Wards
Welcome to your Wards rotation at the DC VA Medical Center!
There are 6 day ward teams and a night float team that our wards residents rotate through. Each team consists of one resident (either PGY-2 or 3) and two interns. You will work with residents and interns from Howard University Hospital, George Washington University Hospital, Walter Reed National Military Medical Center, and MedStar Georgetown University Hospital.
Each team will also have between one and four students (MS3/MS4/PA/Podiatry) from George Washington or the Uniformed Services University.
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Team rooms and passcodes:
Team 1: room 3E-239, passcode 3+4, 1
Team 2: room 3E-105, passcode 3+4, 1
Team 3: room 3E-141, passcode 3+4, 1
Team 4: room 4E-239, passcode 3+4, 1
Team 5: room 4C-194, passcode 4, 2
Team 6: room 4C -100
Team 7: room 4C-135, passcode 4, 2
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Medicine Call Room 4D205: 2+3, 4
Medicine Call Room 4D207: 2+3, 5
Medicine Call Room 4D106: 1, 3+5
Medicine Call Room 4D208: 2+3, 1
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MICU: 1+2, 3
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Vocera log-ins: can say "team 1" or "name"
Team 1: Obi-Wan Kenobi
Team 2: Deuce Bigalow
Team 3: Tres Amigos
Team 4: Fantastic Four
Team 5: Captain Planet
Team 6: Kevin Bacon
Admitting Team: Medicine Admission Team
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Call
Every team admits patients each day, including weekends, from 7am-3pm. Two teams are on late call each day, which means they continue to receive admissions past 3pm until 6pm. This rotates amongst all 6 wards teams every 3 days.
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Med Consult Coverage:
During the week, one call team will hold the med consult pager when the med consult resident is done for the day (~4pm-6pm) and throughout the day on the weekend. Reference the weekend email to see which team holds the med consult pager. The med consult pager will then be passed to a night team resident at signout.
The call team resident will return the page, assess the patient, write a h/p using the Med Progress note template and present the patient to the Med Consult attending. (Due to CPRS constraints, you cannot use the Med Consult note template). OF NOTE: it is important to assess for stability of the patient when returning the page as a rapid response may be more appropriate first with a med consult to follow (if necessary).
Weekends
Weekends are gray here at the VA, meaning you will work one day and have the other off. Interns will work together, and residents will be on their own. If your team was on call Friday, interns will be on the Saturday post-call.
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Each team has a sister team, i.e. Teams 1 & 2, Teams 3 & 4, and Teams 5 & 6. On the weekend the two sister teams become one Super Team. They round together and complete admissions together. The call schedule still stands on the weekend, so two teams will admit until 6pm. The sister team should stay to help with admissions through call.
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One member of each team has to stay until sign out at 6 pm.
caps
Each medicine team caps at 20 patients total per GME guidelines. When the total medicine census is less than 84, the team cap will drop to 18.
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Interns can receive a maximum of 7 new patients on any given day (5 admissions + 2 transfers) and can carry no more than 10 patients.
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Residents can supervise a maximum of 14 new patients on any given day (10 admissions + 4 transfers) and can carry no more than 20 patients at a time.
duty hours
Please let the chiefs know if you are approaching duty hour limits. You cannot work over 80 hours per week averaged over the month and we will work with you to make sure that is not the case.
Admitting Team
We will be starting an Admitting Team on July 29th for the rest of the academic year. The team will consist of 1 resident/1 intern pair. Some of you may have the opportunity to be scheduled on this team. If you are scheduled on this team, you will receive an email from the chiefs the week before your rotation with more specifics regarding expectations, responsibilities, and daily workflow.
In general, the team will function from 2-10PM, Monday to Friday and will assist medicine teams with admissions until 6PM and then will assist night team with admissions until 10PM. During the day, if you are on wards and you receive an admission, you can call the admitting team via Vocera to see if they can help with that admission. The admitting team will assist all teams between 2 – 3PM and call teams between 3 – 6PM.
The team has a hard cap of 12 patients (5 for the intern, 7 for the resident) and the admitting team resident will determine (in conjunction with the team attendings) whether they can take a particular admission. Teams are still expected to complete admissions as usual if the admitting team cannot assist them.
Of note, when a Howard University Resident is on the admitting team, they are still expected to go to their ambulatory clinic. During this time, there will only be 1 intern on the admitting service. Their overall cap will decrease to 5 but they will continue to assist with admissions between 12-3PM; between 3-6PM, they will be assigned to an on-call team to assist with admissions; the other on-call team must continue to complete admissions as usual. The admitting team will admit until 8:45 PM (hard-stop) and are expected to give verbal and written sign out on any patients admitted after 6PM to the night team so they can be adequately monitored and signed out to the appropriate team in the AM.
We will be gathering feedback regularly to see what is working and what is not working; please also feel free to give feedback to us in person.
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PLEASE NOTE:
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If you are on a WARDS team, and are considering asking the admitting team for assistance with an admission:
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You MUST obtain the full hand-off from the ED provider and provide the relevant information (your team #, your attending, and the senior resident) for the ED to put in the ADT order for the patient. The patient is YOUR PATIENT first and foremost, the admitting team is only helping physically admit the patient. Once the hand-off is complete, discuss with your attending if you can ask the admitting team to help you admit the patient. ONLY IF THE ATTENDING SAYS YES, can you call the admitting team (Vocera “Medicine Admission Team”) to see if they can take the admission. The admitting resident will discuss with your attending and later tell you if they can take the admission. SENIOR RESIDENTS, please still see any new admissions that are given to the admitting team for the sake of continuity of care.
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If the admitting team takes the admission, they will be responsible for all notes and orders regarding the patient’s admission. They are expected to staff the patient with you (the team) and the attending IN-PERSON as this will be their hand-off to you. You will then resume care of the patient.
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For *late* call day admissions (e.g. between 5-6PM), the admitting team can still assist with admissions. It is expected that they see the patient, formulate a plan, and attempt to staff the patient with your attending (with you/team present) either in person or over the phone by 6PM so you can include the patient in sign out to night team at 6PM. HOWEVER, if they cannot see the patient and staff them before 6, you are still expected to sign out the patient to night team cross-covering intern. Your sign out should be “The admitting team is still admitting the patient” but the patient information MUST be included on your sign out. The admitting team will then provide formal sign out to the appropriate night float intern after the admission is complete. Furthermore, the admitting team will also, when ready to staff, call the team attending and senior resident to staff the patient, to ensure closed loop communication.
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If you are on the ADMITTING TEAM, you will receive an email with more formal instructions/guidance from the chiefs the week prior to your rotation. ​​
Refer to the buttons below for more information on how to do admissions, best practices with discharges, more information on the night float rotation, etc.