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| ''JOB DUTIES Rev. July, 2016'' | | '''[[Outpatient Family Medicine Job Description|FAMILY MEDICINE OUTPATIENT]]''' |
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| ===OUTPATIENT CLINICS===
| | '''[[Family Medicine Job Description/Duties — Inpatient|FAMILY MEDICINE HOSPITALIST]]''' |
| '''Clinic (C): Mon.–Fri. 9 a.m. – 5 p.m.''' | |
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| Arrive 15 minutes early (at least) to review patients for the day with your assigned nurse. See assigned patients, including add-ons if needed.
| | '''[[Emergency Room Job Description|EMERGENCY DEPARTMENT]]''' |
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| '''Radio Medical Traffic (RMT): Mon.–Fri. 1 p.m. – 6 p.m.''' | | '''[[Pediatric Outpatient Job Description|PEDIATRIC OUTPATIENT]]''' |
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| Using RAVEN, respond to routine RMT from villages. Work until the queue is done for the day. Ask for help if needed.
| | '''[[Pediatric Hospitalist Job Description|PEDIATRIC HOSPITALIST]]''' |
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| '''Admin: Mon.–Fri. 9 a.m. – 5 p.m.''' | |
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| Expected to work a regular workday and attend required meetings. Work with case management to complete patient care duties as needed. As a last resort, may be used as a jeopardy provider or other duties as assigned.
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| '''Village Admin: Mon.–Fri. 9 a.m. – 5 p.'''m.
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| This day is given to a provider who has completed a 3–5 day village trip to complete charting, referrals and follow-up work. Expected to work a regular workday, and attend required meetings. As a last resort, may be used as a jeopardy provider to help with RMT, clinic or other duties as assigned.
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| ===EMERGENCY ROOM===
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| '''E1: 8 a.m. – 8 p.m.'''
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| Gets sign-out from E2 at 8 a.m., sees ER patients, acts consultant to NP/PA working in the ED and Fast Track. Assumes village-to-Bethel medevac medical control. Notifies and gets acceptance of admissions or ensures the PA/NP does this after reviewing the case with them. Patients being admitted must have an accepting physician and admission orders written before they go to the floor. Expected to attend all required meetings as able (may teleconference from the Emergency Room).
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| '''E2: 8 p.m. – 8 a.m.'''
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| Gets sign-out from E1 at 8 p.m., sees ER patients, acts consultant to NP/PA working in the ED and Fast Track. Assumes village medevac medical control. Notifies and gets acceptance of admissions or ensures the ER PA/NP does this after reviewing the case with them. Patients being admitted must have an accepting physician and admission orders written before they go to the floor. Not required to attend daytime meetings, but encouraged to sign out at Thursday morning rounds.
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| '''NOTE''':
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| # The ER physician can expect Night Float (NF) to help in the ER unless NF has an active labor patient, an unstable NW patient, or emergency RMT that requires their attention.
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| # The ER physician may call in the +DW physician only as required for third back up, i.e. true multiple emergencies or if NF goes out on a medevac and a second physician is needed in house.
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| ER (Second Provider): 12 p.m – 12 a.m.
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| PA/NP/MD/DO sees urgent care and moderately ill ER patients. If second provider is PA/NP, all critical patients, sick admissions and transfers are to be reviewed with the ER physician. Will review admission plan with ER physician and get an accepting inpatient physician to accept and write patient admission orders. Not required to attend regular morning meetings (except medical staff on the first Wednesday of the month).
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| '''ER2 (Third Provider) : 10 a.m. – 10 p.m.'''
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| PA/NP/MD/DO sees urgent care and moderately ill ER patients. If second provider is PA/NP, all critical patients, sick admissions and transfers are to be reviewed with the ER physician. Will review admission plan and orders with ER physician and have admitting orders co-signed by the ER physician if the ER second provider is a PA/NP.
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| '''Peds ER Provider: 10 p.m. – 10 p.m.'''
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| Generally sees patients triaged level 3 or sicker and CPP patients, but should be ready to see any level patients to keep the patients being seen as quickly as possible.
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| '''Fast Track Provider: 1 p.m. – 11 p.m.'''
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| NP/PA/MD/DO sees patients triaged at a level 3 or 4 who are appropriate for an urgent care setting. May transfer complex patients back to the main ED for management. May consult with E1 or E2 doc with any questions.
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| ===PEDIATRICS===
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| '''Outpatient Clinic (C): Mon.–Fri. 9 a.m. – 5 p.m.'''
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| * Sees scheduled pediatric and chronic pediatric patients (CPP) for well child checks, ER follow-ups, sports physicals, sick visits, chronic health maintenance (including Remicaide infusions)
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| * Follow-up of chronic issues, sub-specialty care (with the help of Anchorage and Seattle-based pediatric sub-specialists), non acute child abuse evaluations, ADHD evaluation, orthopedic care (including splinting and casting), minor procedures (including incision & drainage of abscesses), etc.
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| * Clinic pediatrician practices a combination of primary care (with continuity of care) and urgent care, including managing respiratory distress, dehydration, administration of IV antibiotics, etc.
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| '''Consult (N): Mon.–Fri. 9 a.m. – 5 p.m.'''
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| * 3-7 patients per day are scheduled.
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| * Notifies charge nurses, Peds CM and Bethel clinic providers who is peds consult for the day. The pediatric consult person carries the ‘Outpatient Pediatric Pager’.
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| * Looks through clinic provider schedules in the morning and does chart reviews of any CPP patients being seen in order to facilitate chronic care coordination for those children.
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| * Contacts Inpatient pediatrician to determine bed availability
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| * Precepts pediatric residents.
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| * Consults and assists with care management of chronic pediatric patients and clinical management of any pediatric patients, as needed.
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| * Provides general pediatric consultation for clinic staff.
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| * Writes brief consult note on any patients consulted on.
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| * Available for pediatric RMT consultation as needed.
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| * Provides backup for the inpatient pediatric provider as needed, including helping with CPP RMT and ER consultations as well as assisting in emergency situations.
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| '''Peds Inpatient (P): 8 a.m.–5 p.m. (8 a.m.–6 p.m. with PNF)'''
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| * Turns on beeper and gets sign out from night Peds doctor
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| * Assumes the pediatric service at 8 a.m.
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| * Responsible for all pediatric service inpatients.
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| * Rounds on patients in the morning early enough to arrange any discharges by noon if possible
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| * Admits all CPP. May accept admission of other pediatric patients if requested and able.
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| * Provides consultation to the ER, Labor and Delivery, Newborn Nursery, SRC providers, and inpatient providers.
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| * Responsible for all chronic pediatric Health Aide Radio Medical Traffic (RMT). May help with high risk pediatric and other urgent pediatric RMT as requested and able.
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| * Goes on medevacs for possible preterm (less than 36 weeks) or anticipated high risk delivery in villages.
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| * Keeps the ER physician updated on any pending medevacs from villages or to Anchorage.
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| * Signs out to Peds Call (or PNF) person at 5 p.m. for Peds Call or 6 p.m. for Peds Night Float.
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| '''Weekends''': Often provides day and night coverage for 33–48 hours at a time (P/P+). Weekend and holiday pediatricians cover all the duties of both inpatient service pediatrician and Peds Call pediatrician.
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| '''NOTE''': ''When PNF pediatrician instituted the day pediatrician will be responsible for management of all CPP inpatients unless alternative plan agreed upon by BOTH the Day pediatrician (P) and Night pediatrician (PNF). PNF may remain primary physician for any patients this makes sense for. If PNF follows a patient as the primary attending, the Day pediatrician will only make acute care need changes as needed and regular management and discharge planning etc will be done by the PNF. This model (similar to OB) will allow extra continuity with NF having the ability to remain the primary pediatric attending for some patients and will help decrease the daytime pediatrician’s workload.''
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| '''Peds Call (P+): 5 p.m. – 8 a.m.'''
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| * Turns on beeper at 5pm and gets Peds Inpatient physician sign out.
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| * Gets a summary of all the inpatients on the peds service plus information about any other concerning pediatric patients on NW, in the ER, in the villages, coming in on medevacs, in L&D, etc.
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| * Takes call from home
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| * Calls NW Night Float provider around 7pm to give a brief summary of all pediatric service inpatients
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| * Provides phone consultation and manages pediatric inpatient service with nursing.
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| * Admits patient from home, using the electronic medical record.
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| * Goes into the hospital for any pediatric emergencies, concerns about admitted patients, high risk deliveries, etc.
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| * Goes on medevacs for possible preterm (less than 36 weeks) or anticipated high-risk delivery in villages.
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| * Signs out to inpatient pediatric provider at 8am and reviews peds service changes plus any potential patients or clinical issues the daytime pediatrician may have to address.
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| '''Peds Night Float (PNF): 6 p.m.–8 a.m.'''
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| * Gets sign-out, in house, from Peds Inpatient Physician at 6pm.
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| * Gets summary of all the inpatients on the peds service plus information about any other concerning pediatric patients on NW; in the ER, the villages and L&D and patients coming in on medevacs etc.
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| * Present in the hospital overnight for management of peds service patients, accepts and does H&P for all CPP admissions (and non CPP patients if FM needs help and as able)
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| * Covers CPP RMT and assists with other sick peds RMT as able.
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| * Assists in seeing patients in the ER, as able.
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| * Available for any pediatric emergencies, concerns about admitted patients, high risk deliveries, etc.
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| * Goes on medevacs for possible preterm (less than 36 weeks) or anticipated high-risk delivery in villages.
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| * Signs out, in house, to inpatient pediatric provider at 8am and reviews peds service changes plus any potential patients or clinical issues the daytime pediatrician may have to address.
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| '''NOTE''': ''When PNF pediatrician instituted the day pediatrician will be responsible for management of all CPP inpatients unless alternative plan agreed upon by BOTH the Day pediatrician (P) and Night pediatrician (PNF). PNF may remain primary physician for any patients this makes sense for. If PNF follows a patient as the primary attending, the Day pediatrician will only make acute care need changes as needed and regular management and discharge planning etc with be done by the PNF. This model (similiar to OB) will allow extra continuity with NF having the ability to remain the primary pediatric attending for some patients and will help decrease the daytime pediatrician’s workload.''
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| '''ER Pediatrician (ER): 10 a.m.–10 p.m.'''
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| * Sees pediatric patients presenting to the ER, ranging from performing urgent care to resuscitation and critical care management.
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| * Works in consultation with ER staff, especially in trauma and code situations, and intensivists and specialists in Anchorage and Seattle.
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| * Communicates with Anchorage physicians about transferring patients and manages critical patients pending medevac arrival.
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| * Communicates with Inpatient/On Call /PNF pediatrician about admissions, follow-up plans, and future patient issues.
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| ===Family Medicine Hospitalist===
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| '''Kusko Wards (WK), Yukon Wards (WY): Mon. – Sun. 8 a.m. – 6 p.m.'''
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| Gets sign-on from NF at 8 a.m., takes urgent group RMT, rounds on inpatients and OB, admits daytime group patients, covers deliveries, x-covers NF moms and babies and may go on medevacs. May need to pick up NF mom and babies on NF shift transition. Gives sign out to NF at 6 p.m. on North Wing in person. Practitioners are required to attend regular scheduled meetings as clinical duties allow.
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| '''Back-Up Call (WY+ & WK+): Mon.–Sun. 6 p.m. – 8 a.m.'''
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| Back-up for scheduled NF doc. Will only be used if the NF is otherwise tied up and/or an additional provider is needed for second back-up for OB, medevacs or ER.
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| '''Night Float (NF): Mon.–Sun. 6 pm. – 8 a.m.'''
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| Gets sign-out from Day Ward Physician at 6 p.m. Responsible for RMT, OB, ER, rounding on their own moms and babies, medevacs, urgent inpatient coverage, admissions '''as able''' assisting on C-sections (+ doc will be second call for this if NF is doing the C-section). NF ONLY works at night and is off during the day, '''NF should sign out any unfinished work to Wards docs'''.
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| '''PRIORITIES for the Night Float – NF (what you should be doing in order of importance)'''
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| #Arrive at 6 p.m. sharp to get sign-out
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| #Active labor patients/truly stable NW admits/emergent RMT
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| #OB triage patients
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| #Help in the ER, even if ER is not backed up. Go to the ER as early in the evening as possible to help out the ER by seeing routine ER patients to decompress and prevent backlog.
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| #Stable NE admissions as able. Stable admissions can be seen by the DW 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 up the patient for the exam, but DW must complete H&P the next day.
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| #Rounding on OB patients.
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| '''Admin (AD): Monday after a Wards Week 8 a.m. – 6 p.m.'''
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| Signs out service to next ward provider, helps discharge patients from inpatient and OB service. Completes all documentation if needed, referrals, follow up and patient care administrative duties. Makes sure all orders and results are reviewed and signed in the RAVEN message center. Assists clinic providers and RMT providers as needed and acts as a back-up for personnel shortages. Before leaving for the day, make sure the routine RMT providers are keeping up with RMT by checking the queues in RAVEN. Practitioners are required to attend regular scheduled meetings.
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