Inpatient Medicine

Access inpatient sign out here (sharepoint)

M&M worksheet

Inpatient Resident Responsibilities  

Arrival 6:30-6:45am for all residents, sign out at 6:45am 

Sign out- detailed by patient by patient – Use Listrunner/IPASS format  

• I- Illness severity- “Stable” “Watcher”  
• P- Patient summary- Brief summary, what brought patient to ED, presentation, plan  
• A- Action list- To do list, timeline and ownership  
• S- Situational awareness- Contingency plan if patient deteriorates  
• S- Synthesis of receiver- Teach back 

Download the listrunner app to update during rounds, etc 

The TEAM SHOULD STAY TOGETHER – in the same area supervised by senior 

Start the Tiger Text with the attending 7:30-8am 

Patient should be seen before rounds – ideally go see patients by 8am 

Senior/PGY3 Role 

Pre-Rounds 

• Assign patients to the juniors during sign out (or think about it in your head)
  • Balance cases/acuity 
  • PGY2 and PGY1 split list 
• Run the list briefly before pre-rounds
  • What to look out for such as SOB, CP, HA, wheezing, edema 
  • Questions to ask to the patient 
• Run through the list BEFORE rounds with the attending *if there is time* 
• Know all patients on the list
  • See/exam sick/concerning patients as well as all new patients 

Rounding 

• Display/control the main computer (Get rolling desk) 
• Put in immediate Orders 
• See/examine all patients during rounds 

After Rounds 

• Run the list
  • Ensure time-dependent orders put in 
  • Go over to dos 
  • Have plan for each patient 
• Update List Runner 
• Review orders put in 
• Ensure AM orders for patients in 
• Senior should not leave until the work is done 

At the end of the month, senior should send an email to our program director and program coordinator with a list all the weekly attendings your team worked with to send out evaluations. 

PGY 1 and 2 will split the entire list pending proficiency 

On clinic days, the person going to clinic will see 5 patients – senior will take 3 more + the regular responsibilities 

PGY2 Role 

Pre-rounds 

• Split list with PGY1 
• See all patients before rounds

Rounding 

• Update List Runner for PGY2 patients 

After Rounds 

• Work on getting notes done by 1pm 
• Call consults 
• Finalize summaries for discharge that day 
• Update hospital course for other discharge summaries 
• PGY2 takes over PGY3 responsibilities when PGY3 is at clinic 

PGY1 Role 

Pre-rounds 

• Split list with PGY2 
• See all patients before rounds

Rounding 

• Update List Runner for PGY2 patients 

After Rounds 

• Work on getting notes done by 1pm 
• Call consults 
• Finalize summaries for discharge that day 
• Update hospital course for other discharge summaries 
• Update List Runner 

Teaching 

10-15 minutes around 1-3pm depending on workload 

Admissions 

• Admissions: starting at 1:30pm
  • PGY1 should take the first admission 
  • PGY 2 second admission 
• PGY 3 help decide who can do the next admission 

End of Day – 4:30pm 

• Run the list as a team – tie up loose ends 
• “Check out” with the attending 
• Sign out – sign out all patients to night team at the end of the day
  • Clinic person can call night team or go back to the hospital to go over the list 

Rapid Responses 

• EVERYONE should go to rapids 
• Who holds the pager?
  • First half of year PGY3  
  • Second half of the year PGY2 

Weekends 

• PGY1 + 3 splits the list 
• PGY 2 splits the list with attending 

At the end of the month, the exiting team will sign out to the oncoming team. PGY-1 will sign out to oncoming PGY-1, PGY-2 will sign out to PGY-2, PGY-3 will listen in on all patients and sign out missing information. 

Inpatient teaching checklist