Onboarding Checklist (pdf)
UNC Division of Hospital Medicine Orientation Checklist¶
Note: Please see SharePoint for full list of expectations for each shift as well as Family Values for our division's 'best practices.' This should also be available in print in the 9 th floor work room mid 2025.
Admitting shifts¶
| Category | Description |
|---|---|
| Epic | Update problem list |
| Place ADT 1 order (except in ortho patients that will be co-management, who are admitted to orthopedics). All patients are placed on New admit list. Ortho patients can be placed directly on Magnolia, New Admit list, or general medicine consult list. | |
| Complete admission med rec | |
| Review helpful order sets for admission (General admission, Diabetes/insulin) | |
| If patient admitted has sepsis, use Sepsis Order set - DHM quality measure | |
| Review where to find dispense/fill history | |
| H&P Template/Consult Template | |
| Dot phrase for sticky note - Update in particular with notes for the following day, things you don't necessarily want to document formally in the chart, and things for night float. Does not substitute for the direct sign out needed to night float if active things to follow. | |
| Logistics MCAT/FLEX | Start epic chat with resident and MAOin the morning to coordinate flow for the day. |
| Log into Hospitalist new admit pager and MCAT pager | |
| If MCAT list has patients from overnight, start evaluating those patients for potential admission (or discharge). If MCAT list is empty, look to see if there are any patients awaiting admission to med H. MAOto send pages or epic chats with new admits. | |
| Hospitalist performs admissions to Med H. Resident gives sign out to admitting team for corresponding teaching services. | |
| Coordinate discharges with ED team (some will perform discharge if asked though unfortunately this is not standardized). | |
| For new admissions needing a psychiatry consult, it is important to know there are two psychiatry teams. One is an ED consult team primarily assessing patients presenting with SI/HI or active psychosis. For patients being admitted to medicine, the inpatient psychiatry consult team will need to be contacted. They see patients for all psych related complaints (SI/HI, psychosis, agitation/behavioral issues, eating disorders, etc). | |
| Logistics - Swing | No pager to log into. MAOpages directly or communicates via epic chat for admissions. |
| Upon arrival at 2 pm, check with MCAT/FLEX person to see where they are in the work flow and who needs to be admitted. Same applies at 9 pm when night shift arrives. Swing admitters should leave around midnight. |
| No need to assign patients to a team (with exception of medicine consult list if you think a hip fracture consult is stable enough not to need co-management) | |
|---|---|
| Logistics CH Night 1 | Review medicine admission list and how to see med H admissions in EPIC |
| Review team CAP of 68 acute patients and how to calculate current number of med H acute patients (total med H patients - long term magnolia APP patients = acute med H patients). MAOalso calculates and can guide you. | |
| Review assignment of patients to MCAT service | |
| Upon arrival, check the admissions list for 'Needs to be seen patients' and check in with the Swing admitter to coordinate division of work. Often times, can be helpful to include MAOin the chat. | |
| Review latest protocol re: admission of patients without medical indication for admission but requiring placement in nursing facility. Often these patients require assessment by PT/OT and case management as well as review by hospital medicine leadership prior to admission. | |
| Hospitalist work rooms and call rooms: 9 BT hospital medicine work room: code 411 4 Anderson call room: code 411, room to right side, more convenient to ED ED work room: code 411 | |
| FOOD and CAFFEINE: Starbucks: closes at 9PM, arrive early for caffeine. opens again at 5:30AM, enjoy a pastry. Corner Cafe: ground floor Anderson. opens at 9PM, dinner served early in shift. Microwaveable meals available for remainder of shift, but they do run out. | |
| Assign all patients to teams by 6 AM. Confirm which teams are staffed via LB. Review assignment guidelines (Pine, Dogwood and Cedar APP teams max 7 patients, magnolia APP team max 3 acute patients among the long term patients, efforts toward regionalization, incomplete HBH transfers assign to cedar or cedar APP) | |
| Logistics HBH 2nd | When on HBR second shift, you cover the MAP pager from 7 pm to 9 pm and take transfer requests. You must return the page within 15 minutes. Always check with the MAObefore accepting a transfer to ensure there are not just beds, but also team spots. Always create a telephone encounter and use template to help receiving team know reason for transfer, to dos, etc. Review EMTALA to guide acceptance for transfer. |
| Review process for sign out from surgical teams and how to forward this to night team | |
| When on HBR second shift on a weekend or holiday, may be responsible for seeing and writing progress notes for CARES patients | |
| Review all imaging capabilities at HBH nights/ weekends | |
| Review all present/ non present consulting services | |
| Logistics HBH Night | Review team numbers (acute and chronic) and how to determine available team spots |
| When on HBR night shift, you cover the MAP pager from 9 pm to 7 am and take transfer requests. You must return call within 15 minutes. Always check with the MAObefore accepting a transfer to ensure there are not just beds, but also team spots. Always create a telephone encounter and use template to help receiving team know reason for transfer, to dos, etc. Review EMTALA to guide acceptance for transfer. |
|---|
| Logging into appropriate pagers at HBH (Hillsborough Hospitalists Admitting and MAP pager) |
| HBH Bed meeting at 9:30PM with house supervisor, ED and CCU charge nurses, respiratory therapy, family medicine team and med A resident. |
| Getting into the call room at HBH Location: 2 nd floor, outside of CCU near entry to the new tower. Door has a lock code on the handle Door code: 144# |
| Review cross cover responsibilities for surgical teams (we do not cover GYN patients) |
| Review guidelines for admitting to general surgery overnight |
| Review logistics of managing critically ill patients overnight (contacting intensivist or CICU fellow on call for recommendations, contacting ED attending for codes and emergent intubations vs paging anesthesia for non-emergent intubations, review process for transfer to main campus with assistance of MAO, review how to activate CODE stroke or CODE STEMI via the PLC as this is appropriate method in these cases) |
| Review all imaging and procedural capabilities at HBH. You may need to transfer to main (admit to med H vs ED to ED) if study or procedure is not available and is needed urgently overnight. |
| Review all present/ non present consulting services. You may need to transfer to main (admit to med H or ED to ED) if consulting service is not available at HBH. |
| FOOD and CAFFEINE: Aside from a vending machine, there is no food. Aside from a small Keurig, there is no caffeine. Bring from home. |
Types of admissions¶
- o Ortho co-management vs consults -Simple more straightforward patients can be added to the General medicine consult list rather than Magnolia co-management. Almost always warrants a Consult Note rather than H&P. Exception is a very medically complex patient that we agree to be primary on.
- o Chemo admits (H&P) -find patient in infusion center on 3 rd floor on cancer hospital. Call heme/onc fellow early to they are aware of admission and chemo is started in a timely fashion.
- o Direct admissions (often outside transfers) (H&P)
- o Transfer from ACH (progress note not necessarily needed but might be helpful for the person taking over the next day); ask ACH team to update hospital course
- o MICU transfers -remember to ask the team to update hospital course
Rounding shifts¶
| Category | Description |
|---|---|
| Start of shift | Sign in to treatment team within Epic (and mark as first contact if appropriate) |
| Make sure that you are logged into the pager in the directory for BOTH tree team and APP team (until the APP arrives for the day) | |
| Change your status on epic chat (Available, Busy, Do not disturb, etc) | |
| Epic | Set up all needed lists with appropriate tabs |
| How to print list vs patient report | |
| Dot phrase for progress notes | |
| Nursing | How to use vocera - 22 at HBR, 33 at main |
| Discharges | Medication reconciliation - consider preparing this 1-2 days in advance, especially if preparing to sign out to a colleague or you think a medication may need a prior auth or may need to be ordered by pharmacy. |
| Review where to see/edit wound care orders in discharge navigator | |
| Review tab in DC navigator to check PDMP | |
| Explain process of signing HH orders, transportation orders, DME orders and point out where these can be found. | |
| Discharge summaries should be signed within 24 hours (DHM incentive measure) | |
| Explain how to fill at UNC outpatient pharmacy vs shared services pharmacy. Hours of outpatient pharmacy (7 days per week but more limited hours on weekends) | |
| Create epic chat between nurse and meds to beds pharmacy techs for any patient needing meds filled from outpatient pharmacy. | |
| Ziopatch ordering/placement for discharge | |
| Daily Sign out | Sign out any active issues that need to be followed up to the night team or cross cover team, either in person or via epic chat. |
| Even if no active cross cover to dos, please let them know that you are leaving and have pushed your pager over. | |
| For sick patients, it can also be helpful to sign the patient out even if no active to dos. | |
| All patients with specific guidance for the night team should have a note in the sticky note for any if/thens. | |
| Service sign out | Make sure that sticky note is updated, especially with pertinent things to follow up the following day. |
| Update hospital course - all patients who have been admitted for >48 hrs should have an up to date hospital course. | |
| Update families prior to transition if you think this would help make the transition smoother. | |
| Contacting consultants | Order in epic for new consults |
| Paging via directory (sometimes supplemented with epic chat) | |
| For sickle cell patients specifically, there is a dedicated APP who can help facilitate their care. Her name is Sherri Morris, and she can be contacted via Epic chat. She will often prescribe their pain medications on discharge, especially if more long term meds (suboxone, etc). |
| Pharmacy | How to contact/look up team pharmacist |
|---|---|
| How to message Meds to Beds techs | |
| Social work / care managers | Introduction to UNC financial assistance program and 30 day pharmacy financial assistance |
| Explain timing/location of IDR (interdisciplinary rounds) | |
| Explanation of PASSR and FL2 | |
| Outpatient follow up | Monique Kambaji - Can send an epic message to request to make a follow up appointment (also can help with obtaining outside records) |
| New referrals can be sent to family medicine, internal medicine, though you do need to specify a location. | |
| Uninsured patients can be discussed with social work o Lincoln Community Health Center o Samaritan Health Center o Piedmont Health Services in Carrboro |