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Inpatient Attending Role and Job Description

Page history last edited by gabrielpalley 12 months ago

Daytime Attending

  • Hours: weekdays
      • weekdays: 7:15am-5pm
      • weekends and federal holidays: 7:15-when done with rounds and any procedures/help with work needed

 

  • We have a morning report daily at 7:15 which includes teaching to both teams together, then separately to hear about overnight admissions from the Night Float team. Teams alternate admitting days, and while one team carries the pager every day, we do rarely ask that both teams admit patients when the teams are very busy (i.e. the admitting team is admitting a patient, and there are more than one patient waiting).  Our goal is to utilize our available resources, which often means working together. 
  • The baseline expectation is to be present (FMC office is fine) from 7:15-5pm on weekdays.  On the other hand, we do want to support outpatient providers while they are working on the inpatient service, so if there are specific circumstances where a small amount of afternoon coverage would be very helpful, please let them know.
  • If necessary you may schedule one afternoon half day of clinic on a non-admitting day with prior communication to the other team attending who will need to be available to cover your team while you are gone (see below).
  • Please make sure you sign your Attending Admission Confirmation orders on a daily basis! Our goal is to have these signed within 12 hours from admission. In powerchart use the CACHE link to see which of your patients still need the order. Please email Gabriel Palley if you have any questions.
  • Present an inpatient topic at the afternoon teaching sessions as outlined in the Inpatient Education Conference Schedule. 
  • Send discharge emails to pt PCP's- this job is shared with the upper level resident. 
  • Be familiar with the resident inpatient expectations

 

Overnight Call

  • From 11/9/2020-12/31/2020, overnight call will be home call. Residents will call attendings with discuss plans, but send H&Ps to the attending who will be seeing the patient the following morning. Please check in with residents several times to make sure the patient flow is appropriate. Of course, you are still expected to come in for emergencies. 
  • Be familiar with the Night Float Expectations page, which explains how we handle overnight admissions.  We staff all admissions before midnight.  If the overnight team has any questions or concerns any time, they may call you and you may need to go in. 
  • Have your pager on/neat all times
  • Be available to be in-house within 20 minutes, for emergencies. 

 

Attending Retreats

  • We previously had 2-3 inpatient attending retreats per year, although that has been put on hold due to COVID. We aim to move to meetings every other month with a required attendance of greater than 50%, but this will be started after the current COVID crisis.  The reasoning behind a requirement is that we discuss changes to both our team system as well as UNMH in general at these meetings, so attendance is helpful to keep up with constantly evolving UNM protocols and to maintain general competency in inpatient medicine.

 

Misc Tips

  • Attendings should offer to write a few notes on stable patients awaiting disposition on really busy days.  This small amount of work can often really help the team get more work done.  This is especially helpful on weekends. Interns should usually see a minimum of 4 patients to make their residency encounter requirements, but should not have to write notes on more than 8 patients.  Upper level residents can write a few notes as well but priority should be on them running the service.
  • On days with very busy census or residents who are unable to come in for work there is a backup resident system. Please discuss with your team seniors if you need to call in backup, and if so it is the attending's responsibility to make the phone call to the backup resident to come in for the day.
  • One of the main ways to maximize efficiency when we are very busy is not having the entire team round on every patient- especially the PAs.  It ties up too many resources.  Perhaps the attending can see some patients on their own, the PAs can see some of their patients by themselves, each intern doesn't need to see the other intern's patients, etc.
  • Discharge Rounds: on the day of discharge for a patient, make sure this information is gone over:
    • Discharge Diagnoses
    • Medication changes (new meds, old meds to be held on discharge)
    • Follow up appointments
    • Labs/tests that PCPs need to be aware of following up or ordering

 

Specific Team A Attending Roles

  • Help run and organize the morning report, making sure there is an educational aspect and things end on time, for the sake of duty hours. Please strive to have Night float people out by 8:00am
  • Help serve as systems expert to help the team B attending with questions such as direct admission procedures that may arise
  • Be able to provide more direct patient care when needed, including admissions, discharges and progress notes, given that Team A usually only has one intern

 

Afternoon For Clinic

  • During an inpatient week, clinic-based inpatient attendings can go to their clinics after 1pm on one non-admitting afternoon. If this happens, it should be clearly communicated with the other team attending as well as the resident team. The attending needs to be easily reachable via pager/cell phone and able to return in case of a clinical situation that needs their presence. Preferred days are tuesday/thursday/friday.  The other team attending should help cover straight-forward issues and be physically present so residents have someone they can approach as needed.

 

 

Other Pages to be Familiar With

Note and Documentation Requirements (Inpatient)

FM-IM Census Overflow Policy

 

Back-up Call

For various reasons, sometimes the on call attending is unable to be on call, and we find this out the last minute.  In these situations, the backup call attending is the weekly attending for the team who carried the pager that day (based on whether it's a Team A/Team B day). 

 

 

 

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