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Visiting residents will be paired (one-to-one) with a Hospitalist faculty preceptor, and will be expected to provide independent care, under the supervision of the preceptor, for a subset of the patients admitted to the Hospitalist service. The degree of autonomy will depend upon each resident’s clinical confidence and abilities. Daily clinical activities will include the following:
- Residents will be expected to follow between 4-8 patients daily
- On the 1-10pm shifts, residents will admit 2-4 patients daily
- Discussing possible admissions with referring physicians (including ED physicians, outpatient physicians, and physicians from outside institutions) to determine the appropriateness of each admission and the goals of hospitalization
- Assessing new admissions, implementing a clinical plan of care under the guidance of the preceptor, and performing appropriate computer-based documentation and order entry
- Defining realistic goals of inpatient care for individual patients
- Communicating the goals and endpoints of care with patients, families, nurses and case managers
- Morning sign-in and afternoon sign-out rounds with the physicians covering during the evening, with use of a computerized sign-out system to facilitate concise, yet adequate, information transfer between caregivers
- Reassessing existing patients daily and developing personal time-management strategies to maintain a short length-of-stay and discharge patients early in the day whenever possible to facilitate hospital throughput
- Implementing evidence-based practices that apply to hospitalized patients, including: thromboembolic prophylaxis, optimal glycemic control, and inpatient pain management
- Recognizing when subspecialty consultation will improve patient care and communicating effectively with consultants.
- Daily review of the specific plan of care with the patient and the interdisciplinary team
- Providing regular updates to referring physicians as appropriate
- Ensuring that appropriate discharge plans are in place for each patient, and communicating these plans with the patient and the primary physician
- Appropriately billing and documenting the care of medical inpatients