Job Duties

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JOB DUTIES Rev. July, 2016

OUTPATIENT CLINICS

Clinic (C): Mon.–Fri. 9 a.m. – 5 p.m.

Arrive 15 minutes early (at least) to review patients for the day with your assigned nurse. See assigned patients, including add-ons if needed.

Radio Medical Traffic (RMT): Mon.–Fri. 1 p.m. – 6 p.m.

Using RAVEN, respond to routine RMT from villages. Work until the queue is done for the day. Ask for help if needed.

Admin: Mon.–Fri. 9 a.m. – 5 p.m.

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.

Village Admin: Mon.–Fri. 9 a.m. – 5 p.m.

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.

EMERGENCY ROOM

E1: 8 a.m. – 8 p.m.

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).

E2: 8 p.m. – 8 a.m.

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.

NOTE:

  1. 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.
  2. 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.

ER (Second Provider): 12 p.m – 12 a.m.

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).

ER2 (Third Provider) : 10 a.m. – 10 p.m.

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.

Fast Track Provider: 1 p.m. – 11 p.m.

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.

PEDIATRICS

Outpatient Clinic (C): Mon-Fri 9 a.m.–5 p.m.

  • Sees scheduled pediatric and chronic pediatric patients (CPP) for well child checks, ER follow-ups, sports physicals, sick visits, chronic health maintenance (including Remicade infusions)
  • 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.
  • 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.
  • Review specialty, and other dictations, for pod patients and updates the problem lists/makes referrals. If not able to review dictations within 1-2 weeks may request peds hospitalist assistance with reviews and updates.
  • Provide pediatric hallway consults as able

Outpatient Precepting (N): Mon–Fri 9 a.m.–5 p.m.

  • Performs all duties of Outpatient Clinic provider as described above, but only sees one patient each hour in order to fulfill the primary responsibility of supervising the pediatric resident working in clinic that day.
  • Staffs all patients seen by the pediatric resident: observes resident’s history-taking and physical exam as indicated, verifies the resident’s exam findings as indicated, reviews care plans created by the resident for each patient, reviews and cosigns the resident’s note for each patient.
  • Provides didactic, case-based, and systems-based (workflow) teaching to the pediatric resident as time allows
  • Resident attending for 1st, 2nd and 3rd year SCH Alaska track residents-shadows and precepts residents for their assigned patients
  • Reviews with resident, patient’s pertinent PMH, HPI and chief complaint. Encourages resident to develop a plan and goals for patient needs for the appointment for that day, provide as much needed care as possible and devise a follow up care plan that is understood by the patient and documnted in the EMR for future encounters.
  • Encourages exposure and opportunities to learn procedures and specialty care from other providers and specialists as able
  • Understands resident’s educational goals and balances these with patient care needs in clinic setting
  • Promotes independent learning and provides positive patient based teaching as opportunities arise
  • Helps residents develop their fund of knowledge; differential diagnosis skills; ability to write thorough and concise notes; and learn organizational efficiency and practical clinical skills that will help them succeed and be ready for independent practice on graduation from residency

Bethel Regional High School Clinic (BRHS): Wed 9 a.m.–5 p.m.

  • Sees scheduled and walk-in patients at the BRHS clinic – which serves students aged 11-21 from Bethel Regional High School and Bethel’s alternative boarding school, the Kuskokwim Learning Academy (KLA) – for sports physicals, sick visits, adolescent health care (including contraceptive counseling and provision, STI testing/treatment, and social/behavioral health concerns), and some chronic care follow-up (such as blood pressure monitoring).
  • See section on BRHS clinic in the WIKI for detailed workflow

Clinic Admin (AD): Mon–Fri 9 a.m.–5 p.m.

  • Flexible time to do clinical administration (including review of subspecialty notes and other care coordination for continuity patients), quality improvement projects, and committee work.

Peds Day Hospitalist (P): 8 a.m.–6 p.m.

  • Assumes the pediatric service and opts into tiger text roll for ‘Peds Wards On Call’, in house, at 8am
  • 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.
  • Rounds with Family Medicine DW/NF docs and charge nurse about concerning peds patients.
  • Admits all CPP patients and responsible for all pediatric service inpatients. May accept admission of other pediatric patients if requested and able.
  • Rounds on patients in the morning early enough to arrange any discharges by noon if possible
  • 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.
  • Responsible for all chronic pediatric Radio Medical Traffic (RMT) and helps with any urgent/emergency pediatric RMT as required.
  • Goes on medevacs for possible preterm (less than 36 weeks) or anticipated high risk delivery in villages. (1.)
  • Keeps the ER physician updated on any pending medevacs from villages or to Anchorage.
  • Signs out, in house, to PNF at 6pm an reviews peds service changes plus any potential patients or clinical issues the daytime pediatrician may have to address.

NOTES:

  1. If Peds day physician has to go on a medevac with a FM day physician, the FM second day physician 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.
  2. The Peds day physician is responsible for going on any “shift-change” medevacs that are activated between 7:01 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.

Peds Night Hospitalist (P+): 6 p.m.–8 a.m.

  • Assumes the pediatric service and opts into tiger text roll for ‘Peds Wards On Call’, in house, at 6 p.m.
  • 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.
  • Rounds with Family Medicine NF docs and charge nurse about all concerning pediatric patients
  • Admits all CPP patients and responsible for all pediatric service inpatients.
  • Accepts admission of other pediatric patients if requested and able.
  • 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.
  • Covers both CPP, emergency and regular pediatric RMT as requested
  • Provides consultation and/or help stabilizing pediatric patients in the ER, Labor & Delivery, Newborn Nursery, SRCs/villages and on the inpatient unit.
  • Goes on medevacs for possible preterm (less than 36 weeks) anticipated high-risk delivery in villages. (see NOTE)
  • Keeps the ER physician updated on any pending medevacs from villages or to Anchorage.
  • Do 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.
  • 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
  • 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.
  • 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.

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.

Hospitalist Admin (AD): 8 hours

  • Flexible time to do clinical administration, quality improvement projects and committee work.

ER/Urgent Care Pediatrician (ER): Mon–Fri 12 p.m.–8 p.m.; Sat–Sun 8 a.m.–4 p.m.

  • Sees pediatric patients in Urgent Care and the ER as needed
  • Helps with emergency pediatric RMT for NW physicians and CPP RMT for peds hospitalist as able
  • May consult on patients that do not need admission and transfer. The pediatric hospitalist should be consulted for sicker patients that require admission or transfer.
  • May see sicker patients in ER if peds hospitalist is not available and a pediatrician is needed, or if few pediatric patients qualify for Fast Track care.
  • May do clinic consults, at the request of the hospitalist
  • This position can be flexible to meet the needs of the ER or Urgent Care depending on volume acuity and resources etc

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)

  1. Arrive at 6 p.m. sharp to get sign-out
  2. Active labor patients/truly stable NW admits/emergent RMT
  3. OB triage patients
  4. 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.
  5. 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.
  6. 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.