Geriatric Inpatient Experience - Nix Rotation

At present clinical time is divided into time at the Nix hospital and the Family Health Center. Prior to the start of your rotation there are several items you need to complete: the Nix clinic orientation, and the Sevocity EMR orientation. Both are listed in the Orientation Info area on the left side of this page. Please familiarize yourself with the Merck Manual of Geriatrics prior to beginning your rotation. You should also carry a copy of Reuben's Geriatrics at Your Fingertips. Electronic and PDA versions are available online: http://www.geriatricsatyourfingertips.org .

Absences other than illness must be cleared with your attending. All absences or changes in schedule should be brought to the attention of your attending. The attending schedule is posted on the departmental electronic scheduling system, Whentowork.com .

We hope you enjoy the time that you spend with us. We are constantly attempting to improve the experience. If you have any further questions or comments, please let the faculty know.

OBJECTIVES

At the end of the rotation the resident will be able to:

diagnose and manage common inpatient medical problems common to the elder population, including critically-ill patients requiring critical care unit management.
provide medical care for the older surgical patient, including pre-operative evaluation and post-operative management.
complete a comprehensive assessment of functional status and appropriate levels of care, e.g., "can this patient go home rather than to a nursing home, or to some other less restrictive environment?"
participate in geriatrics consultations to physicians in the inpatient hospital environment with specific emphasis on geriatric psychiatry and surgical care.
participate in discharge planning to optimize use of community and outpatient services available for the elderly, including follow-up with Senior Health Care Center, if desired.

CLINICAL RESPONSIBILITIES

Residents are primarily responsible for caring for inpatients under the direct supervision of the attending physician. Rounds occur daily at 8:45am, unless told differently by the attending. Residents are responsible for being familiar with the ongoing medical situation of all inpatients and consultation patients.

The geriatrics service, from time to time, provides geriatric medicine consultations from geriatric psychiatry patients 65 years of age or older within 24 hours of admission and for patients on other services by request. The resident has primary responsibility for consultations. **If you have less than 3 patients on the inpatient service you are required to provide outpatient support to the geriatrics clinic (suite 1111) after rounds.

ADMISSIONS

Admissions are always received and authorized by the geriatric attending. The attending will then call you for instructions on evaluation and management.
Patients may be admitted directly to the floor (19th floor). These patients must be seen by a resident upon arrival.
All nursing home transfers are required to be cleared with the geriatrics fellow prior to transfer and communicated with the attending.
Clinic admissions arriving on the floor after 4pm will be admitted by the on-call resident and discussed with the attending.
Monitoring telemetry patients must be seen and admitted by residents within two (2) hours.
Non-monitored patients must be seen within twelve (12) hours or before AM attending rounds, whichever comes first.
Admission orders can be called in to the inpatient nurses after sign-out is received from ER attending by geriatric attending.
We avoid night transfers if at all possible. There are no intra hospital (i.e. ICU to floor) transfers allowed after 12 noon. *****You are required to discuss all admissions with the attending.

Night Calls
Most overnight issues can be addressed by telephone conversation with the floor nursing staff. However, if patients require more intensive evaluation, a physician is expected to go to the hospital. (Please see After Hours Call section below). ***You are required to contact the attending at any hour for any questions or concerns.

Orders & Progress Notes
Residents are expected to write daily progress notes and dictate admission and discharge summaries for all inpatients. All orders and notes need countersignatures by the attending prior to discharge. Dictation formats are listed in the left-hand tool bar on this page.

After Hours Call

Call is primarily beeper call 24 hours, Monday-Friday shared with the GERI-Parklane resident during week nights and on alternate weekends. Please check with the NP to coordinate weekend calls. You are required to report expected 80-hour overages to your inpatient attending BEFORE you reach an overage.

There is always a geriatric attending on call 24x7. The attending call schedule changes every Friday at 12 noon. Please get a copy of the call schedule from either Tisha Rodriguez or at the NIX Senior Health Care Center. Attending beepers and cell phones are available on the schedule.

Charts & Medical Records
Charts are hard copy. Medical records are on the 9th floor. Please before you finish the rotation go and complete any pending medical records. The geriatrics discharge summary template is available in the left-hand tool bar on this page and has will be distributed to you.

Each floor should have a pink identification form with your pager/cell phone. Ask for those pink sheets to be on the charts and inform the nursing staff of your beeper number on all new admissions.

Check the MARS (medication sheet) at least every other day.

Pharmacy Rounds

Every week we also have an interdisciplinary round with Pharmacist, Kristy Fitzgerald, to review a topic of interest for the week related to the inpatient service. This is usually Thursday at the office at 8:45am before attending rounds.
***Please choose a topic and call her at least 48 hours in advance.

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CONFERENCES

Attendance at the following conferences are required:

Geriatrics Division Grand Rounds
held every Monday, 12pm-1pm, 6th floor conference room, NIX cafeteria. Lunch is provided. Charge your lunch to the NIX Senior Healthcare Center. During their rotation, each resident is required to formally present a case of their choice during M&M on the third Wednesday of the month.

HELPFUL HINTS

Parking - Park at Mid City Garage (see map below). Validate your parking each day at the NIX garage (ground image_parking floor of the Nix Hospital). Identify yourself as a resident Nix Senior Health Care Center physician. We can not pay for parking if you do not follow these instructions.

Call Room - Although no call rooms are available the outpatient office (11th floor) has computer access and a place to rest during the night. Coded entry so please take down the code when you get there.

Cafeteria - 6th floor. There is a 25% physician discount with jacket and UHS id. The cafeteria is cash only. SACU ATM available on the first floor in valet parking. Lunch is provided free during the Monday Geriatrics Grand Rounds, but not at any other time.

Further Information on the Nix Hospital can be found on their website, www.nixhealth.com .