Friday 13 May 2011

Day in the life of a Ward Resident

If I were Rebecca Black,  (for those of you who don’t know the reference, this is the most hated video on Youtube as of this year), I would make a monotonously boring account of my day and pack it in a super hit blasé song. However, since I am not, I am just going to narrate my account of how an average day for a ward resident looks like at a tertiary care university hospital.

  • Wake up
  • Get ready
  • Check in from home on EMR how many new admissions to my service
  • Drive in to work
  • Go straight to common resident room, check the admit board for admissions to my service. Tally that with my list that was printed from the EMR
  • Speak to the night resident on call and ask if there were any untoward incidents on my patients, run the list of new admissions (am I getting repetitive here? But trust me the biggest goof up that can make you look stupid unlimited is to ‘lose’ a patient, M&M conference case in making)
  • Run the list with the intern, divvy up the patients and start collecting data
  • Go over your patients and your interns labs and parse for critical bits of information (interns have a myopic view of the patient, it takes time and experience to develop the talent to look at big picture)
    • Hgb trend
    • Creatinine trend
    • Cultures
    • Consult recommendations
    • Etc.

Always check up on sicker and new admissions
  • Go from patient room to room, check up on sicker patients, new patients and then finish up with stable patients.

  • Assemble your team - interns, medical students, observers, discharge planners and have a quick meeting to direct care of the patients and to tell interns what you want done. 

  • speak with social work regarding anticipated discharges for the day and any special requirements - transition to nursing home, long term assisted care facility (LTAC), any other needs. yep. even cab money - if patient has no money to go home.

  • Attending arrives, start sit down rounds, go over cases, new developments and plans for the day

  • Begin walking rounds, type in orders on the go so that they are done on time, call consults or specialists on the go, so they are not pissed as to why you called them at 2 in the afternoon.

Walking rounds are critical for residents
  • Finish walking rounds, attend morning report ( some institutions have morning report first thing in the morning so that may vary)

  • Get a few odd things done, expedite patients who are going to be discharged in the day, finish their notes and work up so they can leave on time and you don’t get stuck with a patient who could not leave because it was too late.

  • Noon conference! ‘Nuff said (free lunch may be?)

  • Time for rapid note crunching, get done with progress notes

  • Go over patients with the intern

  • Make sure labs and orders are placed for patients for today and following day

  • Prepare a hand off list, run the list with the intern

  • Hand off at 4 pm, unless you are on call. Then people hand off to you.

  • Answer at least 40-50 pages in the day in between all the tasks listed above.
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Images from microsoft clipart gallery. 

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