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IM BOOTCAMP 2016 - How to See Patients Daily

Published on Jul 11, 2016

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PRESENTATION OUTLINE

1.

How to see patients daily

ubc IM Bootcamp 2016  |  M. Lam, Nephrology PGy-5
Photo by Adrian S Jones
2.

OBJECTIVES

  • Understanding your role and tasks
  • Scheduling your day
  • Workflow
  • Discharges and Follow-up
  • New Consults
  • #ProTips
Photo by MartíApunts
3.

IM Jr - Your Role

  • Team Workhorse: hands-on patient care
  • "Most Responsible Housestaff"
  • Patient + family updates
  • Coordinating Tests/Consults/Care
  • Teaching
  • Learning
Photo by Stuck in Customs
4.

IM Jr - Your Tasks

  • Know the patient in and out
  • Ensure adequate workup
  • Follow-up on investigations
  • Facilitate d/c planning + paperwork
  • Update Sr + Attending
  • Be a team player
  • Teach med students
  • Reading around cases
Photo by Daniel Kulinski
5.

Workflow

  • Team Coordination + Supervision
  • Discharge + flow planning with PCC/CNs
  • Team scheduler
  • Teaching
  • High level reading
  • Difficult discussions
  • All-round extra pair of hands
Photo by Defence Images
6.

Typical Day Schedule

  • Morning
  • Noon rounds
  • Afternoon
  • Home
Photo by Kaba
7.

Typical Day Schedule

AM preparation: coffee, list, overnight labs, sickies
Photo by dieselbug2007
8.

Typical Day Schedule

AM handover: cases, images, issues
Photo by kevinspencer
9.

Typical Day Schedule

Reviewing New Cases: team efficiency
Photo by jenny downing
10.

Typical Day Schedule

(+/- Team Rounds: more team efficiency)
Photo by rileyssmiling
11.

Typical Day Schedule

Seeing Patients: off into the wild (-2hrs)
Photo by ºNit Soto
12.

Typical Day Schedule

Noon Rounds: nom nom nom
Photo by alachia
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Typical Day Schedule

Afternoon time: stable Pts, procedures, d/c planning, updates
Photo by betsyjean79
14.

Typical Day Schedule

Day's End: team check, handover, setup, reading list
Photo by Luz Adriana Villa A.
15.

Workflow

  • sickest patients
  • planned discharges
  • geographical efficiency
  • *issues-based rounding
  • ~15 minutes/patient
Photo by SolomonVipe
16.

Workflow

Chart, Vitals, MAR: often the hardest things to find
Photo by chunghow33
17.

Workflow

Updates: overnight, consultants, nursing, allied health
Photo by Agus MC
18.

Workflow

Notes: ID, issues + relevant changes, clinical reasoning, housekeeping
Photo by charissa1066
19.

Workflow

The Patient: observe, listen, examine, update
Photo by Alex E. Proimos
20.

Workflow

Review: lines/tubes/movements
Photo by Derek K. Miller
21.

Workflow

De-medicalize: fluids, meds (po), lines, ambulate
Photo by Jamiesrabbits
22.

Workflow

mental discharge checklist: outstanding barriers
Photo by Lino Steenkamp
23.

Workflow

Phone calls: tests, consults (early), family
Photo by garryknight
24.

Notes

full note vs. update note vs. clinical summary
Photo by Klardrommar
25.

Notes

"The One-liner"
Photo by coofdy
26.

Notes

clinical reasoning + anticipatory medicine
Photo by Paul Mannix
27.

Discharges + Follow-up

  • Prescriptions +/- faxing
  • Follow-up appointments + labs
  • BCMA Discharge form
  • Discharge summary (dictate)
  • GP phone calls
Photo by smiling_da_vinci
28.

New Consults

  • Triage
  • Setting up: pre-reading (history + reference)
  • "3 visits" --> "2 visits"
  • Impression, differential, plan
  • Orders
  • Case Review
  • Reassessment + handover
Photo by WarzauWynn
29.

#ProTips

Things to make life easier
Photo by MattysFlicks
30.

#ProTips

anti-entropy: be organized in your own way
Photo by Zeusandhera
31.

#ProTips

Avoid switchboard: on-call schedules, cell phone paging
Photo by PhotoAtelier
32.

#ProTips

Avoid switchboard: common extensions
Photo by christopher_brown
33.

#ProTips

Avoid switchboard: secret extensions
Photo by misterbisson
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#ProTips

Optimize your phone: hospital numbers
Photo by djwudi
35.

#ProTips

Pick Up The Phone: expediting tests
Photo by Dominik Syka
36.

#ProTips

Pick up the phone: Call People!
Photo by uncoolbob
37.

#ProTips

defend your territory: find a computer and keep it
Photo by hellosputnik
38.

#ProTips

Avoid Walking: Tubing
Photo by glasseyes view
39.

#ProTips

Avoid Walking: Telephone Orders (limit use)
Photo by Moe M
40.

#ProTips

Befriend the Unit Clerk... but never be above doing it yourself
Photo by Mobilus In Mobili
41.

#ProTips

technology: learn how to fax / photocopy / print
Photo by WarzauWynn
42.

#ProTips

Know what's urgent... and what can wait
Photo by redbanshee
43.

#ProTips

eat.  Just do it.  Sames goes for bodily functions.
Photo by cc.photoshare
44.

#ProTips

Suffer together: a team is a team is a team
Photo by IQRemix
45.

#ProTips

Know your resources... and use them regularly
Photo by MDMA.
46.

#ProTips

run. jump. play.
Photo by Roberto_Ventre
47.

#ProTips

Know your EMR: PCIS tricks (external)
Photo by chispita_666
48.

#ProTips

Know your EMR: SCM tricks (external)
Photo by Canadian Pacific
49.

#ProTips

balance: talk to your patients - discover who they are
Photo by garryknight
50.

Questions?

Clear as Mud
Photo by rvcroffi

Morgan Lam