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Inpatient Service Instructions

For the PDF presented at the shareholder meeting click here.

For the new Floor Services Call Schedule click here.

Overview:

  • The Inpatient Service will update Friday January 3, 2025. Please click here for instructions for configuring PowerChart/CORES on your computer. Demo Videos for setting up CORES and adding patients to the list can be viewed by clicking here (UTMCK Network Only). If you are a ListMaker, please click here for detailed Listmaker instructions.
  • The Inpatient Services are: A- Acker, L- London, R- Rawson, W- Wortham, EP- EP, CHF- CHF, S- Structural, PROC- Procedures. A patient can only belong to one Service at a time. If there are two services in the Service column, it means that this is the weekend and the first service (ex. London) is covering the second service (ex. CHF) because the CHF attending is not rounding on the weekend. If a patient is on the London service and you want to consult the CHF attending, please do not add L/CHF to the Service column on the rounding utility (image preview) . Rather, add a /CHF to the attendings column (image preview) . The only time you will ever see a L/CHF in the Service column is on the weekend.
  • Attendings are on service from Friday to Thursday but my split the weeks (Friday to Sunday and then Monday to Thursday). Fellows and APPs are on service from Monday to Sunday. The Wortham Service is the teaching service and will have a Fellow plus housestaff. The London and Rawson services will have APPs, one of these is the Quarterback. The APPs will work from 6 AM to 4:30 PM. The Acker Service will have an upper level Fellow. On weekdays, new patients will go to all the fellows/APPs from 6 AM to 4 PM, to the LATEFELLOW from 4 PM to 6 PM, and to the night call team from 6 PM to 6 AM. On weekends, new patients will go to the long call team. See below for the full schedule. Non-urgent consults at night will be held over to the next morning and distributed equally to the Rawson/London/Wortham services, or to the Acker service if the patient is an ICU patient. If the Acker attending has gone home at four, the long call attending should staff the ICU consult.
  • In the morning, all the non-urgent, hold-over "see in AM" consults from the previous night will be distributed equally to either the Acker service (if it is an ICU patient) or the floor services (non-ICU). The post-call team will get the first patient, followed by the short call team, and then the long call team.
  • During the day, ICU patients will go to the ACKER service unless it has capped. If Acker has >= 12 patients and there is no resident on service, they have the option to decline the patient and send that to the floor service instead, as long as the patient has a "non-core" (not critically ill) diagnosis. If Acker has >= 15 patients and accepts a new patient, they may transfer one of their stable patients to the floor services. ACKER will always accept and take care of critically ill patients, even if they are capped. This is the purpose of the ACKER service.
  • During the day, during weekdays, non-ICU patients will alternate going to the long call team and the short call team. If the censuses become grossly imbalanced (difference > 3 patients or > 5 patients), one team may get 2 or even 3 patients in a row (respectively). At 4 pm, all patients will go to the long call team. On weekends, all patients will go to the long call team all day long.
  • During the night, patients will be seen by the night call team/APP and staffed by one of the floor services (or Acker service if ICU) the next morning. These floor-service "staff in am" will be distributed evenly to all the floor services.
  • In the Attendings column, list the initial of the patient's main cardiologist first, followed by any consultants, fellows, or nurse practicioners following the patient in the hospital. An asterisk can be placed by the attendings initial if they are also consulting on the patient, or you can enter the initials twice (M* or M/M means Dr. Mahlow is the patient's cardiologist and is also seeing them in the hospital). If the patient is unassigned, type the initials of the attending that does the initial consult, and the patient will get assigned to that cardiologist for the followup appointment.
  • The Hospital List Utility and Rounding Utility are capable of assigning patients to services (image preview) , and there is also an online web page that can do this (http://universitycardiology.utmck.edu/inpatientserviceassigner). The username and password for this webpage are the same username and password you use for the online attendings calendar (uconcall.com/attendings). It is only accessible from within the UTMCK network.
  • Urgent Consults and Transfers should always be seen immediately by the attending that receives the PerfectServe notification for the patient, and the patient will go on that attending's service.
  • For non-urgent consults: A nurse practicioner "Quarterback" will be assigned to carry the PerfectServe Cardiology MA On-Call Phone. The phone number is (865) 279-9686. The Quarterback will also return all the outpatient phone calls that came in overnight. It may be helpful to log in to the PerfectServe website and communicate via PerfectServe via the website (rather then typing on the tiny keyboard on the iPhone). Instructions for logging into the PerfectServe website can be found by logging in to Inpatient Service Assigner and clicking on the PerfectServe MA Account menu item at the top of the screen.
  • The Wortham fellow will receive correspondence from the ER and urgent new consult requests. The fellow will triage these messages and forward all urgent consults to the long call team or LATEFELLOW.
  • Office staff (the Listmakers) will open the Hospital List Utility each weekday morning, doing list maintenance tasks such as deleting discharged patients and updating room numbers. On weekends and holidays, the Quarterback will be responsible for this task. It is important to click the Print button even if you do not intend to print out a paper copy of the hospital list, because this will also make backup copies and update the census numbers for each service (updating the censuses MUST be done EACH MORNING and may not be skipped). For instructions on how to use the Hospital List Utility go to Listmaker instructions
  • A medical assistant ChartMaker will go through the hospital list each business day, fill in Centricity medical record numbers for all the new patients, and create Centricity charts for the unassigned patients.

Non-interventionalists:

  • Fridays: Rawson is on 24 hour call (Long Call). London (Short Call) accepts patients until 4 PM. The Acker Fellow is on Night Call. Acker reads EKGs.
  • Saturday: Wortham is on 24 hour call (Long Call). London (Short Call) accepts patients until 11 AM. London does PET, ECHO-INPT. Rawson does LASTNIGHTECHO, EKG. The Wortham Fellow is on Night Call.
  • Sundays: London is on 24 hour call (Long Call). Rawson (Short Call) accepts patients until 11 AM. Rawson does PET, ECHO-INPT. Wortham does LASTNIGHTECHO, EKG. One of the APPs may leave early if all work is done. The Night APP is on Night Call.
  • Mondays: Rawson is on 24 hour call (Long Call). Wortham (Short Call) accepts patients until 4 PM. The Night APP is on Night Call.
  • Tuesdays: Wortham is on 24 hour call (Long Call). London (Short Call) accepts patients until 4 PM. The Night APP is on Night Call.
  • Wednesdays: London is on 24 hour call (Long Call). Rawson (Short Call) accepts patients until 4 PM. The Night APP is on Night Call.
  • Thursdays: Rawson is on 24 hour call (Long Call). Wortham (Short Call) accepts patients until 4 PM. The Night APP is on Night Call.

Interventionalists:

  • Daytime STEMIs will be admitted to the Acker service with the Acker service attending being the admitting attending. The PCI Attending during the day will do the PCI on STEMIs. If they are tied up with another PCI, the Acker service attending will back them up.
  • The daytime PCI doctor covers STEMIs/inpatient caths 6 am to 8 pm. The night PCI attending takes over after that.
  • We are required to have two attendings available at all times for simultaneous STEMIs. If the PCI attending needs help, they should reach out to the Acker attending (during the day), the interventional fellow, the on-call attending (24/7), or the on-call EP attending (24/7).
  • At night the Acker service is cross-covered by the night call attending, but any night STEMIs go directly to the on-call interventionalist (who most nights wil be the same as the Acker attending).
  • The Acker service is open for new patients 24/7. If I'm covering the night and get a new patient in cardiogenic shock, I do the consult/H and P and then add the patient to the Acker service with the Acker attending taking over at 6 am.
  • The Acker service should always be willing to accept and take care of unstable critically ill patients, regardless of their room number or whether the Acker service is capped.

Electrophysiologists:

  • During the weekday, consults should go to the EP attending on call. If the patient has a prior relationship with an EP then it should go to them. Put a /B2, /H, /J, or /M in the Attendings Column (image preview) of the hospital list (NOT THE SERVICE COLUMN) to mark that the patient has an EP consultant. If the EP consultant is the patient's primary cardiologist, put a * by the initial to indicate that EP should see the patient.
  • If approved by the patient's EP, appropriate patients can go to the EP service (they will have an EP in the Service column (image preview) instead of A, L, or R). Patients having outpatient EP procedures will also go on the EP service. If a patient is being followed by EP and the main cardiology team wants to sign off, instead of putting a P in the service column put an EP there. That way the EP attending will keep following the patient until they sign off as well.
  • The EP attending on call will round on the EP service patients on weekends, and one weekend a month, a nurse pracitcioner will assist with rounding.
  • If a nurse practicioner is rounding for the EP service, he/she will discuss every patient with the on-call EP attending by phone. If they need an attending to physically see the patient, they may contact the inpatient service attending on long call (Rawson on Saturday, London on Sunday) or the Acker attending (if it is an ICU patient).

CHF/Proceduralists/Patients Not On A Service:

  • Patients that are not assigned to the Acker, London, or Rawson service may be on the EP, CHF, or Structural services, or they may be unassigned (post-procedure patients).
  • These patients should be added to the appropriate CORES list (EP, CHF, Structural, Procedures), and the PerfectServe contact should be set to the responsible attending. At night, the long call fellow will do a temporary assignment of the PerfectServe contacts for the whole group to the night call provider. It is very important to right-click on the patient and add them to a service (if they are an outpatient procedure patient, just add them to University Cardiology- Procedures list). Also, please go into CORES and assign a PerfectServe contact for each patient.

Fellows and Night Nurse Practicioners:

  • Fellows are expected to be in house and accept new patients from 6 am to 4 pm. If a patient comes in at 3:59 PM, the fellow must stay until the patient is seen and taken care of.
  • The LATEFELLOW remains in house and accepts patients from 4 pm to 6 pm.
  • The night call provider takes call from 6 pm to 6 am. Sometimes there might not be a night APP, and the long call provider will be a fellow or attending. All non-urgent consults are held over to the next morning, and floor patients are divided equally between London, Rawson, and Wortham. The ICU patients should be temporarily assigned to the Acker service, but if Acker is capped and the patient has a non-core (stable) diagnosis, the Quarterback can reassign them to the floor services (please equally distribute the patients to London, Rawson, and Wortham, starting with the post-call service).

The Quarterback/Patient Flow:

  • The Listmaker is an office staff member during the week, but during weekends and holidays it is the Quarterback. The ListMaker arrives early (5 AM) and updates the hospital list utility, removing discharged patients (image preview) and updating room numbers (image preview) using the utility. Any patients that have come in overnight will be distributed evenly to the London/Rawson/Wortham services (if they are on the floor) and at least temporarily assigned to Acker if they are in the ICU (although the Quarterback can reassign them if Acker is capped and the patient has a non-core diagnosis). For non-ICU patients, the post-call team will get the first patient, followed by the short call team, and then the long call team. On Saturdays, any patients that are not on the Acker/London/Rawson/EP service will be temporarily assigned to a service for the weekend (image preview) (the ListMaker should click the Assign Weekend Temp Services button). These temporary assignments will be removed on Monday (image preview) (click Remove Weekend Temp Services). NOTE: if someone needs to add a patient to the list that is coming in for an outpatient procedure (cath/TEE/etc.), please write PROC in the Service column. Better yet, please do not even add "future patients" to the list because this creates confusion.
  • At 6 AM, The Listmaker will print out the Excel file and email that out to everyone. At this time, the censuses for each of the services will be recorded and will not be updated until the next morning (so you cannot game the system by keeping signed-off or discharged patients on your service until the end of the day).
  • Fellows and nurse practicioners arrive early in the morning. Using the hospital list utility as the gold standard, the CORES list (image preview) for each service is updated by the fellow/APP on that service. Patients that are signed off/discharged should be removed from the CORES list, and signed off patients should receive a P in the rounding utility. (image preview)
  • Either in the morning or the night before, the fellow can assign patients for the APP to round on (the PerfectServe Contact (image preview) in CORES should be changed to either the fellow or APP. The fellow's or APP's initials can be put in the MDs column of the hospital list rounding utility.
  • Urgent consults and transfers will be automatically routed to the long call service (non-ICU) or Acker service (ICU). This service is expected to see the patient immediately and add them to their service. It is important to click the Assign Service button in the rounding utilty to ensure their service will get credit for that patient (see below).
  • Non-urgent consults will be sent to a person designated as the "Quarterback." The Quarterback is one of the APPs from 6 am to 4 pm, then the Quarterback gives the PerfectServe phone to the LATEFELLOW from 4 pm to 6 pm, then the LATEFELLOW puts the phone in the charger in the medical records office. Please keep reading for instructions for the Quarterback.
  • When a new patient comes in, the long call fellow (for urgent consults) or the Quarterback (for non-urgent consults) needs to add the patient to CORES and the rounding utility. A nice workflow for this can be found here. Basically, go into CORES, search for the patient, open them in PowerChart and add them to the rounding utility. Click Assign Service, close the patient in PowerChart, and add them to that service in CORES. Finally, enter the PerfectServe Contact and notify the fellow and attending on that service.
  • When the Acker service caps, the rounding utility may state that the Acker service is allowed to reassign the patient to a different service. The Rounding Utility may give a message like "Acker has > 12 pts; may pass or play." (image preview) . This message will automatically be copied to the clipboard, and if the Quarterback is using the PerfectServe website, they can just press Ctrl+V to paste this message into the PerfectServe alert that goes to the Acker service. If the Acker service elects to PASS, the Quarterback should be informed (just reply to the PerfectServe message with the word PASS). In that case, the Quarterback should click on the Assign Service button (image preview) AGAIN and specify that the patient should go to London Rawson or Wortham only (image preview) . The London or Rawson or Wortham service should then be notified, and the Quarterback should transfer the patient from the Acker CORES list over to their CORES list. Please do not right click on the patient to attach them to the new service in CORES- this will attach the patient to BOTH services- instead, go into CORES, click on that patient's team, and change it.
  • If the Acker service decides to PASS on a patient, they should make this decision within 30 minutes of receiving the consult notification; if it has been more than 30 minutes then Acker should just see the patient.
  • Similarly, if a Service decides to transfer the patient to another Service, they should first get the new services' attending's permission. Then, notify the Quarterback, who will click the Assign Service button on that patient and select the new service. Please specify whether a cardiology attending has seen and billed for the patient today, so the old service will still get credit for that patient if the attending saw the patient. The Quarterback is responsible for changing the service in the Hospital Rounding List Utility, in CORES, and updating the PerfectServe Contact. Please do not right click on the patient to attach them to the new service in CORES- this will attach the patient to BOTH services- instead, go into CORES, click on that patient's team, and change it.
  • The list of assignments for the day can be found and edited at http://universitycardiology.utmck.edu/inpatientserviceassigner.
  • At night, the on call attending should be contacted for any unstable patient on any service.
  • The Medical Assistant ChartMaker will create a new chart in Centricity for any new patient that comes in, or any patient that came in the day before/weekend before that does not have a Centricity MRN. The attending of record in Centricity for unassigned patients is the cardiologist who did the initial consult on that patient.
  • Before going home, the Quarterback will review all the assignments for that day (http://universitycardiology.utmck.edu/inpatientserviceassigner) and make sure patients were added to the services appropriately.
  • The short call fellow stops accepting patients at 4 PM. Before going home, these fellows will go into CORES and change the PerfectServe contact to the long call fellow, which will end at 6 PM. On weekends, however, all patients go to the long call team or Acker.
  • The long call fellow goes home at 6 PM (unless a patient is unstable) and changes the PerfectServe contact to the night call provider for every patient on all the services (you can click on a box that will select all the patients).
  • At 6 AM the night call provider has the option of changing the PerfectServe contact to the long call fellow/APP. Each provider should change the PerfectServe contact to the appropriate person when they arrive to the hospital.

Weekend Imaging/EKG duties:

  • The Acker attending reads EKGs on Fridays
  • On Saturday, The Rawson attending reads LASTNIGHTECHO and EKG. The London attending reads PET and ECHO-INPT.
  • On Sunday, The Wortham attending reads LASTNIGHTECHO and EKG. The Rawson attending reads PET and ECHO-INPT.
  • If an attending is not credentialled to do an imaging duty, the other floor service attending will be assigned to this duty.

Miscellaneous notes:

  • In the event of a computer downtime, the Quarterback will use their best judgement for distributing patients fairly among the services. A detailed protocol can be downloaded here and all the Quarterbacks should print out a hardcopy for reference.
  • The items on this webpage are meant as general guidelines, and attendings should have flexibility with how to run their service.
  • Please bear with us as this is a work in progress, and if you have any suggestions please let us know. We anticipate that there will be many minor issues with this system at the beginning. Rather than paging Drs. Shepple and Johnson for every minor issue, please consider writing your ideas down and discussing all of the issues in bulk (there will set times to do this in a meeting). For instance, if you feel that you are receiving a patient that you should not receive, please just see the patient, write it down, and discuss it with us later- rather than paging us immediately. Of course, patient safety issues should be addressed immediately.