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Tao T. Le, MD, MHSAssistant Clinical Professor

Chief, Section of Allergy & ImmunologyUniversity of Louisville

Senior EditorFirst Aid Board Series

USMLERx Test Bank Series

Firs t A id for t he Wards:The Real ly Shor t Vers ion

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Overview

Common Ward Mistakes

The Team

A Day on the Wards The Admission

Key Tasks

Survival Tips Getting Off to a Fast Start

Q&A

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Comm on Mis tak es

Not understanding roles,responsibilities, expectations

Not seeking timely feedback

Not using appropriate texts andreferences

Not knowing how to be a teamplayer

Inefficient organization andexecution of daily work

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The Team

Attending/Chief Resident Intern

Sub-intern Nurse Ward clerk Pharmacist Other staff You

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Typ ica l Inpat ien t Medic ine Day

Prerounds: 7-8 am

Work rounds: 8-9:30 am

Work time: 9:30-11 am

Attending rounds: 11-noon

Conference: noon-1

Afternoon work: 1-?

Signing out

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Typic a l Inpat ient Surgery Day

Prerounds: 5-6 am

Work rounds: 6-7:30 am

Preop prep: 7:30-8 am

Surgery/floor work: 8-5

Conference: noon-1

Afternoon rounds: 4-5:30

Postrounds work: 5:30+?

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Tak ing Cal l

Overnight call

Short call

Typically Q4

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The Admiss ion

The Call

Reviewing objective data

Medical record review Interviewing the patient

Physical exam

Putting it all together Reviewing case with the

resident/intern

http://upload.wikimedia.org/wikipedia/commons/6/6c/Physician_in_hospital_sickroom_printed_1682.jpg

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K ey Not es and Orders

Admit orders Admit to Diagnosis Condition

Vitals Allergies Activity Nursing orders Diet

IV fluids Medications Special studies Labs

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K ey Not es and Orders

Admission notesOnset

Progression

ProvocationPalliationQualityRegion

RadiationSymptomsSeverity Time course

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K ey Not es and Orders

Progress notes

Procedure notes

Daily orders

Prescriptions/DC orders

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Docum enta t ion T ips

Get everything co-signed

Date/sign all pages

No documentation = noreimbursement

Illegibility = no documentation

Use only appr. abbrev.

q.d." vs. q.i.d vs. once daily

To CYA, never CYOA!

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Oral Present at ions

Formal presentations

5-7 minutes (surgery: 2-3 min.)

Should tell a story

CC/HPI/PE/Labs sets the stage

A&P delivers the climax

Bullet presentations

1 minute 15-20 facts

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Dai ly Ward Ac t iv i t ies

Procedures

Patient/family

communications Consults

Data collection

Reading up on patients

Walking supply cart

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Survival Tips

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Ef f ic ien t T im e and Pat ien tManagement

Commit all tasks to a to-do list

Prioritize tasks

Organize tasks by location Maximize hospital information

system

Keep scut essentials on board

Always be early!!

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Organizat ional Aids ( Per ipheralBra ins )

Clipboard

Binders

Data sheets Note cards

iPhone/iPad/Android

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Evaluat ions

Critical for deans letter

Know the evaluation criteria

Clinical performanceShelf exam?

Know who is evaluating you

Clarify expectations Ask for feedback early on

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Di f f ic u l t Si t ua t ions

Needlesticks

Abusive/inappropriate house

officers Inappropriate procedures

Gunner classmates

Patient death

Sexual harassment

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Di f f ic u l t Si t ua t ions (cont .)

Difficult/violent patients

Difficult family members

Narcolepsy Personal/family illness

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Get t ing Off t o a Fast Start

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Sc hedul ing Rot at ions

Avoid most likely specialty infirst/last block

Avoid back-to-back toughrotations

Do easy rotation before

desired specialty rotations

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Choosing Rot at ion Si t es

County

VA

Academic/university center Community/private hospital

Outpatient clinic

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Before t he Rot a t ion

Classmates

FA Wardsspecialty chapter

FA USMLE Step 2CK FA Step 1 relevant content

FA Wardsrecommended

pocketbooks/texts/software

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Your Sec ret Weapons

Enthusiasm/hustle

Time

Basic science knowledge Low expectations