Resident Handbook - UC Davis Health System

attending re: the patient’s status or management must be noted in the chart; especiallyif/when the patient’s condition changes significantly. Any transfer to the ICU must becommunicated immediately to the attending.C. DutiesMedicine Admissions and the cap: Unassigned medicine admissions from the ED arealternated with the hospitalist’s service. This should even out the flow of admissions andallow for an appropriate service census. The attending of the week has the authority todetermine the service “full” and invoke the cap. The medicine cap works as follows:• The number and acuity of patients and the number of residents onservice will determine total cap. Generally speaking, for fourresidents, the cap is 16 points, for three residents, 12 points and fortwo residents 8-10 points.• Each floor patient is generally one point. An active ICU patient is twopoints.• The maximum points admitted in one day = 6.• Once the service is closed, it opens only when the day’s dischargesbring the service volume/acuity back under the cap.• The medicine senior resident will let the ED know if the service is"open" or "closed."• During the evening, the night shift resident will be responsible forcontacting the ED.• When the service is closed, all further admits will go to the EDunassigned call list.• Each individual attending has the prerogative to go above and belowthe cap given the overall volume and acuity of the service.• For PGY1s, the minimum average census should be 5 patientsSenior resident duties:• See new admits each morning before rounds• Perform all consults at the attending’s direction.• Assure that ICU patients are seen twice a day• Pre-round each day with the PGY1s if appropriate• Review progress notes each day• Write backup admit notes on all admits and review all orders when onduty in the hospital• Assign admissions• Spend what time is available and appropriate to support the teachingfunctions of the service• Encourage team efforts and support• Give feedback and evaluations to junior residentsPage 53 of 153C:\Documents and Settings\dhutak\Desktop\rshb13.doc