III. Roles and Responsibilities

A. PGY II or III Responsibilities

1. Completes a history and physical for all of his/her admissions. Please note that all H&Ps should be completed within 4 hours of admitting a patient. All H&Ps should incorporate information regarding the patient's baseline functional status (see Appendix A for instructions) and up-to-date list of outpatient medications. The auto-populated medication list in Care Connect may not accurately reflect the medications that the patient is currently taking.
   
   
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 daily progress note on all patients he/she is following; the progress note must include relevant developments that occur throughout the course of the day.
   
   
4. Writes orders for patients. Please note that per hospital policy, orders in general must be entered on Care Connect by the ordering clinician. 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 HS 1304)
   
   
5. Creates and signs discharge summaries within 48 hours of discharge/death, with the following exception: discharge summaries of patients who are to be discharged to the SNF should be prepared the day before their discharge, and are to be updated and available for printing on the day of discharge. Discharge summaries created in advance are to be updated and refreshed to reflect final changes upon discharge, including changes to the discharge medications.
   
   
6. Provides daily communication to the patient/surrogate with regards to the patient's progress and plan of care; expected discharge date is best communicated to the patient and their family in advance so appropriate preparations for the day of discharge are made.
   
   
7. Will work no more than 80 hours per week. Residents are to have an average of one day off in a 7-day period (4 days off in the month). This policy will be strictly enforced, regardless of the resident's census. The Chief Residents must approve any schedule changes.
   
   
8. Provides cross-coverage when other team members are not available.
   
   
9. When supervising a medical student, the medical student may initiate the 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 resident is to amend the note as appropriate and forwards it to the attending physician for cosignature.

B. Attending Physician Responsibilities

1. Conducts daily rounds with the team, which include 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 resident. In the unusual circumstance when the attending physician writes an order, he or she must communicate this to the resident in a timely manner.
   
   
4. Rounds and writes notes on patients exceeding the cross-cover cap and is responsible for signing out these patients at the end of the day to the Long Call resident.
   
   
5. When a resident of his or her team is off:
   1. Updates the family/surrogates of the off-day resident's patients
   2. Conducts discovery rounds jointly with the covering resident for all of the off-day resident's patients to optimize the covering resident's efficiency (i.e., avoid double rounding)
   3. For the off-day resident's SNF discharges, completes (i.e., updates, finalizes, or if necessary, creates) the discharge summary. It is important that discharge summaries be initiated and prepped by the primary resident the day before the patient is to be discharged to the SNF. The covering resident will retain the responsibility of caring for the patient and writing orders on the day of discharge
   4. The covering resident's cross-cover caps during short call and long call remain the same
      
      
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 patient 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.
   
   
8. Provides orientation to the new resident on most Thursdays. Please use the Santa Monica Inpatient Orientation PowerPoint created by Dr. Erin Cook.
   
   
9. Provides daily clinical updates to PMDs.
   
   
10. If emergency coverage is required, contact Dr. Grace Chen, Clinical Chief of Geriatrics