Tuesday, December 30, 2014

Endocrine Round Table Discussion - Dr. Ettinger

The first table discussion with Dr. Ettinger will be in 2 weeks:

Wednesday, January 14, 2015.
2:00 - 4:00 pm
Platinum Room

The topic will be oral diabetic medications. Specifically those that are beyond the restricted county formulary. After this brief lecture, Dr. Ettinger will pick out a topic from the MKSAP endocrine curriculum to discuss in detail. There will be another post regarding the topic chosen.

The setting will be open discussion, round table. Everyone is encouraged to come, especially those on the wards rotation and senior residents. Please review as the material as best as you can to improve the interaction.

We understand that some of you will be in continuity clinic but there will be many other opportunities to participate as these discussions will be held weekly on Wednesday or Thursday.

Tuesday, December 23, 2014

Rotation 7 Updates

OpenVista Medicine Consults
Please ensure that the Emergency Department and any other consulting specialties place an internal medicine consult when calling you. This is important to maintain hospital statistics and ensure proper billing.

Endocrinology
Outpatient endocrine with Dr. Dugal is underway. Please see Sarah's post for more details. Dr Etinger will begin having inpatient endocrine teaching rounds on Wednesday/Thursday from 2pm to 4pm in the platinum room. Everyone is invited.

NIHSS Certification
Remember, the NIHSS certification is due by 1/7/2015. Please e-mail or print your certification to Sharon
Click here for details

Mentorship Program
The deadline to meet with a mentor and complete the evaluation form is 1/30/15.
Click here for details

PostOperative Orders
According to JCAHO, post operative (post PACU) orders to floor must be placed by the surgical team. Under no circumstances is the internal medicine team to place admission orders to the floor. This issue is included in the subspecilaty guidelines (#3) that was approved by the medical executive comission on 9/2/14 

The PACU staff and surgical department has been educated regarding this matter. If the PACU calls you to place post operative transfer order to the wards, please direct them to the surgery attending, resident, or NP/PA to complete the orders. Your responsibility is to add to the medicine related orders.

Senior Resident Notes
Dr. Ragland is actively working with Dr. Johnson on revising senior resident notes at this time. This includes minimizing the senior note to containing a brief and focused assessment and plan without the physical exam or HPI. Again, these are preliminary approaches and there will "beta" testing among several rotations before these goes live.

Candidate Interviews
We have candidate interviews the following dates. There have been several residents selected to tour the residents at 11:30am with a lunch at 12:00pm followed by a program powerpoint presentation. Please plan according and inform your service attending. If you will be unable to help out please inform the chief residents and help us find someone who can cover for you. See Sharon for the powerpoint presentation.
12/18/14 - Shadi
1/7/14 - Lusanik
1/8/14 - Nada
1/13/15 - Shadi
1/14/15 - Joel
1/15/15 - Vahe

Medication reconciliation
During the quality assurance meeting this month there was an emphasis on medicine reconciliation. This is important to ensure Meaningful Use phase 2 required by the government as well as transition to eRX. Please click here for the details surrounding medication reconciliation process


Saturday, December 13, 2014

Endocrine with Dr. Duggal

Dr. Duggal has agreed to start taking us for an endocrine rotation at her private office.

PGY 2&3 Residents on ambulatory care will alternate Tuesday morning and Friday mornings at her office.

David and Avi you are on Amb Care this next rotation. The office manager is Theresa. They expect you there after morning report by 8:45-9AM and they know that you will need to leave by 11:40 to go to noon conference. 


Address:
Jasleen Duggal
Diabetes Center
3008 Sillect Avenue, Bakersfield, CA 93308
(661) 748-1999

Tuesday, November 18, 2014

Faculty Mentorship Program

Please refer to the previous post regarding the faculty  mentorship program. Please use the form and contact a mentor as required by the date specified on the form.

Wednesday, November 5, 2014

Acute Ischemic Stroke - Part 1

Attached are the lecture slides and audio from the Lecture by Dr. Sabetian on 11/5/14

Click Here to Download Slides

Click Here to Download the Swallow Screen


Wednesday, October 29, 2014

Acute Ischemic Stroke Boot Camp!

Hey everyone,

As you know Kern Medical Center is currently in the process of  becoming a stroke center. The next few weeks will be dedicated to educate the house staff about acute stroke.


Wednesday 11/5/2014: Acute Stroke - Part 1 Lecture

Catered noon conference by Dr. Sabetian on evaluation of a patient presenting with acute stroke

Friday 11/14/2014: NIH Stroke Scale training - Part 1
Friday 11/21/2014: NIH Stroek Scale Training - Part 2


Wednesday 12/03/2014: Acute Stroke - Part 2 Lecture

The second part of the conference by Dr. Sabetian. At the end of this conference there will be a review of questions and answers in regards NIH Stroke Scale

Once the lecture series is completed, All residents are expected to complete the NIHSS certification process and provide Sharon with a copy of your certificate. This is FREE test that is taken online.


How do I get NIHSS Certified?





  • Complete the registration information
  • Once you are logged in click on "my activities"










  • Click on Enroll Now for Certification A





  • Complete the videos and answer the questions. Once you complete the certification, you will be able to print out your certificate. Either e-mail or bring a copy to Sharon's office by January 5th 2015

Sunday, October 26, 2014

211 Scheduling for Rotation 8 and 9

Please note the following:

Rotation 8 (1 week each rotation):
Assem: ICU/AC/NF/AC
Ansari: AC/ICU/AC/NF
Cohen: NF/AC/ICU/AC
Galustanian: AC/NF/AC/ICU

Rotation 9:
Awerbuck: ICU/AC/NF/AC
Kassabian: AC/ICU/AC/NF
Mustafa: NF/AC/ICU/AC
Yaghoubian: AC/NF/AC/ICU

Friday, October 24, 2014

Strategic napping for fatigue

ACGME recommendation implemented...STRATEGIC NAPPING

Recommended after 16 hours of continuous duty

True story, click the link


Sunday, October 19, 2014

Mentorship Program

                Ladies and gentlemen,

 Please make note and use the mentorship program as noted below. Faculty members have been assigned categories to mentor us. It is our responsibility to reach out and make use of this offer.

Download the entire document below.

Resident Guidelines 

  1. Select one to three mentors depending on your needs by January 1, 2015
  2. Meet with your mentor(s) at least once
  3. Complete the evaluation form  for each faculty mentor by January 30, 2015


Faculty Mentoring Program -DOWNLOAD HERE

Sunday, October 12, 2014

Schedule Changes for Block 5

Hi Everyone,
Unfortunately one of the ER interns was unable to start his residency this year. Subsequently we are short an intern on wards during the next block. Sarah and I decided to move Hamammi and BenPerlas from ICU to wards. They will be able to do an extra 2 weeks of ICU instead of night float during their 3rd year as the current schedule gave Assem and Cohen an extra 2 weeks of ICU during their 3rd year.

There are several changes that will need to be made to accommodate this

 

Medicine Clinics:

Clinic Cancellations:

  • Hammami 10/21, 10/27
  • BenPerlas 11/4, 11/10
  • Gholam 11/4

New Clinic dates:

  • Hammami 10/23, 10/30
  • BenPerlas 11/4, 11/12
  • Gholam 11/3

Summary:

  • Gholam: move 11/4 to 11/3
  • Hammami: move 10/21 to 10/23 -and- move 10/27 to 10/30
  • BenPerlas move 11/10 to 11/12


Finally,
Chen, Please be aware that on 10/30 and 11/3 Hammami and Chen are both in clinic and Gholam will be off. That means that you will have to sign out your patients at 1pm and likely come early to see and start your patients in time to ensure safetyl


AMiON has been updated to reflect the changes above. Please review the schedule and submit any errors through the blog

Wednesday, October 8, 2014

Cardiology Lecture Series

Guys and Gals,

Please send Avi or myself MRNs of patients that fit into the cardio bread and butter categories. Simple straight forward cases.  Comprehensive Cardiology has agreed to have a Case Conference Series with up to date management guidelines incorporated into the lecture. Dr. Mehta requested patients with the following problems:

-Atrial fib/flutter/Supraventricular Tachycardias
-Decompensated Heart Failure
-Anticoagulant/Antiplatelet Management
-NSTEMI 
-STEMI and Complications
-PCI/CABG
-Cardiomyopathy
-Valvular disease
-Cardiac Perioperative Management 
-Pacemakers and ICD Malfunction

Please let us know ASAP. I would like to get this going. Cards is HUGE on the boards.

Oh and I think Joel is awesome. Check out this pic.


Thursday, October 2, 2014

End of Shift - New Consult Sign Outs (URGENT)

It has come to our attention that several residents are waiting for the next call team to see new consultations. This results in delay of the assessment and treatment implementations patients. The house rules have been modified to optimize patient safety. Please read the following:

1.       Team Senior: (Sunday-Thursday): Senior of the team is responsible for the call from 7am to 9pm.  However, he or she can defer consults to the night float if they are made after 8:30pm to give time for the senior resident to finish notes. The exception to deferring consults after 8:30pm is if the consult is urgent regarding a patient who needs immediate attention.  The senior resident must obtain the consultation from the ED and sign out to the next team. There must be a blank progress note to indicate which resident/attending the patient was signed out to.

2.       Team Senior: (Friday-Saturday): Senior of the team is responsible for the call from 7am-7am. However, he or she can defer consults to the day team if they are made after 6:30am. The exception to deferring consults after 6:30am is if the consult is urgent regarding a patient who needs immediate attention. The senior resident must obtain the consultation from the ED and sign out to the next team. There must be a blank progress note to indicate which resident/attending the patient was signed out to.

In summary:

  • Consults can be deferred for night float at 6:30am and for Wards at 8:30pm.
  • All ED consults must be written down and signed out to the coming team
  • A blank note must be written indicating the resident/attending the patient will be signed out to
  • It is not the ED's responsibility to call the coming team. It is the medicine team's responsibility to ensure the consult is seen in a reasonable time




Tuesday, September 30, 2014

Resident Meeting 9/30/14

The following were discussed at the resident meeting, please review and comment if you have any additions.


  • Several residents indicated that the surgical subspecialties are refusing to place post-operative orders to transfer back to the medical team. This has resulted in patients remaining in the PACU for longer than anticipated. 
    • If this occurs, please report the incident to the adverse event line x23501 and report on the blog
    • The Joint Commission: Accreditation, Health Care, Certification requires the post operative team to place post operative orders.
    • This has been clearly accepted by the sub-speciality admission guidelines at the MedExec meeting, which can be found here (item #3)
  • There have been multiple requests to have uniform adherence to the sub-speciality admission guidelines throughout the faculty. This will be discussed with Dr. Ragland
  • ICU downgrades should be occurring before 5pm unless there is an bed availability issue. It is unsafe for patients to be handed off through 4 team (ICU to ICU-NF to Wards-NF to Medicine Team). We encourage Night Float to reject admissions to the floor until a policy is made. We will discuss this with Dr. Chandra and Dr. Ragland
  • There will be a cardiology lecture series done by Comprehensive Cardiology. They are requesting that you submit bread and butter cases to be used during the lectures. We are looking for the following: Afib, Heart Failure, Cardiomyopathies, Pericarditis, Acute Coronary Syndromes, etc.. please send any cases to Sarah and Avi so we can arrange the lectures appropriately
  • Please complete your duty hours and attending evaluations on time. This is an ACGME requirement

KMC Retreat 2014 - Hermosa Beach

Thank you Dr. Munoz for taking the following pictures


Saturday, September 13, 2014

Fluid, Electrolytes and Acid Base Management

Below is a lecture Dr. Spinello, former ICU Director,  gave to new interns a couple of years ago. I found it extremely helpful and I hope you as interns do as well.

I attached the label "lectures" to it so you can always search for it on this blog in case it gets lost amongst other posts.

Fluid, Electrolytes and Acid Base Management


Monday, September 8, 2014

Landmark Studies

Dr. Chandra was able to provide us with a list of landmark studies that every internist should be aware of. I've attached the list below. If you cannot find a topic for journal club then present one of these studies. Please confirm with Dr. Ratnayake as he may be able to provide you with an article as well.


Tuesday, September 2, 2014

Sub-specialty Admission Guidelines

The program directors from Internal Medicine, Emergency Medicine, and Surgery have sat down and reviewed our guidelines. This is what we have come up with so far. These guidelines were run by med exec and approved.

Please remember, these are guidelines and not policies. As always, the patient comes first!





Tuesday, August 26, 2014

Pain Management Clinic at KMC

A Message from Tonya:

We have a new Pain Specialist working at KMC Clinics 2 full days per week.  We must have an approved authorization to book to his clinic.  Please submit a consult to outpatient pain specialist.  With the provider's supporting notes, we can submit for authorization approval.  His first clinic at KMC will be August 28th.  Please let me know if you have questions.

Thank you in advance,

Tonya Bennett RN BSN | Interim Clinical Director
KMC Outpatient Clinics | Kern Medical Center
1111 Columbus St. Suite 1000 | Bakersfield, CA 93305
(661)326-6502
Email: bennettt@kernmedctr.com

Tuesday, August 19, 2014

Paging via Amion

You can now page Internal Medicine residents via Amion. Please refer to the instructions below.

  • Login to amion
  • Click the green pager icon at the top
  • Select the name of the person you are trying to page from the R1/R2/R3 drop down menu
  • Type your name in the "From" box
  • Type your message and hit Send
Hope this makes things easier. Feel free to share with other specialities.

Thursday, August 14, 2014

Clinic Rescheduling

Please be aware of the following changes:

8/19 (Tue) Dr. Bazmi unavailable
following clinics cancelled:
Ansari
Arutyunov
Sidhu


8/21 (Thu) Dr. Bazmi unavailable
following clinics cancelled:
Azizi
Gholam


9/4 (Thu) Dr. Bazmi unavailable
following clinics cancelled:
Galustanian
Kassabian


9/10 (Wed) Dr. Ragland Unavailable:
following clinics cancelled:
Cohen
Yaghoubian
Azizi
Avertisyan


9/15 (Mon) Dr. Ragland Unavailable:
following clinics cancelled:
Awerbuck
Sidhu
Benperlas
Gholam


9/11 Dr. Ratnayake will be available (spoke to him directly on the phone)
following clinics are RESCHEDULED:
Chen
Galustanian
Gill

AMiON has been updated.



A message from Tonya:
If the resident is not available for the follow up clinic visit, we will book all returns with Ruby Reyes or one of the Internal Medicine Physicians covering the Internal Medicine overflow and KMPG Clinic (Dr. Brar, Dr. Meghapara, Dr. Epinolpoly, or Dr. Sandhu).  The patient will be referred back to the Internal Medicine Resident for Continuity of Care.

Wednesday, August 6, 2014

Urology Clinics

From Dr. Ragland:

We would like to add 4 Urology clinics to be done during Nephrology. This would increase our continuity clinic percentage to further meet requirements as well as increase our rapport with Urology to better understand pathology for consulting reasons during inpatient wards.

What do you guys think? Please comment your opinions below.

CLER Focus Areas

Residents participating in CLER visit should be familiar with this Quality and Patient Safety List and their participation in these areas.

PATIENT SAFETY focus:
  • CLIP (Central line insertion practices)
  • CLABSI (Central line associated bloodstream infections)
  • Restraints/falls (yellow socks)
  • Infection control – hand hygiene, barrier control
  • Procedures- informed consent and time out
  • Do not use dangerous abbreviations


HEALTHCARE QUALITY focus:
  • Sepsis Bundle (refer to pocket card)
  • Medical Necessity – PCOFT daily documentation
    • Pain score
    • Necessity for central line, PIV, oxygen, foley catheter, Review of tele strips
  • Core Measures
    •  Heart failure – ACEI/ARB for LVSD
    • AMI – aspirin prescribed at discharge

Sunday, August 3, 2014

Internal Medicine ITE Schedule

Please check the below schedule for the Internal Medicine In-Training Exam. Make sure to sign out to the cross covering resident before your exam. Cross covering residents, please carry the pager of the person you are covering while he or she is taking the exam. Inform your attendings of the days you will not be available, it is a full day exam.



Exam Date: 9/5/2014
Exam Date: 9/12/2014
Awerbuck (ICU)
Ghafarizadeh (Wards)
Avetisyan (ID)
Assem (BakVA)
Cohen (Wards)
Gill (Wards)
Arutyunov (Wards)
Yaghoubian (Neuro)
Galustanian (Wards)
Ansari (AC)
Azizi (Wards)
Chen (EM)
Talwar (AC)
Lee (Cards)
Hammami (Cards)
Ammar (ICU/AC)
Gholam (AC/ICU)
Sidhu (AC)
Chahal (NF)
BenPerlas (Nephro)
Aguirre (NF)
Mustafa (UCLA)
Kaur (Ger)
Kassabian (ICU)


Nightfloat coverage:
BenPerlas cover night of 9/4, tell attending wont be present 9/4 and 9/5
Sidhu cover night of 9/4, tell attending won’t be available 9/4 and 9/5

Wards coverage
-Assem cover Cohen’s team on 9/5
-Yaghoubian cover Galustanian’s call on 9/5, tell Dr. Sabetian will not be available 9/5

- Lee on wards 9/5 to help Gill with post call, tell Cards attending will not be available 9/5
- Avetisyan on wards 9/12 to help Azizi on call, Tell ID attending will not be available on 9/12

ICU Coverage:
-Kassabian on ICU call 9/5 to care for all patients as ED is off and Awerbuck is taking exam. He will have an intern (Ammar).
-ED resident Blakely to take care of all patients on 9/12/2014. 

Thursday, July 31, 2014

Cancelled Clinics

The following clinics will be cancelled due to faculty clinic cancellation. AMiON is updated.

8/18 Dr. Ragland out
Cohen (ICU)
Mustafa (Wards)
Chen (Wards)

9/11/14 Dr. Ratnayake out
Chen (3 clinics in week)
Galustanian (Wards)
Gill (Wards)

ACLS/BLS Certification

It has come to Dr. Chandra's attention that R3 residents are leading a code blue in the ICU or the Floors without being ACLS certified. This is a serious issue.

We are working on putting together a class for all the R3s.

To reiterate: If you are not ACLS/BLS certified, UNDER ANY CIRCUMSTANCES, DO NOT LEAD ANY CODES. Have the emergency department respond

Thursday, July 24, 2014

Clinica Sierra Vista - Family Practice Inpatient Service

The Family Practice program at Clinica Sierra Vista will be starting an inpatient service starting Monday 7/28/14. Please be receptive to our colleagues if they are ever in need of help with the electronic medical record system or logistical aspect of the hospital.

Thank you,

Scott Ragland, DO
Program Director

Wednesday, July 23, 2014

Surgical Subspecialty Admissions


Dr. Ragland is working hard to improve the quality of our admissions. Because we got cited on the ACGME review about having too much service over education, we are trying to gather info on how to improve this problem. There have been a lot of complaints about admitting too many surgical subspecialty patients (plastics, ent, ortho etc...) or that those services using medicine to "babysit" patients while waiting to go to the OR. 

We need to gather a list of solutions for Dr. Ragland by 8/2/2014. 

So far this is what we have come up with, mostly Dr. Raglands ideas:
  • Surgery is to put in their own post-op orders
  • If we are to continue to admit, we want lectures from the attendings, maybe around 4 a year per subspecialty
  • Mid level (NP/PA) must stop by the room and round with the primary teams each day and give plan OR have their notes done by 10 AM. I vote for the first option as it will be more educational. No more running around chasing the midlevel for the plan. If a surgery is canceled we need to know about it.
  • NO admission without 24/7 coverage from the subspecialty attending. For example. We will not admit patients if ENT is not available that day and the next day to see the patient
  • We need to come up with clear indications on when to admit a patient for surgery when the pt has medical problems. Please give clear suggestions. 
    • ex: HTN if BP is > 160/100 
    • ex: DM with glucose > 250

These are just a few ideas. Please share your suggestions with us so we can have a draft ready by 8/02/2014.


Continuity Clinic Schedule

The following tutorial can be used to generate a report of all your continuity clinic dates. Residents are encouraged to include the exact date they want the patient to return to clinic with them. The scheduling staff are encouraged to use this list as well to maintain continuity.

  1. Go to www.AMiON.com
  2. Login at the top right
  3. Click the My Schedule Icon:
  4. Select your name in the R1/R2/R3 drop down menu
  5. Click on Create Schedule
  6. Click the "Yearly Clinic Summary" at the top right

Subspecialty Patient Limit

It has come to our attention that some residents are concerned about the number of patients they are following on subspecialty rotations. Dr. Ragland and the Faculty has agreed that residents will capped at 12 patients at a time in order to maximize education value.

The following rotations are included:

  • Cardiology
  • Gastrointestinal
  • Infectious Disease
  • Nephrology
  • Neurology
  • Pulmonology

Resident Conference Schedule

The tentative resident conference schedule is posted below.

Please be advised. There will be some rotations where the R3 will have up to 4 conferences to present. The reason this schedule is out so early so you have plenty of time to prepare.

Please see Renee for the M&M conference schedule.


Wednesday, July 16, 2014

Jeopardy system - UPDATE!

The Jeopardy system is now live on AMiON. Request any changes through the blog website


It has come to our attention that some residents are under the belief that they may leave after the jeopardy person gets called into work.

This is false. The residents on call still must stay in the hospital and take care of the floors, interns & seniors.

For example: If there is a code, the call team must respond. If there is a renewal for restraints, the call team must respond, NOT the jeopardy resident.

The sole responsibility of the jeopardy resident is to admit patients.

The point system is under review as well. Stay tuned for possible changes.

Saturday, July 12, 2014

Minor Schedule Change 7/13 - 7/15, 8/2

Gholam will be unable to start night float on Sunday. The following changes will be made:

Ammar will be doing night float on Sunday 7/13 and have Monday 7/14 off. 
As a result, Gholam will be doing night float on Saturday 8/2 instead of Ammar

Avetisyan will cover Ammar's medicine clinic on Monday 7/14
Ammar will cover Avetisyan's medicine clinic on Tuesday 7/15

AMiON has been updated to reflect these changes, the operator has been notified to update the call list.


Friday, July 11, 2014

Resident/Educational Consultant Meeting, Thursday 7/17/14

On Thursday, July 17th, there will be a mandatory Resident Meeting from 1:00 to 2:00 in the OB/GYN Conference room on the fourth floor.

You will be meeting with the program's former program director, Jose Perez, MD, and a consultant, John Ngoi.

The clinics have been notified that you will be late. Patients appointment will be delayed on that day.


11: 45 to 1: 00 -  Jose Perez, MD, and John Ngoi will be meeting with the faculty to discuss our internal medicine residency program and the recent ACGME site visit and citations.

1:00 to 2:00 - they will meet with all the residents. This, too, will be a mandatory meeting for the residents.

Wednesday, July 9, 2014

And now for something a bit more entertaining, sorry for any Brazil fans out there.





Arvin High School Physicals

Hey team. Since the FP program is no longer at  KMC, the Internal Medicine Department has been asked to perform the yearly high school physicals for Arvin high school kids. The faculty wants us to know that it is important to give back. The volunteer activity can be added to your CV.

The date is set for July 31, 2014 @ the Arvin High School Gym

Time: 2 PM

Attending: Dr. Ragland

Residents required to attend:

Dr. Awerbuck
Dr. Talwar
Dr. Hammami
Dr. Kassabian
Dr. Ammar

Vahe, your 7/31 clinic has been officially moved to 7/29 per Tonya

Residents feel free to carpool because as far as I know the hospital is not providing transportation.

Any other residents that are free are more than welcome to come, but the above residents are required to attend. Please make sure your attendings know to round early that day if you are on sub-specialty services

Thank you,

Sarah







Monday, July 7, 2014

Radiology SpectraLinks Live Tomorrow 7/8/14

Radiology is going LIVE tomorrow with status reports of critical studies. A review of the imaging shows that there is less than 10% compliance with team labels.

Please include your team name in the History box anytime you order any type of imaging studies!

Platinum: 62499
Purple: 65289
Orange: 65279
Green: 65134
ICU: 65299


Overflow/Fatigue/Illness Jeopardy / Back Up System

Faculty has approved a back upjeopardy system for the overflows, resident fatigue, and illness.  We previously announced that Friday and Saturday night float would be mandatory for the person on for overflows, while Monday-Thursday would be a home call, well this is no longer!!!


New Rules


  • One person will be assigned jeopardy call for 1 entire week
  • That person is required to be at the hospital within 60 minutes of receiving the phone call that the call team has capped. 
  • Any forms of euphoria enhancing activities for the resident on jeopardy is highly prohibited ;)
  • The resident on call obviously cannot be out of town.
  • Failure of residents complying with the jeopardy system will results in forfeit of this system and we will revert to a weekend night float system
  • If you want to change which week you are on jeopardy call, you must notify Avi or myself prior to the start of the call week. You will not be allowed to change your schedule once that week has started. We preferably want a two week notice.
  • If you are called in on jeopardy call. Make sure to get the pager of the senior on call as it will be difficult to explain the schedule to the operator.
  • The resident on call that cap and jeopardizes another resident do not go home early, they remain in the hospital to care for the inpatient wards.
  • The jeopardy call schedule will be available on Amion soon.

Thursday, July 3, 2014

Outpatient Clinics: Computers and Consults by ER/Inpatient

A message from Tonya:

We (outpatient clinics) are now able to obtain authorization for specialty consults from ER physicians and consults placed upon discharge.  This will help as patient's present to clinic requesting information about their specialty consult, as it should be processing after discharge from KMC.  You will no longer need to repeat these consults in clinic if placed in house upon discharge. 

Additionally, We are working on placing 3-5 more computers in the Doctor's Den at sage brush clinic.

VA Fingerprinting

VA livescan fingerprinting is scheduled for July 8th from 10:00 to 12:30 p.m.  All 2nd and 3rd year residents must go. Make sure to tell your attending to have rounds completed by 9:45 am. People on ward teams and icu please take turns going to the VA so there is still coverage for your team.  If you don't go, it will be your responsibility to drive to LA and get the fingerprints done and you will not be issued a VA badge until complete.

Location:

Bakersfield VA clinic HR
1801 Westwind Drive

Time: 10 AM to 12:30 pm
-from personal experience they will leave 15 min early if no one is in line for prints.

Wednesday, July 2, 2014

Resident Conference - Important Announcements

1. UCLA electives:

Of the two UCLA electives granted throughout your residency, one elective is to be a mandatory hematology/oncology rotation. Please tell Sharon which year (2nd or 3rd) you will be doing your heme/onc rotation so it can be arranged. 3rd years, if you have not yet done a heme/onc rotation at UCLA, your elective is automatically going to be heme/onc.

2.  Endocrine Clinic

Dr. Jasleen Duggal has graciously volunteered to have 1 endocrine clinic per month. Patients referred to the clinic are to be approved by Dr. Duggal in advance and only residents are allowed to refer to this clinic. Only refer "juicy" endocrine patients, not average run of the mill diabetes patients. Details to come.

3. Overflow System:

Each month 4 senior residents on either ambulatory care or electives will be assigned ONE week of overflow duty including a mandatory Friday and Saturday night float duty for that rotation. If a team caps on Monday-Thursday during the day (meaning 10 admissions for each senior, not 10 consults or 10 points) then the resident assigned to overflow must come in and relieve the senior.

The same resident assigned for that week of duty will work Friday and Saturday night starting at 9 pm, thus no more 24 hour calls for senior residents on wards. This is MANDATORY.

This system will start during rotation #2. Expect changes to the amion schedule soon.

4. Logging Duty Hours

Effectively immediately, duty hours must be logged every week in completion on e-value by Sunday night. Every Monday a report will be generated for those residents that hours are not logged and a meeting will be arranged with Dr. Ragland at which point you will log your hours in front of him.

5. Rotation Evaluations

Resident and attending evaluations are to be completed on e-value prior to the completion of each rotation. If by Monday of the following rotation evaluations are not completed, a meeting with either the chiefs or Dr. Ragland will be arranged. EVALUATIONS ARE 100% CONFIDENTIAL.

Attendings are to meet with residents prior to the end of each rotation and give residents feedback on their performance. It is the residents responsibility to encourage the attending for feedback if he or she is not giving it.

6. Outpatient didactics

Outpatient medicine clinic didactics are to be every medicine clinic Monday through Thursday from 1:15 to 1:30 PM . The lectures are to be given by the attending, not the resident.  Please be on time to medicine clinic and show the attendings that we want to learn. Leave the hospital by 1 PM and go to Sagebrush so you can get there on time.  Resident attendance and time of arrival will be noted.

Please feel free to send us any lecture topics you may find useful.


Please stick with us, things will get easier. We are all one team and we need to do everything in our power to make our already great program even better.

Cheers,

Sarah and Avi

Monday, June 23, 2014

Mentorship Program

The new resident mentorship program will go live with the incoming class of 2017. Each resident will be randomly assigned a 2nd year as a mentor to seek advice from throughout the year. Some of responsibilities of the mentors include:

  • Checking in with the mentor daily during the first few weeks of July
  • Seeking advice on how to approach patient care and subspecialty/attending rounds
  • Determining the level of expectations from the various services
  • Asking questions related to the EMR, hospital, logistics, etc...
If any of the 3rd years are interested in providing mentorship, please comment on this post and we will assign you an intern.



Intern Orientation Week

The hospital wide incoming intern class orientation week is scheduled for Tuesday 6/24/14 -  Friday 6/27/14. The medicine intern class orientation is on Wednesday 6/25/14 (12p - 1p). Topics including work hour duties, procedure logging, logistics, and schedules will be discussed. Additionally we will have an overnight survival guide session.

All residents are encouraged to stop by for a meet and greet with the interns. Additional text pages will be sent out as reminders.


Thursday, June 19, 2014

SpectraLinks and Radiology Critical Results

The radiology department has implemented means to deliver critical radiology results. We have been provided with 4 SpectraLinks (one for each team).

Platinum: 62499
Purple: 65289
Orange: 65279
Green: 65134
ICU: 65299

These phones along with the charger will be stored in the medicine supply closet (located between Green room and Orange room). One resident or intern from each team must carry their designated phone between the hours of 7am to 4pm. Once you sign out, return the phones to supply closet and keep them charged.

These phones are delicate and expensive. DO NOT LOSE THEM

When night float comes on, they will carry the team phone designated for the team on call.



Below are the instruction on retrieving critical results:

Sunday, June 15, 2014

Attending/Resident Tally

Sarah has tallied up the Resident/Attending pairing for the last 2 years. This data will help us pair you with a variable amount of Attendings to maximize your exposure, this does not guarantee that you'll get your attending of choice, it is merely a guide for the Chiefs to utilize

Click on the chart and hover your mouse over the colors to see the exact weeks.


Thursday, June 12, 2014

July 1st Schedule Transition

July 1st is a Tuesday for this year. Because of this the typical switch day will not occur until Tuesday July 1st, 2014. What does this mean?

On Sunday 6/29/14:

  • Night Float Team remains unchanged (Yaghoubian/Aguirre)
  • All Wards and ICU teams remain unchanged


On Monday 6/30/14:

  • All wards teams remain unchanged
  • Platinum wards team will be on call (Ragland/Cohen/Gill/Salam)
  • ICU team 1 (Loewen) will be on day call (with Gary Walters NP for overnight call)
  • Kassabian is off during the day and will start as Night Float Resident at 9pm
  • BenPerlas will be starting as the Night Float Intern at 12 Midnight
  • Transfer notes are to be completed in preparation for change in service

On Tuesday 7/1/14 - The schedule posted to AMION will take effect

  • Purple Wards Team (Ghafarizadeh/Sidhu) and ICU Team 2 (Cohen) on call.
  • Night Float Resident: Kassabian
  • Night Float Intern: BenPerlas

Wednesday, June 11, 2014

Wednesday, June 4, 2014

AMiON is now live

Pronounced: Am I on?

Quick instructions:

  1. Go www.amion.com
  2. On the top right enter the keyword that was e-mailed out into the login box and click login
  3. The first screen you will see is a list of who is on call today and their pager number
  4. At the top there will be several links:
    • Block: the complete 2014-2015 block schedule.
    • Call: See who's on call for the selected month (use the arrows next to the smiley face to scroll through different months.
    • Off: Shows the off schedule
    • Clinic: Shows the continuity clinic schedule.
    • Binoculars: Brings you to the first screen. Here you can check who's on Call, Clinic, Wards, etc.. with their contact information available.
    • Calendar with stick figure: Create your own schedule for a certain month.
    • Smiley face: submit special requests (currently disabled)
An easy way to check your call schedule is to click "Call" and on the top. select highlight and choose your name.

Any changes made to the schedule will be reflected immediately on the website.

Get your specific requests in before the continuity clinics and wards are scheduled!

Wednesday, May 21, 2014

The Politics of Medicine









It's getting ugly folks...

As many of you know, being involved in the politics of medicine is important. You must stay involved in order to prevent non-medical professionals dictating how you practice medicine.

Recently, the first CIR Women in Medicine Dinner was held at the Padre. We had an amazing panel of speakers including former faculty, Dr. Jennifer Abraham. Dr. Abraham is a successful (and in my opinion brilliant) IM physician in private practice in Bakersfield.

She educated us on MICRA (Medical Injury Compensation Reform Act of 1975) and more importantly that the trial lawyers have successfully rallied for the anti-MICRA act to be placed on the ballot this November. They are calling the "patient safety act" as a clever disguise to get people to vote for it, and there is talks the title may change to "Drug and alcohol testing of doctors.”

MICRA allows for a $250,000 pain and suffering cap on malpractice claims, thus controlling malpractice insurance rates and improving accessibility to physicians for Californians (which was difficult prior to MICRA...read some newspaper archives from the 1970's).

CLEVERLY DISGUISED UNDER THE "PATIENT SAFETY ACT"... random drug and alcohol testing of doctors and require doctors to check a statewide database before prescribing narcotics (CURES REPORT). 

The repercussions of passing this act will negatively impact any of us planning to stay in California to practice after residency.  Please get informed and read about the history of MICRA and how it set a precedent for the rest of the nation in regards to tort reform.  Inform your friends, family and co-workers. Most importantly, VOTE THIS NOVEMBER.  

A recent poll showed 71% of voters are in favor of the act, most likely because of the misleading title and lack of education on the topic.


 http://www.micra.org/