GS3/MD3 Attending Responsibilities

GS3/MD3 Attending Responsibilities

GS-3 Overview It is a direct care team run by an attending and an APP. GS 3 attending has many other responsibilities at Good Samaritan Hospital besides caring for patients on GS 3. Provide care to 10-12 patients on GS3 with an APP Supervise GS0 APP for 12 patients on complex discharge team until GS6 comes on Accept, triage, facilitate transfer, admit and COHORT GS medicine patients along with those accepted and admitted by ATP/Swing at Chandler. Do medicine consults requested by other services at Samaritan ( Ex: From psychiatry, general surgery and Orthopedic surgery ) GS-3 pager number is 330-0304

GS-3 APP Can see GS3 patients and also help with admissions/consults during the day up to 10 patients a day combined APP can also do admissions and staff them with GS4 and GS5 attendings as needed.

Cohorting Guidelines at Good Sam - 1 All medicine teams at Good Sam including team health (Except GS 3) perform interdisciplinary rounding (That includes a physician, pharmacist, case manager/social worker and Bedside nurse) So, it is very important to geographically localize team patients as per these cohorting guidelines in order to facilitate this and also to help with efficiency and patient outcomes 4 west, 5 east, 7th floor are UK medicine floors, but we take overflow patients from other floors as needed and of course from ICU During morning distribution, assign all 7th-floor patients to MD4/5 with a target of 14 patients on each team from 7th floor. (702-711-Red hall for MD4 and 726-735 Blue hall for MD5 and 714-723 green hall patients can be distributed to either of the teams based on their census). We do this hall wise distribution to match up with nursing assignment to help them join us during rounds. Assign all ICU/Progressive, 4 west (Room 434-445) and 5 east (Room 502 511) patients to teaching teams (MD1/2).

Cohorting Guidelines at Good Sam - 2 MD3 picks up patients from floors other than the above or from the above based on their team numbers. MD 3 can start with low census (around 7) in order to be able to see new consults, admit a couple of patients to the 7th floor and to Non UK IM floors throughout the day with APP s help (which are usually around 3-4). When MD3 admits patients on the 7th floor, they will be checked out to MD4/5 the next day morning. (702-711 for MD4 and 726-735 for MD5) New patients needing admission coming to ICU/4 west/5 east will be given to teaching teams based on their numbers. Patients who come to Good Sam from chandler after getting admitted can also be parked on MD3 to distribute to the respective teams corresponding to the floor the next day morning.

Cohorting Guidelines at Good Sam - 3 Patients who get admitted by the team health night team on the 7th floor, 4 west, 5 east are supposed to be handed over to us (UK IM) in the morning by the nocturnist. If there is a room open for a patient on a particular floor, you can work with capacity commandbed board and Chandler ATP/Swing to bring a patient to that bed. (Can ask ATP/Swing to enter that team in Bed Request) When you are going off service, at the end of the work week, please redistribute MD3/4/5 patients on the 7th floor to facilitate cohorting. (702-711 for MD4 and 726-735 for MD5) Goals are - MD3 picks up patients from floors other than the below - Have all MD4/5 pts on 7th floor (702-711 for MD4 and 726-735 for MD5) - Have all teaching team (MD1/2) patients on 4 west/5th floor/icu. - MD1/2 teams are NOT expected to have any patients on the 7th floor. This automatically cohorts team health patients on 4 main. To prevent redundancy with nursing sign outs and cleaning rooms etc, we do not move patients just for cohorting purposes after they are already admitted to a floor. As always, our patients can be moved as appropriate when their level of care is downgraded or upgraded.

Admissions to Good Sam - 1 We are on service call for the GS ER for unassigned patients on Tues, Wed, Fri, Sun. Mon, Thurs, and 3rd Sat of every month are FP service call; Saturdays (except for 3rd Sat) are Team health/mesa s call for GS ER for unassigned patient We are NEVER on call on Mondays, Thursdays and Saturdays for GS ER unassigned patients Unassigned patients: from Good Sam ED go to on call service for that day. 1. Who have no PCP 2. Who do not belong to UK Hospital medicine, teamhealth/mesa or Family practice as detailed in the next page

Admissions to Good Sam - 2 UK Hospital Medicine patients: 1. UK Internal Medicine Clinic 2. FMC Prison patients 3. Polk-Dalton Clinic patients Family Practice patients: 1.If they have been admitted to the FP inpatient team in the last 1 year 2.If they have been seen in the FP clinic in the last 3 years 3.If they are Blackburn prison patients or State Prison patients When FM is on call and they are capped, Teamhealth admits for FM Teamhealth accepts readmissions within 30 days and Health Dept. patients

Admissions to Good Sam - 3 There is an extensive list of patient criteria who can not come to Good Sam due to lack of those services. The list is in the next two slides. Patients needing IR procedures and cardiac cath can come to Good Sam as they get transported to Chandler as needed and then come back to Good Sam after those procedures There is no fulltime ICU coverage at Samaritan, so if called from other services or ER to accept a patient who needs ICU care, then GS3 attending should direct the call to Chandler ICU. If GS3 attending determines appropriate care can be provided in Good Sam ICU then can accept patient there. We can call capacity command, bed board, ATP periodically to get updates on admissions, transfers and to facilitate them Capacity command 257-3014, Bed board 323-2233, Chandler ATP 330-6951 GS ER 226-7070, 7 main 7030, 6 main 7167, 5 main 7165 ICU 7364, 4 west 7365, 4 main - 7075 Good Sam divisional charge nurse who also coordinates patient transfers and bed assignments 859-338-8250

Services not offered at Good Sam - 1 Cardiac Catheterization: Patients get transported to Chandler for cath and come back to Good Sam after cath Cardiothoracic Surgery Chemotherapy: Even directed therapy for ITP, RA or IBD Critical care services Cystic Fibrosis Emergent Endoscopy (on weekend/off days), in case of doubt ask GI Fellow/Attending Emergent hemodialysis, i.e. Overnight/Sunday or access required Overnight/Weekend Hepatology

Services not offered at Good Sam - 2 Impending respiratory failure. Do not accept patient on BIPAP to Good Sam from Chandler ED or Outside Hospital: If BIPAP is home therapy, they can come Interventional Radiology (only few not offered) services TIPS, PTC, Embolization (Chemoembolization or for acute bleeding) Neurology Stroke Neurosurgery Oncology, active cancer treatment: patients with no active cancer management can come Plasmapheresis Plastic Surgery Radiation Oncology Transplant (bone marrow, heart, kidney, liver lung) Acute pain services

GS-3 Workflow - 1 Arrive around 6:45 am to receive checkout on overnight admissions and significant overnight events. Meet the Nocturnist in their workroom B103 on the first floor or page them at (330-3896). For patients on their way to Good Sam to be admitted, from chandler ED or from OSH, GS3 attending and nocturnist together can call bed board at 323-2233 to know which room the patient is going to and then assign patient team accordingly. (Ex: Patients coming to 4 main will be assigned to teamhealth teams) Distribute overnight admissions by 7:30 AM among Good Sam teams (both direct care and teaching ) as per the Cohorting guidelines. Place the ADT orders on patients distributed to MD4/5 (702-711 for MD4 and 726-735 for MD5)

GS-3 Workflow - 2 Team health Nocturnist/APP should meet GS-3 attending around 6:30 PM in the Hospitalist Workroom on the 3rd floor or Page us at 330-0304 to receive checkout on expected admissions and on patients that needs follow up at night. You can print Good Sam expected admissions from SharePoint to give to the Nocturnist. Give a ballpark number of patients to the nocturnist that you can take in the morning, as per GS UKIM census capacity. But we try to take all patients on 7 th floor, 4 west and 5 th floor from overnight. Team health night team pagers: MD-330-7905, APP 1-330-8476, APP 2-330-3896

Teaching teams MD1 and MD2 Teaching teams (GS1, GS2) Residents must get overnight patients by 7:30 AM for them be able to pre-round on their patients by 9 AM. Residency program pays a very close attention to this time. To help us with the above timeline, residency program encourages GS 3 attendings to just give patient names and MRN to residents, without going in to any history details Resident teams are on call on alternate days Residents work room extension is 226-7129. Both teams combined cap is 28 patients, with a rolling cap of 32. Can start with 14 on each team and with rolling cap can go to 16. Rolling cap is 14 (not 16) on weekends when the team has only one resident GS3 attending need to just give the patient information to the on call resident team about the overnight new patients or new admits through out the day, and then residents on GS1/2 will distribute patients amongst themselves. GS 3 attending does not decide which of the GS1/2 teams patients get distributed or assigned. Residents decide themselves.

Teaching teams patient distribution Teaching teams (GS1, GS2) Example: GS1/GS 2 start their day 9 patients each (18 total). If we give 5 patients from overnight, that brings them to 18+5 =23. This means, they can take 5 more new patients through out the day (28-23=5) if they do not discharge any patients. If they can discharge 4 patients combined, they can take 9 more new patients (5+4). What on call residents can NOT do is, take 5 morning overnight patients to their team and say they are capped for the day. It is GS1/2 residents responsibility to distribute patients amongst themselves in such a way that they can take 5 more patients through out the day (If they do not have any discharges) and 9 more patients if they have 4 discharges. Though residents are supposed to know this through residency program, it is encouraged to discuss this expectation the first day

GS - 0 GS 0 Complex Discharge Team CDT This team can have 12 patients Run primarily by an APP and supervised by GS 3 attending. It is a temporary disposition for low acuity, long term care patients whose disposition is complex till final placement is found for them like : endocarditis or OM who need long term Abx in a controlled environment, elderly demented patients who needs guardians, etc Requests to transfer patients to this team is run through PCF and APP. Patients are chosen very carefully to meet the goals of this team If PCF/APP team determines that a patient is appropriate for GS0 service, they themselves can accept the patient to this service. GS0 attending dose not need to see all of GS0 patients every day but can discuss all of them with the APP given the low acuity and other tasks attending has during the day.

Good Sam hospital floors There are total 7 floors Ground floor has - Gift shop, administrative offices where our weekly meeting occurs, main entrance, inpatient and retail pharmacies First floor ER, Cafeteria, Doctors lounge, security office 2nd floor Endoscopy suite, PACU, Operating rooms, Radiology 3rd floor Our division work space, resident s work place, Select LTAC hospital, Behavioral health unit 4th floor 4 main (401-433 for mainly teamhealth/fp pts), 4 west (434-442 for mainly MD1/2 pts), ICU & Progressive (448-462), Hemodialysis unit in room # 432. 5th floor MD 0 (512 523) and 502 511 for mainly MD1/2 pts 6th floor(601 635) -mainly surgical, family practice, Teamhealth pts 7th floor(702-735) for MD4 and MD5 patients

Good Samaritan UK Medicine Teams