MAR POLICIES, PROCEDURES AND RESPONSIBILITIES (Click to Download each)

– 9 Silver/5 Linsky/Step Down
– 8 Silver
– 9 Dazian/9Linsky/Float (3D/4L/10D)
– 11 Linsky/10 Silver


Team Coverage Issues
1. In the event the Elective resident is not on the floor until 5pm the accepting resident/intern on that floor will start the admission and then can turnover the admission once long call resident is present.
Example: 5 Linsky resident is on long call and in clinic. An admission is given to 9Silver at 410pm, the accepting intern/resident on 9Silver will start admission. Another admission is given to 5Linsky at 415pm, 5Linsky co-resident starts the admission with the intern and when the long call resident is present, turnover can be done.
2. Please allow for flexibility given that some residents may be close to cap. At this point the MAResident with accordance by the chief on call with have other residents do admissions during the daytime hours.
3. Night float MAR must spread the number of admissions out so that no one resident gets overwhelmed or near cap. 11L residents will do admissions for 9S/tele when necessary.
4. MAR cannot ask bedboard or ED to hold admissions unless the program director and chief have been notified and they both have agreed and the program director and chief will speak to bedboard and/or ED.

We do NOT cover
• 6 Linsky, 7 Linsky, 9 Dazian Pod A, 7S/10S medicine overflow patients
• Neurology Service in the evening, at night, and on the weekend
• 3 Karpas and 7 Silver non-Medicine pts from 5PM-7AM and on the weekends/holidays
• 8 Linsky Rotunda
• 4 Karpas

 

How to calcuate if a house officer is over admission cap
ACGME Rules:
PGY-1:  Max of 5 new admissions + 2 transfers in 24hrs
PGY-2/3: Max of 10 new admissions + 4 transfers in 24 hrs.
Nightfloat patients are transfers, not admissions, unless the total number of nighfloat patients exceeds the tranfer cap. In this case, additional nightfloat patient then begin to count as new admissions.
Examples:
1.  Dr. Resident comes in on a long call day at 7am and recieves 6 nighfloats. Then he gets 2 tranfers from 8Silver.  Then he does 5 more new ED admissions before finishing his long call at 8pm.  Did he go over cap?
Anwser: No.
Dr. Resident has 4 transfers from nightfloat. His 5th and 6th admission from night float are counted as new admissions. Any admissions after nightfloat at 7am are counted as new.
He has 9 new admissions (5th and 6th nightfloat admissions, 2 days 8Silver transfers, and 5 ED admissions =9) and 4 transfers (1st 4 nightfloat admissions)

Medical Consult Coverage
Monday-Friday
  – 7AM-5PM—designated Resident
  – 5PM-8PM—11Linsky Resident (long call)
  – 8PM-7AM—11Linsky Resident (night float)
Saturday and Sunday
  – 7AM-8PM—11 Linsky Resident
Monday- Friday Night
  – 8PM-7AM—designated NF resident
Saturday Night
  – 11 L resident
Sunday Night
-- 11 Linsky NF Resident

  MAR
1.  Admissions from the ED 
    * When you recieve an admission from Patient Access Services ("PAS", aka the bedboard), if it is a hospitalist service patient, check the "Hospitalist Week at A Glance" sheet and inform/check with PAS that the correct hospitalist attending will be entered in PRISM.
    * Record all admissions in the “book” including time and the name of the resident who is actually doing the admission
    * Check the admission in EMSTAT-look at chief complaint, vitals, labs, etc.
    * Decide if it is appropriate for the pt to go the assigned floor
    * Speak with the ED if you feel the pt should go elsewhere
    * Once you have the details of the admission, page the resident on call and give the info - YOU MUST GET CONFIRMATION from resident AND ADS
    * Please do not text page the admission without asking for a reply call from the residents
    * We understand that you will not always be able to check every detail on every admission
    * Remember the "Ambassador Theory"--you are an Ambassador from Medicine in the ED - your behavior must remain professional--it is a direct reflection on your colleagues, the Program and the Department of Medicine

2.  Direct Admisssions
    * You should be contacted by the admitting attending at BI or a staff member from the transferring facility
    * SPEAK directly with the admitting attdg about the plan
    * Record all of the info on the Direct Admit Log
    * Call the facility where the pt is and get turnover
    * Get the story from the physician taking care of the pt and make sure that you get the most recent vitals
    * Unstable pts should not be accepted
    * Call bed board back and let them know you have approved the admission
    * Be sure to tell the accepting team all of the turnover information once the pt has a bed
    * NEVER accept a pt without an accepting attending

3. Admissions from the Cardiac Cath Lab or the Endoscopy Suite
    * Cathlab usually bypasses the MAR and contacts bed board directly
    * Endoscopy usually calls the MAR and gives turnover info - you do not need Med consult to see the patient - it is considered a Direct Admit.
    * Make sure that these pts are stable and get the story before they are transferred
    * Pass the info onto the admitting team

4. Admissions from Interventional Radiology (IR)
    * These admissions must be approved by the MAR
    * IR fellow or resident contacts BR with reason for admit—if not, you contact them
    * Fill out a slot in direct admissions
    * Make sure the pt is stable and pass the story onto the team

5. Family Medicine Admissions
    * The list of practices Family Medicine covers can be found in your survival guide.
    * Family Medicine takes ALL admissions to 8L, regardless of whether or not the patient was on the hospitalist service before or of the accepting attending.
   
6. Critical Laboratory Value Notifications 
    * Lab will call the MAR with panic values of discharged pts (Note: it's in your interest to make sure the patient IS actually discharged)
    * Check to make sure that the pt belongs to Medicine
    * Contact the pt with the information and record
    * Contact the outpatient attending - look on Esignout or the DC summary on PRISM
    * If the pt’s phone number is incorrect, send a telegram—bring the completed form to telecommunications on 5 Silver
    * Transfer/communicate information with the strictest respect for a patient's privacy, balanced against the clinical urgency/emergent nature of a critical lab value.

7. Sick Call
    * The MAR is the first and most important call a house officer should make if they cannot come to work
    * The active sick call policy and procedure for house staff can be found here.
    * Record all of the info on the sick call log sheet and email the staff listed on the log sheet.
    * Call the Jeopardy resident to come in - IF they have RYAN NENA clinic you must call a resident in from the RYAN NENA list attached. West Village Clinic does not need coverage.  Please clarify with the chief on call if you have questions.
    * Drop the sick call log in 20Baird

8.  HIV Testing
    * The Medical Consult resident performs HIV testing only on patients on the Medicine Service.
    * See the HIV/Exposure link on website
    
9. ADS or ACS patients
    * If you feel that a patient is appropriate for ACS or ADS, first please review the links above
    * For ADS candidates call Bed Board and tell them you feel that this person should go to ADS. The MAR will call ADS and Bed board directly. ADS should not be contacting Bed Board directly and Bed Board should not contact ADS directly. ALL patients handed out must go through the MAR.
    * For patients you feel would be appropriate for ACS, you will page the ACS beeper (14227) and inform them of the admission

10.  Where do all these forms go?
    * Please bring all of the forms that you complete as MAR to the chief’s office.  

 

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