FAMILY MEDICINE INPATIENT SERVICE

 

Description:

 

1.      The FMIS at University Hospital of Arkansas will hospitalize all inpatients from the Family Medical Center (FMC) and the Primary Care Center (PCC) and unassigned patients from the Emergency Department.

2.      The faculty coverage will be specified by the department Chair of the DFCM (see below).

3.      The FMIS will be supervised-by Family Medicine faculty of the DFCM. The faculty will be responsible for all aspects for patient care, resident education and resident evaluation.

4.      The FMIS team will be composed of a senior level FM resident, one or two junior level FM residents, a senior medical student acting “intern” when available and medical students.

5.      If limited class size of the third-year residents places a hardship on residents, the senior resident may be a second year resident at the end of her/his second year, to be decided by faculty, chief residents and in-service exam scores.

 

 

Faculty and Resident Ward Obligations:

 

1.      Senior Resident (PGY-3 or late PGY-2):

  1. assigns all trainee duties on the FMIS
  2. Supervises junior level residents and medical students.  Helps them manage patient-care problems. Reviews problem lists for each patient
  3. Supervise coding of all patient charges by residents and discusses with faculty.  Submits charges of ward within two working days of charge being made.
  4. Keep track of all patients on the FMIS as well as all FM patients on other hospital services. Monitors ward assignments, identifies problems and takes corrective action.
  5. Conduct rounds with the attending physician and other residents and staff on the service. Is responsible for teaching opportunities for residents and students.
  6. Will participate in night and weekend call schedule, but will not be responsible for patient care at night and weekend unless he/she is assigned to be second-call. This will occur no more often than an average of every third night. However the chief resident will be responsible to provide mechanism of coverage if another resident is unable to provide call coverage for the ward.(See call schedule “c”)  The Chief resident will be off one day of every weekend, if possible. Days-off will comply with UAMS GME Policy.
  7. Is responsible to make sure PCP is notified of her/his patients admitted to the FMIS.
  8. Will keep track of number of admissions and will notify ED to stop unassigned admissions if over the limit of patients able to care for. (See ED unassigned policy).
  9. Accepts all admissions from the FMC or PCC. Will assign duties as appropriate.
  10. Meets with on-call resident each morning, except weekends, to get morning reports on ward patients, telephone calls and ED visits. Will check-out all patients to on-coming call resident every night, except Saturday or Sunday.
  11. Meets with attendings twice each month and evaluates team members

2.      Junior Residents (1st and 2nd years residents that are not ward chiefs):

  1. Are  responsible for day-to-day direct patient care, all routine paperwork . History and physicals will be completed in 24 hours, daily progress notes daily and discharge summaries within 24 hours of patient discharge.
  2. Will be adequately prepared during teaching rounds with current patient information
  3. Will take call as assigned and report all admissions to either the Chief Resident or Faculty member as soon as admission is ascertained.
  4. Will see all admissions from the Emergency Department in a reasonable time after notification by the ED staff.
  5. Will be “off” for one day in seven average during the month.
  6. Will begin call at 5:00 p.m. on weekdays and 8:00 am on weekends. Call will end at 8:00 am the following day.
  7. Will take call “ in-house” when assigned to call schedule and will-not take call on average of more than “one-in-three” nights a month.
  8. Must notify patients’ PCP of admission, discharge and change in status as soon as practical. Will “CC” discharge summary at time of dictation.

 

3.      Ward Attending:

  1. Will set time of rounds each day as they desire.
  2. Is responsible for supervising Chief resident, junior residents and rounding team.
  3. Will make rounds and face-to-face contact of patients with residents Monday through Friday and weekends that they are assigned to call on the ward.
  4. Will be on “back-up” call for the ward as assigned by DFCM.  All DFCM medical faculty members will be on “back-up” call for the ward, also. At times during the month when chief resident is off or not on call, they will be “2nd-call back-up”, with the junior level resident reporting directly to faculty.
  5. Is responsible for teaching coding and supervising coding done by the chief resident. Must ensure accurate coding and  submission of FMIS charges within 2 working days of charge.
  6. Supervises all procedures done by resident or is available for supervision and questions the residents have.
  7. Will review by telephone all admission orders within one-hour of admission or as soon as feasible. This will be accomplished by on-call faculty at night and week-ends. If the patient was seen in clinic that day and assessed by a faculty member, this rule is waived.  Faculty in clinic will write admit note and review admit orders and bill for admission unless negotiated with ward attending.

 

4.      Acting Intern:

  1. Is supervised by senior resident on the service and by ward attending.
  2. Will have call responsibilities with the chief resident but will not stay “in-house” during call.
  3. Will be evaluated by the chief resident and faculty attending for the month. He/she must check all orders with the chief resident.

 

Call Schedule:

 

a.       Faculty will attempt to see patients within 8-12 hours of admission and write notes on day of admission, including patients admitted in the evening before midnight.

b.      Faculty call will begin at 5:00 p.m. on week-days and end at 8:00 a.m. the following morning. On Week-ends, call will begin at 5:00 p.m. Friday and end on Monday at 8:00 a.m. unless otherwise specified.

c.       Chief residents on the ward are responsible to develop a system for emergency call coverage in situations where  residents are sick or have other emergencies and cannot provide assigned call coverage.

d.      No resident will EVER pay money to change call or get another resident or faculty to take call for them.( See UAMS GME call policy.)

e.       Call schedule will be completed by the Program director ,and/or Associate Director , with the help of the chief residents.

f.        Holiday call will be rotated by the residents in the program, each taking their share of call. Third-year Chief residents will assist with this.

g.       Call schedule will be completed for entire year and posted by July 31 of that academic year.

h.       Trades may be made in the call schedule, resident to resident, or faculty to faculty, but must be in writing and must be given to the residency coordinator and the persons involved must notify operators and other persons as necessary for ward call.

i.         Call for the 1st call resident must be taken “in-house”.

 

 

Other Faculty:

 

 

Pharm D. & Behavioral Scientist:

 

a.       DFCM Pharm.D. or  his/her designee will round with ward team Monday through Friday.

b.      Pharm.D will be available to ward team after hours for urgent questions.

c.       The Behavioral Scientist will round one time per week and provide a brief in-service to the team on aspects of behavioral medicine issues one time per month.

 

 

DFCM Director of Inpatient Medicine:

 

A.     Will serve as “rotation manager” of the inpatient service.

B.    

Review trainee evaluations and institute improvements in the educational program.

C.     Negotiates and solves problems with other services.

D.     Reports to DFCM chair regarding unresolved clinical problems.

E.      Audits coding practices and establishes a training module for new team members.