[Örnek Belgeler] Cleveland Clinic Psikiyatri Yataklı Servisi Asistan Rotasyonu (Psych Residency) Genel Beklentileri
13 years 6 days ago - 13 years 6 days ago #1
by umc
Dr Ulaş Mehmet Çamsarı
[Örnek Belgeler] Cleveland Clinic Psikiyatri Yataklı Servisi Asistan Rotasyonu (Psych Residency) Genel Beklentileri was created by umc
Adult Inpatient Psychiatry Resident Rotation at The Cleveland Clinic
inpatient psych units at CCF psych
psych hospital units
3C unit: short stay
3B unit: medium stay
2B unit: long stay
6N unit: mood disorders & research unit
6D unit: geriatrics
campus units
P47 unit : Alcohol and drug detox
P78 unit : child psych unit
main ER:
psych ER:
Dictation Number à 44355 choose option 31 for dictation summary
Medical Records à (216) 363 - 2020
To make long distance calls dial 7777 after number
Intake (216) 363 - 2126
Dr x rotation:
àOn the first morning, arrive around 7:00am. Patients will be assigned to the Junior residents by the senior resident. Review charts. Review labs and nursing notes. Review medication records from the previous night.
àMorning rounds begin at 8:00am. There will be lightening rounds with residents, nursing staff, and OT staff from 8:00am – 8:30am.
àThen rounds will continue with staff and residents. Typically starting with evaluation of new patients by the senior resident. Junior residents are responsible for writing or dictating the new patient’s HPI which must be done with in 24 hours of admission. Than follow up patients are seen in team rounds. Follow up interviews and progress notes are done by the junior resident.
Junior Responsibilities:
1. The junior residents will carry 6-8 patients at all times. Any additional patients will be followed by Dr. x or Dr. y. Responsibilities include H&Ps, daily progress notes and discharge summaries.
2. Junior residents will interview any follow-up patients during rounds.
3. The junior resident will be available after rounds Monday-Friday until 430pm (except for post call, didactics or for pgy 2-4, longitudinal clinic obligations) for patient related issues.
3. Resident doctor of the day: 1 resident will be assigned to be the resident doctor of the day. This resident will be responsible for H+P’s and orders for new admissions after rounds until 430pm, in addition to managing issues of their current patients. The resident doctor of the day responsibility is to be distributed evenly distributed amongst junior residents rotating on the x, y, and z services.
4. Junior residents are to round on the weekends. This is to be decided among the junior residents about which weekend they will round (2 weekends in a rotation).
Senior Resident Responsibilities
A. Clinical Responsibilities
1. Acts as a "Junior Attending:"
a. Oversees all patient care done by Junior Residents.
b. Checks all orders written in patient charts.
c. Reviews new information for each patient in the am (including lab results, consults, and meds listed in MAR).
2. Interviews all NEW patients in treatment team.
3. When a Junior Resident is post-call:
• Assist remaining Junior resident(s) in follow-up interviews/notes until resident arrives from main campus.
• See post-call resident’s patients as soon as possible after discharges to allow post-call resident to leave as soon as follow-up tasks are finished (per duty hour regulations) – see Appendix
4. Signs-out to on-call staff on Friday afternoons (via phone or email – per STAFF preference). Updates list and then has Junior Resident add Friday afternoon admissions to sign-out list. After rounds, seniors should run the list with the junior resident prior to leaving the unit to return to main campus responsibilities. Admission orders should be phoned in for any new admissions to the unit during the afternoons when junior residents are unavailable.
5. In case of emergency, responsible for
a. Covering weekend rounds when Junior Resident is ill, has been pulled onto jeopardy coverage, or is on vacation ONLY IF there is insufficient time for the Junior Resident to find coverage.
b. Covering Friday afternoon admissions until 4:30 pm.
6. Performs one Bio-psycho-social assessment in front of team in preparation for oral boards.
7. Authorizing potential transfers and admissions to 3B unit.
B. Administrative Responsibilities
1. Distribute new patients between Dr. x and Dr. x y z in the morning prior to rounds making both lists.
2. Distribute new patients among Junior Residents as evenly as possible, also among medical students on service.
3. Junior Resident should be given no more than 2 weekends in one module.
• By the middle of the first week on service, have Junior Residents complete a calendar assigning afternoon unit coverage, Saturday rounds, and Journal Clubs. This calendar should also include who is post-call on specific mornings to assist in organizing the other assignments. This calendar should be reviewed by the Senior Resident – specifically for duty hour violations. Once signed-off and posted in the nursing station and rounds room, Junior Residents are responsible for any trading during the rotation.
4. Arrive early enough to prepare for Rapid AM Multidisciplinary Rounds which start PROMPTLY at 8:00am and should end by 8:30 am.
C. Teaching Responsibilities
1. Guide Juniors in selecting articles for discussion during Friday noon Journal Club.
2. Provide short teaching sessions during interruptions in rounds or when rounds end early. Review file of short articles, “pearls,” and handouts in rounds room at the beginning of the rotation and copy enough for the team to review during available moments. Good topics include:
• Recognizing akathesia
• Treating acute dystonia
• Recognizing drug toxicity (i.e. Lithium)
• Reviewing herbals that can affect psychiatric symptoms and treatment
3. Review with Juniors on an as-needed or ongoing basis their progress (strengths, weaknesses) and monitor their reactions to working on the unit.
appendix
Duty Hours Language
VI. Resident Duty Hours in the Learning and Working Environment
A. Principles
1. The program must be committed to and be responsible for promoting patient safety and resident well-being and to providing a supportive educational environment.
2. The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations.
3. Didactic and clinical education must have priority in the allotment of residents’ time and energy.
4. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
B. Supervision of Residents
The program must ensure that qualified faculty provides appropriate supervision of residents in patient care activities.
C. Fatigue
Faculty and residents must be educated to recognize the signs of fatigue and sleep deprivation and must adopt and apply policies to prevent and counteract its potential negative effects on patient care and learning.
D. Duty Hours (the terms in this section are defined in the ACGME Glossary and apply to all programs)
Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
1. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
2. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call.
3. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
E. On-call Activities
1. In-house call must occur no more frequently than every third night, averaged over a four-week period.
2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
3. No new patients may be accepted after 24 hours of continuous duty.
Dr. y and Dr. z rotations:
Dr. x and Dr. z see patients on 2B, 3B, and sometimes on other units. The junior resident rotating with Dr. xxx will carry up to 6 patients on 2B and or 3B. Dr. x and Dr. z do their lightening rounds together on 3B at 8:30am. The resident should come in at 8:00am to pre-round. The patient lists are kept on Sharepoint.
Patient Labs Access/Medical Records/Dictations:
All residents will need to complete a Lutheran Credentialing form to have access to patient labs and tests and dictation capabilities. On your first day, stop by the Medical Staff Office (1st floor) and speak to Nita to obtain a dictation code # and dictation card. This number is the same for accessing labs on NetAccess. All residents must also obtain a Lutheran photo ID badge. Go to the Human Resources office on the 1st floor to receive your badge.
Unlike dictations here at the main campus, each dictation that is done must have a "JOB #" written in the chart to indicate that it was done. After dictating a chart, you will need to press "*(star) 5". You will be given a number which you need to write down in the progress notes. This lets medical records know that the dictation was completed. If you dictate the chart and do not write down this number, the chart will be flagged as incomplete and will be sent back to you.
You will still be able to get the JOB# by listening to the dictation line, but it will take extra time, and maybe another trip to medical records.
Another reason you may have an incomplete chart is for a verbal order signature. Any verbal orders that are given must be signed by the person who gave them. Therefore, if you know that you were called while at main campus for orders, then co-sign the orders the next day.
You will receive a faxed letter in your mailbox here at main campus periodically from Lutheran medical records. This letter will indicate which charts are outstanding. It will further delineate which charts need (D)ictations and which need a (S)ignature (for verbal orders). Also, there will be a column indicating how long each chart has been outstanding. Any chart greater than 30 days is considered "delinquent", which has consequences on the attending’s privileges status.
If you call medical records at 216-363-2459 before going there, they will pre-pull all your charts so the stack is ready when you get there. There will be a colored page on the first page of each chart indicating all the physicians who need to complete the chart and what needs to be done by each.
DESKTOP ACCESS: TO LOG INTO THE DESKTOP COMPUTERS, USE YOUR OUTLOOK E-MAIL USERNAME AND PASSWORD. THE DOMAIN IS “CC.”
ACCESSING CCF INTRANET: From the WestNet homepage, go the "Sites" (at the top of the page), then choose "Health System" from the pull-down menu, then click on "CCF Intranet". (You will be unable to access EPIC this way - see below).
ACCESSING EPIC: From the WestNet homepage, go to "Applications" (at the top of the page), then choose "CCSAM - Secure.ccf.org (EPIC)". When prompted, enter your username, password, and domain ("CC"). Then, click on the green icon labeled "My Practice".
Education:
Grand rounds: the grand rounds from the Cleveland Clinic dept of psychiatry will be broadcasted live in the Castelle learning center on Thursdays at noon. For any questions about this, please call Mary Intorcio - pager (216) 207-1297
Journal club: the journal club is on Friday at 12:00pm sharp. The junior residents from all the treatment teams are required to attend the journal club. It is the duty of the resident who will be presenting to ensure that all attending and other residents receive a copy of the article to be presented, preferably a few days in advance. Articles to be presented should be either related to a case on the unit or be articles of great clinical importance.
1:1 supervision: while at Lutheran Hospital, each PGY I resident will be assigned to an attending for 1 hour of 1 on 1 supervision a week. This supervision can be done on Wednesday between 12:00pm and 1:00pm. The attendings will be assigned to the residents at the beginning of the rotation. This hour is to be used for general supervision and for teaching.
Didactics: the didactics will take place at the main campus on one afternoon a month. A detailed schedule of the didactics will be given out.
Research: By the end of the PGY I’s 6 months rotation at Psych Inpatient the PGYI is encouraged to write a case report or a brief literature review. The attendings at Lutheran will be available to mentor the residents with this effort.
Note: if you have any questions or concerns regarding educational activities at Lutheran, please contact Dr. x Pager x E-mail: x
inpatient psych units at CCF psych
psych hospital units
3C unit: short stay
3B unit: medium stay
2B unit: long stay
6N unit: mood disorders & research unit
6D unit: geriatrics
campus units
P47 unit : Alcohol and drug detox
P78 unit : child psych unit
main ER:
psych ER:
Dictation Number à 44355 choose option 31 for dictation summary
Medical Records à (216) 363 - 2020
To make long distance calls dial 7777 after number
Intake (216) 363 - 2126
Dr x rotation:
àOn the first morning, arrive around 7:00am. Patients will be assigned to the Junior residents by the senior resident. Review charts. Review labs and nursing notes. Review medication records from the previous night.
àMorning rounds begin at 8:00am. There will be lightening rounds with residents, nursing staff, and OT staff from 8:00am – 8:30am.
àThen rounds will continue with staff and residents. Typically starting with evaluation of new patients by the senior resident. Junior residents are responsible for writing or dictating the new patient’s HPI which must be done with in 24 hours of admission. Than follow up patients are seen in team rounds. Follow up interviews and progress notes are done by the junior resident.
Junior Responsibilities:
1. The junior residents will carry 6-8 patients at all times. Any additional patients will be followed by Dr. x or Dr. y. Responsibilities include H&Ps, daily progress notes and discharge summaries.
2. Junior residents will interview any follow-up patients during rounds.
3. The junior resident will be available after rounds Monday-Friday until 430pm (except for post call, didactics or for pgy 2-4, longitudinal clinic obligations) for patient related issues.
3. Resident doctor of the day: 1 resident will be assigned to be the resident doctor of the day. This resident will be responsible for H+P’s and orders for new admissions after rounds until 430pm, in addition to managing issues of their current patients. The resident doctor of the day responsibility is to be distributed evenly distributed amongst junior residents rotating on the x, y, and z services.
4. Junior residents are to round on the weekends. This is to be decided among the junior residents about which weekend they will round (2 weekends in a rotation).
Senior Resident Responsibilities
A. Clinical Responsibilities
1. Acts as a "Junior Attending:"
a. Oversees all patient care done by Junior Residents.
b. Checks all orders written in patient charts.
c. Reviews new information for each patient in the am (including lab results, consults, and meds listed in MAR).
2. Interviews all NEW patients in treatment team.
3. When a Junior Resident is post-call:
• Assist remaining Junior resident(s) in follow-up interviews/notes until resident arrives from main campus.
• See post-call resident’s patients as soon as possible after discharges to allow post-call resident to leave as soon as follow-up tasks are finished (per duty hour regulations) – see Appendix
4. Signs-out to on-call staff on Friday afternoons (via phone or email – per STAFF preference). Updates list and then has Junior Resident add Friday afternoon admissions to sign-out list. After rounds, seniors should run the list with the junior resident prior to leaving the unit to return to main campus responsibilities. Admission orders should be phoned in for any new admissions to the unit during the afternoons when junior residents are unavailable.
5. In case of emergency, responsible for
a. Covering weekend rounds when Junior Resident is ill, has been pulled onto jeopardy coverage, or is on vacation ONLY IF there is insufficient time for the Junior Resident to find coverage.
b. Covering Friday afternoon admissions until 4:30 pm.
6. Performs one Bio-psycho-social assessment in front of team in preparation for oral boards.
7. Authorizing potential transfers and admissions to 3B unit.
B. Administrative Responsibilities
1. Distribute new patients between Dr. x and Dr. x y z in the morning prior to rounds making both lists.
2. Distribute new patients among Junior Residents as evenly as possible, also among medical students on service.
3. Junior Resident should be given no more than 2 weekends in one module.
• By the middle of the first week on service, have Junior Residents complete a calendar assigning afternoon unit coverage, Saturday rounds, and Journal Clubs. This calendar should also include who is post-call on specific mornings to assist in organizing the other assignments. This calendar should be reviewed by the Senior Resident – specifically for duty hour violations. Once signed-off and posted in the nursing station and rounds room, Junior Residents are responsible for any trading during the rotation.
4. Arrive early enough to prepare for Rapid AM Multidisciplinary Rounds which start PROMPTLY at 8:00am and should end by 8:30 am.
C. Teaching Responsibilities
1. Guide Juniors in selecting articles for discussion during Friday noon Journal Club.
2. Provide short teaching sessions during interruptions in rounds or when rounds end early. Review file of short articles, “pearls,” and handouts in rounds room at the beginning of the rotation and copy enough for the team to review during available moments. Good topics include:
• Recognizing akathesia
• Treating acute dystonia
• Recognizing drug toxicity (i.e. Lithium)
• Reviewing herbals that can affect psychiatric symptoms and treatment
3. Review with Juniors on an as-needed or ongoing basis their progress (strengths, weaknesses) and monitor their reactions to working on the unit.
appendix
Duty Hours Language
VI. Resident Duty Hours in the Learning and Working Environment
A. Principles
1. The program must be committed to and be responsible for promoting patient safety and resident well-being and to providing a supportive educational environment.
2. The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations.
3. Didactic and clinical education must have priority in the allotment of residents’ time and energy.
4. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
B. Supervision of Residents
The program must ensure that qualified faculty provides appropriate supervision of residents in patient care activities.
C. Fatigue
Faculty and residents must be educated to recognize the signs of fatigue and sleep deprivation and must adopt and apply policies to prevent and counteract its potential negative effects on patient care and learning.
D. Duty Hours (the terms in this section are defined in the ACGME Glossary and apply to all programs)
Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
1. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
2. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call.
3. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
E. On-call Activities
1. In-house call must occur no more frequently than every third night, averaged over a four-week period.
2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
3. No new patients may be accepted after 24 hours of continuous duty.
Dr. y and Dr. z rotations:
Dr. x and Dr. z see patients on 2B, 3B, and sometimes on other units. The junior resident rotating with Dr. xxx will carry up to 6 patients on 2B and or 3B. Dr. x and Dr. z do their lightening rounds together on 3B at 8:30am. The resident should come in at 8:00am to pre-round. The patient lists are kept on Sharepoint.
Patient Labs Access/Medical Records/Dictations:
All residents will need to complete a Lutheran Credentialing form to have access to patient labs and tests and dictation capabilities. On your first day, stop by the Medical Staff Office (1st floor) and speak to Nita to obtain a dictation code # and dictation card. This number is the same for accessing labs on NetAccess. All residents must also obtain a Lutheran photo ID badge. Go to the Human Resources office on the 1st floor to receive your badge.
Unlike dictations here at the main campus, each dictation that is done must have a "JOB #" written in the chart to indicate that it was done. After dictating a chart, you will need to press "*(star) 5". You will be given a number which you need to write down in the progress notes. This lets medical records know that the dictation was completed. If you dictate the chart and do not write down this number, the chart will be flagged as incomplete and will be sent back to you.
You will still be able to get the JOB# by listening to the dictation line, but it will take extra time, and maybe another trip to medical records.
Another reason you may have an incomplete chart is for a verbal order signature. Any verbal orders that are given must be signed by the person who gave them. Therefore, if you know that you were called while at main campus for orders, then co-sign the orders the next day.
You will receive a faxed letter in your mailbox here at main campus periodically from Lutheran medical records. This letter will indicate which charts are outstanding. It will further delineate which charts need (D)ictations and which need a (S)ignature (for verbal orders). Also, there will be a column indicating how long each chart has been outstanding. Any chart greater than 30 days is considered "delinquent", which has consequences on the attending’s privileges status.
If you call medical records at 216-363-2459 before going there, they will pre-pull all your charts so the stack is ready when you get there. There will be a colored page on the first page of each chart indicating all the physicians who need to complete the chart and what needs to be done by each.
DESKTOP ACCESS: TO LOG INTO THE DESKTOP COMPUTERS, USE YOUR OUTLOOK E-MAIL USERNAME AND PASSWORD. THE DOMAIN IS “CC.”
ACCESSING CCF INTRANET: From the WestNet homepage, go the "Sites" (at the top of the page), then choose "Health System" from the pull-down menu, then click on "CCF Intranet". (You will be unable to access EPIC this way - see below).
ACCESSING EPIC: From the WestNet homepage, go to "Applications" (at the top of the page), then choose "CCSAM - Secure.ccf.org (EPIC)". When prompted, enter your username, password, and domain ("CC"). Then, click on the green icon labeled "My Practice".
Education:
Grand rounds: the grand rounds from the Cleveland Clinic dept of psychiatry will be broadcasted live in the Castelle learning center on Thursdays at noon. For any questions about this, please call Mary Intorcio - pager (216) 207-1297
Journal club: the journal club is on Friday at 12:00pm sharp. The junior residents from all the treatment teams are required to attend the journal club. It is the duty of the resident who will be presenting to ensure that all attending and other residents receive a copy of the article to be presented, preferably a few days in advance. Articles to be presented should be either related to a case on the unit or be articles of great clinical importance.
1:1 supervision: while at Lutheran Hospital, each PGY I resident will be assigned to an attending for 1 hour of 1 on 1 supervision a week. This supervision can be done on Wednesday between 12:00pm and 1:00pm. The attendings will be assigned to the residents at the beginning of the rotation. This hour is to be used for general supervision and for teaching.
Didactics: the didactics will take place at the main campus on one afternoon a month. A detailed schedule of the didactics will be given out.
Research: By the end of the PGY I’s 6 months rotation at Psych Inpatient the PGYI is encouraged to write a case report or a brief literature review. The attendings at Lutheran will be available to mentor the residents with this effort.
Note: if you have any questions or concerns regarding educational activities at Lutheran, please contact Dr. x Pager x E-mail: x
Dr Ulaş Mehmet Çamsarı
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