Intern Survival

Guide
17th Edition

Department of Internal
Medicine
 UKMC Quick Facts Page 1

Parking:
1) Parking structure #1“E” lot by VA entrance, open for parking for
residents 24 hours a day, 7 days a week.
2) Parking structure #6 on Virginia Ave- great if you are going to clinic.
You are not supposed to leave your car overnight
3) Parking Structure #8 across from new hospital- only controlled Mon-Fr
8a-4:30pm, (but have to pay until 11pm) so OK to park on the weekends
4) Commonwealth Stadium ORANGE “E” lot - can shuttle or walk
5) Parking Structure #3 Kentucky Clinic. Do not park at the Kentucky
Clinic Parking Garage unless it is a weekend
Shuttles: Takes employees from front of hospital to Stadium parking lot and
to Limestone ST. garage. Shuttles leave every 5-15 minutes from front of
HSRB or employee entrance at Pav A.
Cafeterias (hours subject to change)
Wildcat Deli (KY Cafés
Clinic) Pavilion CC
M–F 7:30am–3:00pm • Whitney Henderickson Bldg: M-F
7:30 a– 3:00 p
Pavilion A
• Courtyard café (ground floor): M-F
6:30a-3p
• Terrace café (1st floor): M-F 11a-2p

Coffee Shops- Cafeteria- Pavilion A

Pavilion H Open 22 hours a day: Closed from 5am-6am
M-F 10:00am-2:00pm and 10am-11am.
Daily 11:00p-6:30a
KY CLINIC
Starbuck’s M-F 6:30a-
6:00pm

ATMs
1. Main hospital north of information desk.
2. Hallway between medical school library and dental school.
3. 1st Floor of KY Clinic across from pharmacy.
4. Big Blue Deli during business hours.
Vending Machines
Located across from main cafeteria. Accessible 24/7.

Employee Health: First floor of UHS building. Performs TB screening

 UKMC Quick Tour Page 2
Post Office: Basement of Medical school. Open M-F 8 a.m. – 4 p.m.

Hospital Address Your Professional Mailing Address

A.B. Chandler Medical Center Your Name
800 Rose Street 900 S. Limestone
Lexington, KY 40536 306 Charles T Wethington Building
Lexington, KY 40536-0200
General Layout:
Pavilion H: “original hospital”; divided in to 4 wings: North, South, East,
West. Critical Care Center (Pavilion HA) on south end of building.

Floor Contents
8th Medical/ surgical wards
7th Medical/surgical wards
6th Medical wards, Internal Medicine Resident Lounge (BS
room), noon conference room, resident library, Grand rounds
auditorium, medical records, progressive care units (6S/6W),
clinical laboratory, microbiology
5th Medical/surgical wards (isolation ward 5E), dialysis (code
6353#), clinical research center (5N), vascular lab
4th Children's hospital, Peds Conference Room, Transplant
Center, Pathology Lab, NICU, PICU, cytopathology.
3rd OB/GYN, L&D, endoscopy, radiology film library, IR,
angiography, specialty pharmacy
2nd Radiology, OR materials, surgical pathology, 2ACT, 2MED,
CT scanner, UK SIM lab
1st Administration, GME, gift shop, chapel, call rooms, coffee
shop, MRI
Basement Post office, Central supply, EEG, Nuclear medicine (V/Q
scans, stress tests), pager replacement, radiation oncology

Markey Cancer Center (Pavilion CC) – Inpatient Hospice, Heme-Onc fellow

and attending offices 4th floor, Heme clinics 1st floor

Whitney Hendrickson Building (Pavilion WH): Multi-D Oncology clinics

on 1st and 2nd floor

Gill Heart Building (Pavilion G): Contains cath labs, ECHO, GXT, ECG,
Cardiac MRI, Cardiology clinics, outpt minimally invasive surgery
 UKMC Quick Tour Page 3

Pavilion A – “new hospital”

General layout of patient floors is two towers—100 (S. Limestone side) and
200 (VA side)—with connecting corridor between that is location for
elevators and waiting rooms.

Floor Contents
Ground ED, Pediatric ED, Radiology department (off lobby),
courtyard, coffee shop, atrium, auditorium
1st Cafeteria, Concourse/atrium, terrace/ patient library/ resource
center
2nd PACU and ORs, cath lab, walkway from old hospital
3rd Pharmacy
6th Neurosciences—ICU, progressive, acute care
7th Trauma & Surgical Services—ICU, progressive, acute care
8th CCU, CTICU, Cards floor service
9th MICU 1 and 3, Private Hospitalist Teams,
10th MICU 2, Private Hospitalist Teams
11th Markey Cancer Center Inpatient
*9 and 10 can have patients on teaching teams as well
Room numbers:
• Alpha prefix designates pavilion
• Next two digits indicate floor
• Next digit indicates tower
• Last two digits indicate room number
Example: A.06.124
→ A = Pavilion A
→06 = 6th floor
→1 = Tower 100 (i.e. S. Limestone side)
→24 = room 24

Connections to Pavilion A from Pavilions H& HA (“How do I get to the

new hospital from the old hospital?”): hint: wear comfortable shoes!
• Ground floor: Walk through employee hallway past the ER
• Floor 1 concourse: Many signs with directions on the main
concourse
• Floor 2 concourse: from old surgery/OR desk to Pavilion A staff
elevators, also connects with Gill heart
 UKMC Quick Tour Page 4
Other Connections between various pavillions:
1. KY Clinic bridge – 3rd floor of KY Clinic to 2nd Floor of Pavilion H
2. Markey CC – north end of 2nd Floor Pavilion H to 2nd floor MCC
3. VA – beautiful first floor walkway; Requires PIV access
4. Gill Heart Institute – connections on 1st via concourse from Pavilion
HA to A (front of hospital) and 2nd via double doors near 2 ACT
Also connects from 3rd floor to 3rd floor CTW
Key Locations
Radiology
1. Reading rooms are located on the ground floor of Pavilion A next to
the lobby and the auditorium (just past the main entrance)
2. ER reading room - on the hallway between the adult/pediatric ER
3. CT/MRI/ultrasound – 7-5829
4. Weekend/nights. Hint: It is good form to look at films yourself
prior to asking rad resident to help. It may be easier to call resident
in the ER reading room (3-5338)
5. Film library – 2nd floor rad by US
6. Dx Rad pager – 0663

Supply (So you want to do an LP. You can order supplies and wait for
the runner or get it yourself (much faster). Most of this can be found in
each floor’s supply closet.)
1. Basement of the new hospital is main materials office
2. Check list:
a. procedure tray (eg LP, paracentesis, etc.),
b. gloves for you and upper level,
c. betadine, box of 4x4s, extra towels,
d. gown, mask, hair net, glasses,
e. ?extra tray (just in case), ?extra lidocaine,
f. med student to help carry.
3. To be sure your sample makes it to lab, ALWAYS deliver it
yourself to 6th floor far south end. If you don’t, it may mysteriously
disappear and you will have to repeat the procedure—that would be
bad
Pager batteries: GME, info desk HA main lobby, basement pager office,
clerk on your floor
Medical Library: first floor of medical school
Pager replacement/loaner for day (if you forgot yours): basement –
MIS office
 VAMC Quick Facts Page 5

Parking: 5 level garage located southeast of hospital.

Free with an “E” parking permit.

Cafeterias
Main cafeteria on 1st floor:
24/7; closed 10a-11a
Starbucks Coffee Shop located in the Main lobby
M-F 7:00 a.m. to 3:00 p.m.
Does not take badge money

Vending Machines
Near main cafeteria and multiple floors.

VA Auxiliary Store (AKA “Canteen”)

Located in basement. Snacks, drinks, personal
items, clothing, electronics. You can find some
really random stuff here! M-F 9a.m. – 3p.m.

Main Telephone Number

(859) 233-4511

Call room
4th floor, north side, past Endo
Free food and water when on call
Code 4578#

Admin and Tech support

4th floor North side, opposite chapel
 VAMC Floors Page 6
VAMC
General Layout: Original Hospital divided in to 4 wings: North, South, East,
West.
Main hospital
Floor Departments or Services
6th SICU/MICU, OR, PACU
5th Medical / surgical ward, medicine team rooms
4th Endoscopy, psychiatric ward(4S), dialysis, Hem/Onc
Office, call rooms, and your ADPAC, Greg Hazlett
3rd medical/surgical wards- non tele, PFT, respiratory
2nd Progressive care unit, outpatient specialty clinics, heart
station, ECG, exercise stress tests, cath lab, warfarin
clinic, Morning Report Room (2N)
1st clinical laboratory, inpatient and outpatient pharmacy,
nuclear medicine, radiology, MRI, ER- an always
exciting place- Badge access needed from VA police
Basement cafeteria, morgue, physical therapy, VA auxiliary store
Ambulatory Care Center
(Attached to the VA Hospital, immediately south.)
3rd and 4th Floors: Basic Research
2nd Floor: auditorium, medical library, optometry, dentistry, ophthalmology,
prosthetics, medical records, vending machines.
1st Floor: ED, Urgent Care Center, outpatient pharmacy, radiology, CT
scanner, MRI.
Key Locations
MICU: 6th floor (Door Code 4567#)
Endoscopy: 4th floor (Door Code 4511#)
Heart station: 2nd floor near PCU
Morning report: North outpatient clinics conference room 2 nd floor
ECHO: Heart station, 2nd Floor
Purple Medicine Office: 5 right hallway B512; Ph 4786,4755,4777
Blue Medicine Office: 5 right hallway B518; Ph: 4331,4334,4336
Red Medicine Office: 5 right hallway B514; Ph 4412,4485,5521
Orange Medicine Office: 5 right hallway B 515; Ph 5168, 4732, 4738
Nuclear Medicine: 1st Floor across from inpatient pharmacy
Radiology: 1st floor
Attending/Hospitalist Room: 2nd floor just inside entrance to 2-PCU- code
3453#
 Graduate Medical Education Quick Facts Page 7

ACGME Hot Topics

1. Hours: It is the responsibility of both the program and the
residents to be compliant with these national rules:
a. 80 hour rule: No more the 80 hours per week
(AVERAGED over four week period)
b. 24+4 hour rule: No resident will work a shift longer than 28
hours. - 24 hours with new patients
- 4 hours to complete work with no new patients
- if you stay later than that it should be for one of the following
reasons: 1. Continuity for a severely ill or unstable pt
2. Academic importance of the events transpiring
3. Humanistic attention to a pt or family
c. Days off: Each resident will get one day off in seven
(AVERAGED over a one month period)
d. Graduated responsibility: interns should not work more than 16
straight hours
e. Time off between shifts: must be 10 hours unless coming off a
night float or overnight call
*To verify compliance we must log hours. We are using Medhub
Uky.medhub.com-need to log weekly or you will be locked out!

2. Core Competencies: These are the six areas in which you will be
evaluated:

- Patient Care
- Medical Knowledge
- Systems Based Practice
- Practice based learning and improvement
- Communication and Interpersonal skills
- Professionalism
 Residency Program Phone Numbers Page 8
IM Residency Program
Program Leadership
Kristy Deep, M.D (Program Director) 323-1946
Sarah Schuetz, MD (PC Director) 562-2467
Sarah Vick, M.D (Associate Program Director) 323-7641
Joseph Sweigart, MD (Associate Program Director)
Devin Oller, MD (Associate Program Director) 323-3872
Sean Lockwood, M.D (VA Site Director) 330-4526

Core Faculty
Jacqueline Gibson, M.D Angela Webb, MD
Vedant Gupta, MD John Romond, MD
Kristen Fletcher, MD

Residency Program Coordinator

Kristi Lovell 218-2834

Med/Peds Program Directors

John Stewart, M.D. (Program Director)
Kelli Trent, M.D. (Associate Program Director)

Med/Peds Residency Program Coordinator

Leann Jacobs 323-6561

Education Specialist
Jamie Taylor 323-1388

Data Coordinator
Carl Broaddus 323-1180

Program Assistant
Holly Elkins 218-2834

Clerkship Coordinator Jon Gent 323-6540

Chief Residents (CTW 306E) Pager Office Cell

Megan Wolak, MD 0850 80896 (586)-719-4142
Chris Thomas , MD 0470 80837 (859)-382-3297
Sara Klinger, MD 1360 80891 (336)-671-6706
Neil Backer, MD (314)-971-7281
 UKMC Phone List Page 9
UK numbers begin with 257, 218, 562 or 323. To
call UK from VA dial 9 then number.
Frequently Used Numbers
BS Room 3-5889 / 7-8153 UK ER 3-5902
Medicine 3-8691

Paging office 3-5321

UK MDs 7-5522

Service Pagers
Cardiology 330-2700 Pulmonary 330-1885
Fellow Fellow
Pharm-D on 330-1875 Trauma Surg- 330-0912
call Jr resident
PICC nurse 330-7447 Rapid 330-6860
HOA 330-6855 Response

Medicine Staff General

Kristi Lovell 218-2834 Capacity 3-2233
Carl Broaddus Command
Holly Elkins 8-2834 Med Records 7-3591
Leann Jacobs 3-6561 Risk Mgmt 7-6212
Patient rep. 7-2178
IT Help desk 3-8586
Housekeeping 3-5133
OR front desk 3-5631
Security 3-6152
UK Police 3-6156
Employee 3-5823
Health

Therapeutic Services
Dental emerg. 3-9707-day
3-5321 -eve Dialysis 3-6353/ 3-6115
Physical 3-5841/ 7-8001 Nutrition 7-4347
Therapy Home Health 3-5501
Pharm inpt 3-5641 Pharm outpt. 3-5854
Social service 3-5501 Audiology 7-3390
Chaplain 3-5301
 UKMC Phone List Page 10

UK numbers begin with 257, 218, 323 562. To call

UK from VA dial 9 then number.
 UKMC Phone List Page 11
UK numbers begin with 257 or 323. To call UK from
VA dial 67 then number.
 UKMC Phone List Page 12
UK numbers begin with 257, 218 or 323. To call
UK from VA dial 9 then number.
Emergency
Fire/police 911 Risk 7-6212
Security 3-6156 Management
Code 500 3-5200 Poison Control 1-800-722-5725
Safety Officer 259-6690 Chemical spill 3-6280

UK MD’s 7-5522 (for outside doctor’s numbers and faxes)

Computer
Help desk 3-8586
College of med 3-3580
TASC Center 7-8272

Miscellaneous
Emp. health 3-5823 Housekeeping 3-5133
Home health 3-5501 HR 7-9519
Infection 3-6337 KODA 800-525-3456
Parking 7-5757 Physical plant 3-6281
Public Affairs 36363 Sexual Harass 7-3100
UK Workers 800-440-6285

Fax numbers
5 Main: 3-5924 7 Main: 7-5211
6 Main: 3-8935 8 Main: 7-1863
6 North: 3-1933
 VAMC Phone List Page 13
VAMC Phone list: From outside 233-4511 or 281
and then the extension.

General
Admitting/ Bed 4360/4969 AOD 4950
control Transcription 4393
med records 4379 Risk mgmt. 4904
Code 500 4500 IT help 5550

Floors
ED 4966/4660 2 South PCU 4932
3 North 4934 Hospitalist office 4171
4 South 4931 Dialysis 4938
5 Main 4933 Recovery/PACU 4782
6S MICU/SICU 4942 OR 4619
NP office 4746 5 Main Fax 281-4881

Laboratories
Clinical Add. 4503 Blood Bank 5937
Bone Marrow 4432 Chemistry 4529
Hematology 4516 Micro 4522
Histology 4530 Gen. Pathology 4508
Surg Rpts. 4509 Cytology 4519

Radiology
CT Scan 4567 Neuro rad 4469/5327
Vascular/dupl 4261 MRI 4560/4569
Reception/ gen 4267 Ultrasound 4566
Angio/IR 4254

Diagnostics
Audiology 4972 Card cath lab 4417/4468
ECHO 4458 EEG 4463
EKG/Heart 4414 EMG/NCV 4461
Station Holter monitor 4454
Endoscopy 4735 Exercise stress 4419
Nuclear results 4921
Pulmonary Lab 4441
 VAMC Phone List Page 14

From outside call 233-4511 or 281 and enter the

extension.
Therapeutic Services
SATP (LD) 3756 Chaplain 4910
Dialysis 4938 Dietetics 4330
Pharmacy 5631 Phlebo 7609
Outpt Prosthetics 4952
Pharmacy Inpt 5202 Home O2 4641
Disch Pharmac 5218/5365 PT 4573
ID Pharm 4240 OT 4577
CHF Pharm 2357
Heme Pharm 5241 Speech/ 4154
Palliative 4116 Dysphagia

Team Rooms
Red 4421/ 4485 Blue 4331/4334
Purple 4786/ 4755 Green 4229
Orange 5168/ 4732

Miscellaneous Access Codes

ER Badge access CALL ROOMS
Team Rooms 1234 # A425B 4755#
Supply Closets 4511 # A425C 4412#
ICU Stairwell 4500 # A425D 4732#
ICU entrance 4567# A425G 4563#
rd
3 Floor 4511#

Computers
Greg Hazlett, IM business manager: 4790

Regional Help desk: 5550

To page a VA pager from the VA dial 66, wait for the prompt,
and then enter 3 digit pager number.
 UKGS Phone List Page 15

GS numbers begin with 226. Not all lines are

accessible from an outside line, so if you page
someone at Chandler, page them to the main floor
number.
Operator – 226-7000
Laboratory 7090 / 8566 PT 7026 / 7095
Lab Pager 330-1945 Speech Therapy 330-7624
Pathology 7094 Respiratory 330-8637
Blood Bank 323-9694 Wound Care 7050
Materials 257-9211
Admitting 7100 2nd floor surgery 7139
Medical Records 7033 / 3-6624 3rd floor – select 7321
Pharmacy 8135 / 7038 4th Floor ICU 7364
Security 8524 4th Floor Med/Surg 7075
Housekeeping 330-1011 5th Floor Med/Surg 7165
Help Desk 7500 5th Floor Surg 7065
PICC nurse 330-7447 6th Floor Ortho 6700
Meds-to-beds 218-4775 7th Floor Med/Surg 7030
ER 7070

Diagnostics
EEG 7009 Sleep Lab 7006
ECHO (Peta) 230-1586 Radiology resident 1755
ECG stat 7025 / 2740 Nuclear Medicine 2532
Dialysis 4620 Radiology 2505
Endoscopy 7067 CT 7013
Reading room 7214 MRI 7200 / 8269
Ultrasound 7016 / 2874

Phone in the 226-7129

resident work
room:
 Discharge Planning Page 16

-Begins at admission!
-Keep hospital course updated in snapshot daily, or at least
when having off to another resident.
-Discuss issues at daily DC meeting.
-Important questions to address daily
*What is keeping them in the hospital?
*Where will the patient go?
*What needs will they have after discharge?

TIPS
-Nursing home patients:
*Usually return to where they came from
*MUST HAVE DC SUMMARY PRIOR TO DC
*Scripts for controlled substances must be provided,
even if it was a prior med (few days)
*Other meds do not need scripts, but must be detailed
in the DC summary
*Ensure NH knows days in advance when you
anticipate DC. The social worker will help with this.

-Veterans:
*Many different options, SW can provide a lot of
help with this
*If the patient is admitted for placement it is
important the SW know early
 Discharge Planning – Patient Returning Home Page 17

TIPS FOR DISCHARGE PLANNING

1. Discuss plan with the patient and clarify any questions.
2. Complete hospital course in the designated box in the
snapshot tab.
3. Head to the discharge tab and follow the the various sub
tabs,
• Care providers- Enter your attending and list all
services consulted during hospitalization.
• Diagnosis- Enter discharge diagnoses, Reason for
Hospitalization: should be a one liner explaining why
patient presented. Hospital course: problem based
summary of events. Do not paste in assessment and
plan
• Medication: Will prompt you to complete med rec;
prompted – very important to clarify new meds,
changes made, and ensure accuracy
• Disposition: Where they are going and list any
pending test
• Appointments: List all appointment details in
Schedule For* box for all appts for follow up. On
some floors, clerks will schedule appts based on what
you enter on this part of discharge tab in advance
4. Click discharge patient > Discharge note will populate
details from this tab. Please put physical exam, check
mark on order rec and select attending co-signer for the
note.
5. Discharge order will pop up when you save note.
*If DC summary is dated the day of discharge and has physical exam
it will also count as a progress note for the day.
*Stuff sometimes disappears if you leave the discharge tab alone for
too long, save any long hospital courses elsewhere.

6. Prior to DC ensure all follow-up appointments are

 A Day in the Life of the Intern at UK Page 18

Pre-rounds at UK (06:30 – 07:00)

You should start your day with the following:
1. Night Float – Discuss any issues the night float intern may have had with
any of your patients first thing in the morning.
2. Check SCM for new orders and nursing communication.
-physician rounding reports are a good for a quick summary and taking notes
3. Medications
- Check Medication Administration Record (E-MAR) DAILY.
Found in SCM. Always know what meds your patient is on .
- Day #/# for antibiotics
- Usage of PRNs
- If patient refuses or nurse does not actually give a scheduled med
4. Telemetry if applicable. Check for overnight alarms and print strip if
necessary. Found in Nursing stations or central tele on 6.
5. Vitals (Tmax, I&Os, etc.) Found in SCM
6. Labs and test results. Review all pertinent labs and check on cultures.
7. Enter any orders you know need to be done.
8. Head to Morning Report at 07:30 if there is time. If you are worried
about any patient, go see them BEFORE morning report
9. 8:15-9: go see your patients and get a brief overnight history and physical
10. Start electronic notes if there is time

Rounds (09:00 - 11:40):

1. Communicate. Be sure your upper level knows of any urgent or
unexpected findings from your pre-rounds prior to starting official rounds
with the attending, preferably before morning report. NO DISCOVERY
ROUNDS.
2. Learn
3. Teamwork. Enter orders, etc. while other intern presents.
4. Multitask. Review all consultant notes. Look for a chance to call that
consultant or arrange that test during a lull in rounds. Your upper level may
help you spot a good time.

Noon Conference: Eat and learn from 12:00 – 1:00

Work: Procedures, test results, etc. Admit new patients
Check on your patients one last time before you head out.
Let your upper level know when you are ready to go.
Checkout: at 17:00, Make sure all orders for the next day are entered. Go
over your checkout list with the Resident and check out to cross cover intern.
 A Day in the Life of the Intern at the VA Page 19

Your Morning Plan at the VAMC:

1. Get checkout from the intern on overnight.
2. In your team office, log into CPRS and check vitals and new orders
from overnight. Record significant findings, vitals, etc. on your
prerounding sheet. Look for trends in BP, Pulse, Resp, Pulse Ox, O2
requirements, Temp. (Tmax in particular). Notes: review all notes
written since you last looked Look for cross cover notes, nursing notes,
consults notes, etc. In the Labs Section, look for any new results,
review micro to see if culture results have been update. In the
Procedures/Imaging section, check to see if official or prelim results
are in the computer. Vitals are in Philips system for the PCU and
MICU (Use you initial VA login to log on)
3. Go to Morning report on 2N (7:30 am- 8:15am) on Thursday
4. Make one circuit of the floor, examining each patient in turn, and
recording all findings on your prerounding sheet. Ask patient about
any events, problems, symptoms, etc. Record I’s and O’s on
prerounding sheet (Found on bedside board, NOT located in
computer; In the PCU data is located on Clinicomp U: & P: your CPRS
ID & password; Clinicomp1! For first time users password). Do
focused physical exam.
5. Check telemetry on 5 & 3 for any overnight events.
6. Prioritize patients to expedite discharge of patients prior to noon.
7. Enter orders for any new meds, labs, tests as indicated based on
prerounds. If orders need to be done STAT, you should call the nurse
taking care of the patient or radiology as needed or your test will not
be done in a timely manner.
8. Write SOAP notes
9. Round with team and take notes during discussions on each
patient regarding med changes, new tests or consults.
10. After rounds, enter any new changes as needed. Call consults
early. Enter new labs, tests, procedures, meds. Prioritize order entry in
order to get to conference at noon.
11. Go to Noon Conference
12. Check on patients again after noon conference, complete notes,
and perform procedures as needed.
13. Check out to on call team after all work is completed and all
patients are stable.
 First Day of Rotation Page 20
The First Day of the Rotation
As teams finish their rotation and move to the next, the handoff
of patients to the new teams needs to be seamless. From a patient
safety standpoint, the patient is vulnerable to less than adequate
care during this transition. This is the main reason that interns
switch service on the 1st of each month and the residents switch
on the 4th of the month. Even though it will be impossible to
know your patients as well as the intern who just left the team,
the entire medical staff along with the patient and family will be
looking to you like you know everything. To hit the ground
running and complete a good handoff, the following tips will be
helpful.
Beginning a Service:

1. Call your new resident the day before you begin.

2. Discuss the patients with the off going intern to get a feel for
what needs to be done.
3. Briefly review the chart of each patient the day before you
start. You may want to write down previous culture results
and imaging studies. Take notes re: plan of care
4. Arrive early to preround on your patients the morning of
your first day on the service.

When Leaving a Service:

1. Write s succinct email check out with family dynamics not

present in note. Complete hospital course in Snapshot tab
for all patients, especially those close to discharge so that the
incoming intern is able to better understand the details of the
hospitalization.
2. The responsibility of the discharge summary(especially
hospital course and meds) will go to the off going intern if
the discharge is within 24 hours of leaving the service.
 UKMC Diagnostic Services Page 21
UKMC: How Do I Order a……?
Transthoracic ECHO: Order complete Study
Transesophageal ECHO: TEE order. Call the TEE Cardiology Fellow.
Carotid duplex: type carotid and select cerebrovasc study. Results in SCM
documents.
Venous duplex: type venous and you will find it. Best study is with vascular
lab but they are only here M-F 8-5 If weekend or afterhours be sure to select
the non vascular lab one.
Nuclear stress tests: Go to Browse then cardiology then Gill Nuclear Med
Stress ECHO: under stress ECHO and assoc EKG is in the order set.
Exercise stress tests: type Stress and you will find it.
ECG: type ECG. Make sure to pick the inpatient one. Hardcopy in chart.
Results in SCM imaging.
Angiography(IR): Enter order- Consult interventional radiology. Call
interventional Radiology 30348 or page 1729 or sub-specialty listed on
Provider on call. Talk with them first about if they will do the procedure.
Make sure patient has recent coags and platelets and is NPO the night prior.
X-rays: Search with part of body. ‘Foot’. Order with Indication for test and
timing (stat vs. am, etc)
CT: order ‘CT____’ with Indication and technique, i.e. with contrast, without
contrast, pancreas protocol, PE protocol, etc. Consider prehydration fluids.
MRI: order under ‘MR___’
MRCP: order. Call MRI station to schedule.
Ultrasounds: order US. Specify indication.
Ultrasound guided tap*: order U/S and specify area to be marked, if you
want radiology (IR) to do the procedure you need to call them first
CT guided biopsies: Call Interventional Radiology.
EEG: Order EEG routine or EEG and video. Results in SCM documents.
EMG: EMG/ NCV. Specify limb. Call EMG for results.
Bone Marrow Biopsy: Consult Hem/Onc fellow
Hemodialysis: consult Renal fellow to schedule. They put in the orders.
ABG: ABG order set. Have the nurse page respiratory if emergency.
PFT: PFT- specify full or screening
Respiratory Therapy: order nebs with instructions on dosage and frequency.
The neb orders automatically expire in 3 days so make sure to review meds
and renew these if needed
PT/OT: order PT/OT evaluation order and reason. They are separate orders.
Who needs to be NPO?: EGD, colonoscopy, surgery, PEG , IR, tube
placement, abdominal ultrasound, ERCP, stress tests.
Heart cath in AM (except EP procedures)- Clears from MN, NPO from 7AM.
 VAMC Diagnostic Services Page 22
VAMC: How Do I Order a……?
For all testing at VAMC, put an order in CPRS first. It is always important to
notify people of the order at the VA to ensure that orders get done. STAT may
mean tomorrow to someone else…
Follow the steps below:
Transthoracic ECHO: listed under common procedures
Transesophageal ECHO: Call TEE Fellow on Cardiology to schedule.
Carotid duplex: Under Radiology/Nuclear Medicine from main screen,
Then, order #29- vascular lab. Then #1
Venous duplex: Under Radiology/Nuclear Medicine from main screen,
Then, then order #29- vascular lab, then order #3
Nuclear stress tests: listed under common procedures (myocardial spec)
ECG: listed under common procedures
Angiography/ CT guided bx: Call interventional Radiology to make sure
they are willing to do the procedure then: Radiology/CT orders and pick CT
guided bx , angiography etc.
X-rays: Listed Under Radiology/Nuclear menu, Then under Radiology
Quick Orders
CT: Listed under Radiology/CAT. If you need it STAT then call down to CT,
as often times they prioritize the outpts over the inpt so let them know you
need it now.
MRI: Listed under Radiology/MRI. Usually this will happen at night so
warn the pt—they do outpt during the day, so don’t count on a STAT MRI
Ultrasounds: Listed under radiology/Nuclear, Then U/S #28
Hemodialysis: consult Renal they will schedule the pt and put in the orders
ABG: order under labs menu
Respiratory Therapy: Under Respiratory, Then Respiratory Care Orders.
Here is where order CPAP/ BiPAP
PT/OT: Under Consult menu, then PM&R, then PT/ OT inpt (the RIGHT
colum). Same menu for PMNR consult
Home supplies: To order BP cuff, bed/ mattress other things at home go to
consult menu, under prosthetics consult, then pick what you need
Home O2 : consult menu, then Home oxygen request order
Pharmacy Consult: Consult menu, then pharmacy. Where can place non-
formulary consult or warfarin consult

Tip: if you do a procedure like paracentesis, LP, etc there is a lab fluid tests
order under then Lab menu that has useful order sets. A Urine lytes order set
is here too
 Dictation VAMC Page 23

VAMC Discharge Summary

Note: discharge summaries are required prior to discharge to
a nursing home or a VA facility.
Donna Miller at 4379 will let you know which Discharge
Summaries are yours and that you haven’t done yet.
Make a list in your workroom of outstanding d/c’s for other pt

The discharge summary serves as an overview of the events of

the hospitalization and provides the PCP and subsequent
providers with medication changes, follow-up plan and
significant events. Since the VA operates an electronic
medical record, with easy access to all notes, diagnostics, and
labs, an extensive summary is unnecessary. The main focus
should be on the hospital course based upon the assessment
and plan, discharge medications, and follow-up plan. **DO
NOT SIMPLY CUT AND PASTE LARGE SECTIONS OF
PREVIOUS NOTES INTO A DISCHARGE SUMMARY!!
** Don’t forget to always flag the PCP as an additional cosigner on the
discharge day progress note
VAMC Discharge Summary Format
Identifying data: included as part of CPRS including patient
name, SS, admit date, discharge date.
Service: Red, Purple, Orange, Blue
Attending
Discharge Diagnosis (list all diagnoses)
Reason for Hospitalization/HPI (1-2 lines)
Past Medical History
Hospital course (problem by problem is easiest to read)
Discharge meds
Procedures
Discharge instructions
Follow up instructions
 Death Note Page 24
Death Note

Things to Do When Called for a Patient Death

1. See patient and assess for signs of life: listen for heartbeat, feel for
pulse, check for pupil reactivity, do a sternal rub. If patient found and
NOT a DNR, initiate a code and ACLS algorithm.
2. Check telemetry if patient is being monitored.
3. Inform next of kin of the death of their family member – face to face is
much preferred.
4. Ask family if they want an autopsy and name of funeral home.
5. Call KODA, the organ and tissue transplant organization. You will have
to record the name of the KODA rep you talk to so write it down! If at
the VA you are not supposed to give the name of the pt to the KODA
rep unless they are a possible donor. This does not apply at UK.
6. Documents for pronouncing MD (these include numbers for step 5):
a. Notification of Death from in SCM at UK
b. Death procedure note at VA.
7. Work for primary intern – Death Summary (Abbreviated version of a
discharge summary, choose d/c summary in SCM)
8. Many attendings want to be informed immediately, even at 3am. Ask at
the beginning of the month.

Death Summary Format

COMPETE -
Patient ID: patient’s full name and MR #.
Attending : they will be the one to sign the official death certificate
Service
Date of Admission
Time and date of death
Cause of death
Complete name and address of referring physician or PCP
Admitting diagnosis
Final Diagnoses at time of death
Procedures
Brief History: reason for hospitalization
Hospital course: procedures and treatments with focus on events leading to
death. Be brief.
Physician pronouncing.
 Computers Page 25
What we have here is . . . (failure to communicate)
UK:
1. Lightning Bolt – paging / on-call system
2. LifeImage (radiology images including CT,MR, XR, US)
3. Sunrise Clinical Manager (home access from
https://medconnectplus.mc.uky.edu)
4. Up to Date (hospital & from https://medconnectplus.mc.uky.edu
via SCM)
VA:
1. CPRS (available at home. See Medicine ADPAC, VA computer
support for how to set this up) - IF YOU GO LONGER THAN 90
DAYS WITHOUT LOGGING INTO THE COMPUTER YOU
WILL BE LOCKED OUT. If that happens make sure you get
your codes updated several days before you have to go back to the
VA and be on service.

Some men you just can’t reach . . .

Lightning Bolt –Our on-call system
To Report Mistakes in on call pager #s - phone the
Paging/Communications operators at 7-3700. During daytime
hours, also report the mistake to person in that department who
enters the information.
Remember to always have your pager on SCM next to the patients
you are taking care of on your list under the On-call tab.
 Voalte Page 26

Voalte

What is it? A HIPPAA-compliant messaging system used by

UK Healthcare system. It is a secure way to communicate
with nurses and other members of patient care team as well as
a directory of users. You will be instructed on how to
download to your mobile device.

Expectations:
1. Sign in to Voalte every shift if on rotation utilizing Voalte
(GSH, MT, Consults, ICU/CCU, CA-3)
2. Assign yourself to appropriate role.
3. Respond in timely manner to all messages.
4. Sign out at the end of shift.

Note: As of now, you are still required to carry your pagers.

Tip: Lightning Bolt is available under “Menu”→”On-Call

Schedule”

Resource for additional questions: https://bit.ly/3d2MHZ9

 Paging Basics Page 27

Paging 101
How To Place A Page At UK Hospital

• For 7-digit pager numbers - 330-xxxx

- dial 9 + the pager number.
•Can also page via www.usamobility.net
• You can text msg to a 330-xxxx pager from
your cell phone- have to use 859 first
• If at VA dial -6-6 and then the 3-digit pager
number when prompted.
• For older four-digit pager numbers (not
many left), dial 3-3000 (or 323-3000 from
outside), and then follow the prompts ("Enter
the display digits" refers to the phone number
you want the person being paged to call).

Press * and your pager # after call back # to let

them know who is paging.

How to read between the numbers when paged

- Four digit number – someone at VA or GS is
paging
- Five digit number – someone at UK is paging
- Ten digit number – A patient in Hazard got your
pager number.
- Don’t forget to push *67 if you are calling a
patient back on your cell phone, otherwise they
will seriously call you for years… seriously
 Crosscover calls Page 28
Crosscover calls
Your will receive calls on ALL of the following topics at some point during
your intern year. The key questions are “What do I do first?”, “Do I need to
see the patient on every call?”, “At what point do I call my upper level?”
When in doubt go see the patient! On your way to the room go ahead and
think through possible situations and what you will do for each.
Chest pain This is a must see patient scenario. Have nurse get a stat ECG
and give NTG SL if the CP sounds like ischemia. Check vital signs. Do a
chest, CV, and lower extremity exam. Obtain ABG, cardiac enzymes, and
portable CXR if necessary. You could try a GI cocktail if the story supports.
If this is typical cardiac pain and the patient has already received NTG x 3
with continued pain or EKG changes, call your upper level for additional recs
or the cardiology fellow. Consider ASA and starting heparin therapy.
SOA This is a must see patient scenario. Have nurse get a stat ABG and
portable CXR if appropriate. Exam: heart, lung, JVD, lower extremities.
Check O2 sat. Deep NT suction when appropriate (Order these before leaving
your bed). Differential could be ischemic heart disease, CHF, pneumonia,
pleural effusion, pericardial effusion, mucous plug or PE. Stat EKG.
Consider lasix if history appropriate. Nebs Tx by RT if COPD or asthma.
Fall: This is a must see patient scenario. Musculoskeletal exam; if hip hurts
get Stat x-ray to r/o fracture, do neuro exam to r/o CVA, check FSBG to r/o
hypoglycemia. CT of head without contrast if head injury or acute CNS bleed
is suspected as the cause of the fall. DDx = syncope vs. gait abnormality vs.
simple fall. Nurse will have an incident report for you to complete and sign.
Low BP: Go see patient. Review meds and hold anti-hypertensives as
necessary. Look at vitals trend. This may be normal for some patients.
Recheck manually; if truly hypotensive can give healthy young patients a
1Liter NS bolus. If appropriate (mild cardiac dysfunction) try a 500 cc NS
bolus. If severe systolic/diastolic dysfunction or renal failure patient then try
250 cc bolus. Remember, if the cause of the hypotension is cardiogenic shock,
fluids may make things worse. If BP not really too low and asymptomatic (i.e.
urine output and mental status ok) then can try a little fluid or nothing at all.
Take history and see why low: new meds, heart failure, or sepsis.
High BP: Check meds, other vital signs. Look at MAR- previous nurse may
have held a med. Consider pain, accelerated HTN, or CVA. Also, a markedly
elevated BP may be caused by pain, distended bladder, or hypoxia. Rule out
these causes before giving anti-hypertensives. Consider giving a dose early or
an extra dose. You don’t need to be too aggressive if asymptomatic. Don’t
give a dialysis pt a bunch of antihypertensives if they will be going for HD
soon or they will bottom out in dialysis.
 Crosscover calls Page 29
Cross Cover calls

Tachycardia: Order an ECG and rhythm strip on way to see patient.

Review VS and oxygen sats. Determine rhythm with the help of upper level
or CCU resident. Usually secondary to fever or dehydration or underlying
arrhythmia. Can give fluids (1 liter or 500 cc), check temp, if febrile give
Tylenol, pain control if necessary. If sinus tach, treat the underlying cause.
Ask for help if considering IV rate control metoprolol IV or dilt drip.
Bradycardia: Hold any contributing meds. Are they symptomatic,
asymptomatic, asleep? If asymptomatic just be sure to r/o heart block with
ECG. If symptomatic you will need atropine (0.5 to 1 mg Q3-5 minutes PRN
IV, max 2 mg total dose). If you’re giving atropine you probably need to ask
an upper level or cards fellow for help and get pacing pads ready just in case.
Constipation: If obstruction is suspected, it would be better to give
something from “below” before stimulating the bowels from above. Consider
PR Dulcolax or enema first. DOSS for prophylaxis (but does nothing once
already constipated). Miralax 17gm daily is great for prevention but won’t
relieve the patient right away. Lactulose or Mag citrate usually do the trick.
Decreased urine output: If Foley catheter is in place check for
obstruction first. (flush or replace with new Foley). If no Foley, then can do a
bladder scan or do I/O cath. Can give fluids if you think they are
hypovolemic. If renal patient may simply be oliguric/anuric. If hematuria,
change Foley. Never treat low UOP with Lasix.
Hyperglycemia: Use the insulin protocol in SCM. Can give more sliding
scale. Make sure they don’t have dextrose in their IVF. Then adjust their
insulin regimen so this does not happen again.
Fever: Have nurse recheck. if > 101 F orally or > 100.4 F orally and
neutropenic, then get UA, urine culture, blood cultures x 2, CXR, sputum
gram stain and culture (Don’t forget to follow up UA, CXR). You don’t have
to start antibiotics right now if they are not neutropenic or looking especially
bad. Check all lines for signs of infection. Check for decubitus ulcers.
Consider sinusitis if NG tube in place or intubated. A thorough review of
systems and physical examination is mandatory. If they are neutropenic or
look like they are declining fast, begin empiric/directed antibiotics. Schedule
Tylenol/ibuprofen if indicated.
Diarrhea: Send C. diff PCR. If newly admitted, consider comprehensive GI
panel. Maybe hemoccult check. In ICU, could start empiric Flagyl or PO
vanc until C. diff tox comes back.
 Crosscover calls Page 30
Crosscover calls
Hypoglycemia: if in 50's and awake, give 4 ounces of orange juice and
recheck. If 30's to 40's or dizzy/very symptomatic, give 1/2 amp of D50
(especially prefer 1/2 amp if pt. diabetic) or 1 AMP of D50. Then make sure
you or the team adjusts their insulin regimen so this doesn’t happen again.
Anxiety: Try to figure out why they are so anxious first. You can give
ativan 0.5 to 1 or even 2 mg if it is a young person with a functioning liver.
The elderly do much better with haldol, risperdal, or seroquel. Sometimes a
pt just needs to talk and to hear that things are ok. You can also give hugs!
Transfusion issues: It is common for people to have a slight fever. A
hemolytic reaction is uncommon but can cause abdominal, back, or chest
pain, fever, chills, HTN, hemoglobinuria. Stop transfusion, send blood bag
and serum specimen to blood bank. Use vigorous hydration, mannitol,
benadryl, and solumedrol.
-Antigen/antibody reactions are from WBC contaminants and cause fever,
chills, urticaria. Always r/o hemolysis. Tx with benadryl 50 mg IV and use
WBC filter with future transfusions.
-Anaphylaxis rare, but need epinephrine, fluids, H1 & H2 blockers, steroids
Mental status changes: Go see patient. Get Hx and VS. Do a quick
neuro exam. Check pulse ox, finger stick, and EKG. Review meds and look
at the MAR to see what they have gotten. Administer D50 if hypoglycemic or
narcan if receiving narcotics. Always think about infection! As well as
hypoxia, CO2 retention or renal failure/ electrolyte disturbance.
Seizure: Go see patient. En route can give ativan 1 or 2 mg IV. You can do
this several times. If does not stop with first or second dose call your upper
level or neuro resident. Consider withdrawal, meningitis, electrolytes,
hypoxia, HTN, brain mass. Maintain airway- if still seizing may need
intubation. You also may have to load with Phenytoin or Fosphenytoin
High potassium: For lab values under 6.0 then give 60gram kayexalate
(PO or enema if necessary); patient must be having regular BM's for this to
work. If > 6.0, obtain an ECG. If the ECG is normal, repeat the lab value. If
there are loss of P waves, new prolonged R interval, or a widened QRS
complex, call your resident and give calcium gluconate 2 gm IV. Next reduce
the serum K by giving sodium bicarbonate, glucose, and insulin with 1/2 amp
of D50 and 8 units regular insulin if diabetic. If not diabetic, give 1 AMP of
D50 and 10 units of regular insulin IV. Repeat BMP in 30 minutes to 1 hour.
The total body potassium needs to be reduced by kayexalate, or hemodialysis. 1
– there is an order set in SCM under PUL-hyperkalemia with all the orders
you may need and you can just click the boxes
 Codes Page 31
Code Blue - What Do I Do Now?
As an intern, it helps to have perspective well before you arrive at your first code
on the floor. Excluding trauma, a coding patient likely represents very advanced
disease and poor likelihood of survival. With that in mind, take the advice found in
The House of God and check your own pulse first. If it is present, even though a
little tachy, chances are you are going to do more good than harm for the patient in
extremis, no matter what you choose to do.
UKMC code team:
-Consists of wards senior resident on call, MICU resident, CCU resident, ER
resident, rapid response nurses, MICU nurses, and respiratory therapy.
-The first physician to arrive will assume control of the code until the MICU
resident arrives. MICU resident has priority and may assume code leader role.
-ER resident is responsible for securing airway

VAMC code team: The code team consists of the on-call floor resident and on
call interns or the night float team. At night the MOD will also respond.
If you are the first one on the scene: ABC’s before all else!
Airway: eliminate airway obstruction and get an airway (not necessarily
intubation). If you can oxygenate the patient with a bag-valve-mask there is no
emergent need for intubation. Oral airways can be helpful. Get someone to hook
up suction!
Breathing: give oxygen, bag valve mask patient. Have someone check for breath
sounds. If breath sounds are present and you feel you are adequately ventilating
the patient (O2 sat coming up), there is no reason to immediately intubate.
Circulation: check for pulse, if you don’t feel one have someone start chest
compressions if necessary. Fast and Hard is key…
Do Not: simply pronounce; initiate code unless patient is a known DNR
Get Pads on the patient quickly because the most important thing you can do after
you have gone through the ABC’s is check for a shockable rhythm. Look for v-
fib or pulseless v-tach and shock if that is the rhythm. Each minute a patient
spends in v-fib, the likelihood of recovering to sinus rhythm decreases 10%. Do
whatever it takes to determine the rhythm early. Defibrillate or cardiovert
immediately if indicated.
Also, Remember the 5 B’s:
Bedboard: remove and start compressions
Box: get code cart, monitor, lead placement
Bucket: suction
Blood: CMP, coags, Mg, phos, ABG, type and cross, CBC, cardiac enzymes
Backup: have a nurse or tech call the upper level of the patient for background
information
ACLS protocols form the basis for codes: So know it!
 The Checkout Page 32

The Checkout
What a long day!. Time to go home…..not so fast Doctor.
Your patients expect and deserve good continuity of care while you are out of
the hospital. So…a good checkout helps ensure that excellent care continues.
The patient must be stable without pending procedures when you leave.

Important Points
When constructing your checkout list, put yourself in your colleagues place.
Be sure to: provide if/then solutions for the labs or results you are asking them
to check! Bad: BMP due at 6 pm. Good: BMP due at 6 pm; if potassium still
above 6, give another dose of kayexalate.

Be sure to update the Handover tool with above IPASS information

 Needlestick Page 33

Needlesticks
Avoid it by: 1. Universal precautions
2. DON’T RUSH- SLOW DOWN whether you
are experienced or not!
If it happens:
1. Take comfort that you aren’t the only one
2. Wash with soap and water. Don’t “milk”/massage/press
wound to help them bleed freely; this can increase risk of
transmission of blood borne illnesses
3. Find the Charge Nurse on the floor and she will give you a
red packet with forms to fill out and instructions.
4. It will instruct you to call 1-800-440-6285 to report to
workers comp (who will pay for tests)
5. They will ask you if you want care for it. Say yes (This
gets you and patient tested)
6. If it is normal business hours they will then schedule you an
appt at Employee Health. If it is at night or a weekend, they
will connect you with an on-call physician and they will
advise you on the risk and decide if it can wait until employee
health opens.
7. Fill out the rest of the forms in the packet.
* This is tedious to make all these calls and go to the lab
multiple times, but worth it. Do NOT ignore this protocol if
you have an exposure. Seriously!
Other info:
Sanford Guide
National Clinicians Postexposure Hotline (PEPline)
http://www.ucsf.edu/hivcntr (888) 448-4911
NEEDLESTICK!
http://www.needlestick.mednet.ucla.edu
CDC
http://www.cdc.gov/niosh/topics/bbp/emrgnedl.html
 Table of Contents
Topic Page
UKMC Facts 1
UKMC Floors 2
Key Locations 4
VAMC Facts 5
VAMC Floors 6
ACGME Topics 7
Residency VIPs 8
UKMC Phones 9-12
VAMC Phones 13-14
GS Phones 15
Discharge Planning 16-17
Typical Intern Days 18-19
First Day of Rotation 20
Ordering tests at UK 21
Ordering tests at VA 22
Discharge Summary 23
Death Summary 24
Computer Stuff 25
Voalte 26
Paging Basics 27
Cross Cover Calls 28-30
Code BLUE 31
Checkout 32
Needlestick Injury 33