Geriatric Medicine

III. Roles and Responsibilities

A. PGY II or III Responsibilities

  1. Completes a full H&P for all de novo admissions, and admissions with only a Medical Resident Admit Note (MRAN). All H&Ps should be completed within 4 hours of admitting a patient, and sooner if the patient is undergoing an urgent procedure or surgery. All H&Ps should incorporate information regarding the patient's baseline functional status and up-to-date list of outpatient medications. Use the Geriatrics H&P Inpatient template available using the SmartPhrase .DOMINPTGERIATRICSHISTORYANDPHYSICAL or the SmartText GERIATRICS H&P INPATIENT (click here for the screenshot on how to access the SmartText templates on CareConnect). Please note that auto-populated medication lists in Care Connect may not accurately reflect the medications that the patient is currently taking. See Section IX for detailed guidelines when admitting patients.
  2. Conducts morning rounds with the bedside RN; this is a SM-UCLA Medical Center initiative. Please request the bedside nurse to join you at the bedside.
  3. Writes a comprehensive Geriatrics Progress Note on overnight admissions with completed H&P from Night Admitting Resident (NAR) or Night Float (NF) including admissions who are admitted after midnight. Use the Geriatrics Progress Note Inpatient template available using the SmartPhrase .DOMINPTGERIATRICSPROGRESSNOTE or the SmartText GERIATRICS INITIAL PROGRESS NOTE INPATIENT (click here for the screenshot on how to access the SmartText templates on Care Connect). Progress notes must include relevant developments that occur throughout the course of the day.
  4. Writes orders for patients. Please note that per hospital policy, orders must be entered on Care Connect by the ordering clinician. Verbal orders may be given in emergencies. Limited telephone orders to address urgent issues may be accepted when the ordering clinician is not present in the hospital or is physically caring for a patient in the ED. (click here for Verbal and Telephone Orders-Policy HS 1304)
  5. Completes discharge summaries of patients who are to be discharged to the SNF or to  be transferred to RR-UCLA/other outside hospitals, on the day of discharge. They should be prepared the day before discharge and are to be finalized and available for printing on the day of discharge. Other discharge summaries may be completed within 48 hours of discharge/death. Discharge summaries created in advance are to be updated and refreshed to reflect final changes on the day of discharge, including changes to the discharge medications.
  6. Provides daily communication to the patient’s  surrogate with regards to the patient's progress and plan of care. Expected discharge date is best communicated to the patient and their surrogate in advance so appropriate preparations including transportation for the day of discharge are made.
  7. Provides an email signout to the covering nurse practitioner (NP) at the end of the day prior to the resident’s off day, and cc current attending physician (on Fridays, please also include incoming Saturday attending). The  NP Coverage Schedule for Geriatrics is available on AMION with login: ucla cc (all lowercase). Go to the “UCLA SM Nurse Practitioner” section for the specific date, and look for Geriatrics. The inpatient attending schedule for Geriatrics is available on AMION with login: ucla. Click on Internal Medicine and scroll down to Santa Monica Geriatrics.
  8. Will work no more than 80 hours per week. Residents are to have one day off in a 7-day period (during the Geriatrics rotation, either a Saturday or Sunday that falls on the resident’s short call day in the call cycle). This policy will be strictly enforced, regardless of the resident's census. The Chief Residents must approve any schedule or coverage changes.
  9. When supervising a medical student, the resident is expected to see the patient together with the medical student before presenting the patient to the attending physician. The medical student may initiate the Geriatrics H&P or the progress note in Care Connect. However, the medical student identifies the supervising resident as the co-signee. Upon completion, the medical student forwards the note to the resident and the supervising resident is to amend the note as appropriate and forwards it to the attending physician for co-signature after seeing the patient with the attending.
  10. On some Tuesday mornings from 7:45 AM to ~ 11:30 AM, may have one UCLA pre-medical student shadow during rounds. The undergrad student will be assigned to the Geri resident with no assigned medical student/sub-I. (click here to review the attached Undergraduate Student Shadowing guideline from the Department of Medicine).

 

B. Attending Physician Responsibilities

  1. Conducts daily rounds with the team, which includes reviewing clinical information and plan for each patient.

  2. Provides patient-based teaching, structured didactics, and guidance during interdisciplinary rounds (IDR).

  3. Oversees order writing and reviews discharge orders with the residents, and with covering NP on weekends. In the unusual circumstance when the Attending Physician writes an order, the Attending must communicate this to the resident and covering NP in a timely manner.

  4. Rounds and writes consult notes on patients exceeding the residents’ consult cap and is responsible for signing out these patients at the end of the day to the Night Float (pager 90016). Consult patients exceeding the resident cap are not to be transferred to the resident panel when the resident has capacity, unless the initial consultation was signed off previously and a re-consultation is requested by the primary team.

  5. When the resident supervising the medical student is off, provides direct supervision to the medical student, amends and co-signs the medical student note.

  6. Provides verbal feedback and written evaluation of the residents and medical students.

  7. Is on pager throughout the inpatient week, which starts at 8AM on Saturday to 8AM the following Saturday. Please note that the Blue Team attending is also designated to authorize outside hospital transfers, as appropriate, from hospitals and emergency rooms outside of the UCLA Health System. The authorizing Geriatrics Attending is to promptly provide the Geriatrics admitting resident with the contact information of the physician in the originating hospital or ED to facilitate direct communication and a detailed handoff of the patient's clinical information (click here for Outside Hospital & RRUCLA Lateral Transfer Policy).

  8. Staffs the long call resident’s admissions the same day  (long call admits up to 4PM). Note that when short call on  weekdays, the short call resident on very rare occasion may admit more than the usual 2 de novo admissions after 2:00 PM (and up to 4:00 PM) to accept a direct admit by a UCLA geriatrician from the office, home or SNF, if  the long call resident is already capped and the short call resident is not capped i.e., has space. If the direct admit is called out by the bedside nurse to the Geri resident before 4:00 PM  as having arrived on the floor, the patient  must be staffed with the short call resident the same day.

  9. When the residents are capped for Geri consults, will see new consult/s independently until signed off. This excludes surgical co-management requests, which are counted and triaged as primary patients. The attending will also staff re-consults if the team resident is capped, for continuity. If the attending has rotated off, the re-consult will be triaged based on the residents’consult capacity (click here for Consult algorithm).

  10. Provides orientation to the new resident on Thursdays. Please use the Santa Monica Inpatient Geriatrics Orientation PowerPoint included in Lynn Bautista’s “Weekly Didactic Schedule for SM Geriatrics Teaching Service” email which is sent out the week before starting inpatient.

  11. Provides daily clinical updates to UCLA PCPs electronically. Please use the DOM Geri Inpatient listserv. Add #secure in the email subject line.

  12. If emergency coverage is required, contact Dr. Grace Chen, Clinical Chief of Geriatrics.

    Note: The Geri Short and Long Call schedule is available on amion. To access:

    • a. Google: amion ucla, then select amion physician scheduling, then enter the log in, which is ucla im

    • b. Once schedule appears, enter the exact date of interest on top and then click on Go.

    • c. Scroll down to Santa Monica Geriatrics. It will show the names of the Geri residents, the Geri team they are assigned to, and whether the team is long or short call that particular date.