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TS AM Announcements

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Aim to deliver these by 8:30am at the latest, which is when your didactic should be wrapped up!

Know your audience--you don't need to mention all of these, depending on the experience of the juniors/seniors. The following is a simply list of things you might want to bring up before CM announcements.

1. Sign In/Sign Out

  • Please sign in with me before BOTH 9am and 11:30am pts
  • We will discuss “TOP 3” problems/issues to address during the encounter.
  • You need to sign-out to me at the end of the day. There will be a sign-up list on the door.

NOTE: ALL Senior Clinicians should be continually updating the Call Sheet with their patients’ status as they go through their day in order to keep everyone in clinic on the same page and to keep track of our patients. This is very important so that nothing gets missed before they leave

2. In-Clinic Procedures

Always verbally inform Labs TS of any procedures you ordered (e.g. vaccines).

A note on Labs: please make sure any labs or vaccine orders are signed by the attending before bringing your patient to the Labs TS. The order labels need to print first after being signed. Please verbally inform the Labs TS if your patient is getting a vaccine: (vaccine order labels are not printed) All POCT: POCT (Pregnancy, Udip, Fingerstick) NEED to be a) ordered as POC tests and b) communicated in person to Labs TS.

EKGs: Please follow these instructions on the EHHapp.

Pap Smears and GC/Chlamydia: Clinical teams MUST INFORM Head TS/Labs TS BEFORE ALL PAP SMEARS and GC swabs.

  • For any pt getting a speculum exam, the attending must visualize the cervix
  • Please call me in to assist you with the Pap and GC order (the details are not trivial)
  • Make sure to specify “with HPV cotesting” in the Pap smear order!

3. Prescriptions

  • Remember to clean up the medication list and indicate which medications the patient is taking or not taking.
  • Confirm that the pharmacy listed is “Icahn School of Medicine” (not Mount Sinai School of Medicine)
  • You MUST review the EHHOP formulary on the EHHapp before prescribing/refilling ANY medications.
  • DO NOT prescribe blacklisted or off-formulary medications. Consult with Head TS immediately if any non-formulary meds need to be prescribed.
  • If your patient needs an URGENT medication (e.g. antibiotics for a UTI), patients can pick up these medications at Metropolitan pharmacy on the weekends. Please follow instructions on the EHHapp for protocol and inform the Head TS immediately.
  • We have diabetes supplies in clinic. If your patient needs these, you must check in with the CMs who will log and distribute these.

4. Referrals

  • Please consult the EHHapp for detailed protocols and instructions for the Senior Clinician to make referrals (including ancillary clinic referrals). Make sure the referral has been ordered in EPIC (if necessary) and that the pt sees ACT (if necessary)
  • For ancillary clinic referrals, including MHC, EHHOPhtho, WHC, Cards, and Podiatry, the SC should use the EHHapp to access a link to the Google Form that initiates these referrals. They should complete this with the patient as some of them require specific questions (e.g. PHQ-9, gravidity/parity) or exam maneuvers (Snellen test).
  • For social work referrals, you can make the appointment with the CM, but you MUST sign-out the referral to the teaching senior (like any other referral).
  • For mental health referrals, you MUST document a PHQ-9 or GAD-7. Please do so in a student note or in Visit Navigator under “Questionnaires”

5. Food insecurity screening

  • ALL patients should be asked the 2-question food insecurity screen. The screen is available on the EHHapp.
  • Please document that you have asked these questions in your student note and inform me of any positive screens.
  • Patients with food insecurity should see ACT same day and may be referred to the NY Common Pantry to receive groceries today.

6. Timing of Follow Up

NOTE: All Senior Clinicians should do a “warm handoff” with their patients by walking them over at the end of their encounters to the back - CM to schedule a follow-up appointment

  • 6-12 months is recommended for generally well patients.
  • 3-4 months for chronic issues, at least every 3 months for diabetic patients
  • Consider NP visits for f/u on chronic issues within 4-6 weeks
  • If you would like to schedule a QV within 4 weeks, you must run it by me (you can schedule it yourself but please inform me during sign out so that I can re-assess the necessity).

Follow Up Instructions: Teams should write 5 or fewer KEY POINTS for the patient. These should be entered in the “Patient Instructions” section of the Visit Navigator and then print (Chart Review → Notes → Pt instructions you just wrote → print pt instructions) it so their patient can take it home with them at the end of the visit.

If your patient has ANY active medications at the employee pharmacy, please ensure that they have received pharmacy refill line instructions from the CMs.

7. Closing charts

UPDATE (1/4/17): We are now requesting that attendings assign THEMSELVES as providers once senior clinicians/TS present to the attending. This will facilitate closing the chart faster. Please instruct the attending to reassign themselves as providers when you present to them!!

You should still assign yourself as the provider for the student note.