intern responsibilities
This experience on the wards will have many similar components to your home institution and some different ones. In order to make the transition easier, here is a list of your expectations and responsibilities as an intern while here. The goal is for you and your resident to work together, learn, and take care of this amazing patient population.
Pre-Rounding / Rounds
Pre-round on your patients. Before rounds, every day, see and examine ALL your patients. Look through their vitals, labs, imaging, and consultations. You are the expert on these patients!
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Round. With the attending, typically starting between 8:30-9am depending on your attendings preference. The goal is to finish rounds by 11:30am. The order of what patients you round on first is usually decided by the resident but tends to be new or sickest first, followed by known discharges.
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Presentations are typically in a SOAP format: overnight events, subjective, objective: physical, labs, microbiology, imaging, EKGs followed by your assessment and then a plan that is organized by problems.
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To keep rounds efficient, typically the other intern on the team will enter orders for the intern presenting. Prioritize getting orders in during rounds.
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Call consults early, ideally before noon – it is acceptable to call during rounds while your co-intern presents. Please note you must call AND place an order in CPRS in the "Consult" tab.
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Noon Conferences
These are required and it is expected that you attend. Conference starts at 12:30PM Tuesday-Friday. Please make sure you are on time and drop off your vocera to the chiefs, as the chiefs will cover your calls during this time. The conference schedule is on the calendar on the website.
Afternoon Expectations
Ensure medications are accurate & important new meds are administered throughout the day.
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Check the orders tab for active meds under “Infusion” and “Inpt. Meds” – double click on them to see when received (this is important to check, especially for new stat dose antibiotics or anticoagulants).
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Can also go to Reports >> Med Admin History (BCMA) which has a full list of the medications given in the past 7 days (note does not include today) or can click on “Today” at the top for today’s meds.
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If a stat dose medication hasn’t been given within an hour – call the floor nurse to make sure they aren’t running into any issues (no IV, backup in pharmacy, etc.) and then to your pharmacist to make sure it is approved and expedited.
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Each team’s pharmacist name/number under Phone Book on dcvamedres.com
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Vocera the charge nurse on the floor to get direct contact with the nurse (e.g., use vocera to say “4-C Charge Nurse”).
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Write a progress note on each patient every day. This does not need to be done before rounds, but does need to be finished in a timely fashion. Notes should accurate, thorough, and updated. The progress note template is “Med: Inpatient Progress Note.”
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Make sure to not just copy forward the note but edit and update daily.
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Document everything! If there is a big change in a patient's clinical status and the plan of care has changed, don’t wait until the next day’s progress note but write a “Medicine: Cross-Cover Note” so that everyone who views the chart is aware of the change!
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Communicate with the nurses! Especially with the pandemic, bedside rounds have become more difficult. Make sure the nurse for the patient knows what the plan of care is. Your resident should run the list with the charge nurse daily. If you are planning on discharge, or if need something to happen stat (get a CT scan, start a heparin drip, stat dose antibiotics), let the nurse know! They can help you navigate VA specifics and expedite important patient care items.
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Follow up with consults – it’s always best to speak directly if possible.
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Update families frequently. Especially because of the pandemic and the decreased visitors to the hospital, family members are frequently very worried and at a loss of what to do. Try and update a family member (if the patient agrees) every couple days.
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On that note, take care of your patients as if they were a loved one.
discharges
See the discharges section for more details on Part A, Part B, the Discharge Summary, and the process of discharging. Other things to be aware of include:
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Follow up appointments and transportation can be helped and made by social work and case management. This should be discussed during interdisciplinary rounds, ideally the day before intended discharge.
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You will be asked to complete “Travel Hybrid Request Form” and “Beneficiary Travel Notes”. Ask your SW to help you complete the pertinent aspects of these forms.
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Discharge summaries should be completed 24 hours after a discharge except if the patient is going to rehab and then it needs to be completed and signed by attending PRIOR TO DISCHARGE.
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Identify the patient’s primary care doctor as an additional signer. Right click the note, hit “Identify Additional Signer” and search for their PCP. Their PCP’s name is at the top of their chart along the banner.
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Sign-out
Please update the HANDOFF tool regularly (if you don’t change things at least every 7 days, the items will disappear!). Make sure to have active problems, family contacts, etc.
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FYI
Remember that disruptive behavior by patients is not acceptable – if you feel like this is happening, please inform your attending and the chief residents!
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Call your attending if you have any questions or concerns! If there are clinical quandaries, figuring out how to escalate care, if a patient leaves AMA, and especially if there are deaths.