DACR/NACR Reference Card

IMPORTANT PHONE NUMBERS:

Bed control: 72400Family Medicine: pager 35111

ER: 43726 (A side), 42735 (B side) 43900 (Rapid care)Fang: pager 37566

Transfer center: 41111

CCLHD: pager 33116UH chief: pager 31250

ALHD: pager 37436 (or personal pager)Dr. Armitage: pager 31552

Medicine Teams:

  • Naff[33726]: LK 20/Wearn [32654]: LK 20

-General Medicine, good teaching cases

  • Dworken [32299]: LK55

-GI cases, especially those who will need GI procedures

-Up to 4 patients with liver disease/cirrhosis who are established with UH hepatology IF approved by hepatologist on service

  • Carpenter[32661]: Tower 8

-Almost all HIV pts– if pt has HIV+ESRD, use your judgment

-Other ID cases, General Medicine

-If Carpenter is capped and HIV patient is being admitted, try to get intern to take a patient a day early or get resident to flex

-Patients must be in Tower (no Lakeside patients)

  • Eckel [33559]: LK50

-ESRD on dialysis (if Eckel full, try to flex and put on the team the next day)

-Pts with ARF in ICU followed by renal consult should go to general medicine

-Pt with ESRD on another service (surgery-plastics) if needing transfer go to Eckel

-Hypertensive urgency can go to Eckel

-Family Medicine + ESRD go to Eckel -- no exceptions

  • Ratnoff[33306]: S3 /Weisman [33970]: S4

-Pts with known heme/onc disease followed in Seidman OR with new bx proven cancer diagnosis

-Bone Marrow Transplant pts go to BMT service (call the fellow31252) during the day; staff patients overnight with the fellow

  • Hellerstein[32605]: T5

-All patients with a UH cardiologist and a cardiac issue go to Hellerstein

-Chest Pain, HF patients, CICU transfers

-Avoid patients with complicated medical issues who just happento need telemetry

  • Geriatrics [39385]: LK60

-Cap of 8 total patients, last admission at 5pm

-Elderly patients with simple geriatric syndromes (ie UTI/AMS, fall/placement)

Flex Board patients [31855]:Lakeside, Tower, or Seidman

  • Primarily Dr. Delores Brown patients
  • Can also take pulmonary patients (pulmonary HTN, CF, etc)
  • Can take heme/onc patients when heme/onc teams are full. Staff with Ratnoff or Weisman attending (Ratnoff and Weisman attendings will decide between the two of them which it will be).
  • Occasionally other simple patients when the hospital is full and staff with UH chief or Dr. Armitage.

House Doc [CCLHD: 33116] [ALHD, ESHD, LSHD: personal pagers]:Lakeside, Tower, or Seidman

  • Early SHD (5pm-11pm): 3 pts
  • Late SHD (7pm-1am): 3 patients
  • Admitting LHD (6pm-6am): 6 patients (before 4am)
  • Cross-cover LHD (8pm-8am): If no NP: 1 patient (before 6am); if NP overnight: 3 patients (before 6am)
  • Try to give them complex pts and OSH transfers
  • Cross-cover LHD covers BMT patients and Hanna House

Medical Nurse Practitioners [35642]:Lakeside or Tower

  • Preferred Patient: Private pts, elderly with placement/social issues or complex general medical problems
  • Privates, but Not D. Brown
  • NoACS rule outs, but syncope on tele is ok. No sickle cell patients or patients who will need bedside procedures (beside paracentesis, LP, etc).
  • Patients must be on the floor by 5pm
  • Have a staff cap of 15on weekends, 18-20 on weekdays
  • On Saturday and Sunday only take nightfloat admissions. Sunday is off for NP’s but covered by hospitalist-will take night float admits
  • Can take ICU transfers that are non-ACS rule outs
  • Do not take ANY form of dialysis patients
  • Patients can be on Lakeside or Tower

Fang Service [37566]: Must be on Tower

  • Can admit general cardiology patients if they have less than 12 patients on their team
  • Admit Effron, Ginwalla, Oliveira, El Amm, and Benatti patients regardless of how many patients are on their team
  • They CAN admit patients overnight and over the weekend (covered by moonlightersduring this time)

Hospitalist B[36387]and C [37166] and D [32508]:Lakeside or Tower

  • Patients without complex social issuesand quick turnover. No Privates.
  • They have a cap of 12. One pt after 5 and none after 6.
  • Cannot take ICU Transfers that have been in the unit >48 hours.
  • Can take non-complicated sickle cell patients NOTON SEIDMAN. If it is a busy heme-onc night, can put sickle cell on Towers with plan to give to Hospitalists in AM.

Berger Team [36599]: Seidman or Tower

  • Hospitalist + Heme-Onc NP Service: Heme-onc pts with less complex issues.
  • Can admit NF or new patients.

RULES FOR OTHER SERVICES:

Family Medicine [35111]:

  • Accept Bolwell family medicine patients
  • If patient sees a family medicine provider, have the ED call the family medicine service to see if they will accept the patient
  • Do NOT accept patients who are ESRD on dialysis (even if seen in Bolwell family medicine clinic)

Pregnant patients:

-Pt < 12 weeks – admit to medicine

-Pt > 20 weeks – admit to OB/GYN

** FOR THE SERVICES BELOW, IF THE PATIENT SHOULD GO TO THEIR SERVICE, THEY HAVE TO CALL THE ATTENDING AND THE ATTENDING HAS TO REFUSE BEFORE WE ACCEPT (AND THE FACT IT WAS DISCUSSED WITH ATTENDING MUST BE DOCUMENTED)

  • Neurology [General- 30116] [Stroke- 35663]:

-Strokes with private attendings can go to Neurology with neuro residents as housestaff and neuro attending as consultant but private MD as attending

-Insist that all seizures be seen by neurology before assignment made in ED

  • Transplant Surgery[Day 38447] or [Night/Weekend 31330]:

-All pts with kidney transplant <1 month MUST go to transplant surgery

-All pts with kidney transplant <1 year OR with pancreas or liver transplant shouldgo to transplant surgery

-Always call the IM transplant attending if there is a question- they make the call

  • General Surgery [35213]:

-Insist that all SBO and other surgical cases be seen by surgery in ED before assignment is made.

-If resident refuses, we will take the patient if their ATTENDING also refuses.

  • Orthopedic Surgery [32663]:

-If pt has orthopedic issue + complex medical issues (e.g. DKA, COPD exacerbation) that would otherwise be admitted to medicine, then admit to medicine with ortho consult

-If orthopedic issues but stable medical issues, then admit to ortho, but medicine consult manages all medical issues – see them for “co-management” and see them in a timely fashion

EMERGENCY DEPARTMENT ISSUES:

- Call Admitting (72400) to coordinate proper bed assignments based on geographic localization

- Pts can be moved to floor without assignment, pts can be assigned without a bed

- ED should call Delores Brown, Family Medicine, Fang, Transplant Medicine to accept patient to their service

- If a pt is a Vet and goes to the VA, have ED call VA transfer center during day and M.O.D. (x4433) at night

MEDICINE CONSULT ISSUES:

- When a consult is called overnight, see the pt in a timely fashion and leave at least a preliminary note(‘full consult to follow’)

- Staff pt with Gen Med consult attending

- Comanagement: we comanage with Ortho, ENT, Ophtho (they do not need a question to consult us)