Resident Continuity Clinic (RCC) Manual

Transcription

1 Resident Cntinuity Clinic (RCC) Manual RCC Clinic Manual, Babic B. (Revised 2016, BB)

2 Table f cntents Page 1. Intrductin t RCC clinic 3 2. Rtatin specific learning bjectives 4 3. Resident allcatin MUMC 2G RCC clinics 8 a. Survival tips 8 b. Navigating Cmmunity Wide scheduling 10 c. RCC expectatins Cmmunity RCC clinics 13 RCC Clinic Manual, Babic B. (Revised 2016, BB)

3 Dear Pediatric Residents, Welcme t yur resident cntinuity clinic! Resident cntinuity clinics have been demnstrated t imprve resident learning and autnmy, as well as resident-patient relatinships. Resident cntinuity clinic shuld enable yu t integrate many f the specific bjectives achieved in previus ward and subspecialty rtatins. Yu will have a unique pprtunity t build cmmunicatin, management and prfessinalism skills while prviding quality care t patients. We hpe that this rtatin will be a relevant experience that cnslidates yur previus learning and challenges yu t see yur ptential as cnsultant pediatricians. Sme f yu are assigned t the 2G clinic at McMaster and sme f yu are placed in the cmmunity ffices. Regardless f lcatin, yu are respnsible fr pre-reading, cmpleting timely patient assessments, reviewing with supervisr, cunselling, dcumentatin and billing f the encunters. Yu will be expected t see 3-4 patients per clinic, generally 1-2 new and 1-2 fllw-ups. It is crucial that yu stay cmmitted t the assigned clinic dates, as that is the nly way t ensure cntinuity fr yu and fr the patients. Yu shuld review each patient with the assigned staff within the alltted 10 minutes. One mini MAS shuld be dne per clinic and yu shuld chse which aspect f the patient encunter yu want bserved. The final ITER will be cmpleted yearly. In additin, yu will cmplete the staff evaluatin frms as well as rtatin evaluatin at the end f the year. All evaluatins can be fund n One45. We welcme yur cnstructive feedback as we cntinue t imprve yur educatinal experience. Yur RCC clinic resident rep is Lindsay Fleming, and yur faculty rep is Bjana Babic. Dn t hesitate t cntact either ne f us if yu have any questins r cncerns. Sincerely, Bjana Babic babicb@mcmaster.ca RCC Clinic Manual, Babic B. (Revised 2016, BB)

4 Rtatin Specific Learning Objectives Resident Cntinuity Clinic is a lngitudinal cntinuity experience starting in PGY-2 until graduatin. This experience shuld allw residents the pprtunity t develp an understanding and appreciatin fr the lngitudinal nature f general pediatric care (and mst f its subspecialties). Under graduated supervisin, residents are expected t be primary physicians and decisin makers fr their patients. Residents will be able t manage a variety f acute and chrnic general pediatric cnditins. They will gain better insight int therapeutic relatinship f patient-physician as it evlves ver time. There is emphasis n learning practice management and health resurces utilizatin. This lngitudinal experience shuld enable the resident t be prepared fr independent practice capable f assuming a cnsultant s rle. (A) Medical Expert (1) The resident displays knwledge f cmmn acute and chrnic prblems encuntered in cnsulting pediatrics. (2) The resident demnstrates an understanding f nrmal/abnrmal develpment, nutritin and behaviral issues. (3) The resident can take cmprehensive histries and perfrm accurate exams in patients f different ages. (4) The resident is able t utline an apprpriate management plan including relevant investigatins, subspecialty cnsultatins and resurces (allied health/cmmunity). (B) Cmmunicatr (1) The resident demnstrates age apprpriate interview techniques. (2) The resident demnstrates sensitivity t emtinal and cultural issues, as well as knwledge f cnfidentiality limitatins. (3) The resident presents cases in an rganized and succinct fashin and dictates ntes summarizing the assessment and management plans in a timely fashin. (C) Cllabratr (1) The resident cllabrates with his/her clleagues ensuring resident cverage fr all clinics if a switch is required. (2) The resident wrks well with all members f the clinic. (D) Manager (1) The resident shws awareness f cst/benefit issues in the management f patients. (2) The resident shuld demnstrate knwledge f apprpriate shadw billings. RCC Clinic Manual, Babic B. (Revised 2016, BB)

5 (3) Residents in the Cmmunity Stream shuld develp an understanding f hw a busy cnsulting pediatric ffice functins. (E) Health Advcate (1) The resident actively prmtes invlvement f the patient and family in medical decisin-making. (2) The resident is aware f the imprtance f cmmunicatin between all members f the health care team including public health, schls, pediatric subspecialties, allied health and family dctrs. (3) The resident shws knwledge f cmmunity resurces available t help their patients (i.e. COPE, Child Welfare, Cntact, and ther reginal resurces) (F) Schlar (G) Prfessinal (1) The resident recgnizes the imprtance f cntinuing medical educatin and demnstrates reading arund cases. (2) The resident s knwledge and skills cntinue t prgress as expected during the lngitudinal nature f this clinic. (1) The resident understands the imprtance f meeting cmmitments t patients, families and clleagues. (2) The resident recgnizes his/her limitatins in cnsulting pediatric practice and seeks apprpriate assistance RCC Clinic Manual, Babic B. (Revised 2016, BB)

6 Resident Allcatin MUMC 2G Clinic: Carline Diri Brianna Empringham Ashley Mackey Rebekah Smith Attila Ahmad Nreen Che Fawaz Al-Anzi Haifa Al-Faraidi Juliana Girald Humaira Nael Je Oliver Maria Chacn Hannah Geddie Abeer Hegazi Kristin Inch Vidushi Khatri Lukas Kieswetter Jennifer Klwak Daniel Mulder Cmmunity Clinics: Drs. Orvec, Babic and Ramji: Lindsay Fleming, Jessica Dley Dr Seigel: Sarah O Cnnr Dr Hallett (Waterdwn ffice): Katelyn MacKenzie and Meredith Nel Drs. MacNay and Chitayat: Christine Teneder Dr. S. Wahi: 6

7 Madeline Burdick and Mena Bahnam Drs Alderazi/Bnsu: Rbin Mackin, Kendra Kmsa Dr. Nwebube: Nadia Mansr (as f January 2017) Dr. Hunter (Rn Jyce): Ania Van Meer and Anushka Weerarathne Kitchener Waterl: Jessica Nrris Mallry Fx Matthew Purser 7

8 Tpic MUMC 2G RCC Clinics Survival tips t new residents in the Resident Cntinuity Clinic (r SRC = Senir Resident Clinic) Tips Questins If yu have any questins, please feel free t ask the RN. She will be happy t assist yu. Any feedback is greatly appreciated and imprves clinic fr all N Shw If a patient is a n shw : dictate a letter utlining this s the family physician is aware Cmmunicatin Please bring and wear yur pager in clinic. This is hw the RN cmmunicates that yur next patient has arrived and t keep the clinic flw efficient. Als, text messages are less disruptive than kncking n the dr t relay this infrmatin. All patient/family cmmunicatin will be relayed by the RN via unless it is urgent. Please check yur s peridically fr any cmmunicatin and respnd in a timely manner. If the matter is urgent, the RN will attempt t page yu r the supervising pediatrician. It wuld be appreciated that yu cmmunicate when yu are away (e.g. vacatin, cnference) s that the RN is aware in case any patient / family wishes t cmmunicate with yu. Please be curteus t the 2G Business Clerks. If yu have a questin, and the Business Clerk is busy registering a patient, please wait until this prcess is cmpleted befre asking yur questin. In all cmmunicatin, please state which resident clinic yu are in. Fr example, if yu want t pick up yur clinic dcuments n Wednesday, be prepared t state which resident clinic yu are in. The Business Clerks d nt have the resident schedule t refer t. Dictatins Timely dictatin! The gal is t dictate befre leaving clinic. Always put the dictatin number n the Svera face sheet. This way, if the dictatin des nt appear in Meditech yu have a way f tracking it fr Transcriptin Services. Once yur dictatin is cmpleted, place yur dcuments in the left upper cabinet in muster statin 2 in the 2G clinic. Please include all dcuments, including patient labels. The RN will srt and send the apprpriate dcuments t Svera. The cupbard says General Pediatrics. Clinic Prep Yur clinic list, RMA billing and new referrals are prepped by the 2G Business Clerks n Wednesday and can be picked up late Wednesday. 8

9 Tpic Tips Transitins If the fllw-up appintment is scheduled fr the next resident year, please dictate a cmprehensive summary as a curtesy t the next resident, wh will be seeing the patient as a fllw-up appintment. Clinic space Space is at a premium in clinic. We nly have ne clinic rm per physician assigned t us. This pses a challenge fr efficient clinic flw. It has always wrked because everyne wrks tgether t facilitate this prcess. Dcuments There are 2 carts with clinic dcuments; ne fr patient educatin dcuments and ne fr clinical frms. If the RN is in clinic, then she will ensure that they are available. If she is away (e.g. n vacatin), they can be lcated either in muster statin 5 r the 2G supply rm. Please feel free t lcate these carts if the clinic nurse is away and then return them t the supply rm nce the clinic is dne. At the frnt f the 2G clinic, behind the frnt receptin area are slts fr cnsult frms, test requisitins etc. These slts are clearly labelled. If the RN is in clinic, she will place the frms in the apprpriate slts, but if she is away (e.g. vacatin) then it will be yur respnsibility. Anther tip, if the test r cnsult is urgent, please clearly label this n the frm. The triage prcess is different fr any urgent referral r test. Als, please state the supervising pediatrician n any frms. Fr example, nuclear medicine will nt accept any frm that des nt clearly state the pediatrician s name. If a patient s Diagnstic Imaging CD frm an external surce needs t be upladed int Meditech, a DI frm needs t be cmpleted stating t uplad t the system. If yu wish t have it interpreted by ur radilgist, just add this as well t the frm. Place the CD and frm in an envelpe with it clearly labeled n the frnt f the envelpe t g t Film Library. The RN will assist with this if she is in clinic. Otherwise, give the envelpe t ne f the 2G Business Clerks. If yu use the back f the utpatient prgress nte, please leave rm fr a patient label. Bkings There is a prcess fr bking new patients int the clinic and this always includes a paper prcess. Fr patients discharged frm hspital, a discharge rder AND a green referral frm shuld be written and is sent by the ward Business Clerk t the 2G clinic. Fr ER patients, a referral frm is faxed t the 2G clinic (Fax#: ). If yu plan t fllw this patient yurself, yu will need t knw the exact date and time f the appintment frm yur SRC clinic schedule as well as the resident cde (RES1, RES2, RES3 r RES4). It is wise t Wendy and/r Yvnne 9

10 Tpic Tips There is a clinic template fr scheduling (2 new and 2 fllw-up patients per clinic). If this template schedule needs t be verridden, please cmmunicate with the RN befre prceeding t bk the patient. The template fr all clinics are: Mrning clinic is frm 9-12 at muster statin 2 and we have rms 5, 6, 7 and 8 Afternn clinic runs frm 1-4 at muster statin 2 and we have rms 6, 7 and 8 Switches If yu switch with anther resident, please cmmunicate this t the RN in additin t the ther key medical individuals. Yu are respnsible t ensure that yu maintain patient cntinuity. If any patients need t be rescheduled please cmmunicate this at the time f the switch t the RN and ther key individuals. If rescheduling is nt pssible, please pass n a reprt t the resident wh will be seeing the patient in clinic. The RN will update and pst any changes t the resident schedule. This schedule is printed and psted at muster statins 1 and 2 in the 2G clinic. Navigating Cmmunity Wide Scheduling Enter int Meditech After entering yur USER ID and PASSWORD, chse Cmmunity Wide Scheduling Type RES1, RES2, RES3 r RES4 then Return Use arrws t select the appintment date yu wish t view Press A fr appintments, and a list f yur patients fr the selected date will appear with their bked appintment times 10

11 Use arrws t highlight and select the patient f interest Type M r click n Mdules t mve int a standard Meditech list f ptins fr that patient Patient names listed here MUMC 2G RCC Clinic Expectatins Pre-read abut each patient by reviewing available ntes n Meditech r reviewing referral letters faxed t the 2G clinic; cme prepared with any ntes, handuts r actin plans that may be needed fr each patient. If the clinic nurse is absent, prepared harts are available fr pick up the mrning f the clinic in the business clerk area. Arrive at least 5 minutes befre clinic begins t gather and rganize any necessary paperwrk and review any dcuments that may nt available n Meditech. Dress in prfessinal attire - OR greens, jeans etc. are nt acceptable fr clinic. Time management recmmendatins: 1 hur fr new cnsultatins (40min histry and physical exam, 20 mins t review with staff and cunsel patient/their family) 11

12 30 mins fr fllw-up (20 min histry and physical exam, 10 mins t review with staff and cunsel patient/their family) Mini-MAS must be cmpleted with each RCC clinic. The resident and staff will pre-identify which prtin f the histry, physical examinatin, r cunselling sessin will be bserved fr a patient at the beginning f clinic. Staff will cme int the clinic rm, bserve the encunter and prvide feedback. Residents are encuraged t write billing cdes fr each patient encunter n clinic billing sheets Residents are expected t dictate each patient encunter. Dictatin jb ID numbers are t be written at the bttm f each chart. Dictatin must be cmpleted the same day. Patient charts can never leave the clinic. Residents are expected t fllw up n the investigatins rdered and review them with the staff. If investigatins are dne utside f the hspital, staff is expected t frward the investigatins t the resident fr review. If a patient is a N Shw, please dictate a brief letter t the referring physician/family dctr s that they are aware and ask fr the appintment t be rescheduled if still warranted. If there is a schedule cnflict, the resident is expected t find his r her wn replacements and ntify the RCC clinic resident rep f the switch. She will ntify the RCC clinic nurse wh will make changes t the schedule. It is the resident s respnsibility t knw when their RCC clinic takes place. Missing a scheduled clinic will result in dcumentatin f unprfessinal behaviur and the resident will be required t meet with the prgram directr t discuss the reasn fr their absence. Residents shuld frward frmal evaluatins via One45 every 6 mnths t their clinic supervisr. 12

13 Cmmunity RCC Clinics Resident Scheduling 2 nd and 3 rd year residents will be bked fr their half-day RCC clinic nce a mnth. 4 th year residents will be bked fr their half-day RCC clinic twice a mnth. During ut f city electives, residents may miss clinics fr that mnth and can make up this missed time n a different rtatin if acceptable t their attending A half day will be chsen that is mutually agreeable t the resident and the staff supervising the cntinuity clinic Residents will be requested fr availabilities at least 6 mnths is advance Residents will fllw patients whm they have seen previusly t encurage cntinuity Patient Bking Residents will ideally see 3 r 4 patients per half-day (i.e. 2 cnsults, 2 fllw-ups OR 3 cnsults) Bking times are suggested as fllws: 1 hur fr new cnsultatins (40min histry and physical exam, 20 mins t review with staff and cunsel patient/their family) 30 mins fr fllw-up (20 min histry and physical exam, 10 mins t review with staff and cunsel patient/their family) Educatin/Evaluatin A mini-mas is t be cmpleted by residents with each RCC clinic. The resident and staff will pre-identify which prtin f the histry, physical examinatin, r cunselling sessin will be bserved fr a patient at the beginning f clinic. Staff will cme int the clinic rm, bserve the encunter and prvide feedback. Educatin ccurs n a case-by-case basis arund each patient during discussin. Residents are encuraged t learn hw t bill fr each patient encunter Residents shuld frward frmal evaluatins via One45 every 6 mnths t their clinic supervisr. Prfessinal Behavir Pre-read abut each patient by reviewing available ntes r reviewing referral letters faxed t the clinic; cme prepared with any ntes, handuts r actin plans needed Arrive at least 5 minutes befre clinic begins t gather and rganize any necessary paperwrk and review any dcuments that may nt available n Meditech. Dress in prfessinal attire - OR greens, jeans etc. are nt acceptable fr clinic. 13