Team Expectations

"You're throwing fastballs at a catcher with no mitt"

A: Pts who are acutely ill or worsening quickly, “watcher” status, or never seen together as a team
B: Pts responding to therapies but still require updates to care and ongoing hospitalization
C: Pts pending discharge that are not able to be discharged for some defined reason (i.e., EOT for antibiotics, HD chair, placement)
D: Pts anticipated for discharge

A/B/C/D should be set prior to rounds by intern/resident and determines presentation:
- A/B: team dependent (full, problem focused, etc.)
- C: brief update
- D: DDEMAP
Attending rounds typically run from 9-11:30a on weekdays, team responsibility to troubleshoot difficulties with this
See all A (including new to team) and definitive D patients in person (non-primary intern can be excused if busy).
- Primary presenter for patient should lead patient discussion.
Interns can be split for rounds to get work done
All team members should be prepared for rounds
Use of AIDET, communication with patients or surrogate decision makers and appropriate use of
Interpreter services (as well as correct documentation where appropriate)
A note should be completed each day (H&P – overnight team H&P counts if completed after midnight, progress or transfer note, or discharge/transfer summary). Team should be clear about who is responsible for note (i.e. typically student, intern, or resident)

See all patients every day. D patients should be seen prior to 12:30 to allow for discharges.
Coordinate teaching
Ensure CM rounds are running appropriately (providing resident and CM team with feedback)
Be available to help team members throughout the day
Supply feedback on patient care, presentations, cache, and documentation
Help in resolving conflicts between services
Be available to staff all new admissions with primary intern/resident by 4pm on short call days and by 6pm on long call days
Cover pager during Afternoon Report and non-Long Call/Short Call days Thursday Schools Resident responsibilities
Resident should review plans for patients with team members (medical students and interns) from 8:30-9a so that plans are prepared for attending rounds
Complete chart rounds prior to attending rounds on all patients every day and have a plan for every patient
See all A and D patients prior to attending rounds, prioritize active B patients and patients with new overnight issues

Ensure days off are scheduled for the team and that patients are distributed appropriately each day, including who will see new admissions, who will see patients when people on the team have days off, and a reasonable distribution of the work
Supervise and run team rounds and CM rounds with attending support
Run list and ensure orders, consults, and discharges mostly done by 1pm
Ensure interns are completing all assigned duties and aid with intern direct care duties (i.e., calling
consults, arranging transitions, updating cache)
Perform sign out on long call days
Assist with teaching the medical student(s) and/or making time in the day for teaching
Ensure all notes and tasks are completed by 6pm on non-long call/8pm on long call, and help to alert attending if this is not happening
Ensure patients that need to be admitted are assigned and seen within 2 hours

Be the primary intern for up to 8 patients at a time and perform admissions with the team
See all OWN patients every day, prior to rounds
Be prepared to present on all own patients, review main plan with resident prior to rounds
Prepare DDEMAP on discharges prior to rounds including medication reconciliation with knowledge of home medications
Write notes on all patients or attest student notes
Update Excel daily
Split up between the two interns: pager connect duties during rounds, perform sign out on non-long call days
Intern on pager duty is expected to return to the hospital if acute issues arise and to know the other intern’s patients well enough to respond and appropriately cross cover until sign out to night cross-cover resident.
Day-to-Day for Interns:
- Checkout from Night Team
  - Senior to determine each intern’s patients for the day
  - Let your senior know if you have afternoon clinic
- Morning Labs/Follow-up items
  - Check Morning Labs as well as any follow up items from the day prior
  - Start “Lab” & ”Box” System if desired; See Staying Organized
- Replace relevant electrolytes/start new medications as needed
  - See Electrolyte Replacement Guidelines if needed
Discuss with senior!
Pre-Rounds
Morning Report
Rounds
Lunch
Didactics
Post-Didactics
Handoffs
Please try your hardest to update hospital courses
- This is especially important for discharges, end of the rotation handoff, and patients in the hospital longer than one week

Supporting the vibes of the entire team should be your #1 priority

See patients you are assigned and prepare presentations for them, review main plan with resident prior to rounds
Up to 3 notes/day with resident/intern verification/attestation
Should be present for all of rounds
Help with patient care duties on their patients (i.e., calling consults, helping with follow-ups, depart summary, patient education, family updates, cache updates)
Place basic medical orders on patients if they can be co-signed by physician at appropriate intervals
Predominantly see and present patients with A/B/D status. For C patients, if the student still follows, the intern/resident may present for efficiency.

Again: Supporting the vibes of the entire team should be your #1 priority

See patients you are assigned and prepare presentations for them, review main plan with resident prior to rounds
Write H&P, progress note, and discharge summaries on all patents you see
Attending attestation/verification for progress notes/discharge summaries
Resident attestation/verification for H&P
Should be present for all of rounds
Perform all patient care duties on their patients (i.e., calling consults, requesting follow-ups, depart summary, patient education, family updates, cache updates)
Place basic medical orders on patients and requesting co-signature at appropriate interval