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UKMC Phone ListPage 12UK numbers begin with 257, 218 or 323. To callUK from VA dial 9 then number.EmergencyFire/policeSecurityCode 500Safety Officer9113-61563-5200259-6690RiskManagementPoison ControlChemical spill7-62121-800-722-57253-6280UK MD’s 7-5522 (for outside doctor’s numbers and faxes)ComputerHelp deskCollege of medTASC Center3-85863-35807-8272MiscellaneousEmp. healthHome healthInfectionParkingPublic AffairsUK usekeepingHRKODAPhysical plantSexual HarassFax numbers5 Main: 3-59246 Main: 3-89356 North: 3-19337 Main: 7-52118 Main: 7-18633-51337-9519800-525-34563-62817-3100

VAMC Phone ListPage 13VAMC Phone list: From outside 233-4511 or 281and then the extension.GeneralAdmitting/ Bedcontrolmed recordsCode 50043794500AODTranscriptionRisk mgmt.IT help4950439349045550FloorsED3 North4 South5 Main6S MICU/SICUNP office4966/4660493449314933494247462 South PCUHospitalist officeDialysisRecovery/PACUOR5 Main l Add.Bone MarrowHematologyHistologySurg Rpts.45034432451645304509Blood BankChemistryMicroGen. PathologyCytology59374529452245084519RadiologyCT ScanVascular/duplReception/ genAngio/IR4567426142674254Neuro Card cath labEEGEMG/NCVHolter monitorExercise yECHOEKG/HeartStationEndoscopyNuclear resultsPulmonary Lab4360/4969473549214441

VAMC Phone ListPage 14From outside call 233-4511 or 281 and enter theextension.Therapeutic ServicesSATP (LD)3756Dialysis4938Pharmacy5631OutptPharmacy Inpt5202Disch Pharmac5218/5365ID Pharm4240CHF Pharm2357Heme Pharm5241Palliative4116Team RoomsRedPurpleOrange4421/ 44854786/ 47555168/ 4732Miscellaneous Access CodesERBadge accessTeam Rooms1234 #Supply Closets4511 #ICU Stairwell4500 #ICU entrance4567#rd3 Floor4511#ChaplainDieteticsPhleboProstheticsHome 4154BlueGreen4331/43344229CALL ROOMSA425B 4755#A425C 4412#A425D 4732#A425G 4563#ComputersGreg Hazlett, IM business manager: 4790Regional Help desk: 5550To page a VA pager from the VA dial 66, wait for the prompt,and then enter 3 digit pager number.

UKGS Phone ListPage 15GS numbers begin with 226. Not all lines areaccessible from an outside line, so if you pagesomeone at Chandler, page them to the main floornumber.Operator – 226-7000LaboratoryLab PagerPathologyBlood BankMaterialsAdmittingMedical RecordsPharmacySecurityHousekeepingHelp DeskPICC nurseMeds-to-bedsDiagnosticsEEGECHO (Peta)ECG statDialysisEndoscopyReading roomPhone in theresident workroom:7090 / 8566330-19457094323-9694257-921171007033 / 3-66248135 / 25 / 2740462070677214226-7129PTSpeech TherapyRespiratoryWound Care7026 / 7095330-7624330-863770502nd floor surgery3rd floor – select4th Floor ICU4th Floor Med/Surg5th Floor Med/Surg5th Floor Surg6th Floor Ortho7th Floor p LabRadiology residentNuclear 137200 / 82697016 / 2874

Discharge PlanningPage 16-Begins at admission!-Keep hospital course updated in snapshot daily, or at leastwhen having off to another resident.-Discuss issues at daily DC meeting.-Important questions to address daily*What is keeping them in the hospital?*Where will the patient go?*What needs will they have after discharge?TIPS-Nursing home patients:*Usually return to where they came from*MUST HAVE DC SUMMARY PRIOR TO DC*Scripts for controlled substances must be provided,even if it was a prior med (few days)*Other meds do not need scripts, but must be detailedin the DC summary*Ensure NH knows days in advance when youanticipate DC. The social worker will help with this.-Veterans:*Many different options, SW can provide a lot ofhelp with this*If the patient is admitted for placement it isimportant the SW know early

Discharge Planning – Patient Returning HomePage 17TIPS FOR DISCHARGE PLANNING1. Discuss plan with the patient and clarify any questions.2. Complete hospital course in the designated box in thesnapshot tab.3. Head to the discharge tab and follow the the various subtabs, Care providers- Enter your attending and list allservices consulted during hospitalization. Diagnosis- Enter discharge diagnoses, Reason forHospitalization: should be a one liner explaining whypatient presented. Hospital course: problem basedsummary of events. Do not paste in assessment andplan Medication: Will prompt you to complete med rec;prompted – very important to clarify new meds,changes made, and ensure accuracy Disposition: Where they are going and list anypending test Appointments: List all appointment details inSchedule For* box for all appts for follow up. Onsome floors, clerks will schedule appts based on whatyou enter on this part of discharge tab in advance4. Click discharge patient Discharge note will populatedetails from this tab. Please put physical exam, checkmark on order rec and select attending co-signer for thenote.5. Discharge order will pop up when you save note.*If DC summary is dated the day of discharge and has physical examit will also count as a progress note for the day.*Stuff sometimes disappears if you leave the discharge tab alone fortoo long, save any long hospital courses elsewhere.6. Prior to DC ensure all follow-up appointments are

A Day in the Life of the Intern at UKPage 18Pre-rounds at UK (06:30 – 07:00)You should start your day with the following:1. Night Float – Discuss any issues the night float intern may have had withany of your patients first thing in the morning.2. Check SCM for new orders and nursing communication.-physician rounding reports are a good for a quick summary and taking notes3. Medications- Check Medication Administration Record (E-MAR) DAILY.Found in SCM. Always know what meds your patient is on .- Day #/# for antibiotics- Usage of PRNs- If patient refuses or nurse does not actually give a scheduled med4. Telemetry if applicable. Check for overnight alarms and print strip ifnecessary. Found in Nursing stations or central tele on 6.5. Vitals (Tmax, I&Os, etc.) Found in SCM6. Labs and test results. Review all pertinent labs and check on cultures.7. Enter any orders you know need to be done.8. Head to Morning Report at 07:30 if there is time. If you are worriedabout any patient, go see them BEFORE morning report9. 8:15-9: go see your patients and get a brief overnight history and physical10. Start electronic notes if there is timeRounds (09:00 - 11:40):1. Communicate. Be sure your upper level knows of any urgent orunexpected findings from your pre-rounds prior to starting official roundswith the attending, preferably before morning report. NO DISCOVERYROUNDS.2. Learn3. Teamwork. Enter orders, etc. while other intern presents.4. Multitask. Review all consultant notes. Look for a chance to call thatconsultant or arrange that test during a lull in rounds. Your upper level mayhelp you spot a good time.Noon Conference: Eat and learn from 12:00 – 1:00Work:Procedures, test results, etc. Admit new patientsCheck on your patients one last time before you head out.Let your upper level know when you are ready to go.Checkout: at 17:00, Make sure all orders for the next day are entered. Goover your checkout list with the Resident and check out to cross cover intern.

A Day in the Life of the Intern at the VAYour Morning Plan at the VAMC:Page 191. Get checkout from the intern on overnight.2. In your team office, log into CPRS and check vitals and new ordersfrom overnight. Record significant findings, vitals, etc. on yourprerounding sheet. Look for trends in BP, Pulse, Resp, Pulse Ox, O2requirements, Temp. (Tmax in particular). Notes: review all noteswritten since you last looked Look for cross cover notes, nursing notes,consults notes, etc. In the Labs Section, look for any new results,review micro to see if culture results have been update. In theProcedures/Imaging section, check to see if official or prelim resultsare in the computer. Vitals are in Philips system for the PCU andMICU (Use you initial VA login to log on)3. Go to Morning report on 2N (7:30 am- 8:15am) on Thursday4. Make one circuit of the floor, examining each patient in turn, andrecording all findings on your prerounding sheet. Ask patient aboutany events, problems, symptoms, etc. Record I’s and O’s onprerounding sheet (Found on bedside board, NOT located incomputer; In the PCU data is located on Clinicomp U: & P: your CPRSID & password; Clinicomp1! For first time users password). Dofocused physical exam.5. Check telemetry on 5 & 3 for any overnight events.6. Prioritize patients to expedite discharge of patients prior to noon.7. Enter orders for any new meds, labs, tests as indicated based onprerounds. If orders need to be done STAT, you should call the nursetaking care of the patient or radiology as needed or your test will notbe done in a timely manner.8. Write SOAP notes9. Round with team and take notes during discussions on eachpatient regarding med changes, new tests or consults.10. After rounds, enter any new changes as needed. Call consultsearly. Enter new labs, tests, procedures, meds. Prioritize order entry inorder to get to conference at noon.11. Go to Noon Conference12. Check on patients again after noon conference, complete notes,and perform procedures as needed.13. Check out to on call team after all work is completed and allpatients are stable.

First Day of RotationThe First Day of the RotationPage 20As teams finish their rotation and move to the next, the handoffof patients to the new teams needs to be seamless. From a patientsafety standpoint, the patient is vulnerable to less than adequatecare during this transition. This is the main reason that internsswitch service on the 1st of each month and the residents switchon the 4th of the month. Even though it will be impossible toknow your patients as well as the intern who just left the team,the entire medical staff along with the patient and family will belooking to you like you know everything. To hit the groundrunning and complete a good handoff, the following tips will behelpful.Beginning a Service:1.2.3.4.Call your new resident the day before you begin.Discuss the patients with the off going intern to get a feel forwhat needs to be done.Briefly review the chart of each patient the day before youstart. You may want to write down previous culture resultsand imaging studies. Take notes re: plan of careArrive early to preround on your patients the morning ofyour first day on the service.When Leaving a Service:1.2.Write s succinct email check out with family dynamics notpresent in note. Complete hospital course in Snapshot tabfor all patients, especially those close to discharge so that theincoming intern is able to better understand the details of thehospitalization.The responsibility of the discharge summary(especiallyhospital course and meds) will go to the off going intern ifthe discharge is within 24 hours of leaving the service.

UKMC Diagnostic ServicesUKMC: How Do I Order a ?Page 21Transthoracic ECHO: Order complete StudyTransesophageal ECHO: TEE order. Call the TEE Cardiology Fellow.Carotid duplex: type carotid and select cerebrovasc study. Results in SCMdocuments.Venous duplex: type venous and you will find it. Best study is with vascularlab but they are only here M-F 8-5 If weekend or afterhours be sure to selectthe non vascular lab one.Nuclear stress tests: Go to Browse then cardiology then Gill Nuclear MedStress ECHO: under stress ECHO and assoc EKG is in the order set.Exercise stress tests: type Stress and you will find it.ECG: type ECG. Make sure to pick the inpatient one. Hardcopy in chart.Results in SCM imaging.Angiography(IR): Enter order- Consult interventional radiology. Callinterventional Radiology 30348 or page 1729 or sub-specialty listed onProvider on call. Talk with them first about if they will do the procedure.Make sure patient has recent coags and platelets and is NPO the night prior.X-rays: Search with part of body. ‘Foot’. Order with Indication for test andtiming (stat vs. am, etc)CT: order ‘CT ’ with Indication and technique, i.e. with contrast, withoutcontrast, pancreas protocol, PE protocol, etc. Consider prehydration fluids.MRI: order under ‘MR ’MRCP: order. Call MRI station to schedule.Ultrasounds: order US. Specify indication.Ultrasound guided tap*: order U/S and specify area to be marked, if youwant radiology (IR) to do the procedure you need to call them firstCT guided biopsies: Call Interventional Radiology.EEG: Order EEG routine or EEG and video. Results in SCM documents.EMG: EMG/ NCV. Specify limb. Call EMG for results.Bone Marrow Biopsy: Consult Hem/Onc fellowHemodialysis: consult Renal fellow to schedule. They put in the orders.ABG: ABG order set. Have the nurse page respiratory if emergency.PFT: PFT- specify full or screeningRespiratory Therapy: order nebs with instructions on dosage and frequency.The neb orders automatically expire in 3 days so make sure to review medsand renew these if neededPT/OT: order PT/OT evaluation order and reason. They are separate orders.Who needs to be NPO?: EGD, colonoscopy, surgery, PEG , IR, tubeplacement, abdominal ultrasound, ERCP, stress tests.Heart cath in AM (except EP procedures)- Clears from MN, NPO from 7AM.

VAMC Diagnostic ServicesPage 22VAMC: How Do I Order a ?For all testing at VAMC, put an order in CPRS first. It is always important tonotify people of the order at the VA to ensure that orders get done. STAT maymean tomorrow to someone else Follow the steps below:Transthoracic ECHO: listed under common proceduresTransesophageal ECHO: Call TEE Fellow on Cardiology to schedule.Carotid duplex: Under Radiology/Nuclear Medicine from main screen,Then, order #29- vascular lab. Then #1Venous duplex: Under Radiology/Nuclear Medicine from main screen,Then, then order #29- vascular lab, then order #3Nuclear stress tests: listed under common procedures (myocardial spec)ECG: listed under common proceduresAngiography/ CT guided bx: Call interventional Radiology to make surethey are willing to do the procedure then: Radiology/CT orders and pick CTguided bx , angiography etc.X-rays: Listed Under Radiology/Nuclear menu, Then under RadiologyQuick OrdersCT: Listed under Radiology/CAT. If you need it STAT then call down to CT,as often times they prioritize the outpts over the inpt so let them know youneed it now.MRI: Listed under Radiology/MRI. Usually this will happen at night sowarn the pt—they do outpt during the day, so don’t count on a STAT MRIUltrasounds: Listed under radiology/Nuclear, Then U/S #28Hemodialysis: consult Renal they will schedule the pt and put in the ordersABG: order under labs menuRespiratory Therapy: Under Respiratory, Then Respiratory Care Orders.Here is where order CPAP/ BiPAPPT/OT: Under Consult menu, then PM&R, then PT/ OT inpt (the RIGHTcolum). Same menu for PMNR consultHome supplies: To order BP cuff, bed/ mattress other things at home go toconsult menu, under prosthetics consult, then pick what you needHome O2 : consult menu, then Home oxygen request orderPharmacy Consult: Consult menu, then pharmacy. Where can place nonformulary consult or warfarin consultTip: if you do a procedure like paracentesis, LP, etc there is a lab fluid testsorder under then Lab menu that has useful order sets. A Urine lytes order setis here too

Dictation VAMCPage 23VAMC Discharge SummaryNote: discharge summaries are required prior to discharge toa nursing home or a VA facility.Donna Miller at 4379 will let you know which DischargeSummaries are yours and that you haven’t done yet.Make a list in your workroom of outstanding d/c’s for other ptThe discharge summary serves as an overview of the events ofthe hospitalization and provides the PCP and subsequentproviders with medication changes, follow-up plan andsignificant events. Since the VA operates an electronicmedical record, with easy access to all notes, diagnostics, andlabs, an extensive summary is unnecessary. The main focusshould be on the hospital course based upon the assessmentand plan, discharge medications, and follow-up plan. **DONOT SIMPLY CUT AND PASTE LARGE SECTIONS OFPREVIOUS NOTES INTO A DISCHARGE SUMMARY!!** Don’t forget to always flag the PCP as an additional cosigner on thedischarge day progress noteVAMC Discharge Summary FormatIdentifying data: included as part of CPRS including patientname, SS, admit date, discharge date.Service: Red, Purple, Orange, BlueAttendingDischarge Diagnosis (list all diagnoses)Reason for Hospitalization/HPI (1-2 lines)Past Medical HistoryHospital course (problem by problem is easiest to read)Discharge medsProceduresDischarge instructionsFollow up instructions

Death NoteDeath NotePage 24Things to Do When Called for a Patient Death1.2.3.4.5.6.7.8.See patient and assess for signs of life: listen for heartbeat, feel forpulse, check for pupil reactivity, do a sternal rub. If patient found andNOT a DNR, initiate a code and ACLS algorithm.Check telemetry if patient is being monitored.Inform next of kin of the death of their family member – face to face ismuch preferred.Ask family if they want an autopsy and name of funeral home.Call KODA, the organ and tissue transplant organization. You will haveto record the name of the KODA rep you talk to so write it down! If atthe VA you are not supposed to give the name of the pt to the KODArep unless they are a possible donor. This does not apply at UK.Documents for pronouncing MD (these include numbers for step 5):a. Notification of Death from in SCM at UKb. Death procedure note at VA.Work for primary intern – Death Summary (Abbreviated version of adischarge summary, choose d/c summary in SCM)Many attendings want to be informed immediately, even at 3am. Ask atthe beginning of the month.Death Summary FormatCOMPETE Patient ID: patient’s full name and MR #.Attending : they will be the one to sign the official death c

Sarah Schuetz, MD (PC Director) 562-2467 Sarah Vick, M.D (Associate Program Director) 323-7641 (Associate Program Director) Devin Oller, MD (Associate Program Director) 323-3872 Sean L