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| '''[[PEDIATRIC OUTPATIENT]]''' | | '''[[PEDIATRIC OUTPATIENT]]''' |
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| ==PEDIATRIC HOSPITALIST==
| | '''[[PEDIATRIC HOSPITALIST]]''' |
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| '''Peds Day Hospitalist (P): 8 a.m.–6 p.m.''' | |
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| *Assumes the pediatric service and opts into tiger text roll for ‘Peds Wards On Call’, in house, at or before 8am
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| *Gets peds sign out and summary of all the patients on the peds service plus information about any other concerning pediatric patients on NW, OB, ER, in the villages and patients coming in on medevacs etc.
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| *Rounds with Family Medicine DW/NF docs and charge nurse about concerning peds patients.
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| *Admits all CPP patients and responsible for all pediatric service inpatients. May accept admission of other pediatric patients if requested and able.
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| *'''''(If there is a question about whether a patient should be admitted or not…inpatient provider will discuss with admitting provider and evaluate patient in person. If admission is determined to NOT be necessary or appropriate, inpatient provider to write a note documenting why admission was not accepted ie needs higher level of care, can be managed outpatient.)'''''
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| *Rounds on patients in the morning early enough to arrange any discharges by noon if possible
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| *Provides consultation and/or help stabilizing pediatric patients in the ER, Labor & Delivery, Newborn Nursery, Outpatient Clinics (as able)/ SRCs/villages and on the inpatient unit.
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| *Responsible for all chronic pediatric Radio Medical Traffic (RMT) and helps with any urgent/emergency pediatric RMT as required.
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| *Goes on medevacs for possible preterm (less than 36 weeks) or anticipated high risk delivery in villages. (1.)
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| *Keeps the ER physician updated on any pending medevacs from villages or to Anchorage.
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| *Signs out, in house, to Pediatric Night Float at 6pm and reviews peds service changes plus any potential patients or clinical issues the daytime pediatrician may have to address.
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| '''NOTES:'''
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| #''If Peds day physician has to go on a medevac with a FM day physician, the FM second day physician (or Peds ER provider, if available) opts into tiger text roll for ‘Peds Wards On Call’ and covers peds pages until the peds day physician returns and is able to resume tiger text coverage again.''
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| #''The Peds day physician is responsible for going on any “shift-change” medevacs that are activated between 7:00 a.m. and 6:00 p.m., to spare the night shift person from having to work more than 14 hours at a time. '''If you end up on a medevac outside your regularly scheduled shift hours notify peds scheduler.'''''
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| '''Peds Night Hospitalist (P+): 6 p.m.–8 a.m.'''
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| *Assumes the pediatric service and opts into tiger text roll for ‘Peds Wards On Call’, in house, at or before 6 p.m.
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| *Gets peds sign out and summary of all the patients on the peds service plus information about any other concerning pediatric patients on NW, OB, ER, in the villages and patients coming in on medevacs etc.
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| *Rounds with Family Medicine NF docs and charge nurse about all concerning pediatric patients
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| *Admits all CPP patients and responsible for all pediatric service inpatients.
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| *Accepts admission of other pediatric patients if requested and able.
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| *'''''(If there is a question about whether a patient should be admitted or not…inpatient provider will discuss with admitting provider and evaluate patient in person. If admission is determined to NOT be necessary or appropriate, inpatient provider to write a note documenting why admission was not accepted ie needs higher level of care, can be managed outpatient.)'''''
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| *Rounds on PEDS service patients as early in the evening as possible and as needed for patient assessment, counseling of parents and education/support of staff. Examine patients and review meds and care plans; make small or acute care changes as needed; allow day physician to make major changes to care if possible.
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| *Covers both CPP, emergency and regular pediatric RMT as requested
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| *Provides consultation and/or help stabilizing pediatric patients in the ER, Labor & Delivery, Newborn Nursery, SRCs/villages and on the inpatient unit.
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| *Goes on medevacs for possible preterm (less than 36 weeks) anticipated high-risk delivery in villages. (see NOTE)
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| *Keeps the ER physician updated on any pending medevacs from villages or to Anchorage.
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| *Helps ER peds physician (if able) see patients in ER as needed. This will help them to be able to leave at a reasonable time.
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| *Helps the day physician with detailed chart reviews and help get as much primary/chronic care arranged for complicated CPP patient, who do not get to clinic much, and are admitted. This will be done by both day and night hospitalist as a joint effort, as able. (The night peds hospitalist may have more time to do this.)
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| *When requested and if all other priorities have been fulfilled, sees pediatric patients in the ER/Urgent Care, does routine newborn admit exam and note for NF and helps in whatever capacity that is needed, as a team member, for any emergencies
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| *Checks proxy boxes for absent providers; reviews Cub pod (and helps with other pods as needed) dictations and specialty notes and updates problem list/makes referrals etc; '''''helps with pharmacy medication order requests as needed. '''''
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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''': If Peds night physician has to go on a medevac with the FM Night Float physician, the on call FM physician is called in, opts into tiger text roll for ‘Peds Wards On Call’ and covers until the peds day physician returns and is able to resume tiger text coverage again. (''''Peds ER would be a preferable handoff if available.'''')
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| '''Hospitalist Admin (AD): 8 hours'''
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| *Flexible time to do clinical administration, quality improvement projects and committee work.
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| '''ER/Urgent Care Pediatrician (ER): Mon–Sun 12 p.m.–10 p.m.'''
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| *Based in ER. Sees pediatric patients in Urgent Care and the ER as needed
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| *Checks in with day pediatrician at beginning of shift. Gets sign out about medevacs, admissions, recent ER peds consults, etc
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| *Helps peds hospitalist with emergency pediatric RMT if needed and regular CPP RMT for peds hospitalist as able
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| *Provides pediatric consultation for ER and Fast Track providers
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| *May assume medical control of sick pediatric patients from ER doc or inpatient pediatrician if needed.
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| *May assume Hospitalist role if pediatric hospitalist goes out on a medevac
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| *May do clinic consults if required and able
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| *This position can be flexible to meet the needs of the ER or Urgent Care depending on volume acuity and resources etc
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| *Checks out with night pediatrician with updates on patients that may require follow up or assumption of care, medevac or admission etc...
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| ''Last updated 9/17/2019''
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| ==FAMILY MEDICINE HOSPITALIST== | | ==FAMILY MEDICINE HOSPITALIST== |
OUTPATIENT CLINICS
EMERGENCY ROOM
PEDIATRIC OUTPATIENT
PEDIATRIC HOSPITALIST
FAMILY MEDICINE HOSPITALIST
Kusko Wards (WK), Yukon Wards (WY): Mon. – Sun. 8 a.m. – 6 p.m.
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.
Back-Up Call (WY+ & WK+): Mon.–Sun. 6 p.m. – 8 a.m.
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.
Night Float (NF): Mon.–Sun. 6 pm. – 8 a.m.
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.
PRIORITIES for the Night Float – NF (what you should be doing in order of importance)
- Arrive at 6 p.m. sharp to get sign-out
- Active labor patients/truly stable NW admits/emergent RMT
- OB triage patients
- 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.
- 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.
- Rounding on OB patients.
Admin (AD): Monday after a Wards Week 8 a.m. – 6 p.m.
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.
