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

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

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.

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.

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.

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.

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

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.

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.

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