Dr. Audoung

ORIENTATION
PRESENTATIONS
• History is important!
• Obtain hypothesis-driven history or further clarification
Serves as the basis for everything (key factors and understanding each case)
• Presentations
• Bedside new patients (or sick/unstable), table old patients
Stick to the SOAP format when presenting
• Trend VS and labs if relevant
Focus on active problems and KEY CLINICAL FACTORS to help generate ddx
• Goal of rounds = enhance ability to synthesize information and think critically
NOTES
• Goal of notes = 1) communication of thought process and treatment plan, 2) protection
• Daily progress note for every patient unless discharge note that day
Keep it updated and accurate
Common pitfalls
• Copy/paste, especially of consultants and physical exam
• Too long or too short
• Mentioning something in subjective and not addressing in your A/P
• EVENT NOTES
• Acute decompensation and updated plan/code status
• Patient/family discussions (includes informed consent and informed refusal)
• Significant changes in the plan
AMA discharges
• Does the patient have capacity?
• Document discussion of risk/benefits and return precautions
Reduce harm by providing discharge medications and follow-up
• Change of service
• In general, notes follow orders (transfer orders = NPTF, discharge orders = dc note/sum)
• ICU downgrades = progress note as "medicine accept note"
• Discharge notes
• Finish within 24 hours of discharge
• DO NOT sign discharge summaries (ok to sign discharge notes)
PATIENT CARE
• Start of the block
• Update all admit orders with new team members (right click -> change)
• Team list name on CPRS "team# MMDDYY to MMDDYY"
Review/clean up orders and notes
• Triage
Sick/unstable, new patients, cases where bedside evaluation will influence plan
• Admissions
• Get ED sign-out within 15min
• Ensure patients are stable (vital signs) and place basic orders
• Staff patients same day if possible, with the exception of long call

ORIENTATION
• IDT
Start thinking about dispo on day of admission
• Anticipate discharge barriers
Skilled needs (PT, IV therapy, wound care/wound vac, new G tube)
• Supplies/teaching
• Ziopatch (ordered prior to 2PM), prosthetics, home 02, HH orders
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Supplies for foley, G tube, wound care
• Diabetes or anticoagulation teaching
• GEC note for placement
Delegate to IDT members as appropriate
• Communication
• RTL in the afternoon
• Available on TEAMs or call/text
TIPS FOR EFFICIENCY
• Stay organized and have list of tasks in a central location
• PRIORITIZE
1. Consults and time-sensitive orders
2. Discharge early (med rec first)
3. FOLLOW UP
• Labs/diagnostics (replete electrolytes)
• Consultant notes
4. Daily to-do
REVIEW ORDERS
• PDO, restraint orders/notes
• IV meds and IVFs
Start notes early
Remember to order AM labs
Sign out together.
Update handoffs early
• Accurate and appropriate for night team
• Anticipate for if-then scenarios
• Update family members
• Run the list with yourself early and often
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Anticipate likely discharges for the next day and start de notes/med rec
Utilize your resources
• How can SW, CM, pharmacy help you