VA Orientation

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THINGS MEMBERS OF IDT MEETING NEED TO KNOW
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CASE MANAGERS:
Service connection
Home situation
Caregiver support
Subjective prior levelof function (PLOF)
Transportation at discharge
SOCIAL WORK
Insurance status based upon CPRS
Service connection
Advance directive/decision maker
Home situation/ caregiver support
PHYSICIAN:
Active medical diagnosis (reason for admission)
Pending/delayed imaging, studies, and consults (ie. Echo, MRI, X-Ray)
Required test/referrals/labs to determine medicalclearance
Required outpatient follow up
Decision making capacity of patient
Recommended level of care at discharge
PHYSICAL THERAPY
Current functional status
Anticipated discharge destination for rehab
Rehab and equipmentneeds
Current living situation, prior level of function, family/ caregiver support
OCCUPATIONAL THERAPY
Current functional status for ADL's/lADL's
Assess general baseline cognition/problem solving ability
KINESOTHERAPY
Complete prosthetic requests for DME and assistive devices
• Only if not followed by PT Assessment
PHARMACY
Medication related issues for admission/discharge


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HOSPITALIST ORIENTATION FOR MEDICINE 

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SENIOR RESIDENTS
Long Beach VA Health Care System Hospitalist Section
1. Speak with your attending about concerns.

a. If your attending does not provide guidance, ask your attending how he or she wants things done.

Clarify if you have questions.

b. Ask for feedback early and often.
c. Let your attending know about any special circumstances.

1. Special concerns or anxieties
Weaknesses you'd like to focus on
Religious or ethnic priorities

iv. Disabilities

v. Gender or pronoun preferences if they're relevant to how you want to be addressed.

2. CORE ATTENDING ROUNDS AND EXPECTATIONS

a. Attending rounds start at 9:30 AM and end at 11:30 AM weekdays.

Rounds will break so that you can attend noon conference. We expect you to attend morning and noon conferences

C. Your attending may want early discovery rounds, and this will be communicated separately.

d. Afternoon extensions of attending rounds will start at 1:30 PM. e.
Weekend rounds are at the attendings preference.

F. WHEN YOU ARE CALLED BY THE ED FOR AN ADMISSION, CALL THE ED BACK WITHIN 10 MINUTES AND PLAN TO ENTER THE DELAYED ADMIT ORDERS WITHIN 60 MINUTES.

G. ENTER PRE-DISCHARGE ORDERS FOR ALL PATIENTS AS SOON AS YOU CONFIRM THAT A DISCHARGE WILL OCCUR WITHIN THE NEXT 24 HOURS, EVEN IF IT IS JUST AN HOUR UNTIL DISCHARGE.

3. IDT Rounds

a. Interdisciplinary Team Rounds (IDT) are led by the team case manager.

b. The senior resident is expected to possess

a concise summary of the medical problem a concise list of what is preventing discharge
ill. a concise list of the DME, interventions and appointments required after discharge
c. Interns should be prepared, if necessary, to present on the senior's day off. This will be at the preference of the attending
4. DMS Rounds
a. Daily Management Rounds (DMS) occur each weekday at 8:20 AM.
b. Daily work issues and obstructions are reviewed.

c. Senior residents are encouraged but not required to attend DMS.

d. The senior resident should provide the attending with any quick hits or big issues to bring for discussion if the senior does not attend DMS

5. THE OFFICIAL CPRS TEAM LIST

a. The senior resident is responsible for the CPRS list of the team's patients.
b. The list should be named according to the following protocol and examples:
i. Team# month/day/year to month/day/year
1. Team # xx/xx/xxxx to xx/xx/xxxx
2. Team 1 01/01/2020 to 01/21/2020
3. Team 2 12/09/2020 to 12/29/2020

6. ALWAYS CALL YOUR ATTENDING FOR THE FOLLOWING

a. AMA
b. Unexpected discharge 
C.
A death, expected or not expected
d. A sudden turn for the worse, including a movement to a higher level of care
\Teaching, Med Ed, Teams & Faculty Development Teaching Course & Curriculum for Faculty Development Orientation Exercise for Ward Teams\ Hospitalist Orientation for Residents 6/21/2023 8:45 AM
c. RRT or Code
f. Some attendings may want a nightly checkout or discussion. Ask your attending for his or her preference.

7. TEAM ROOMS

a. All papers should be stored neatly.
b. All old medical records or identifiable patient records must be sent to medical records or shredded
Do not keep obsolete patient records on shelves or on desktops. Store them or Shred them.
c. All food must be in covered and closed containers and stored in cabinets or drawers off the desktops and out of sight.

8. DISCHARGE SUMMARIES & FOLLOW-UP

a. Discharge summaries must be completed within 48 hours of discharge.
B. DO NOT SIGN YOUR DISCHARGE SUMMARIES (when they come back to you). YOUR ATTENDINGS WILL SIGN THE SUMMARIES AFTER THEIR REVIEW OF THE DOCUMENT.

c. Maintain a list of all discharged patients to ensure the discharge summaries are complete and to follow-up on any pending labs, procedures or appointments.
9. Discharge Notes - Discharge notes should be signed before you discharge the patient

10. PRESENTATIONS

a. Copies of standardized presentation formats for new patient presentations and ongoing patient presentations are attached to the VA schedule documents.
b. Check with your attending for direction on how to use these documents for yourself and your interns.

11. MEDICAL STUDENT RESPONSIBILITIES AND EXPECTATIONS.

a. Presentations: Medical students have been oriented to the required formats for new patient presentations and ongoing patient presentations. Please be aware of these formats and help the students prepare for their presentations.
New presentation should be no more than 7 minutes and must include a recitation of key factors, differential diagnosis, related plans, and a brief learning issue presentation.
il. Presentations of ongoing patients should be no more than 5; students should use the SOAP format and should provide their analysis by problem from the active problem list.
b. New patients & Ongoing Patients: Students must work-up a new patient every day they are present.
They should carry no more than 3 patients. Rotate students off patients when appropriate.
Avoid overnight patients. Students will not have been able to see these patients. Reading the nocturnist note is not an adequate experience.
il. H&Ps: Students must provide their attending with a written H&P for each new patient. You
can review these before they turn them in to help refine the notes.
c. Weekday Hours: Students are expected to arrive when you arrive and leave when you leave on weekdays.
d. Weekends and Holidays: Students are off on weekends, holidays, the last Tuesday of their 8-week rotation for their OSCE and the last Thursday and Friday of their rotation for their shelf exam.
e. Concerns: If you have concerns about a students' performance, bring them to your attending and the clerkship director, Angie Nguyen, sooner rather than later.
\Teaching, Med Ed, Teams & Faculty Development\Teaching Course & Curriculum for Faculty Development Orientation Exercise for Ward Teams\ Hospitalist Orientation for Residents 6/21/2023 8:45 AM