Family Medicine Job Description/Duties — Inpatient

Kusko Wards and Yukon Wards

Mon. – Sun. 8 a.m. – 6 p.m. (some providers choose to arrive at 7 a.m. to round before taking over for the day)

Inpatient

Admit and care for adults, non-chronic peds, and behavioral health patients. Behavioral health patients are transferred to the psychiatric practitioners when medically stable.

Responsible for responding to admission requests from the ER, clinic, and, at times, direct admit requests as appropriate from ANMC, sub-regional clinics, and other entities. If in your best clinical judgement, the patient warrants transfer to a higher level of care or does not meet criteria for admission and so does not require hospitalization, documentation must be placed on the chart of your decision-making process. In addition, assistance should be given to the provider requesting admission for an appropriate disposition.

OB/Newborns

• Triage, assess for induction, admit, and manage labor with vaginal deliveries and postpartum care for OB patients.
• Admit and manage care for uncomplicated babies delivered in OB unit.
• Cross covers Night Float (NF) moms and babies; may need to pick up NF mom and babies when NF off shift
• see OB & Newborn Main Page for more information

Documentation which must be completed at the time of admission include

• Holding orders and / or complete admit orders
• Admission diagnosis
• Medication reconciliation form
• Promoting interoperability (AKA meaningful use) reconciliation in workflow view
  • allergies, medications, and problem list
• VTE assessment (on ad hoc forms)
• H&P (this must be completed in 24 hours)

Urgent and Emergency Radio Medical Traffic (RMT)

Consultation is accomplished via EMR and telephone with village community health aides (CHAs) and SRC PA/NP providers for patients requiring urgent or emergent care and/or transport. Telemedicine patient pictures and EKGs are available on Multimedia Manager. After review, review of these should be charged for by going to orders-> Visit (E&M charges) ->Telemed Consult Level I or 2. There are also video conferencing telephones located in the FM, Peds and ER offices for evaluating patients real time with the health aides and SRC providers.

Going on a medevac

Usually for evaluation of either preterm labor or complicated term labor or other emergencies with which the medevac crew may need assistance.

see Pediatric Village Delivery Orientation or OB Labor in the Village

Other responsibilities

• Day Wards providers are required to attend a multidisciplinary discharge planning meeting ~every day when scheduled by the Inpatient Case Manager.
• There are hospital meetings throughout the week/month that Day Wards providers are encouraged to attend as clinical duties allow.
• These meetings can be easier to attend even with a busy service if you plan and use them as a time to complete notes/orders on your RAVEN laptop.
• Attendance at mock codes
• All other duties: As the chief-of-staff or designee (CD on-call) might request

Sign-out

Occurs, in person, between day Wards providers and Night Float (NF) at 6 p.m. and 8 a.m. on the Inpatient unit.

The OB/Inpatient Patient List (sign-out sheet) should be updated for each sign-out.

Emergency back-up / medevac call

Mon.–Sun. 6 p.m. – 8 a.m.

This is assigned to the Wards provider every other night and is intended only for EXTREME situations. Only the NF, CD-on call, or Chief-of-Staff may request that the Wards provider come in to cover. The most typical situation for being called in would be when there is a laboring preterm patient in a village who requires a physician’s sterile vaginal exam (accompanied by the pediatrician on-call) to determine safety of air transport back to Bethel vs delivery in the village. Although it is customary for the star-doc to go on the medevac, sometimes NF may go, but the medevac on call provider gets the final say. Other appropriate reasons for being called in would be the inability of the ER attending to fulfill his/her duties, mass casualties, or other multiple traumas /resuscitations.

Under no circumstances should the star-doc be used as a “convenience” for a backed-up ER waiting room or to otherwise help move patients more quickly through the ER.

Admin Day: Usually Monday after a Wards Week 8 a.m. – 6 p.m.

This day is used to provide comprehensive transition of care for all patients remaining on service and is focused on completing discharges of appropriate patients, updating problem lists, finishing up all documentation, making referrals and ensuring all patients on service receive excellent transition of care to the oncoming providers.

Off service providers are also expected to help out in the afternoon with regular clinic RMT, the ER, clinic or wherever needed as able and as directed by the chief-of-staff or their designee (CD on-call). If the provider has chosen to round at 7 a.m. during the preceding week, they may compensate for their time on this day if their assistance is not required.

Night Float (NF)

Mon.–Sun. 6 pm. – 8 a.m.

PRIORITIES for NF (in order of importance)

• Managing critically ill patients on the unit or in the village (may include going on medevacsusually for preterm labor with a pediatrician)
• Imminent deliveries
• Writing admission holding orders or complete orders (goal is within 30 minutes of accepting the patient)
• Followed by:
  • Less critical RMT and OB triage
  • Completing admission orders
  • Rounding on moms and babies that you delivered
  • Completing H&Ps
    • (stable admissions can be seen by the wards physician if NF is not able to get to them due to other clinical responsibilities. It is acceptable to perform a thorough chart review, complete H&P up to the exam portion if needed and not wake the patient for the exam, but the day ward provider must complete H&P the next day)
  • Helping in the ER as time allows (go to the ER as early in the evening as possible to help by seeing routine ER patients to decompress and prevent backlog)

NF ONLY works at night and is off during the day; NF should sign out any unfinished work to Wards providers

Yukon and Kusko Service Division

see Kusko and Yukon Village Clinics List

Patient responsibilities for North Wing/Obstetric and RMT patients are generally divided up by village of origin (see Kusko and Yukon Village Clinics List) with equal populations in each.

Bethel patients are generally proportioned out to the less busy service. When one service is extremely busy, it may be appropriate to pick up an occasional non-service patient in order to help out.

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