Tips on Managing your Resident Team

Staff new admits on the same day when possible:

• Shortens length of stay
• Increases billing and departmental revenue
• Opportunity to observe learners in action.

Control the team census (max 16 on Firms).

• You can hold short-call admit slots when your census is large.
• Schedule transfers that are non-urgent for an admission the next day
• Ask for help from your fellow firm staff if your team is large. 
• Follow patients by yourself = staff only.
• Complete a few of the daytime admissions yourself, in order to prevent the nightfloat from capping when they enter the hospital.
• Identify discharge goals for each patient with your team at admission.
• Identify barriers to discharge for each patient at admission (such as potential nursing home placement, need for PICC line, etc.).

Minimize the amount of paperwork for you and your team:

• At discharge, a brief attending note is sufficient for billing.  The residents do not need to leave a separate progress note, because of the discharge summary.
• ICU and Night Float transfers do not require another full H and P.  All that is required is that the residents document that the patient was examined, the chart reviewed and that the team will be assuming care.
• --Patients admitted as a bounce also do not require a full H&P; a brief note summarizing the changes and reason for readmission, along with references to the previous H&P and d/c summary, is sufficient.
• If you staff a new patient with a medical student, your residents will not need to re-write a full H and P if you leave a complete note, excluding the FH, SH and ROS – which “count” so long as your medical student includes them.
• Intervene if you see the housestaff being asked to do things outside of their job description (i.e.:  calling clinics to schedule follow up appointments, arranging weekend nursing home transportation).
• If your team is really busy, it would be very helpful to them if you called a patient’s primary MD on the day of discharge or if you personally called consultants.

Rearrange other responsibilities

• The best days for clinics are pre-call and long-call.
• Afternoon clinics work better than morning clinics

Updated: 12/20/06