WHo does your admissions during the day?

[McP]

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What model do you use at your program for admissions during the day? We have a senior resident take all calls for admissions (from the ED, specialty clinics and direct admissions). An Intern or student then sees the patient first and the senior resident "Seniorizes" the admission. Our interns often are resistant to doing admissions as they feel pressured to complete floor work and often do not want to do admissions with or seem confused when a student is doing the admission with them. As a student, I did admissions with the intern and the patient was seen after us by the senior resident.

We have already transitioned to 12 hour shifts for our residents, so afternoon admissions add to the workload of someone who needs to be done with floor work by 5. I'm just curious as to how other programs do this.

 

[FutureInternist]

Lubbock -
A Consult senior does all floor admissions from 7a-12p, since the floor seniors are on rounds. Then it's the call senior from 12p-9p.

 

[BADMD]

Lubbock -
A Consult senior does all floor admissions from 7a-12p, since the floor seniors are on rounds. Then it's the call senior from 12p-9p.

If the seniors are doing all the admissions, then what do interns do?

 

[FutureInternist]

If the seniors are doing all the admissions, then what do interns do?

Sorry I meant the on-call team does them after noon i.e. intern does H&P and senior approves orders etc

 

[45408]

I'm in surgery, so it's different for us, but we handle the admissions around the clock. The attendings pass the baton off at 7am for who we staff the patient with, but the residents see every patient. The medicine residents here don't take any admissions after midnight. I wish...

 

[Dr.LeoSpaceman]

I'm in surgery, so it's different for us, but we handle the admissions around the clock. The attendings pass the baton off at 7am for who we staff the patient with, but the residents see every patient. The medicine residents here don't take any admissions after midnight. I wish...

Or when they cap at their 8 patients...

 

[CyberKnife19]

Or when they cap at their 8 patients...

Be thankful, we cap at 10 patients each. 🙁
That's OK though b/c in just over four months, it's off to the blissful world of Radiation Oncology. 🙂

 

[dpmd]

I always wondered, what happens to patients after the medicine folks cap. I assume they must still receive care from somebody, right? What would happen in the real world in that situation? It always seemed wrong in my mind, so I figure I just don't understand it correctly.

I'm in surgery. We have interns receiving the consults and sending a student to see it first unless it requires more urgent senior eval. Intern sees the pt too then presents their plan to the senior who SHOULD see the pt (I heard that it isn't always happening) before okaying the plan. Intern is then responsible for orders, but student may or may try to come up with appropriate orders first.

 

[nowhinebuckets]

I always wondered, what happens to patients after the medicine folks cap. I assume they must still receive care from somebody, right? What would happen in the real world in that situation? It always seemed wrong in my mind, so I figure I just don't understand it correctly.

I'm in surgery. We have interns receiving the consults and sending a student to see it first unless it requires more urgent senior eval. Intern sees the pt too then presents their plan to the senior who SHOULD see the pt (I heard that it isn't always happening) before okaying the plan. Intern is then responsible for orders, but student may or may try to come up with appropriate orders first.

Usually there is an overflow team comprised of non-teaching hospitalists who take turns with call throughout the week. As far as consults go there is usually a separate consult service staffed by residents on an elective and faculty not on ward service. I'm sure the structure of these teams and their duties vary somewhat depending on your institution, so take this with a shaker of salt. Regardless, patients are not going unseen from midnight to 7 AM on the medicine service.

 

[gutonc]

Usually there is an overflow team comprised of non-teaching hospitalists who take turns with call throughout the week. As far as consults go there is usually a separate consult service staffed by residents on an elective and faculty not on ward service. I'm sure the structure of these teams and their duties vary somewhat depending on your institution, so take this with a shaker of salt. Regardless, patients are not going unseen from midnight to 7 AM on the medicine service.

Also, with the shift in many programs to a night float system, the number of admits to the house staff service will generally increase. I don't know what the actual ABIM numbers are but on our VA Gen Med service, the day team (7a-7p) admits 10 and the night float team admits 6 (alternating with the non-teaching hospitalist service). This is in addition to 4 patients who go to the "short call" team before the on-call team admits. So instead of 10 in a 24h overnight shift (which I think is the max a resident can take in a call shift), they can actually admit 26 in a 24h period to the different teams.

 

[DD214_DOC]

On medicine here, a senior evaluates patients in the ED and does a brief note if the patient is admitted. If the patient is not admitted, a full H&P is done by the senior.

Once on the ward if admitted, the overnight ward intern sees the patient and writes the full H&P and tidies up the orders.

The astute amongst the crowd can already see a problem with this setup ...


On psych, the senior does it all.

Oops! Just saw this was for daytime admission.

Medicine here has some obtuse system that I still cannot make sense of. In general, it's always a senior doing the evals in the ED.

On inpatient family medicine, I was doing ED consults and staffing the cases. I think I learned a lot more doing it myself than tidying up someone else's work.