Rotation: Night Float (NWTH)
Site:
- Northwest Texas Hospital , Amarillo
Instructors:
- General Internal Medicine Faculty. Each attending to whose service patients are admitted will round with the night float resident.
Make up of team (responsibility of each team member):
- Senior Resident - Admit new patients, evaluate certain ED patients for necessity of admissions, provide urgent services as consultations on patients under other specialties and provide supervision and support to PGY-1 resident
- PGY-1 Resident - Responsible for admitting patients from ED, follow-up of new admissions of that day and provide back-up to cross cover patients of other IM team(s) during the night
- Attending Physician - Provide supervision and teaching on this service, provide immediate guidance in the management of new admissions and consultations.
Days per week (night call):
- Sunday through Thursday 9:00 PM to 7:00 AM, followed by checkout to team and attending rounds until approx 8:30 AM, 5 South conference room.
Type of Patients:
- Patients of both sexes with a broad range of ages from adolescent to geriatric, including the socio-economically disadvantaged
Educational goals/competencies:
Patient Care:
Demonstrate history and physical examination skills necessary for diagnosis of cross-cover problems, learn to utilize sign-out information from their peers to care effectively for patients whom they do not know, interpret laboratory data, review radiological studies, and develop procedural skills including central venous lines, lumbar puncture, arterial blood gas and joint aspirations.
Medical Knowledge:
Learn diagnosis, complications and management of commonly occurring problems including chest pain, nausea, hypo/hyperglycemia, dyspnea, altered mental status, fever, abdominal pain, headache, electrolyte disturbances, insomnia, intravenous fluid management and management of pain. The range of patients and disease process will be essentially the same as those encountered on the general internal medicine ward rotation.
Interpersonal/Communication Skills:
Demonstrate humanistic qualities that foster the formation of appropriate patient-physician relationships, develop skills of interpersonal communication maximizing information exchange with patients, fellow residents, attending physicians and consultants, develop an approach for a comprehensive sign-out at the conclusion of night float, emphasize writing legible orders and record-keeping.
Professionalism:
Acquire the values of professionalism including integrity, respect, compassion, professional responsibility, courtesy, sensitivity to patient's needs and comfort and encouragement, appropriate professional attitude and behavior towards colleagues; emphasize respectful interaction with nurses in ED and in-patient wards and respiratory therapists.
Practice based learning and improvement:
Improve patient care by learning from prior mistakes and from consultants, incorporate life-long learning habits including utilization of computer resources (Medline, mdconsult, micro-medex etc) and library materials to assist and improve patient care, facilitate learning of his/her limitations when it is vital to patient care to involve consultants after-hours, a skill that will be used later in the practice of medicine.
System based practice:
Utilize social workers for indigent patients discharged from ED who require placement/shelter and medication assistance, emphasize cost containment with respect to prescription medications and use of consultants.
Text or references to be consulted:
- Harrison's Principles of Internal Medicine
- Current Medical Diagnosis
Resident evaluation: Attendings at morning report will be asked to complete an evaluation of each resident at the end of the rotation regarding participation in patient care and management through oral presentations and chart review.