As an SMR you will often have many questions that will come up; these are some of the more frequent questions that we ran into when we were SMRs and we hope that the answers will help guide you.
Q1: I am not sure about my team distribution, what should I do ?
Q2: When should I call chiefs for potential back-up residents ?
Q3: What is the cutoff time to assign/inform teams about day float admissions ?
Q4: Which kind of admission I should give to Neurology Team ?
Q5: What about the Med-Onc team (yellow) ?
Q6: What should I do if I receive a call from NCB SMR to transfer patient to JMC ?
Q8: Who should I board to 3B ?
Q9: Neuro team weekend coverage
Q1: I am not sure about my team distribution, what should I do ?
In the beginning of the year, don’t place the assignment/distribution sheets in the conference room until the chief doing intake has seen it; sometimes we have to redistribute patients and it becomes chaotic if the residents have started signing out patients already.
Q2: When should I call chiefs for potential back-up residents ?
If by 10 PM you have 10 admission for the night team. Go down to the ED, check to see how many pending admissions both sides of the ED have and then call the administrative pager/chief to see if backup has to be called in.
Q3: What is the cutoff time to assign/inform teams about day float admissions ?
Monday to Friday
- 3 PM for non-call teams
- From 3 to 5 PM the Day Float can continue to admit and the admission will be assigned to one of the on call interns. This will count towards their admission cap for the day.
Saturday – Sunday
- 1 PM for non-call teams
- From 1 to 3 PM the Day Float can continue to admit and the admission will be assigned to one of the on call interns. This will count towards their admission cap for the day.
Q4: Which kind of admission I should give to Neurology Team ?
Neurology Team cannot get admissions that are overflow medicine cases. Admissions to their team are stroke patients and some neurology cases that the Neurology Consult will discuss with the stroke attending. If in doubt SMR can contact the Neurology Consult to confirm the disposition for a patient.
Q5: What about the Med-Onc team (yellow) ?
Yellow team has a soft cap of 18 patients: If all other teams are at 19 or 20 then cap can be increased to 19. There is a hard cap of 19 for the team unless the patient is an inpatient chemotherapy patient then the team can go to 20 patients.
(New 8.2017) Oncology patients should be distributed to all the primary inpatient medicine teams evenly (NOT ACS, PULM OR NEURO) as Yellow team will no longer be the only team accepting oncology patients. They will, however, continue to take the direct admissions from oncology and/or active chemo patients.
Q6: What should I do if I receive a call from NCB SMR to transfer patient to JMC ?
Please make sure:
- The transfer is coming to medicine (occasionally you get contacted for transfers to surgery).
- From 8a-5p the Medicine consult resident is the one handling all the transfers. After 5p it’ll be the SMR.
- If the transfer is from ED, then the patient should be transfer to ED. Please ask them to contact ED attending.
- You should not give your name as the accepting physician.
- Ask the transfer center to connect you to the person asking for the transfer. You can get some of the information but they should speak to the critical care attending after 5p and they are the accepting physician. Floor patients get transferred directly to the floor which is why everything should be clarified before the patient is transported here. Same rules apply for ICU to ICU transfers.
- If a patient is being transferred from JMC to NCB (most will be patients who need to go to Moses for radiotherapy). The floor team should contact the NCB SMR/Dr. Ramasamy. The SMR can help facilitate the process but it is not his/her responsibility to make the arrangements it is the primary team’s responsibility.
Q7: What should I do if all the teams have very high census ? When should I give patient to Pulm/ACS team ?
Please refer to escalation policy.
Q8: Who should I board to 3B ?
(New 8.2017) Patients with ANY onc-related diagnosis should go to 3B WHENEVER possible. “Onc-related diagnosis” means any patient with active malignancy AS WELL AS any patient with onc-related complications, patients with prior onc-related diagnoses, as well as clear malignancy workups
Q9: Neuro team weekend coverage
(New 8.2017) Neurology inpatient team will not be taking Friday DF admissions or Saturday AM pickups. Any patients that would normally be admitted to them will go to another inpatient floor team (to be presented Saturday morning), and remain on that team until Saturday night at which point they will be signed out to the Neurology team night intern.