Unit Orientation/Expectations for Attendings
We believe in a interdisciplinary team approach to care that addresses the physical, mental, emotional and spiritual needs of hospitalized elders while rendering a continuum of exemplary and efficient care. Additionally, we seek to be the innovative leaders in defining and delivering the highest standards of patient care to the older adult population.
Curriculum Outline
Assessment Tools
Teaching
Evaluations
Daily Assignments on ACE Unit
Call Structure
Curriculum Outline
Core Topics in Geriatrics
Assessment Tools
Needs Assessment Tool for Residents
Teaching
- An evidence-based approach will be used by the faculty to teach core topics in geriatric medicine, specifically relating to the care of acutely ill elders in the hospital setting.
- Please see list of core topics for curriculum outline.
- Presentations of specific topics are available on our web site (http://www.med.unc.edu/aging/ace/ed_present.htm).
- Residents and students also serve as role models and teachers for students on the rotation.
Evaluations
- Evaluations are important!
- Attendings are expected to do evaluations after their first week and at the end of the 2 week block. Evaluations at the 2-week mark will be included on the resident housestaff website for review by the residency director and inclusion in the resident’s record.
- Please remember to evaluate the attending and the service/rotation.
Daily Assignments on ACE Unit
7:00: Formal Sign Out Rounds for all teams, every morning, seven days per week, in the 3 Anderson Conference Room. All team residents are required to attend, and attendings are strongly encouraged to attend. As the team resident and interns are no longer taking overnight call, this formal sign out is absolutely critical to improving safe transfer of patient care.
AM Rounds- 7:30 AM – 9:00 AM - Rounds should be crisp, not didactic, very short with bulleted problems lists. The team should all understand “the plan for the day.”
- Attendings should be present on AM rounds. Then discharges, testing for the day, and other plans will be formulated quicker than waiting to “run the list with the resident” later in the morning when the house staff may have already ordered tests that may not be appropriate or needed or omitted those that are needed and now can’t be scheduled until the following day.
- Attendings should see patients the day they are admitted. This makes rounds quicker, and plans are formulated sooner since the service resident usually has not seen but 2-3 of the new patients.
- Attendings should make time to independently teach students on a daily basis.
- Attendings should hold teaching rounds each AM from 11:00 AM –12:00 noon, approximately. These should be “non-optional.” House staff should not be interrupted except for 911 pages. Rounds should be supported with papers, evidence, etc. Encourage nurses to text page if necessary during this time of day.
- Attendings should hold daily X-ray/check-out rounds in the afternoon, to see x-rays, blood films, look at urines of patients with renal disease, etc. This is a good time to make certain everyone is on board for what to do at night, especially when we are not on call.
- Our attendings – and not the hospitalists – should write initial attending notes on all our patients. There are several reasons for this including: the division will not retain the first day billing, appropriate geriatric plans will be in place by the next morning, and the geriatric attending will already have seen and evaluated the patient before a day passes in house.
Additional Points of General Concern
- The attending should continue efforts to aggregate patients on 8 BT, especially the “geriatric unit,” where we should aggregate the very sickest and weakest of our patients. This will improve nursing retention and give our NP a place to focus his attention.
- Professionalism – No drinking or eating on rounds. No talking about patients in the hallways. No voicing of displeasure or dissent in front of patients. Please ask students and housestaff to dress appropriately. (Please see Am J Medicine 118, Issue 11, November 2005, Pages 1279 – 1286.)
- Attendings should intervene to avoid “fights” with nursing staff by housestaff.
- Attendings should attempt to prevent house staff from working up patients by committee. (By committee = attending, resident, intern students, or various combinations of the above, all going in together to “work up the patient”.)
- Students should be forbidden to work up patients by committee.
- The attending should ensure that students are involved in the care of all patients.
- Discharge planning has fallen on hard times. Attendings and housestaff in co-operation with social work should make certain that details don’t fall through the cracks.
- Attendings should ensure that housestaff always call the patient’s doctor of record.
Attendings should feel empowered to require the house staff to adhere to these principles.
Remember, interns and the team resident are no longer taking overnight call through the week. Close communication with the night resident, seeing patients who are admitted on the call night, and attending 7 AM sign out rounds are essential.
Call Structure:
Long Call is every fourth night. An intern and the team resident will take admissions until 7 PM. After 7 PM, admissions are worked up by the night resident assigned to your team (there are 5 night residents in the hospital each night; their responsibilities include admissions and cross cover call duties);
The team can take 2 "on call floats" from the night before on their call day. In addition, the team can take up to 5 new admissions during their long call day until the 11 pm time cap.
On the "off call day", the team can take one patient as a "short call" admission. This patient is worked up by the team intern and resident and attending. This "spot" should be reserved for a patient that is appropriate for the geriatric service.
Weekend coverage: Service intern that is "on call" on a Friday or Saturday WILL take overnight call and will see admissions and perform cross cover duties for the team. During the weekend, there will be only 3 night residents in addition to the service interns that are taking overnight call. On the post call weekend day, the team's other intern will also come in from 7 am - 7 pm to help round on the patients. The post call intern will need to leave the hospital by 12:30 pm. From 12:30 - 7 pm, the "sister team" resident will be available to support the other intern and team.
The resident and on call intern both come in on on call days on Friday, Saturday and Sunday. Sunday night is treated like a weeknight (with 5 night residents and no overnight intern coverage). The resident's day off is the non call weekend day. There is no short call on Saturday or Sunday.
Last updated 10/4/2007.
