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MDX Direct Care

Hospital Medicine MDX Direct Care Service

Bluebird and Cardinal are the direct care teams for our general medicine patients at the Hillsborough campus, under f the MDX service. Each team has separate MD and APP teams. Although there are small differences between the teams (listed individually later in this document), there are common expectations and responsibilities. Rounding teams: Hospitalist teams at HBH consist of: - MDX BLUEBIRD MD – surgical co-management, acute patients (attending) - MDX BLUEBIRD APP – surgical and orthopedics co-management (APP) - MDX CARDINAL MD – acute patients (attending) - MDX CARDINAL APP – long-term and acute patients (APP) There is a second shift hospitalist (11am – 9PM) and a night shift hospitalist (9PM – 7AM) as well.

Expectations and Responsibilities: - Providers are expected to arrive and assume responsibility of the assigned team pager at 7 am. If an emergency arises and you are unable to arrive on time, you must arrange coverage for your patients starting at 7 am. - Rounding providers should assign themselves as the Attending of Record AND Sign In as “Attending Provider” for your team. These are best done as separate steps! See MDX Logistics Tips, below - The paired MD or APP is expected to aid when our multidisciplinary teammates are unable to reach the other provider through the pager system. - If you would like verbal sign out from the Night providers, you should make contact with the Night providers by 7 am. Cross cover issues from overnight will be written at the bottom of the patient’s “Plan Note” sticky note and these notes should be reviewed by team providers daily. - IDR at Hillsborough are attended by CM/SW, nursing, therapy services, and the medical team every Monday through Friday. It is expected that each provider touch base in the morning with the CM/SW for each patient discharging today to finalize discharge plans/needs. This can be done in person, via phone, or through secure chat. Please do not wait until IDR to arrange for today’s discharge needs. - IDR rounds in CCU conference room: Bluebird 1200 Cardinal 1215 - Please note that you are expected to attend IDR for your team - Physicians should touch base with their paired APPs each morning and see patients who require MD assessment. See “Working with APPs” for best practices working with our APP colleagues. - For all patients admitted to a team for more than 48 hours the MD/APP should update the problem based “Hospital Course” with an "outpatient to do" list available for transitions of care among providers. Additionally, when MD/APP has written 2 or more daily notes on a patient, the “Hospital Course” should be updated. - If the daily work is complete and the patients are stable, providers may sign out to the 2nd Shift after 4 pm. Anticipatory guidance should be provided on sick or unstable pts. - Prior to sign out, all patients should have a formal sign out note written under the “Plan Notes” window on the “Overview” tab of the “Summary” page in Epic, using the smart phrase “.LMNOTESIGNOUT” for standard format. Any guidance or follow-up items should be written in this location and should be updated daily. - Follow up items for cross cover should be signed out to the covering provider, either verbally or via epic chat. At sign out, it is the responsibility of the team provider to ensure that the associated pager is forwarded to the covering provider. - Covering providers should resume role of “First Contact” in Epic

Cap guidelines for MDX DIrect Care Service:

Our total census across MDX BLUEBIRD MD, MDX CARDINAL MD, and CARDINAL APP is 26 acute/consults + 8 long term, for a total of 34 total patients. Acute and long term patients are distributed across MDX BLUEBIRD MD, MDX CARDINAL MD, and CARDINAL APP.

  • Suggested distribution:
  • BLUEBIRD MD: 11 acute/co-management patients + 2 long term patients.
  • CARDINAL MD: 11 acute patients + 2 long term patients.
  • CARDINAL APP: 4 acute patients + 4 long term patients
  • BLUEBIRD APP will be assigned Tikosyn/sotalol loads and co-management patients.
  • Assign acute patients as appropriate to each team for balance and regionalizing each provider
  • Long term patients will be distributed across the 3 teams by Keva based on space and clinical needs
  • This cap number should not be lowered unless directed by DHM leadership.

Weekend Rounding Reminders: Similar to the weekend rounding structure for Magnolia APP, there are patients on the CARDINAL APP list that need to be seen on the weekend – both HCAR and acute. Below is the division of responsibility for MDX BLUEBIRD MD/MDX CARDINAL MD and 2nd shift. 2nd shift: - Sign into the CARDINAL APP pager on arrival - You will see all HCAR patients on Saturday that are on the Tues/Thurs/Saturday schedule. In the event that the CARDINAL APP provider is absent (for illness or vacation), 2nd shift is responsible for HCAR patients. - You may need to see HCAR patients with urgent needs over the weekend - Keva will send an email on Friday with sign out and any active management at that time. If there’s any major updates to send back to Keva, please email her sign out on Sunday

BLUEBIRD MD/CARDINAL MD: - Acute patients remaining on CARDINAL APP will be divided between DX BLUEBIRD MD and CARDINAL MD for the weekend. Please make sure these patients are assigned to the MDX BLUEBIRD MD/MDX CARDINAL MD lists as well so no patients are missed with changes in attending. Any acute patients who are still admitted on Sunday evening can move back to CARDINAL APP for Monday. - BLUEBIRD APP will be covered by the BLUEBIRD MD attending - If there’s a moonlighter on 2nd shift, you will need to see and co-sign for the patients they are seeing (HCAR or acute)

MDX Logistics Tips

Daily tasks: - Sign into pager via MyUNC Health Directory. If directory not working, you can sign into the directory via Citrix MyApps or call 984.974.7272 and follow the prompts. - Assign yourself as the Attending of Record by highlighting patients, right clicking and picking “Assigning Others” with Attending box checked on the first day on service as well as each subsequent day on service for new patients added to the list. - If you click “Override 1st Contact” during this step it will lock you as 1st contact, so avoid this problem but signing in as below. - "Sign In" to the team and patients on your list as “Attending Provider” with a sign out time, this should set you as “First Contact” in Epic (click “Take over overlapping assignments”). It is helpful to set an end time to prevent receiving messages inappropriately. - At end of the day, sign out to the 2nd Shift provider

Other tips

  • Hospital phones are listed with 5 digits starting with 4 or 5. The corresponding extensions 984-974-* or 984-215-*
  • To reach Vocera, dial 33 or 5-4502 at the Medical Center or 22 or 5-4500 at Hillsborough.
  • The easiest way to reach a nurse on Vocera is to say "room #" + "nurse" (i.e. “8301 nurse”). Can also use the nurse's name (but frequently Vocera will misunderstand). Can also call the unit (ex: *33 --> "6BT") and ask the HUC to connect you to the nurse.
  • When switching off service, update the hospital courses and plan sign-out notes and contact the provider taking over to offer verbal sign out.
  • To contact the MAO search epic chat for "MAO" and click "groups" or can text/call them 919-667-4493