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All patients admitted between 8AM-5PM are to be seen by the Chiefs Residents for an admission H+P. Both the R1 and the R3 are responsible for complete H+Ps for each patient.

All patients admitted between 5PM-8AM are admitted by the R3 on call.

All admission are called to, and reviewed by, the Chiefs Attending,

The cap on the number of patients on the Chiefs Service is 12. If an admission is pending to the Chief Service and the Service is full the patient will be referred to the core faculties private service (Abington Adult Medical Associates) or the on call General Internist

Patients are admitted to the Chiefs service regardless of insurance status. We do take patients with insurance.

All patients who are seen in the ER should be discussed with the Chiefs Attending. The decision to discharge a patient to home will be made jointly.

ICU/CCU patients should be seen first on a daily basis. These patients require an AM and PM note by the Chief’s Residents.

New admissions to the General Medical Floors should be seen next.

There will be new Chief Attending Coverage on a weekly basis. On Monday of each week please call the Attending to touch base regarding sick patients.

Teaching / management rounds will occur with the attending every day between 10AM and noon. All patients must be seen by 10AM by the residents.

Prior to ordering all consults please review the indication and goal of the consult with the Attending. Remind the Attending that he or she is responsible for placing the actual order or signing the blue consult sheet within 24 hours.

Please consider discharge planning very early in the course of each admission. Acquire a social service consult earlier rather than later in the hospital course if necessary.

Cross coverage for the Chiefs R3 is provided by the R3 either in the CCU or the ICU (alternating admissions) when the Chiefs R3 is in clinic.

             - Both the R3 and Intern will have one day off per weekend.  
                    - R3 duties will include writing daily progress notes on all patients.  
                    - The R3 will be expected to do admissions prior to11AM (when                 
                       the On Call R3 arrives for sign in.  
                    - The R1 is also expected to write progress notes on his or her working day 
                       of the weekend.   
                    - Sign out of the hospital on weekends is 12PM.

You must call Michelle Johnston at beeper 12067 by 10AM the morning prior to your Chiefs rotation to review issues in case management

The case manager will assist with discharge planning.

You must keep in mind that insurance companies will deny payments for entire hospital days based on severity of illness and level of care delivered. Remember to be efficient in order entry (i.e. don’t discuss getting an ECHO or a consult on morning rounds and not place the order until the afternoon.) This delay in care may lead to a denied day.

 

If the patient is followed in the ASU, please fill out the orange sticker that summarizes the hospital course and indicates labs or tests that are pending at the time of discharge. Give these stickers to Lana within one day of discharge.

If the patient is followed in the ASU and has active problems that need close follow up in the several days post discharge, contact the ASU resident who functions as the patients Primary Care Physician and verbally review the issues.

A discharge summary must be dictated by the R3 in Medical Records within 5 days of discharge. This summary should include a record of what occurred during the hospitalization and also include any tests which are pending at the time of discharge.

 

Other Responsibilities

You are required to maintain at least one office based longitudinal session per week.

If you are in the ASU you are required to cancel your non ASU session.

Please notify the Office Manager regarding your cancellation of hours.