to call the team, and write a death note and fill out paperwork the nurses give you. The team can dictate the death summary the next day. You should also call the team if a patient unexpectedly deteriorates and needs to be transferred to the unit.
Figure out the cafeteria hours so you don’t get stuck without food! Don’t forget your meal cards. If you tell the chiefs what day you are on, we can bring them to you at the beginning of the rotation.
Don’t settle for bad checkout! Housestaff are to checkout in person, no exceptions. We need to know if there are any repeat offenders that are giving back checkout!
If you implement a new management plan for a patient (other than the usual Ambien, Tylenol, etc,) write a short note so the team knows what you are thinking. If you are called to evaluate an unstable patient, write a note. Go see patients with new fever, pain, chest pain, shortness of breath, or hypotension and write a short note. Page the team the next morning for any significant events. When in doubt, go see the patient and write a note. If a patient is unstable, notify the ICU resident early on. If you cannot quickly stabilize the patient, initiate transfer to the ICU under the supervision of your backup resident.
Don’t give patients big boluses of insulin when the nurses call you at 9pm with a high blood sugar!
Watch out for renal and hepatic function when writing meds!
Get an idea what the team wants you to do if an event happens. For example, if a patient is here for an infection, what do they want you to do if they spike a fever?
If the team wants you to follow up on labs (i.e. q 8 H/H’s) ask what time they expect the next lab to be done (and what they want you to do if they Hgb drops! – if the answer is transfuse – make sure they have consented their patient).
Ask the team to write as many “prn” orders as is appropriate.
Politely defer family discussions until the primary team is available the next day.
Good resources: The Washington Manual Internship Survival Guide, Survival Guide for Interns by Hammond, the UCSF Hospitalist (http://medicine.ucsf.edu/housestaff/handbook/index.html).
If something fishy is going on, like a nurse can’t figure out what team a patient belongs to, and they’ve been calling around, go to the chart and help figure it out. There have been lots of patients sent to the floor without a doctor or checkout. You can help avoid having a patient on the floor several days without ever being seen by a doctor – it happens!
Remember to coordinate your clinic days this month with the clinic coordinators at LBJ or Hermann, and adjust your float schedule accordingly.
Keep the chiefs in the loop for any issues we can help you with, or instructions we need to clarify, so we can resolve it quickly.
The official code team is made up of the CCU fellow, resident, and intern on call. If you are called that a patient you are covering is coding, assist the code team by calling the primary team and the family of the patient. Ask the code team resident if there is anything else you can do to help out.
1. Enjoy your 14 days off!
2. 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).

Float Resident

At this time, the Float Resident DOES NOT take admissions for the Renal Transplant Service.

The Float Resident serves three functions:

To cover overflow admissions for:

Ø the general internal medicine team that is on-call when that teams has capped, or starting at 2 am (which ever comes first) through 7 am. The Float does not come in earlier than 4 pm on weekdays, 12 pm on weekends and holidays. The cap for general medicine admissions is four.

Ø the nephrology in-patient service from 4 pm through 7 am.

Ø assume duties as Resident Admissions Officer (RAO) from 4 pm to 7 am, Monday through Friday, and 12 pm to 7 am on weekends and UT Holidays (Please Refer to RAO Duties)

To provide urgent consultations for general medicine or any internal medicine subspecialty. If the Medicine Consult Service is following a patient, you are responsible for addressing any new of acute medicine issues that may come up overnight.
To provide primary back up for the Float Intern on duty. This is especially important when the Float Intern is called to see an unstable patient and needs help. Please help the Float Intern with all transfers of unstable patients to the MICU.

The Float Resident reports for duty at 4 pm during the week and noon on weekends and official UT holidays (see UT calendar). The Float is responsible for handing off the general medicine admission pager to the RAO at 7 am Monday through Fridays and to the on-call Medicine Team at 7 am on weekends and UT Holidays.

Consults: The Float takes all general internal medicine and cardiology consults after 4 pm on weekdays and after noon on weekends and holidays. All urgent cardiology consults should be discussed with the cardiology fellow on call. The Float is responsible for notifying the appropriate consult team of overnight consults the following morning. All General Medicine Consults need to be discussed at the time of consult with the medicine consult attending. 713-608-0071.

If urgent/emergent consults in other internal medicine subspecialty services (e.g., endocrinology, rheumatology) are requested, the Float should contact the fellow on call for that service. Non-emergent consults can be referred to the appropriate consult service the next day; however, the Float should briefly see these patients and document that the issue(s) are non-emergent.

Cap: The Float Resident’s cap is TEN total patients. The cap on new admissions from the ER to various Inpatient Medicine Services is four. The remaining cap would then be any combination of six; this can include nephrology admits / hepatology admits / MICU transfers / consults. Please, triage these patients accordingly and attend to the sickest patients first. You may begin seeing a patient in the ER while they are waiting for transport to their assigned bed. In the event the ER "retracts" a patient after you have already spent time evaluating the patient, you still count that patient toward your total cap. If you are inundated with cases, do not hesitate to call the CCU fellow on call to help see cardiology consults.

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).

Backup Attending: Your backup attending is the On-Call Medicine Ward Team Attending (A, B, C, or D).

Ready Reserve

Everyone on Ambulatory or Geriatrics will be on Ready Reserve. This system is designed as a back-up plan to cover clinical assignments due to illness or family emergencies. During this month, you are subject to being pulled to temporarily cover other clinical assignments. You should not leave town without permission from the Float Chief Resident.

In the event that you have to miss a day for personal reasons (e.g., illness, death in family), the Float Chief Resident should be contacted promptly so that ready reserve coverage can be arranged. The Residency Program will not provide coverage for voluntary absences (e.g., weddings, birthdays, interviews, USMLE); instead, you should wisely plan ahead and utilize your days off or arrange your own coverage with other house staff. If you professionally arrange for one of your colleagues to cover for you, you must promptly notify the Float Chief Resident as well as the page operator if you have modified the call schedule.

Ready reserve house staff must keep their pagers on at all times. If you fail to return a page from the Float Chief Resident, you risk being penalized by accruing an additional ready reserve duty. Your ready reserve month will be listed in your schedule on Amion.com. If you foresee a problem with your designated month, notify in advance the administrative Chief Resident in charge of the schedules (Kim Tyler for the residents, Erica Hightower for the interns).

Miscellaneous

When using the paging system, we strongly recommend specifying a full ten-digit phone number. You may also add an asterisk ( * ) followed by your five-digit pager number in case the person is not able to promptly return your page. Please, do not assume that the person who you page is at the same facility as you are and will recognize a four or five digit call back extension. At Hermann, in addition to paging with 713-605-8989. If you are certain that the other party is also at Hermann, for example, you may page to an extension that begins with 4 x x x x but not 5 x x x x. For example, if you page Dr. Farnie to extension 53375 and he is at his office in the medical school, he will not be able to return your call. However, if you page him to extension 44008, then he will recognize that extension as 704-4008, and be able to return your call.

All orders written and progress notes must be signed legibly with a physician’s name with the physician’s pager number and hospital ID number. Please co-sign your medical students’ orders and notes as well as your verbal orders within twenty-four hours of giving the order. If you need to make corrections on your handwritten notes, use one line to cross through the error, then initial and date the correction.

The Telecommunications Office is located on the first floor of the Robertson Pavilion in the hallway adjacent to the service elevators for that pavilion. It is located on the left side through the double doors. At this office you may obtain replacement pagers and batteries. The phone number for the page operator is 704 - 4284.

Ø Radiology (plain films and CT) is located on the 2nd floor of the Jones Pavilion.

Ø The MRI suites and reading rooms are on the 1st floor of the Cullen Pavilion down the corridor from the atrium.

Ø The hemodialysis unit is on the 9th floor of the Jones Pavilion.

Ø The House Staff Association Office is located on the 1st floor of Cullen Pavilion. This office manages call room keys, scrub cards, and parking.

Ø The Cafeteria (Cafe Hermann) is on the 1st floor Robertson Pavilion.

Ø A general ATM machine is adjacent to the general elevator bank on the 1^st floor of the Jones Pavilion.

The UT General Medicine Clinic is located on the sixth floor of the UT Professional Building (UTPB). Some house staff will have their continuity clinics here. The general number for the clinic is 832-325-7100. Please verify your clinic day assignments prior to each month. You are responsible for contacting your clinic scheduler Sheri Janowski at 832-325-7462 for UTPB clinics or Donna McKee at 713-566-5079 or 713-566-4921 at LBJ to inform of clinic cancellations for post-call days and MICU/CCU/ER/vacation months. Clinics missed post call need to be rescheduled for some other time that week. Please note that you are the clinic patients’ primary care physician, and the clinic must be notified in advance if you will be absent. There is no scheduled clinic for the following rotations: MICU, CCU; and ER.

Days Off

Housestaff can take one day in seven off, free from educational, administrative, and clinical responsibilities, averaged over a 4 week period. Please arrange for days off early in the month, and coordinate with your fellow teammates. Upper level residents on call months (except at St Luke's) CANNOT take the 1st or the 2nd of the month as a day off. You CANNOT take these last two days of the month off because there are brand new interns on service, new attending, and a new fellow when applicable. The overlap of interns and residents from month to month is intended to facilitate a smooth handoff and taking these days off would defeat this purpose.

Medical Students

Students will be assigned to each ward team. You are expected to educate them. They will evaluate you at the end of each month. A few ground rules:

Ø Students must take overnight call

Ø No more than 3 new admissions per student per night

Ø No more than 5 “active” patients per student

Ø Their month ends on Saturday, not the last Friday of the month

Ø They are excused from all duties Thursday prior to their exam and have no call on the Wednesday before their exam

Ø They must have on average 1 day off per week and are excused on Labor Day, Memorial Day, Thanksgiving (Thurs and Fri) and July 4th

All student notes must be co-signed by a resident on service. A full resident note should accompany every student note each day. Acting interns should follow patients with the upper level resident on that service. A full resident note should accompany every acting intern note.

Moonlighting

Moonlighting is a privilege, not a right. Your primary responsibility lies with the rotation to which you have been assigned. Moonlighting is not permitted on call months. Moonlighting privileges are granted solely at the discretion of the Program Director, Dr. Farnie. Moonlighting shifts will count towards your eighty-hour work week.

Official UT Holidays 2007 – 2008

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

Ø Jan 1, 2008 –