FMIS Inpatient Seniors

2-senior schedule format 

Please see: PGY 2&3 Night Float 

Please see: PGY2&3 Day Shift 

Saturday Senior (24 hour call): 

-the schedule for coverage is made by the chief residents (see schedule here .please ensure you know when you are scheduled) and involves discussion with them as to when you prefer to be assigned

- The intern is expected to do the day admission

- Resident from ED rotation will be there 8pm-8am to do overnight admissions.

-Rounds start at 9AM.  Breakfast should be provided by the weekend covering attending.

-Friday NF sticks around Saturday AM and presents follow-ups for half the patients after admissions (i.e., Intern B's patients).

-Saturday is Intern B's day off.  Sunday is Intern A's day off. Intern A's patients (in terms of pre-rounds, writing notes, and presentations to team) are your responsibility for Sunday morning. 

FHC resident coverage on Wed Afternoons: 

• afternoon shift on Wednesdays to cover the service while the inpatient senior does panel management

• read up on the census before coming to shift

• arrive no later than 1pm for signout from day senior 

• because you are only here once a week, event notes and documentation about things that might not otherwise be charted is essential to furthering patient care

Resident overnight coverage on Saturday->Sunday Overnight: 

• the schedule for coverage is made by the chief residents (please ensure you know when you are scheduled) 

• you are responsible for admitting the 2 overnight admissions on Saturday night that can be assigned from 830pm-5am

• the day team will arrive at 9am at which time you will have first dibs to present your admissions and then leave 

Resident overnight coverage on Saturday->Sunday Overnight: 

• the schedule for coverage is made by the chief residents (see schedule here .please ensure you know when you are scheduled) and involves discussion with them as to when you prefer to be assigned 

• you are responsible for admitting the 2 overnight admissions on Saturday night that can be assigned from 830pm-5am

• the day team will arrive at 9am at which time you will have first dibs to present your admissions and then leave 

*Phone triage is signed out to 88000 all day Saturday, Sunday and nights.

• We receive phone triage from clinic patients 

• If you are not sure about management of the problem, talk to a fellow resident or call the attending. 

• We often get pages for hyperglycemia or hyperkalemia on labs. 

  • • Any abnormal K>6 should go to the emergency room for repeat K and EKG (see hyperkalemia algorithm under "on call resident resources" on main FMIS page) 

    • Hyperglycemia will depend on the patient's clinical status, sometimes it can be managed at home if the patient is stable and reasonable follow up can be arranged (walk in to Farrell the next day.

• If the page is for a Farrell patient, manage them and document as an "Amb Family Med Phone Call Note", adding the covering attending as a co-signer. Notify the attending by rounds the next day

• If you are unable to reach the patient, try to Document least 2 phone attempts. 

• Telephone Management of Post Abortion Problems 

• Sub-Interns will rotate for a 1 month block usually from the 1st to the 31st of each month.  

• Sub-Interns are not permitted to rotate during the month of July.  

• The senior resident and the attendings are responsible for the direct supervision of the Sub-Interns.  

• Everyone is encouraged to give continuous and constructive feedback to facilitate their learning. 

• The interns should continue to write notes on patients co-managed with the sub-interns

• Discharge summaries on patients managed by the Sub-Intern must be fully edited by the senior resident 

NYP Housestaff Manual Instructions: Declaring Death

• See the patient. Check the ID bracelet. Verify that the patient is unresponsive to verbal/painful stimuli, no respirations, no pulse, no auscultatable heart sounds, no corneal, reflexes, no pupil reaction to light, no doll’s eye pupils.

• notify the attending. Call the family if they are not present.  Ask the family if they wish to view the body before it is moved to the morgue, because once it has been moved, they will no longer be able to view it. If they wish to view the body, they must come into the hospital within a certain number of hours (discuss with charge  nurse).

• Request an autopsy from the next of kin (see below).

• You must always contact NY Regional Transplant Inc. at 1-800-443-8469 within 1 hour of declaring death to determine if any organs (including corneas) are suitable for transplant.

• Call Census / ADB (932-5078 Allen. 305-2624 Milstein) to notify them of the expiration. They will ask you information for the Death Certificate including: Name, MRN, age, date of admission, any surgeries or invasive procedures while in house, cause of death. For the cause of death, “cardiopulmonary arrest” is insufficient; they need the underlying diagnosis and the immediate cause (e.g. ‘cardiopulmonary arrest secondary to Strep. pneumoniae sepsis.’)

• Census will also determine whether the case is ‘reportable’ to the NYC Medical Examiners Office. These cases involve accidents, crime, drug overdose, suicide, HIV, or an operation or major procedure in the past 24 hours. If the case is reportable, call the NYCME at (212) 447-2030 to receive a case number that you must record in the chart before it leaves the floor. Not all reportable cases will require an autopsy.

• Questions from the family regarding the body should be directed to the AOD / census and the funeral home of the family’s choice. Generally, funeral homes handle the transfers.

• Fill out the small “Death Notice,” which you may obtain from the unit clerk.

• Write a short “Death Note” in Eclipsys. Include the patient’s name, age, admit date, diagnosis, date, time and cause of death, and any circumstances such as an unsuccessful code. Note the proper lack of pulse, respirations and brainstem reflexes. Document that the family, attending and census have been notified.

• Census/ADB will bring a Death Certificate form for you to fill out. After they enter the form into the computer, they will contact you for your electronic fingerprint signature.

• At the Allen Pavilion, page the Nursing Care Coordinator (NCC beeper 83906) who will bring you and assist you with the filling out of the Death Certificate form.

• The intern must complete the chart for all deaths in the form of a discharge summary.

Orders must be reviewed and updated every SHIFT. The hospital can be fined for any gaps. Use of 1:1 should be minimized.When possible group patients eg. 2:1

As the FMIS senior, residents will have a Farrell panel management session once a week. The goal of this session is to learn how to care for a panel of outpatients in a structured way.

• The panel management session is scheduled on Wednesday afternoons or Thursday mornings (if there is a second senior); please confirm on the Orange schedule.

• The panel management session is done via telehealth.  The resident does not need to come to Farrell in person but must precept via zoom (or can do in person if the resident prefers) with the assigned preceptor.

• Instructions for Panel Management 

• How to generate Epic reports