1) Get to know the patient list
- Note the purpose and goals of the visit (see #2 Triage below)
- Note any outstanding referrals and contact Referrals chair with questions; email ACT chair as well as needed. (see #5 re: ACT email)
- If a patient coming in was just seen last week, get any outstanding sign out from the last TS (should happen on Wednesday)
- If the pt is here for a Quick Visit with the TS make sure you know why!
- If a Chronic Care Senior wants to see their patient for a focused return, please note that this is NOT a “Quick Visit” and they must still be precepted by an Attending.
- Know why a Labs visit is happening. You will communicate this to the Labs TS for the week, although the Labs TS is responsible for pending all orders.
2) Triage the patient list (with Chief TS)
Clinic often is either overbooked or underbooked. Please also note that your triaging may be dictated by the # of Seniors and # of Attendings scheduled that day. The # of Seniors unfortunately is not always finalized early in the week, therefore please work closely with Student Recruitment Chair and Chief CM.
- Use the scheduling template (Docs > CM Docs > Scheduling Template) to help guide your triaging.
- Review the previous sign-out carefully and the purpose of the visit. In certain cases, patients may not need to be seen yet – for example, perhaps a redundant visit was booked or the patient is doing well and can wait until a later date for a return visit. If it is a Chronic Care patient, you must always involve the Chronic Care senior and his/or TS.
- Look up CC seniors for patients on the Master Patient List.
- Make sure that all NEW patients on the list have been pre-screened by ACT or SW. If not, then you will need to either
- reschedule them for a later date and make sure they have a pre-screen before then (note: email Chief CM and ACT) or
- keep their appointment and make sure ACT pre-screens the patient 15 mins prior to their return visit (8:45am or 10:45am, email Chief CM and ACT)
- Respond to the CM introductory email indicating which if any appointments should be cancelled (indicate time frame for rescheduling) or switched to another appointment type (e.g., if too many QVs, may want to convert one to a nursing appointment). The Chief TS may also send an email with requested changes. Send this list to the CMs of the week and the Chief CM by Tuesday (Chief TS CC'ed).
3) Create list of patients to pull-up
- You can pull patients from future clinic days to fill underbooked schedules.
- If the schedule has open slots, you should create a list of patients to pull up and communicate with the Chief TS about this on Sunday or Monday. The Chief TS will approve and send schedule changes to the CMs. CC patients should not be pulled up unless cleared by CC senior.
4) Respond to CC senior sign-ins
- CC seniors will send you their sign-ins by Sunday at midnight. If they are late email the CC senior with Chief TS CC'ed.
- Review and provide feedback. You can do this via comments in Google Docs; adding +first.last@icahn.mssm.edu to the comment will automatically notify them via email. Try not to just correct the sign-ins. This is a learning experience for the CC seniors so try to make it educational. Ask questions or provide material for further reading.
- Consider highlighting a few good teaching points and challenge the CC senior to incorporate these in a lesson for their junior.
5) Prepare your Sign-In for patients
- The purpose of this is to provide the best continuity of care for patients! Not to over-burden you.
- You can use the most recent TS sign-out in EPIC as a template but always review the chart as well for any new lab results/imaging/encounter notes.
- Make sure it is a problem based plan with a one-liner about the patient including the date of their last visit.
- Do not forget healthcare maintenance
- Include labs/studies/tests not to be missed by clinic team
- It should be printed out, individual copies per patient, on the day of and distributed to the teams.
- Your draft of sign-ins for all non-CC patients (including Labs Only and Quick Visits) should be complete by Monday at 11:59PM, at which point the Chief TS will begin reviewing it
- For NEW PATIENTS, see this template: New Sign In Template
- Please email this to the attendings of the week, as well as Chief TS and Yaz by Friday at 5:00PM
6) Email CMs with any info that should be relayed to patients by Tuesday
- Pts who should be fasting (please ask them also to bring a snack; if they are labs only, have them schedule them for a 9am labs only appt; if they are return, try to make it a 9am return and make sure clinic team knows the day of clinic). Only need to be fasting for lipid panel if specifically concerned about triglycerides.
- Pts who should bring glucose log, medications, etc.
- Pts who need their EH resident status confirmed
- Pts who need to bring in medical records, etc (make sure they also have signed a medical release form authorizing the release to Mt Sinai)
- Pts who need to have their EPIC charts merged will need to bring in a photo ID, the CMs will photocopy this ID and give to the chief CM.
7) Prepare a 20-minute didactic topic
Email outline of didactic to Dr. Soriano and Chief TS by Wednesday at 5pm for feedback.
8) Respond to ACT/Referrals emails regarding patients to be seen that week by Friday
ACT should email you by Tuesday-Wednesday.
Please note that their email tends to compile a lot of information about patient referrals, many of which either will not become relevant until AFTER the clinic visit OR are outdated. You can make note of that in your email.