Duties of the Acting Intern

…A User’s Guide to the Universe… step by step

  1. Admitting Patients

    1. You will admit 2-3 patients each call night
    2. Perform a complete history and physical exam on new patients
    3. Write/dictate the complete history and physical in the standard format used by your hospital
      1. The History and Physical Exam should include a complete problem list, well developed differential, and a thoughtful treatment plan based upon the available data
      2. Outline of Problem Based Assessment:
        • Problem
        • Differential Diagnosis
        • Supporting data for differential
        • Workup based upon differential
        • Treatment plan based upon differential and workup
    4. Write/enter orders based upon your treatment plan. Orders are reviewed and co-signed by your resident
    5. After admitting the patient, go back and check on them later that night. Make sure the admission orders are being carried out and that the patient is stable
  2. Follow your patient during their hospital course

    1. Preround: gather/record or do the following
      1. Check out from the covering intern
      2. Medications from the MAR (this may NOT be the same as those ordered or thought to be ordered); record any and amount of prn medications used
      3. Lab data
      4. Vital signs
      5. Information from the nurse: ALWAYS talk to the nurse for the real scoop
      6. Talk with the patient and do a focused physical exam
      7. Tubes and lines: look for/document foley catheters, telemetry boxes, IV lines, central lines, restraints, oxygen
      8. Develop a plan for the day BEFORE you round with the team
    2. Rounds: Present the above data in concise format, including your plan for the day
      1. Know more than you write, write more than you say…
      2. KEEP YOUR DATA ORGANIZED
      3. Suggestion: KEEP A FULL SIZED NOTEBOOK: DO NOT BE TOO PROUD; YOU WILL LOOK GOOD IF YOU ARE THE ONE WITH THE DATA!!!
    3. Routine Daily Care
      1. Consults
        • Call initial consult EARLY
        • When calling initial consult, have clinical question to be addressed
        • Follow up VERBALLY with the consultant; do not just rely upon the note; you will learn more and have a better understanding of your patient if you talk with the consult team
      2. Talk with the team and staff, nurses, PT, OT, RT, pharmacy
      3. Daily notes should be thorough but concise
        • Avoid pitfalls of the “template” if using EMR; read the entire note and make sure that it makes sense for that day
      4. Enter daily orders, labs, medication changes for the following day
      5. Do daily reading based upon clinical questions
      6. Organize and be an active part of any family discussions
      7. If you order a Test:
        • Let the patient and family know!
        • Follow up the result
        • Look at the result: Look at the EKG, xray or other study, not just the report
        • Make sure you understand how to interpret the results; discuss with your resident
        • Let the patient/family know the result
      8. Review medications daily, stop those that are unneeded; keep a record of admission/home medications for reconciliation
      9. Discontinue medications, lines, tubes, boxes, oxygen that is not needed
      10. Touch base with social work daily; complete needed forms such as the FL-2, find out what will be needed before anticipated discharge
      11. Inform the patient’s primary care provider of admission, key issues and future discharge needs
  3. Call Nights:

    1. An AI is expected to stay in the hospital overnight. Follow your intern for crosscover calls and emergencies. You should cover your patients, but not cross cover the patients of other interns.

  4. Off Call Nights:

    1. “Sign Out” or “Check Out” to intern covering for the night
    2. Face to Face exchange (do not just leave list)
    3. Important data
      1. Anything the intern needs to do or follow up on (important tests, consult advice)
      2. Code status
      3. Anticipate…
        • If this… then do this…
        • Reculture if fever? Change antibiotics? ICU needed? Family issues?
    4. Ask your resident to supervise your first 1-2 check out sessions
  5. Daily Sign Out

    1. Your resident and attending need to know before you leave for the day
    2. Review progress and results, check out any uncompleted tasks, plan for tomorrow
  6. Discharge Planning

    1. Keep the patient and family informed of upcoming discharge
    2. Touch base daily with social work
    3. Do as much as you can ahead of time
      1. Preliminary discharge summary
      2. Forms, FL-2, green sheet, home health orders, ambulance form
      3. Out of Facility DNR form signed by your attending if needed
      4. Follow up appointments
    4. Review medications
      1. Compare to admission medications
      2. Make sure patient understands discharge medications and changes
    5. Dictate/Write Discharge Summary: Review with your resident and attending for feedback
    6. Keep any tests that are pending on a list – just because a patient is discharged does not mean the work is “done”
    7. Follow up after discharge: keep a list, make sure they get to their follow up, call them if needed