Transcript Intern Orientation - Sign Out

Intern Orientation
Sign Outs
UCI DEPARTMENT OF INTERNAL MEDICINE
Objectives
 Help interns feel more comfortable with the sign
out sheet
 Walk through a sample patient sign out
How to get to the sign out page
 AT UCI:
 Medicine Home Page:
http://www.medicine.uci.edu/residency/residents.asp
 Click on Residency Portal and log in
  “Shared Documents” (Column on left hand side)
  Your Team and log in again. An excel sheet will open up
 AT VA:
 Through CPRS: Click on Options  Handoff Tools
Tips for Sign-Out
 Keep in mind that nightfloat residents are covering
>30 patients per night and are busy. It takes time
to learn on what to include in the sign out
 If the service isn’t too busy, try to quickly review
the sign out with your senior resident so no tasks
are overlooked.
 Do not wait until the last minute to update the sign
out list!
Tips for Sign-Out
 EVERY patient should have last name, first
initial, location, and MRN listed
 Write a one liner about the patient
 List an ACTIVE problem list and whether
the patient is stable or unstable from that
standpoint
 To Dos: Next slide
 ALWAYS write the CODE STATUS of every
patient
Tips for Sign-Out
 To Dos for nightfloat: What to include? What to
exclude?
 List tasks for nightfloat to follow up on (labs,
imaging, etc) and instructions on what to do with
those results (transfuse, replete lytes, etc.)
 Anticipate what night float will get called on follow
up labs, imaging, Is/Os
 Include FYI notes: if patient may decompensate,
pass away, consultant recs, etc.
 DO NOT sign out procedures! They should be
completed before going home
Example
 Your patient on the wards: She is a 64yo F with
pmhx of CHF (EF 35%), HTN, HLD, DM s/p right
toe amputation, and breast CA in remission who
was admitted for DOE and LE swelling. She hasn’t
been compliant with her medications and the team
deemed her to be in CHF exacerbation. The patient
was started on IV lasix BID and resumed on her
home meds. You also noticed her right foot had a
diabetic ulcer concerning for osteomyelitis. She
has a leukocytosis of 18,000 and spiked a fever
after being admitted. Ortho was consulted.
Example (cont’d)
 She was pancultured at the time and started on
vanco, & zosyn. A nuclear scan (creatinine 1.7) was
ordered earlier and still has not been performed.
Her breast cancer has been in remission for 5y and
her heme/onc doctor is an out of UCI network. Her
daughter, Susie, is very involved in her care and
requested to be called if there are any updates with
her mom. Patient is stable. She is full code.
 How would you write the sign out on this patient?
Sample sign out
Patient
Problem
Doe, S
T5B1
MRN
999999
64yo F w/pmhx CHF (EF 25%),
HTN, and DM s/p right toe
amputation admitted for CHF
exacerbation 2/2 med
noncompliance and possible
osteomyelitis.
#CHF exacerbation: Resumed on
ASA, ACE, bB and started in IV
lasix BID. Breathing comfortable
on room air.
# Diabetic ulcer: Leukocytosis,
febrile. On vanc, zosyn. Awaiting
nuclear scan. Ortho aware.
#DM: On RISS
Meds
To DO
List all
[ ] Check K and
pertinent Mg at midnight
meds
and replete
[ ] If febrile, do
not reculture or
change abx.
FYI: If
decompensates,
transfer to CCU
for lasix gtt.
FYI: For major
overnight
events, call
daughter: Susie
(xxx)xxx-xxxx
Code
Status
FULL
CODE
Summary
 Be concise and include pertinent info on the sign out
 Anticipate events that may occur with your patients
and notify nightfloat