Category:Inpatient

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Overview

The Yukon-Kuskokwim Health Corporation (YKHC) provides hospital services to all residents (native and non-native) of Bethel and the surrounding 57 villages (total population~28,000). The service catchment is spread over an area the size of the state of Oregon and the nearest tertiary care center is 400 air miles to Anchorage.link to map YKHC Delta Regional Hospital is a 44 bed General Medicine/PEDS/OB/BH facility with a Level IV trauma certified emergency room, local and regional medevac services, OB L&D with C-section capability, limited OR/endoscopy services, newborn rooming-in, extended care facility and an array of lab and X-ray capabilities including US and CT.

Inpatient Unit (facility)

The North Wing is comprised of three areas, a pediatric unit, a medical-surgical unit, and Behavioral Health evaluation beds. The unit area can accommodate up to 28 patients with an average daily census of 14.

The primary focus of care includes, but is not limited to, acute adult, adolescent and pediatric care. The patients cared for on this unit are from infancy to elderly. North Wing is comprised of private rooms and semi-private rooms including four negative pressure rooms. All beds are capable of cardiac-respiratory monitoring. Three beds in two video-monitored rooms are dedicated to serve as the Behavioral Health evaluation beds.

The delivery of patient care is provided utilizing a multidisciplinary team approach including physicians, pharmacists, nutritional support personnel, respiratory therapists, social workers and other support personnel to maintain and update the patient plan of care. Physicians and nurses daily update patients and families concerning their progress and what goals and treatments will be used for the day.

Normal hours of operation are 24 hours a day, 7 days a week.

There is currently a 28-bed cohorted inpatient adult and pediatric unit with up to 10 pediatric beds in seven rooms. General medical and pediatric hospital services are available with some remote monitoring capability. However, there are limitations to care including; no patients can be admitted that require high alert drips, 1:1 nursing, intensive respiratory therapy, PICU/step down care, or unstable potential surgical intervention. Also, there are a number of diagnoses that are best treated elsewhere such as acute MI and unstable stroke (includes brainstem stroke) patients should not be admitted to North Wing but transferred directly to Anchorage from the ER (unless the patient does not want a higher level of interventional care).

Family medicine physicians admit all adult and Behavioral Health patients plus most routine pediatric patients. Pediatricians admit all Chronic Pediatric Patients (CPP=chronic and complex care pediatric patients) and can help family medicine service with occasional regular pediatric admissions when the family medicine hospitalists are especially busy or uncomfortable with a pediatric patient’s condition or diagnosis. It is expected that the pediatric service will help out with routine pediatric admissions if they are not too busy. It is expected that everyone will work on helping each other as much as possible. Team work is a vital part of providing good patient care at YKHC.

Family Medicine Job Description/Duties — Inpatient

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Family Medicine Hospitalist Job Description (DW/NF/*Doc)

Pediatric Hospitalist Job Description (PEDS/CALL)

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Peds Hospitalist Duties

Required and Recommended Meetings

Time: 8–9 a.m.

  • Monday: Outpatient Family Medicine (Required if doing regular daytime rotations)
  • Tuesday: Grand Rounds (Main Conference Rm.)
  • First Wednesday: GMS (Main Conf. Rm)
  • Second Wednesday: MSEC (West Wing Conf. Rm.)
  • Third Wednesday: Performance Improvement (West Wing Conf. Rm)
  • Fourth Wednesday: P&T (West Wing Conf. Rm)
  • Thursday: Clinical Rounds (Main Conf. Rm)
  • Friday: HROB Rounds (Main Conf. Rm)

Time: 2-3 p.m.

  • Thursday: Inpatient Rounds on North Wing (Required if doing regular daytime rotations)

Hospitalist Documentation

Providers are encouraged to review other provider’s pre-completed notes in their free time and modify/create their own pre-completed notes when time allows.

Freetexting HPI and Plans is encouraged in all provider notes. A freetexted brief description in the HPI of the chief complaint and pertinent history plus a free text A/P with decision making info, plan and needed f/u will make the next provider’s job easier. Providers are also encouraged to use “Other Diagnosis” field to pull the Diagnoses in the note. This will be important for ICD-10.

category:RAVEN

Hospitalist Workflow and Priorities

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Overview
Getting the Day Set and Organized
Admissions

  • Admission Process
  • Adult Admissions
  • Common Adult Admissions
  • Pediatric Admissions
  • Common Pediatric Admissions

Rounding
Procedures
Special Situations
Discharges
Signing out a service

Consults

Bethel Consult Services

Outside Consult Services

Medevacs and Transport

Case Management

Presently there is no care manager on NW.

All referrals (except YK-internal surgery) should go to the nurse manager as an AFHCAN case. They and outpatient care managers can help with referral-appointment issues as well as ordering supplies, etc.

RMT: Urgent and Emergency RMT

How to Refer for Specialty Clinics and Services

  • RAVEN
  • e-Referrals

Telemedicine

Ancillary Services (Inpatient-Specific)

See also: YKHC Ancillary Services

Lab: Blood and micro results now auto-fill in your patient’s chart. If there are issues, a phone call is appropriate but sometimes a walk to the lab works better, especially to understand the situation

Radiology: Radiologist readings auto-fill under Results. The radiologist on call is also available via speed-dial if you wish to discuss read or seek advice on order-see monthly schedule posted in Doc’s Office. They are in-house every 2 months for procedures.

Pharmacy: They are likely your best friend inpatient and do a lot for you day-to-day: manage vancomycin dosing, research patient med profile, advise-warn on meds & interactions, order the med “that you can’t get to” on Raven and all with a good attitude, smile and collegial spirit.

Respiratory Therapy: They are great. Talk to them daily about your respiratory patients. Anything to do with O2 and breathing treatments should have them involved.

Physical Therapy: Even with their “bare-bones” department and village travel, they still get down to NW to help our patients, especially; ambulation-ADL assessment for our elders, acute stroke rehab potential assessment, and wound care especially now without a wound care nurse.

Wound Care: Currently this position is unfilled but between we Ward docs, inpatient nursing and PT above, we can still do a lot especially abscess and frostbite management.

Nutritionist/Dietician: It has been unusual to have one dedicated to NW in Bethel. The current policy is to fill out a paper consult to receive advice-see NW Nurse Mge.

WIC: available in West Wing

Community Relations/Translation: At least one person, medically fluent in Yupik, is available usually M-F 8AM-6PM and other times on call. Many of our mostly elderly Yupik patients do not speak fluent English and medical translation is encourage. Although a family member may be able to do this in a pinch, it has definite drawbacks. An end-of-life conversation is often done with an interpreter. Also, other language interpreter services are available via telephone.

Diabetes: We have a well-funded DM department which offers education and practical help services including access to a Glucometer. Currently they have an office in the Delta clinic.

Social Services: Marcia Coffey handles social services consults very importantly including transfer to an LTC. Please remember that many of our villages do not have running water and some patients do not have electricity. Lower 48 standards of hygiene can often not be met; this is not always neglect. You can contact one of our experienced YK providers prior to consulting social services if you have any doubt that the consult is appropriate. A referral to either Adult Protective Services (API) or Office of Children’s Services (OCS) is at times necessary and is encouraged if there is any doubt of usually home-based harm to a patient.

There are often times when a patient is best served staying inpatient while awaiting LTC placement. There may be no other option. Marcia Coffey closely monitors such situations and we should not interfere with this process. Practical rounding involving daily vital signs, no labs and of course only “level-1 charge” may be appropriate.

Tobacco Cessation: Tobacco products are not allowed inpatient nor is accommodation to seek nicotine elsewhere tolerated. Prescription nicotine replacement and anxiolytics are available. All patients admitted with nicotine use should be seen by Nicotine Control so cessation (and better health) can be discussed.

Infection Control: Our hospital Infection Control Nurses oversees both implementation and enforcement of our inpatient infection control measures. Any unusual infections, especially active TB should be reported this person. Please religiously follow isolation precautions as you see your patients and gently encourage others to do the same. Remember, how you carry yourself is a huge example to others around you (besides helping to protect our most vulnerable patients). As we all know, every patient visit should both precede and end with hand washing or sanitary hand gel.

Dental: A YKHC on call dentist is always available by phone and sometimes as appropriate in person inpatient. Because Dental is now across the street, our patients can only be seen there at the time of discharge or thereafter.

Optometry: As Dental above.

Guidelines

Link opens YKHC Clinical Guidelines document (pdf). Browse document table of contents for specific guideline flowcharts.

Bethel Formulary

Link opens Bethel Formulary document (pdf). Browse document table of contents for meds. Click page logo to return to TOC.

Pages in category "Inpatient"

The following 3 pages are in this category, out of 3 total.