Swing Shift

Swing Shift:

Swing shift provides evening coverage for admissions to the MDH team (there is no cross-cover component).

Swing Shift Expectations and Responsibilities: - Hours: 2 PM – 12 AM. Weekdays/Weekends: Perform H&Ps for new admissions to the inpatient hospitalist teams, working with MCAT and Night 1 providers. Consult on any new co-management patients (see separate co-management document). The Swing provider should sign into the Medicine Consult Attending pager at 4PM (once the consult team leaves).

Admission expectations: - When admitting a patient to the inpatient services, you are expected to perform a full History and Physical, including updating PMH, Family and Social Hx and Medication Reconciliation through the appropriate Epic process. Please review the Processes section on the DHM SharePoint site for more details. Please use the .HMNOTEHP smart phrase for the history and physical note. - For admission orders: - All new admissions / transfers to the hospitalist service should be placed on the “Med H New Admit” list as the primary team (this is done through the ADT1 order). In the “Place Patient Bed” order, you should list your name as both the “admitting” and “attending” provider. If you a moonlighter, list your name as the “admitting” provider and the “Cedar” attending provider name as the “attending provider.” Using the General Admission set will include the Hospitalist PRN order set with your admission orders (this helps reduce cross cover pages later on). For each admission, place a formal sign out note under the “Plan Notes” window on the “Overview” tab of the “Summary” page in Epic using “.LMNOTESIGNOUT” for a standard format. The sign out note should contain pertinent diagnoses/issues and “to do” list for daytime hospitalist. For appropriate patients, we will admit from the UNC Emergency Department to the rounding teams at our Hillsborough Campus.  If you feel that a patient may be appropriate for HBR, please discuss this with the MAO and the provider at HBR, who will provide the attending/team assignment for the admission.  Use this information when placing the Place Patient in Bed order and make sure to select “Hillsborough Campus” from the drop down menu “Preferred Facility”.  You are still responsible for completing admission orders and the H&P. See the Admissions/Discharges document in the Processes section of the DHM Handbook site for more details. Tips when busy Our goal is having a “place patient in bed” order within 1 hour from receiving the call from the ED. If you are unable to meet this goal due to workload, please communicate where the request is in the queue and how long you expect it will be before orders are placed. This goes a long way to setting expectations and having a discussion about re-triage if needed (patient already has a bed, etc). Being clear, yet flexible, goes a long way. Suggested script: “There are _ direct admissions and ___ patients who I have already been called about. I am happy to see this patient, but I expect it will be _ before I could have orders in.”

Process for identifying new admissions: Night 1 provider and Swing provider should work together to triage and admit new patients. The ER will call the MAO with admissions to the Department of Medicine and the MAO is responsible for assigning an appropriate team. The MAO will label all admits under the letter “H” and “NEEDS TO BE SEEN” and page the appropriate admitter with patient info. When ready to take an admission, please delete the “NEEDS TO BE SEEN” and replace it with your name in the Primary Team Sign Out Note. It is your responsibility to know that there are still admissions to be seen and to sign on to these admissions. Please communicate closely with each other to ensure admissions are being covered and that work is not being duplicated, especially if there’s a lull in admission volume. There is a provider workroom just outside of the Emergency Department double doors that can be used. The punch code to access this workspace is 4-1-1.

If teams are at cap/MCAT: The MCAT team is a service designed to improve triage pathways and advance the care of medicine patients during times of insufficient team space. This team will function as a consult/support team for patients while we wait for team space to open up. Any admitting provider (resident or hospitalist) may place patients on the MCAT list. MAOs triage admissions for anticipated destination team (Hospitalist versus Teaching teams) per their usual workflow. When no team space is available, MCAT space will be used to help advance the plan of care for these patients. When teams are capped but patients are awaiting admission, the Swing admitter should perform consultations on up to 4 additional patients waiting for admission and place them on the MCAT team Currently, there is a cap of 8 patients on the MCAT service, comprised of 4 teaching patients and 4 hospitalist patients. See MCAT documents for more details.