- WHO: Attending, Day Resident, Day Interns, GMS Twilight Resident, Twilight Intern. Led by attending and residents as follows:
- Attending: 2x/week.
- Day Res: 1x/week.
- GMS Twilight Res: 1x/week.
- 1 day per week special:
- Follow-up Friday: provide follow up on patients discharged from the service.
- STRATUS (2x/month [1x per person] starting Sept).
- Physical Diagnosis Rounds every three Thursdays (rotates between GMS-B, GMS-C, and GMS-D). Please see GMS page for further details and schedule.
- Consider going to Heme lab, inviting a consultant to discuss a specific patient, etc.
- WHEN: Weekdays at 4:30pm-4:50pm.
- WHERE: Bedside, Field Trip (path, lab), Conference rooms (GMS B – Conference room next to 14B pod; GMS C – Small conference room adjacent to family waiting room; GMS D – 14A conference room; ITU-A/B in their respective conference rooms).
- WHAT: learning!
- Note: Peripheral blood smear rounds with Dr. Aric Parnes occurs every Wednesday from 4 to 4:15pm for ITU-A and 4:15 to 4:30pm on ITU-B in lieu of signout rounds teaching.
- Note: A pathology rounds pilot on ITU started in June 2018. Look out for details regarding a restart in October 2018.
- Tuesday and Thursday mornings. Please see weekly email from MRO regarding 15-minute window for each team.
- WHO: Residents and interns if done pre-rounding
- WHEN: 7:30am to 8:20am Monday to Thursday .
- WHERE: Shapiro Breakout Room (Except Wednesdays: Shapiro Board Room).
- WHO: Nightfloat Residents.
- WHEN: 7:30am to 8am on Fridays.
- WHERE: Eppinger Library (occasionally relocates to Pod C in the cafeteria).
Medical Grand Rounds
- WHO: Interns and Residents
- WHEN: 8:00am to 9:00am on Fridays starting in the fall.
- WHERE: Bornstein Amphitheater.
- WHO: Interns and Residents
- WHEN: 12:00pm to 1:00pm Monday to Thursday
- WHERE: Carrie Hall
- WHO: Interns and Residents.
- WHEN: 12:10pm-1pm on Mondays starting in the fall.
- WHERE: Jen Center Conference Room.
- In the summer, replaced by junior / senior bootcamp, locations will be announced
- WHO: Interns, pager covered by resident.
- WHEN: 12:10pm-1pm on Mondays.
- WHERE: Eppinger Library.
- In the summer, replaced by intern curriculum, locations will be announced.
Friday Noon Report
- WHO: Interns and Residents
- WHEN: 12:00pm to 1:00pm Friday
- WHERE: Shapiro Breakout Room
Keys to Successful Regionalization:
- Identification and communication of anticipated discharges: The more accurate information admitting has regarding anticipated discharges, the more likely that they will be able to assign patients to the right teams when the house is full. The unit coordinators enter information re: anticipated discharges into the bed management system. Residents should be proactive in communicating updates re: discharges to their Unit Coordinators.
- Early discharge of patients: If we can open beds before the peak of admits come through the ED, admitting will be able to assign patients to open beds rather than to beds with anticipated discharges. This will require 1) prep of discharges by Twilight team 2) preparation of the patient regarding their discharge and 3) good communication with the interdisciplinary team. The ED’s support for our regionalization initiative is based upon the notion that by creating more efficient teams, we will be able to discharge patients earlier and improve flow out of the ED. At times we will be asking the ED to hold our patients in ED longer until the right bed becomes available (see # 5 below). To sustain their willingness to do this, we will need to show them the benefit of our regionalization.
- Late discharges of patients: Our GMS restructuring into integrated day/night teams creates the opportunity to discharge patients in the evening, e.g. 8 pm, which was not previously possible due to evening crosscover of patients. This may be appropriate for patients who just require a bit more monitoring, e.g. tolerance of a meal or another set of labs.
- Identification of patients requiring precautions: When taking passoff from the ED or early in the admitting process, be mindful of whether you anticipate needing to assess a patient for an infection that will require a private room, e.g. flu, C.diff. Check to see if patient has been assigned a private room and, if not, notify admitting office to determine if patient will need to be reassigned to another pod/team.
- Reassignment of New Patients: At times, it may be necessary to reassign an admission from one team to another. For example, when admitting has assigned an admission to a team based upon an anticipated discharge, there may be times when that discharge falls through or a room on another pod opens up first. In this scenario, admitting will contact the ED flow managers to determine if 1) the patient can be kept in the ED until a bed on the pod of the initial team becomes available, 2) another patient in the ED can be assigned to the bed that opened first, or 3) whether due to conditions in the ED, the patient will need to be reassigned to the pod/team with the open bed. In the event of the latter, the team originally assigned the patient will give passoff to the new team to ensure a safe transition. The frequency of such reassignments will be monitored by residency, GMS, ED, and Admitting leadership and adjustments will be made to minimize these.
- Relocation of Off-Pod Patients: Off-pod patients not expected to be discharged within 48 hrs can when possible be re-located to a team’s unit. Team resident should notify the admitting staff of such patients. Admitting staff will determine whether relocation will be possible based on bed availability and overall hospital census
We have unprecedented support from the hospital leadership for this GMS Restructuring and Regionalization initiative. We will need to work hard at the above to help make regionalization successful and to maintain this support. Regionalization will not always be perfect and it will require patience from us during these times as well as continuous efforts to improve processes and to address barriers to successful regionalization.