We had a meeting on tuesday and made the following changes to the inpatient service system (Dr. Shepple, please correct me if I am wrong):
The Acker service caps at 15 patients except when there is not a resident on the Acker service- then the cap changes to 12. There is no longer a "pass or play" option at 12 patients.
Two new inpatient services have been created: the L-APP (London APP) and R-APP (Rawson APP) Services. These services will be managed by the APP. The London or Rawson attending will meet with the APP once a day and run the list. The attending will not need to cosign any notes or see any of the patients. The APP will generally bill a 99231 or 99232 on each of their patients, and the attending will bill a 99231-S. The R-APP service will cap at 10 and that APP will generally be the Quarterback except on weekends. The L-APP service will cap at 15.
Dr. Shepple will send out another email with more details.
I am about to push out a major update to the Rounding Utility and Hospital List Utility. Below are the changes:
When the Quarterback clicks the Assign Service Button, it will now ask if there is a resident on the Acker service.
The answer will be Yes most of the time. The Acker attending should inform the Quarterback if there is no resident. I also made a new team member on the online calendar uconcall.com/attendings called NORES. We will give that "person" the Acker shift on days there is no resident. I will soon update the rounding utility to "sense" this on the calendar and choose No by default if there is no resident.
The second major change is the addition of two new inpatient services: the L-APP and R-APP services. The service is the leftmost column on the rounding utility. To transfer a patient to an APP Service, click the Assign Service button and select Automatically Assign to APP Service. It is better to do the Automatic option than picking the specific L-APP or R-APP option (you could do that too but it is discouraged).
If the patient is already on the London service, the computer will try to put the patient on the L-APP service unless that service is capped- then it will go to R-APP. If both services are capped then it will leave the patient on the original service. Please note the question, Has the patient already been seen by the cardiology provider today? If you select Yes then the APP doesn't need to see the patient until tomorrow, and the APP service census will not increase until tomorrow.
Side note: the Assign Service dialog has some questions about whether the patient has a CORE diagnosis, whether they are in the ICU, and who there clinic attending is. If you are just putting the patient on the APP service, the answers to these questions don't matter.
You can filter the list to look at just the L-APP service or R-APP Service. At the end of the day, the attending can verbally run the list with the APP and bill a 99231-S for each of those patients. I've made a button called Bill for Entire APP Service to make this quick and easy. The APP will need to bill a 99231 or 99232 for each of their patients as well (the button is just for the 99231-S codes).
I'm now going to use this email as an opportunity to discuss some housekeeping issues with the hospital list.
We now have eight inpatient services:
A for Acker
L for London
R for Rawson
L-APP for London-APP
R-APP for Rawson-APP
EP for EP
CHF for CHF
S for Structural
The Hospital List utility will now start prompting you to use the correct Service abbreviation (you can't use Structural; just use S instead). The utility will also discourage you from using PROC; just leave the service column blank or let the attending add that patient to the list. If the patient is just coming in for a cath, I would indicte that in the Notes column. We have some old school attendings (Bresee) who want to keep using that. The problem is that the computer can't remove a PROC patient since it doesn't know when their cath day is (they are a "future patient"), and so these patients tend to stay on the list forever. I suppose it is fine to keep doing this as long as you or your MA deletes the patient the next day. Also, please clearly indicate in the Notes column what date the cath is.
You can also put a P or a WP in the Service column (WP means Weekend Pass). For instance, if a patient is on the EP Service but they don't need to be rounded on during the weekend, put EP/WP in the Service column. The WP will be removed on Monday.
A patient should only belong to one service. If you want to consult EP, then find out who the EP attending is and put a /M (or /H, etc) in the MD(s) column. Sometimes it is helpful to put an asterisk (/M*) especially if the attending's initial is the only initial in the MDs column. If the patient is on the CHF service and Dr. Mehmood is not rounding during the weekend, please click the Assign Service button and transfer them to the Acker, Rawson, or London service. You can indicate that they should go back to the CHF service on Monday in the Notes column. You could also put CHF/WP if they don't need to be rounded on during the weekend. If you just want to consult the CHF Service, put a /M3 in the MD(s) column.
On the weekends, whoever is running the Hospital List utility in the morning (updating room numbers, etc) should click the Assign Weekend Temp Services button. This will make sure that every patient in the hospital is on a service that will actually be rounding that weekend. This way, nobody gets skipped by accident. On Monday, the Listmaker can click Remove Weekend Temp Services.
If you have consulted another attending (for instance, me) and you want to sign off, please don't just write a P in the Service column. I might decide to skip that patient tomorrow! Instead, click the Assign Service button and change the service to EP. That way, the patient will still get seen by an EP (assuming they need that).
Every patient on the list should be assigned to an attending, so we know with whom to make the followup appointment. If a patient has never seen a cardiologist before, the attending should generally be the first doctor that sees the patient. If a patient saw an attending (inpatient or outpatient) more than 3 years ago, they are regarded as unassigned.
Please avoid cluttering up the notes column. If you are signing off a patient, write a P in the Service column instead of SIGN OFF in the Notes column.
A final note about EP consults (both inpatient and outpatient):
If one of us has an established relationship with a patient, it is a nice if you try to talk to that patient's EP attending first (or consult them even when they are not on call). However, if you have any difficulty with this, please send a PerfectServe to the EP "dude" on call. There is always an EP attending on call, you can look that up on uconcall.com/attendings. This applies to both inpatients and outpatients. Please refrain for sending out a blanket Centricity Alert to all four of us at the same time; this has resulted in many duplicate appointments and confusion. The EP "dude" is always available to make sure that patient is taken care of in a timely manner.