## Direct Care Admitting
On this page:
- Admitting Shifts/Roles Diagram (Day and Night)
- Where to Work
- Signing In and Out
- Shift Responsibilities
- Notes on Admitting
- Types of Admissions
- Set Yourself Up for Success
- List Management
- The Admitted ER Patient Moves to a Floor Bed
- Triggers in the ER
- Other Issues
_For the purposes of admissions:_
_HMED = Direct Care_
_MEDED = Teaching Service/Resident Teams_
**Other Helpful Pages**
- [Pagers/Lists](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Pager-List-Coverage.aspx?csf=1&web=1&e=l8F696)
- [The Triage Role](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/The-Triage-Role-and-MedED-Attending-Guide.aspx?csf=1&web=1&e=8hPVgY)
- [9-HOSP/Transfer Pager](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/9-HOSP-Guide.aspx?csf=1&web=1&e=0xao5i)
- [Internal Transfer/Consult Workflow](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Transfer-Consult-Workflow-Tool.aspx?csf=1&web=1&e=WPhkfY)
- [CMED (Zoll), OMED, and ET](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/CMED-\(Zoll\)-and-OMED-Overflows.aspx?csf=1&web=1&e=NhfkXS)
- [Geography Preferences - East vs West](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Geography-Preferences.aspx?csf=1&web=1&e=Ts21rt)
- [BIDMC Service Names](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/BIDMC-Service-Names.aspx?csf=1&web=1&e=SXiadv)
**Admitting Shifts/Roles Diagram (Day and Night)**
## **Where to Work**
[](https://bilh.sharepoint.com/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx#where-to-work "Permalink for Where to Work")
**East Campus**
- On the respective floors
- Gryzmish 431 (badge access)
- Yamins Dept of Medicine office on the 1st floor (badge access)
**West Campus**
- The “Med Shed," RB194 (code 52524)
- Walk left from the cafe/Starbucks until you hit the elevators. Then turn right and go straight past the vending machine into a hallway. The door will be in front of you to the right.
- W/Span 2 office (badge access)
**Signing In and Out**
## **Shift Responsibilities**
[](https://bilh.sharepoint.com/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx#shift-responsibilities "Permalink for Shift Responsibilities")
__
**Special Notes about Shifts**
All Shifts
- Some shifts have rounding and cross-coverage responsibilities. Make sure you sign in appropriately to all lists and pagers and are aware of your responsibilities for the shift.
- Admit patients per round robin distribution.
- There will be different types of admissions (see “Types of Admissions”). Please be equitable in the distribution of admissions and include direct admits, services transfers, ICU stepdowns, and so on in the round robin sequence.
- It can be helpful to have an Epic Secure Chat with all the active admitters for situational awareness.
- Last admission should not be later than 1.25-1.5 h before the end of your shift, unless admissions are very busy. In that case, please try to help as able.
- Admitters remain First Contact for the patients they admitted until the end of their shifts.
- If admissions are becoming overwhelming, ask for help. Reach out to the administrator on call.
- _****Do NOT leave the hospital without signing over your pager and First Contact patients. Do NOT leave the hospital with Epic Chat signed in unless you will be available and expect to respond to messages.****_
ED Day 1, ED Day 2, ED Rounder
- ED Rounder should cap at 8 patients given the high turnover and acuity of the ED boarding patients. Ideally, the ED Rounder will have a list of 6-7 patients. Once the ED Rounder has capped, ED Day 1 and 2 should round on the remaining patients.
- ED Rounder hours should be treated as a “middle shift,” though the ED Rounder may occasionally be asked to fill in for an Early or Late call.
- Double-check that all patients on the HMED West Admissions Lists are accounted for - someone is admitting, ER rounding, or cross-covering in the ER until transport to the floor.
- If a patient boarding in the ER has been assigned a bed and is expected to leave the ER before 10am, they will be assigned to a Rounder in the morning distribution. The assigned Rounder will round on them once they move to the floor bed. However, if there is a delay and the patient remains in the ER after 10am, the ER admitting team should round on them.
- Sometimes, patients are assigned a bed after the morning distribution has been sent, but before 10am.
- East Campus
- If a patient boarding in the ER physically moves to East Campus before 10am and before being rounded on, the patient can tentatively be distributed to a rounder vs the East Admitter.
- If a patient boarding in the ER physically moves to East Campus before 10am and after being rounded on, the ER admitter/rounder who rounded on them will remain First Contact until the end of their shift. The ER admitters are not expected to go to East Campus. If a patient who moved to East Campus requires active bedside management, sign out to the East Admitter, who will take over as First Contact and provide bedside management.
- West Campus
- If a patient boarding in the ER physically moves to a bed on West Campus before 10am and before being rounded on, the patient can tentatively be distributed to a rounder.
- If a patient boarding in the ER physically moves to a bed on West Campus before 10am and after being rounded on, the ER admitter/rounder who rounded on them will remain First Contact until the end of their shift.
East Admitter
- Provides acute cross-coverage for patients on East Campus who were rounded on/admitted in the ER during the current shift who now require bedside management.
- Rounds on patients on East Campus who were boarding in the ED and moved before being rounded on by the ED Day physicians (if East rounders are capped)
## **Notes on Admitting**
[](https://bilh.sharepoint.com/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx#notes-on-admitting "Permalink for Notes on Admitting")
**Types of Admissions**
- West Campus
- ER
- Direct OSH transfers
- Direct post-procedure admits (IR, IP)
- In-house service transfers
- ICU stepdowns
- East Campus
- Direct OSH transfers
- Direct post-procedure admits (GI)
- In-house service transfers
- ICU stepdowns
**Set Yourself Up for Success**
- Lists to have easily accessible:
- BIDMC General Medicine Admissions - Medicine admission requests from the ER. Patients will automatically appear on the list when an admission request order is placed. These patients will be assigned to HMED (direct care) or MEDED (teaching service).
- BIDMC HMED East Admissions - Work list for the East Campus Admitters. Includes patients currently or assigned a bed on East Campus. These admissions will be distributed to East Rounders the next morning.
- BIDMC HMED West Admissions - Work list for the West Campus Admitters. Includes patients currently in the ER or West Campus floors. These admissions will be distributed to West Rounders the next morning.
- BIDMC Medicine East Consults - Medicine consult requests from non-medicine services on East Campus. Patients will automatically appear on the list when an East medicine consult order is placed.
- Other lists for reference:
- BIDMC West Teaching Med Admissions - Distribution list for teaching team admissions. Managed by the residents.
- BIDMC MED ED - Work list for the teaching team admissions. Managed by the residents.
- Set up your List headings:
- Consider using the code 368051 (from Susan McGirr's list, thank you!) to pull in the recommended headings
- Bed Request Status - Shows if a bed request has been made ("Ready to Plan"), a bed has been “Assigned,” or “Bed Ready” for the patient to be moved
- IP MD Handoff - Shows if a medicine doctor (resident or attending) has “Accepted" the patent. You can click the dashes to jump to the "Provider Admission Acceptance" box. Two green checkmarks will appear if medicine has accepted.
- RN Handoff Status - Shows whether the RNs have completed their handoff. Two green checkmarks will appear if this has been completed.
- Handoff Overnight Hosp Med - Keep track of who is reviewing/doing admissions, To-Dos for the next shift, contingencies, cross-coverage events.
- APP/Res - Shows the ED provider directly caring for the patient and their contact information (hover over the initials)
- Other helpful tips
- Wrench in “ED Handoff” to your Summary Tab. This is the primary source of info/handoff from the ED before they write their note.
**Admitting from the ED**
- The hospitalist doing the Triage Role (often the MEDED attending) will receive a message with the admission request. Epic will concurrently add the patient to the General Medicine Admissions List. If HMED is up next for admission based on the Admission Tracker, the Triage hospitalist will add the West Admissions group to the message and ask HMED to review.
- See the “Triage Role” page for more information about the role
- Whichever hospitalist is up next for admission will respond to the chat that they will review.
- Add your name and #[admission] to the “Handoff" in Epic and on the Admission Tracker.
- Please be equitable in distributing the admissions amongst the admitters.
- Your last admission should not be later than ~1.25/1.5 h before the end of your shift, unless admissions are very busy.
- Review the admission. Either “Accept” or “Initiate Discussion.”
- Open patient chart, go to the Admission Tab →"Provider Admission Acceptance" → click "New Reading"→ "Yes" to accept or "Discussion Required" to initiate discussion
- If you initiate discussion, the ER providers are typically on the initial chat with the admission request and you can talk with them there.
- You can “Accept” before or after seeing the patient. If you are accepting, try to do so in a timely manner.
- If you “Accept,” add the patient to the BIDMC HMED West Admissions List as the Primary Team and remove them from the BIDMC General Medicine Admission List.
- You will only have to “Accept” once. The patient could be transported to their inpatient bed at any time after that “Accept”-ance and the bed is assigned. If you do not think a patient is appropriate for their current assigned level of care or there is a change in the patient's clinical status or disposition plans, you can use the “Discussion” button to pause the transportation flow.
- Enter Admission Orders.
- You can use the General Adult Admission order set.
- In the admission/observation order, use “Hospital Medicine” as the service. If there is a campus preference, add it to the comments of the order.
- If you use the Admission tab, make sure to release your signed and held admission orders. To do so, go to Orders → Signed & Held Tab → "Click Here to Release Signed and Held Orders" → release all admission orders so that they show up under the Active Tab. The ER RNs cannot use the orders until they are released.
- The Attending and First Contact will change to you when you sign the admission orders. If you are delayed in the admission orders, but have formally accepted the patient, you can change the Attending and First Contact manually.
**List Management**
- This is the responsibility of all the admitters.
- If an ER patient is accepted to HMED, add them to the West Admissions List as the Primary Team and remove them from the General Admissions List.
- If an ER patient gets a bed on East Campus, they will often be automatically added to the East Admissions List. If not, add them manually.
- If a hospitalist physically on West Campus is still First Contact for a patient on East Campus, keep them on the West Admissions List. When a hospitalist on East Campus takes over as First Contact, make sure the patient is on the East Admissions List (or Rounder List) as the Primary Team and then remove the patient from the West Admissions List.
- If a hospitalist is still First Contact for a patient on a Farr resident floor, keep them on the West Admissions List. When the residents take over as First Contact in the morning, make sure the patient is on their teaching team list as the Primary Team and then remove the patient from the West Admissions List.
- If there are non-ER admission, ICU stepdown, or overflow patients who will need to the distributed to the Rounders in the morning, add them to the appropriate campus Admissions List.
- In the morning, make sure each patient who is in a floor bed has a Primary Team that is a floor team and an Attending/First Contact who is a floor Attending/First Contact, then remove them from the Admissions List.
**The Admitted ED Patient Moves to a Floor Bed**
- _In general, HMED takes care of medicine patients on East Campus, CC6, Klarman, Farr 7, Farr 8, and Farr 11 and the resident teams take care of medicine patients on the remaining Farr floors. Sometimes, patients admitted by HMED are assigned beds on a resident floor and patients admitted by the resident teams are assigned beds on a direct care floor. The residents cross cover overnight with two interns and a supervising resident. Given their already challenging workload, we have a somewhat asymmetric cross-coverage plan for “wrong geography” patients._
- _Medicine patients are rarely on Farr 8, but if they are, HMED takes care of them._
- ER (HMED) → East Campus
- The admitting/rounding physician remains as First Contact until the end of their shift.
- You are not expected to go to East Campus. If a patient who moved to East Campus requires active bedside management, sign out to your East Campus counterpart, who will take over as First Contact and provide bedside management. See “Special Notes about Roles."
- ER (HMED) → CC6, KM, Farr 7, Farr 8, Farr 11
- The admitting/rounding physician remains as First Contact until the end of their shift.
- ER (HMED) → Farr resident floor
- If the patient moves before 10am, the patient will be assigned to a resident floor team based on geography and availability.
- If the patient moves after 10am, HMED will continue to cover the patient until they are distributed to a resident team the following morning and the residents take over.
- Reach out to the Flex resident in either situation for closed-loop communication.
- ER (MEDED) → CC6, KM, Farr 7, Farr 8, Farr 11
- If a resident team admitted/rounded on the patient during the current shift, they will cross-cover the patient until the end of their shift. They will sign-out to the appropriate hospitalist at the end of their shift.
- If a resident team was cross-covering the patient during the current shift, they will sign-out and change the First Contact to the appropriate hospitalist once the patient moves to the floor bed.
- The residents will find out who the appropriate hospitalists are from the MEDED attending.
- ER (MEDED) → East Campus
- The resident team will sign-out and change the First Contact to the appropriate hospitalist on East Campus when the patient moves.
- The residents will find out who the appropriate hospitalists are from the MEDED attending.
**Triggers in the ED**
There are a wide range of potential triggers. If it is a trigger that could otherwise be managed safely on the floor, we should continue to take the lead on these. If a patient is truly unstable, they may need to go back to the care of the ED team. Triggers in the ED will continue to be paged overhead, so an ED team will be at bedside to discuss.
**Transfer Requests for Patients Admitted to Other Services but Physically Located in the ER**
This sometimes happens with patients who were admitted to a surgical service, but remain in the ER for an extended period of time and subsequently no longer have surgical needs. In this situation, the patient should be added to the Admission Tracker under the ER Admits list and the next team up for an admission (either HMED or MED ED) should triage and do the transfer if accepted. See [Internal Transfer/Consult Workflow](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Transfer-Consult-Workflow-Tool.aspx?csf=1&web=1&e=CyS4cg).
**Other Issues**
If you run into logistical, communication, or other issues while admitting in the ED, **please let the admins know!** The admins are reviewing cases and communicating frequently with the ED and resident teams to improve the system.
# ## Direct Care Rounding
Published 1/27/2026
On this page:
- Logistics
- Workflow
- Additional Notes
_We sometimes refer to the medicine direct care service as “HMED," as opposed to the resident/teaching teams._
_In other contexts, all inpatient internal medicine is referred to as “HMED” since hospitalists from our HMED group are the attendings for all medicine inpatients, regardless of whether the patient is on a teaching or direct care service._
**Other Helpful Pages**
- Review the “Clinical Care Resources” tab
**Logistics**
**East Campus:**
- Floors
- 12 Reisman
- 8 Feldberg
- 7 Stoneman
- 5 Stoneman
- Lists in Epic: BIDMC HMED East A-D
- We sometimes take care of OMED overflow patients as the primary team if the oncology services are capped.
- On East Campus, all medicine primary patients are under HMED/direct care.
- On East Campus, there are non-medicine primary teams, including OMED, which is staffed by medicine residents, and the oncology hospitalist service, which is staffed by oncology hospitalists.
- Where to work:
- On the respective floors
- Gryzmish 431 (badge access)
- Yamins Dept of Medicine office on the 1st floor (badge access)
**West Campus:**
- Floors
- Farr 7
- Farr 11
- Rosenberg 6 (CC6)
- Klarman 7-10
**All medicine inpatients on the above floors are HMED/direct care. Medicine inpatients on other Farr floors are covered by medicine teaching teams**
- Lists in Epic: BIDMC HMED West A-H (and beyond)
- We sometimes take care of cardiology/CMED overflow patients as the primary team if the cardiology service is capped.
- On West Campus, there are other non-medicine primary teams that are staffed by medicine residents, including the cardiology primary teams (Zoll) in the Klarman building and the hepatology primary team (ET) in Farr.
- Where to work:
- On the respective floors
- Farr 6, room # 601 (Badge access)
- W/Span 2 office (Badge access)
**Workflow**
_The workflow below applies to direct care rounding on both East and West Campuses._
**Before starting service**
- Review the signout email sent by the preceding hospitalist on their last day of service/the day before your first day of service.
- Chart check the patients per your workflow. Reach out to the preceding hospitalist with any questions.
- Review your schedule for when you are Early/Middle/Late.
**Rounding Structure**
_Both East and West Campus rounders are assigned early, middle, and late roles._
_The workflow is the same during the week and weekends._
- Early Rounder
- Arrive at 6:30am.
- Receive sign out from the nocturnist in the fourth-floor hospitalist office. Please be on time to relieve the night team!
- Sign into the East or West Campus Pager and personal pager.
- On East campus, Early rounder covers the East Campus Pager.
- Sign in as First Contact for all the patients on the respect campuses and lists.
- West: BIDMC HMED West A-H, any new admissions on the BIDMC HMED West Admissions list that are on the floors.
- East: BIDMC HMED East A-D, any new admissions on the BIDMC HMED East Admissions list.
- Cross-cover patients for the Middle and Late Rounders until they arrive. Any significant events or pages should be documented in the Handoff.
- Other rounders will sign-in to their pagers/Epic chats and assign themselves as First Contact as they arrive.
- All other rounders should arrive by ~8am. The Early Rounder should not be cross-covering any other lists by 9am at the latest.
- Can signout and leave at 5pm if work is complete.
- Middle Rounder
- Arrive by 8 am.
- Can signout and leave at 5pm if work is complete.
- Late Rounder
- Arrive by 8am.
- Between 5-7pm, cross-cover the other rounders' lists after they sign out.
- The other rounders will reach out to the Late Rounder via Epic chat, page, text, call, or in person to ask to sign out. See signout process below.
- At 7pm, sign out personal and cross-covering lists to the Nocturnists.
- Any rounders who are still signed in at 7pm will signout to the Nocturnists directly.
**When the census is high, an extra rounder may be added. The extra rounder will always be Middle.**
**Rounding Hours:**
Early: 6:30 am to 5 pm
Middle: 8 am to 5 pm
Late: 8 am to 7 pm
**Signing In Daily**
1. Touch base with the Nocturnist or Early Rounder for pertinent overnight events.
2. Sign in to your pager.
3. Sign in to Epic Chat.
4. Assign yourself as First Contact for your patients.
5. Change yourself to the Attending for your patients if it is your first day on service.
6. Add your new patients from the respective Admissions list to your Rounding list and remove them from the Admissions list. Change yourself to First Contact and Attending for these patients as well. (See the morning distribution email for your new patients.)
7. Check Overnight Events in the Handoff.
Link to document: [Starting the Day in Epic .docx](https://bilh-my.sharepoint.com/:w:/g/personal/sdatta3_bidmc_harvard_edu/EVeNy1u_5k5DnpkI3mBohX8BgM0hhtRCOdbGj-a8IsSZDQ?e=aLCGJ6)
**Signing Out Daily**
1. Write a signout in the Handoff with pertinent info and overnight to-dos. Make sure this is up-to-date. **Put your checkboxes with your to-dos at the** _**top**_ **of the nocturnist sign-out box.**
2. Reach out to the Late Rounder/Nocturnist via Epic chat, page, text, call, or in person to let them know you would like to signout. Give signout on any sick/complicated patients and to-dos.
3. Change the First Contact for your patients to the covering physician.
4. Sign out of Epic chat.
5. Sign over your pager to the covering physician.
**If leaving earlier than 5pm, talk with the late rounder to ensure they are in a place in their workflow to cross cover.**
****Do NOT leave the hospital without signing over your pager and First Contact patients. Do NOT leave the hospital with Epic Chat signed in.****
_[Exception is if there is a clear plan for you to continue to respond promptly to messages and for signout later in the evening to the night providers. If this is the case, make sure the late provider is aware.]_
**Multi-Disciplinary Rounds (MDR)**
Attend MDR in person on your primary floor and other floors if/as feasible, especially if you have two or more patients on the floor. Some MDRs are scheduled concurrently but are usually long enough to attend both back-to-back.
Reach out to the assigned CM before MDR via Epic Chat or CM phone regarding:
1. Each patient for whom you will not be attending MDR in person (all 'off geography' patients).
1. You can alternatively check in with the charge RN when you are on the floor seeing your off-geography patients and they can often help coordinate with CM.
2. Each patient for whom discharge by noon (DBN) is planned that day (reach out by 830am in this situation).
During the week, discuss every patient on your list.
During the weekend, discuss patients on your list who are being discharged on Sat/Sun/Mon and any complex clinical cases that will require coordination/communication with nursing over the weekend (ie sick patients, staffing for IVIG infusions, etc).
Patients who have extremely challenging discharge situations or long hospitalizations are assigned to a specialized team called the **complex transitions care team.**
See [CM and Charge RN Phone Numbers](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Case-Management-Rounds\(1\).aspx?csf=1&web=1&e=IbjC8I).
**Signing Out Your List on the Last Day of Service**
1. Complete the Handoff for each patient. Include a list of “To Dos.”
2. Update the hospital course for each patient.
3. Prepare discharge instructions for any patients who are anticipated to discharge the day after you go off service.
4. Call/text/email the oncoming provider to offer a verbal signout.
5. Send an email to the “HMED-signout” email with your list (patient names and MRNs; can take a screenshot of the Epic list) and list patients who may discharge over the next few days.
6. Refer to this document for Sign-out expectations/Details: [HMED signout Expectation.docx](https://bilh-my.sharepoint.com/:w:/g/personal/sdatta3_bidmc_harvard_edu/EQBPAHqz7opJtFUGliTpMAwBTEPkvy6Tc1Il_MkQN70scQ?e=quP6DO)
**Additional Notes**
**Additional Expectations**
- Bill within 24 hours after each encounter.
- Complete CDI queries within 24 hours.
- Follow up any labs that are pending when your patient is discharged (usually results appear in your Inbasket, but keep a list of pending results to review as backup).
- Write discharge summaries within 3 days of discharge..
## Direct Care Nocturnist
Published 2/16/2026
On this page:
- Overview
- Shift Descriptions
- Additional Notes
- The Morning Distribution
- East Campus Considerations
- FAQs
_For the purposes of admissions:_
_HMED = Direct Care_
_MEDED = Teaching Service/Resident Teams_
**Other Helpful Pages**
- [Pagers/Lists](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Pager-List-Coverage.aspx?csf=1&web=1&e=l8F696)
- [The Triage Role](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/The-Triage-Role-and-MedED-Attending-Guide.aspx?csf=1&web=1&e=8hPVgY)
- [9-HOSP/Transfer Pager](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/9-HOSP-Guide.aspx?csf=1&web=1&e=0xao5i)
- [Internal Transfer/Consult Workflow](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Transfer-Consult-Workflow-Tool.aspx?csf=1&web=1&e=WPhkfY)
- [CMED (Zoll) and OMED Overflows](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/CMED-\(Zoll\)-and-OMED-Overflows.aspx?csf=1&web=1&e=NhfkXS)
- [Geography Preferences - East vs West](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Geography-Preferences.aspx?csf=1&web=1&e=Ts21rt)
- [BIDMC Service Names](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/BIDMC-Service-Names.aspx?csf=1&web=1&e=SXiadv)
- [Direct Care Admitting](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx?csf=1&web=1&e=fesWvR)
- [Teaching Service Admitting (MedED)](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Teaching-Service-Admitting-\(Med-Ed\).aspx?csf=1&web=1&e=aKnDEb)
**Overview**
There are 7 nocturnist shifts.
- East Campus
- East Nocturnist
- East Evening 5p-10p Admitter - Cross-cover, East Campus admissions (*not a true nocturnist role*)
- West Campus
- Farr Nocturnist - Cross-cover, West Campus direct care admissions
- Klarman Nocturnist - Cross-cover, West Campus direct care admissions
- Overnight Admitter 1 or ED nocturnist - Cross-cover, West Campus direct care admissions
- Overnight Admitter 2 - Cross-cover, West Campus direct care admissions
- Night (5p-5a) Swing - Triage Role, staff with residents, West Campus direct care admissions on Sundays
- Night MedED - Triage Role, staff with residents
The nocturnist group at BIDMC has always worked to be proactively collaborative and are in close contact throughout the night to see where someone may need help.
**Shift Descriptions**
**Starting February 16:**
**Shift Changes:**
- **Overnight Admitter 2 (West):** Hours now 7p-7a (previously 10p-7a). This adds an extra nocturnist during the 7-10pm window when admission volume peaks and cross-coverage is often busiest
- _On a few nights where Overnight Admitter 2 is already scheduled as 6p-6a, Overnight Admitter 1 will have extended hours instead._
- **Late Admitter (East):** Now Evening Admitter hours, 5p-10p (previously 5p-2a).
- Renamed East Evening Admitter in OnService
**Cross-Coverage Changes:**
In addition, this change would help us be able to better balance the cross-coverage workload. The new cross coverage scheme starting Feb 16:
- **Farr Nocturnist:** West A, B, C (~30 patients) - ideally mostly on Farr
- **Klarman Nocturnist:** West F, G, H (~30 patients) - ideally mostly on RB6, Klarman
- **Evening Admitter / Overnight Admitter 1 (10p-7a) or ED nocturnist (6p-6a):** ED 1/2, Flex, ED Rounder + first admit (~22 patients)
- **Overnight Admitter 2 (7p-7a):** West D, E, Swing Admitter, TMED transfers, transfers from east campus + 2nd admit (~25 patients)
**If the East Nocturnist needs help:**
To help support the East Nocturnist, who will now be alone most of the night, the Swing Nocturnist (5p-5a) would also be the designated East Backup, so there is someone designated to call over to east if in-person help is needed. I expect this will not be needed frequently, but if the east nocturnist needs an extra pair of hands, this is the person they should reach out to.
**West morning distribution:**
Finally, the responsibility of the _**morning distribution will shift to the Med ED Nocturnist**_, who arguably has a better "view of the board" overnight. This also frees up the Farr/Klarman nocturnists during a busy cross-coverage window. Of course we would expect that if the Med ED nocturnist is busy staffing late admissions then this can/should be delegated to another nocturnist with bandwidth.
__
**Additional Notes**
**The Morning Distribution**
---
Will there really be a "Morning"?
Is there such a thing as "Day"?
Could I see it from the mountains
If I were as tall as they?
Has it feet like Water lilies?
Has it feathers like a Bird?
Is it brought from famous countries
Of which I have never heard?
Oh some Scholar! Oh some Sailor!
Oh some Wise Men from the skies!
Please to tell a little Pilgrim
Where the place called "Morning" lies!
The nocturnists create and send out the morning distribution of patients to the day rounders. ([bidmc-HMEDsignout@bidmc.harvard.edu](mailto:bidmc-HMEDsignout@bidmc.harvard.edu)). On East Campus, one of the nocturnists should be designated to create the East distribution. On West Campus, the West Nocturnist will create the West distribution.
**Distribution Guidelines:**
- **Soft cap of 11, “hard-ish” cap of 12** – If the numbers are beyond this, please call the Hospital Administrator on Call (HAOC) about pulling backup (unless a plan is already in place).
- Hierarchy of priorities:
1. **The first priority is to maintain geography.**
a. On East Campus, please try to keep people to 1-2 floors.
b. On West Campus, please try to keep West A-E providers on the Farr tower and West F-H on Klarman/Rosenberg tower.
2. **The second priority is payor status.** Particularly from July to October, please assign patients to providers who will be able to bill for them. Early in the academic year, new providers typically can only bill for Medicare patients. As the year progresses, consult the payor status emails to determine insurance approval status.
3. **The third priority is to maintain roughly equal census numbers between rounders.** Please aim to prevent a difference of more than 2 patients between providers. Other rules, including geography and payor status, may be violated to achieve this.
- Please take into account these additional considerations:
- Sick patients should be preferentially assigned to the early rounder.
- Please try to take into account the overall complexity of a list when assigning new patients.
- Attendings working with capstone students have a lower cap of 10. These attendings will inform you if this is the case.
- Breastfeeding mothers should be assigned 2 fewer patients. If some rounders are at 10 and others are at 11, they should be capped at 9 (2 fewer than the higher number).
- **Remember** - The guidelines are just guidelines and should be adjusted as needed to create an equitable distribution that meets the needs of patients and providers.
**List Management:**
- Finding all of the patients that need to be distributed in Epic can be very challenging. Please check the East and West admissions list, the Gen Med list, and the MED ED lists. If you see patients on the West admissions list who are going to a resident floor, please also assign them to the BIDMC West Teaching Med Admissions list and let the residents know so they get distributed correctly in the morning.
- While it takes more work, manually adding all patients to the rounding lists in the morning and removing them from the East and West Admissions lists helps everyone keep track of patients, and decreases the chance of anyone being missed.
**Overflow Patients:**
- The oncology service on East and cardiology service on West are run by resident teams and therefore have a hard cap.
- When these services cap, “overflow” patients may be distributed to HMED attendings.
- On East, the oncology nocturnists (attendings) will let the East nocturnists know about oncology overflow. On West, the resident teams doing the distribution will let the West nocturnist known about cardiology overflow.
- See [CMED (Zoll) and OMED Overflows](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/CMED-\(Zoll\)-and-OMED-Overflows.aspx?csf=1&web=1&e=dRMzLC).
**East Campus Considerations**
**East/West Service Availability:**
- When a patient gets a bed on East Campus from the ED, be mindful that some services are only, or preferentially, available on West campus. See [Geography Preferences - East vs West](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Geography-Preferences.aspx?csf=1&web=1&e=OpBEtm).
- If you are covering the East Admissions List and see a patient assigned to East Campus but should be assigned to West Campus instead, please talk about this with the HMED admitter who is covering the patient, and the bed placement office if needed.
**CT Scans with Contrast:**
- There is no radiologist physically located on the East Campus at night.
- For any study with IV contrast performed after 10pm, a nocturnist will need to be physically present in the 3rd floor radiology suite for the duration of the study.
**Finard ICU (FICU):**
- This is a resident-run, closed, 12-bed ICU on the East Campus.
- When maximally staffed, the FICU can take 11 patients (plus a crash bed).
- If you need to transfer a patient to the ICU, page the FICU resident on call.
- There is also an intensivist available 24/7.
- If you receive a call-out from the ICU, please take sign out and place transfer orders as soon as possible.
- Please be proactive, do not wait for the resident to contact you.
- Transfer orders should be entered within 30 minutes of an ICU bed assignment.
**FAQs**
**Who runs the codes at night on the East campus?**
- The 12R nocturnist carries the code pager, and codes are paged overhead at night. All nocturnists should respond to all codes. The oncology nocturnist, ICU team, and anesthesia also carry code pagers and respond.
- We are often the first to arrive and so should start running the code. When the ICU resident arrives, if it feels safe, it is okay to pass that role over to them, but it is still your responsibility to support them. They are often junior residents with varying comfort with code leadership, and they may require your assistance.
- The ICU intern will bring the LUCAS CPR device to the code.
**What is a “First Aid” and should I respond?**
- A First Aid is a medical urgency/emergency for someone who is not a patient. You will be notified by the code pager.
- These events run the spectrum of severity. You should respond to these, but the ICU resident can take the lead. If the situation is controlled, check in with them before you leave.
**Where can I eat and caffeinate?**
- The East cafeteria is open until 9pm weekdays, 7pm weekends. There is a coffee maker in the HMED suite and in Yamins.
- The West cafeteria is open until 7pm. There is also a badge in “snack room” on Klarman 3 by the IR suite where you can purchase coffee and snacks and is open all night.
**Where can I rest?**
- On East, there is a call room on 8Feldberg room 860 (code 34677) and a call room on Rabb 4 (obtain key card from the security desk under the name of the 12R nocturnist).
- On West, there is a call room on Klarman: KM-9203 (obtain the key card in the Rosenberg Lobby).
**Keeping track of admissions:**
- Please see [Direct Care Admitting](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx?csf=1&web=1&e=4cl8ny) for more information.
# Teaching Service Admitting (MedED)
Published 2/16/2026
On this page:
- Day MedED
- Night Swing
- Night MedED
- Notes on Admitting
_For the purposes of admissions:_
_HMED = Direct Care_
_MEDED = Teaching Service/Resident Teams_
**Other Helpful Pages**
- [Pagers/Lists](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Pager-List-Coverage.aspx?csf=1&web=1&e=l8F696)
- [The Triage Role](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/The-Triage-Role-and-MedED-Attending-Guide.aspx?csf=1&web=1&e=8hPVgY)
- [9-HOSP/Transfer Pager](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/9-HOSP-Guide.aspx?csf=1&web=1&e=0xao5i)
- [Internal Transfer/Consult Workflow](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Transfer-Consult-Workflow-Tool.aspx?csf=1&web=1&e=WPhkfY)
- [CMED (Zoll) and OMED Overflows](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/CMED-\(Zoll\)-and-OMED-Overflows.aspx?csf=1&web=1&e=NhfkXS)
- [Geography Preferences - East vs West](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Geography-Preferences.aspx?csf=1&web=1&e=Ts21rt)
- [BIDMC Service Names](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/BIDMC-Service-Names.aspx?csf=1&web=1&e=SXiadv)
- [Atrius ER Patients - SAfE Program](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Atrius-Patients.aspx?csf=1&web=1&e=PyBUtO)
||**Day MedED**|**Night Swing**|**Night MedED**|
|---|---|---|---|
|**Hours**|- 7a-5p (triage starts at 7a, but ok to arrive in-person at ~8a)|- 5p-5a|- 7p-7a|
|**Location**|- West Campus|- West Campus|- West Campus|
|**Sign-in**|Pagers
- Personal pager
- MEDED (p31926)
Lists
- BIDMC Gen Med Admissions - Covering Provider
First Contact - None|Pagers
- Personal pager
- [5p-11p] MEDED (p31926)
Lists
- BIDMC Gen Med Admissions - Covering Provider
First Contact - None|Pagers
- Personal pager
- [11p-7a] MEDED (p31926)
Lists
- BIDMC Gen Med Admissions - Covering Provider
First Contact -None|
|**Rounding**|- Staffs ED boarders admitted to MEDED with ED Flex resident|- None|- None|
|**Admitting**|- Staffs new admits to MEDED with admitting residents|- [M-Sa] Staffs new admits to MEDED with admitting residents
- [Sunday] See “Other” below|- Staffs new admits to MEDED with admitting residents|
|**Cross-Coverage**|- None|- None|- None|
|**Other**|- None|- [5p-11p] Triage Role
- Staffs triggers for patients on medicine teaching floors; PRN resident support with clinical/logistical questions
- **Sundays**:
If there is an extended overnight admitter, the Swing Nocturnist (5p-5a) can continue their current role in helping with MedED, though may switch to direct care if overall need is low.
- If there is not an extended overnight admitter they should do direct care admits on arrival (given that there is also no 5p-10p admitter)|- [11p-7a] Triage Role
- Staffs triggers for patients on medicine teaching floors; PRN resident support with clinical/logistical questions|
|**Sign-out**|Pagers
- MEDED (p31926) → Night Swing
- Personal pager → Night Swing
Lists
- BIDMC Gen Med Admissions → Night Swing
First Contact
- None|Pagers
- [11p] MEDED (p31926) → Night MedED
- Personal pager → Night MedED
Lists
- BIDMC Gen Med Admissions → just sign out
First Contact for own admits
- Pts currently on East Campus → East Nocturnist
- Patients currently on West Campus → West Nocturnist|Pagers
- MEDED (p31926)
- Personal pager
→ Day MEDED
Lists
- BIDMC Gen Med Admissions → Day MEDED
First Contact
- None|
---
**Signing In Daily**
Day MedED
1. _Optional:_ Check in with the Night MedED to let them know you have signed in and see if there are any outstanding issues.
2. Sign into your pager.
3. Sign into ED and Floor Trainee Hospitalist pager (p31926).
4. Sign into your Epic Chat.
5. Sign into BIDMC General Medicine Admissions List as **Covering Provider**.
6. Begin Triage Role.
7. Review Admission Tracker and Epic work list. Check where the previous day left off in the triage pattern and mark this on the admission tracker for the current day.
8. Check the Medicine Residency AM Distribution email for any assigned boarders or pending admits
1. This should also be reflected in the Admission Tracker under the “Pending for Day MED ED” section.
Night Swing
1. Check in with the Day MedED to let them know you have signed in and see if there are any outstanding issues.
2. Sign into your pager.
3. Sign into ED and Floor Trainee Hospitalist pager (p31926).
4. Sign into your Epic Chat.
5. Sign into BIDMC General Medicine Admissions List as **Covering Provider**.
6. Begin Triage Role.
7. Review Admission Tracker for pending MedED admits
Night MedED
1. Check in with the Night Swing to split staffing new admits and teaching team triggers.
2. Sign into your pager.
3. Sign into BIDMC General Medicine Admissions List as **Covering Provider**.
_At 11pm:_
3. Sign into ED and Floor Trainee Hospitalist pager (p31926).
4. Begin Triage Role (shared with Swing MedED)
**Signing Out Daily**
Day MedED
1. Ensure Admissions Tracker is updated for the Swing/Night MedED.
2. Sign out of Epic chat.
3. Sign out of Epic lists.
4. Sign over your pager to Night Swing
5. _Optional_: Touch base with Night Swing for any outstanding admissions/issues.
**Do NOT leave the hospital without signing over your pager and First Contact patients. Do NOT leave the hospital with Epic Chat signed in.**
_[Exception is if there is a clear plan for you to continue to respond promptly to messages and sign out from home.]_
Night Swing
1. Sign out of Epic chat.
2. Sign out of Epic lists.
3. Sign over your pager to the covering physician (the person covering more of your patients).
*On Sundays, if you do any direct care admissions, sign over the east patients to the East Nocturnist and any patients on west to the Overnight Admitter 2
**Do NOT leave the hospital without signing over your pager and First Contact patients. Do NOT leave the hospital with Epic Chat signed in.**
Night MedED
1. Ensure Admissions Tracker is updated for the Day MedED.
2. Sign out of Epic chat.
3. Sign out of Epic lists.
4. Sign over your pager to the Day MedED.
5. _Optional_: Touch base with Night Swing for any outstanding admissions/issues.
**Do NOT leave the hospital without signing over your pager and First Contact patients. Do NOT leave the hospital with Epic Chat signed in.**
**Notes on Admitting**
- Refer to the [Direct Care Admitting](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx?csf=1&web=1&e=DCBQYp) page for more information about Admitting in general.
- Any general medicine patient assigned to the MED ED resident team will be staffed by the MED ED/Night Swing attendings.
- If the patient is a Geriatrics patient, the Geriatrics team should be contacted by the residents to staff first. If the Geriatrics team declines to staff in the ED, then the MED ED attending would staff.
- Coordinate with the residents in the Med Shed for timing of staffing.
- ICU callouts, OSH transfers, post-procedural admits, and service transfers to medicine will be seen/staffed by the MED ED teams/attending.
- It is optional to staff these as the MED ED attending depending on your bandwidth, but generally the expectation that these are staffed.
- When direct admits arrive to the floor before 2pm, the floor teams will see/staff them. After 2pm, MED ED will see/staff them. Sometimes, if the floor teams are very full and the MED ED teams are not too busy, the MED ED teams will generously take one of these admissions earlier in the day. If you are not sure, just ask them!
- The direct admission patients DO NOT count towards the 60/40 split of general medicine patients. The 60/40 split applies to ED admits ONLY.
- Please document these patients in the Admission Tracker on the right-hand side.
- Try to see patients while in the ED, so that in case they get a bed East, they will have been seen before they go.
TIP: When you sign into an Epic List, make sure to sign into the List only, not the patients on the list.
TIP: Make sure you review the Admission Tracker, esp the “Pending” sections.
# Teaching Service Rounding
Published 1/27/2026
On this page:
- Logistics
- Workflow
- Additional Notes
- Overnight Cross-Coverage
- Extra Roles
- How to Divide on West Weekends
- Expectations for Residents and Medical Students
- Tips on Working with Working with Residents and Medical Students
_All of the inpatient medicine teaching services are in the Farr building. The residents also staff non-medicine services/patients in the Farr building with the specialists (Geriatrics, Hepatology/ET) and the cardiology services in the Klarman building with the cardiologists._
**Logistics**
**Firm Teams (Traditional Teaching Teams)**
_(Named after former BIDMC physicians)_
**Teams/Floors:**
- Blumgart: Farr 2
- Tullis: Farr 2
- BT: Farr 3
- KR: Farr 3
- Kurland: Farr 9
- Robinson: Farr 9
**Team Members:**
- 1 attending
- 1 resident
- 2 interns
- 1-2 medical students
**Weekends:**
- Cover your team
- Cover patients from other lists (see morning distribution email)
- Interns will be off 1 weekend day. Residents will be off 0 or 1 weekend day.
**Sub-Intern Resident Services (SIRS)**
**Teams/Floors:**
- SIRS 1: Farr 10
- SIRS 2: Farr 10
- SIRS 3: Farr 10
**Team Members:**
- 1 attending
- 1 resident
- 1 sub-intern medical student
**Weekends:**
- Cover your team
- Cover patients from other lists (see morning distribution email)
- The resident will be off 1 or 2 weekend days (and there will be a covering resident or you manage patients directly with sub-Is).
**Additional Notes:**
- Given the lighter census, attendings will often have additional roles (see below)
- Medicine teams may have a few off-service patients (ie Geriatrics, Hepatology/ET), for whom the residents will round with the respective specialty attendings each day at some point during the day.
- The Epic lists are called “BIDMC [team name].”
- Where to work:
- W/Span 2
**Herrmann Blumgart**
First person to use radioisotopes to study the heart (forerunner of interventional cardiology).
**Stephen Howard Robinson**
Hematologist who researched porphyria, sickle cell disease, and stem cell maturation.
**James Lyman Tullis**
Hematologist who focused on the treatment of ITP, TTP, and leukemias.
**Workflow**
**Before starting service**
- There is an information session reviewing expectations for teaching attendings while on service. Invitation will be sent via email.
- There is a scheduled orientation/expectation meeting at 8:15am on day one of the resident switch day for a new block. You should receive an email reminding you about this meeting in Deac 315 by the residency administrative staff.
- Review your schedule for any additional roles (specifically for SIRS attendings).
**Rounding Structure**
_Weekday_
- Typically, teaching attendings arrive by ~8am. Sign in process as below.
- Coordinate with your team about rounds start time, typically 830am-9am. At 9:05am, the residents have MAP (quick touchbase with RNs about any questions for their patients), so coordinate rounds around this.
- Run the list in the afternoon in-person or via phone.
- Can leave in the afternoon once patients are settled, everyone is seen, list has been run.
- Remain available by page/text/Epic Chat until ~7pm.
- Teaching schedule:
|Mon|Tues|Wed|Thurs|Fri|
|---|---|---|---|---|
|730a: Resident intake rounds|8-9a: M&M|730a: Resident intake rounds|8-9a: Internal Medicine Grand Rounds|8-9a: General Medicine Grand Rounds|
|12-1p: Noon conference|12-1p: Noon conference|12-1p: Noon conference|12-1p: Noon conference|1145a-1245p: Noon conference|
|4p: Intern teaching|4-445p: Teaching attending rounds|4-445p: Teaching attending rounds|4-445p: Teaching attending rounds|None|
_- Teaching attending rounds: small group teaching sessions run by the teaching attending/hospitalist and resident on the topics of your choice_
_- Consider using Friday afternoon for Feedback Friday_
_Weekend_
- The number of teaching attendings/hospitalists decreases from 9 to 6.
- Each teaching attending/hospitalist covers their team plus parts of other teams with the respective residents/interns of the other teams.
- Half the interns and residents are off on the weekends, so the patients may have both a covering attending and a covering resident team.
- The distribution is made in the morning by a previously assigned senior hospitalist and emailed out daily on Sat and Sun by 830am.
- Coordinate directly with the residents/interns regarding rounds start times (look at the “First Contact” for the patients you are covering).
**Signing In Daily**
_Weekday_
1. Sign into your pager.
2. Sign in to Epic Chat.
3. Change yourself to the "Attending” for your patients if it is your first day on service.
1. Make sure not to change the attending for any off-service patients on the resident lists.
4. Review the resident morning distribution email for new patients and major overnight events.
1. Change yourself to the "Attending” for new patients.
2. You can see the resident handoff/overnight event signout in the “Internal Medicine” Handoff (rather than “Hospital Medicine”).
_Weekend_
1. Sign into your pager.
2. Sign in to Epic Chat.
3. Change yourself to the "Attending” for your patients if it is your first day on service.
1. Make sure not to change the attending for any off-service patients on the resident lists.
4. Review the West Weekend distribution email for the patients you are covering.
1. Change yourself to the "Attending” for the patients you are covering for the weekend.
5. Review the resident morning distribution email for major overnight events.
1. You can see the resident handoff/overnight event signout in the “Internal Medicine” Handoff (rather than “Hospital Medicine”).
**Signing Out Daily**
_Weekday_
1. Consider filling out the “Hospital Medicine” Handoff with a one-liner.
2. Sign over your pager to MedED (p31926).
1. In general, there is no need to reach out to MedED when signing out.
2. If there are any sick/complicated patients, consider reaching out to the MedED attending via Epic chat, page, text, call, or in person to give signout for those patients.
3. Sign out of Epic chat (change status to “Offline”).
_Weekend_
1. Consider filling out the “Hospital Medicine” Handoff with a one-liner.
2. Sign over your pager to MedED (p31926).
1. In general, there is no need to reach out to MedED when signing out.
2. If there are any sick/complicated patients, consider reaching out to the MedED attending via Epic chat, page, text, call, or in person to give signout for those patients.
3. Sign out of Epic chat (change status to “Offline”).
4. On Sun, if you were covering a team just over the weekend, update the Handoffs with “Weekend Updates.”
1. Update the full Handoff for any new patients from over the weekend who do not already have a Handoff.
5. On Sun, if you were covering a team just over the weekend, send a sign out email to “HMED-Signout” with the team name and patient names and MRNS you were covering (a screenshot of the Epic list is sufficient) and include which patients may be discharged the next day.
**Multidisciplinary Rounds**
During the week, the senior resident and teaching attending will attend MDR together on their primary floor. The senior resident will lead. Discuss every patient on your list. Check in with the residents that they have been able to update CM regarding any off-geography patients.
During the weekend, the teaching attending will update the charge RN in the morning for the floors on which they have patients re: patients who are being discharged on Sat/Sun/Mon and any complex clinical cases that will require coordination/communication with nursing over the weekend (ie sick patients, staffing for IVIG infusions, etc).
*The residents may also do this, so check in with them to avoid duplicating work.
Patients who have extremely challenging discharge situations or long hospitalizations are assigned to a specialized team called the **complex transitions care team.**
See [CM and Charge RN Phone Numbers](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Case-Management-Rounds\(1\).aspx?csf=1&web=1&e=5LbGd2)
**Signing Out Your List on the Last Day of Service (or if off for the weekend)**
1. Complete the “Hospital Medicine” Handoff for each patient. Include a list of “To Dos.”
2. Call/text/email the oncoming provider to offer a verbal signout.
3. Send an email to the “HMED-signout” email with your list (patient names and MRNs; can take a screenshot of the Epic list) and list out patients who may discharge over the next few days.
**Additional Notes**
**Overnight Cross-Coverage**
- Overnight, the teaching team patients are cross-covered by 2 interns with oversight by a senior resident.
- The day residents will give in-person verbal signout to the night team.
- Cross-coverage events are documented in the resident hand offs ("Internal Medicine-Teaching").
- Overnight triggers are staffed by the Night MedED attending.
**Extra Roles**
- Check your schedule on OnService for any additional roles while on teaching service rounding.
- SIRS attendings will often cover consults, procedures, and back-up on the weekdays (see below).
- One senior hospitalist will be assigned as the divider for each weekend. The divider will assign the consults and procedures roles for the weekend.
- **Consults (CST):** Staff medical consults on West Campus with the consult (CAT) resident. Note, the Flex person will cover this role if they are not pulled to do a different shift. See [Medicine Consults](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Medicine-Consults.aspx?csf=1&web=1&e=SjsJs4).
- **Procedures (PRC):** Performs medical procedures (abdominal paracenteses, ultrasound guided IVs, and lumbar punctures) and teaches and supervises a procedure resident (if there is one for the block). Procedure attendings are part of the Core Proceduralist group who have additional procedure skills and training. Please contact the leader of the service, Dr. Josephine Cool, with any questions or if you wish to be a core proceduralist.
- **Back-Up (BCK):** Serves as an additional back-up if needed for East Campus and West direct care. The back-up role is only assigned if there are 3 SIRS attendings on service. If a SIRS attending is pulled, they will be notified by the Hospitalist Administrator on Call (HAOC) and their SIRS team will be covered by the other SIRS attendings.
- **Divider (DIV):** Distributes all the medicine teaching service patients among the teaching attendings/hospitalists for the weekend.
**How To Divide for West Weekends**
1. **Friday afternoon/evening:** Identify the weekend hospitalists. Assign each attending at least 1 teaching team for the weekend. If a weekend hospitalist was on service the prior week, keep them with the same team. If a weekend hospitalist will be on service the following week, give them the team that they will be seeing during the coming week. Email the weekend hospitalists their preliminary team assignments along with any additional role/duty assignments as below.
1. Procedures: Ideally a hospitalist on the Procedures Team.
2. Consults: Could tentatively be covered by Flex if they have no other additional role over the weekend.
2. **Friday evening (after ~8PM):** Create an Excel Sheet with all teaching service patients separated by team. Include the West consult patients as well (can touch base with the consult attending or resident about patients who will need to be seen over the weekend). Find the patient lists by reviewing each Epic team list and cross referencing them with any signout emails sent by the off-going attendings. This will give an accurate account of the “old” patients before adding new admissions from overnight. See previous West Weekend distribution emails for the Excel template.
3. **Saturday morning (~630-7AM):** Review the Epic team lists to ensure that the list from the previous evening remains accurate for “old” patients (i.e. nobody went to ICU, expired, self-directed discharge). Review the resident morning distribution email for overnight teaching service admissions and their team assignments. Review the West Consult list for new consult requests. Add the new patients to the Excel sheet. Assign the patients to each of the weekend hospitalists, keeping the following in mind:
- Try to distribute the patients as equitably as possible by numbers across the weekend providers.
- Try to keep continuity for the teaching attendings who were/will be on service during the weekdays.
- If the teaching attendings for a team for the preceding and following weeks are both working over the weekend, consider giving the preceding attending the old patients and the oncoming attending the new patients for the team.
- Hospitalists with additional roles should generally be given 1-3 fewer patients to see, if possible.
- Since dividing the patients is a very time-consuming task, it is reasonable for the divider to carry 1-3 fewer patients as well.
- Try to geographically co-locate patients and attendings as able.
4. Send the distribution/list via email to the address to "BIDMC-Hospitalists West Weekends" as soon as it is complete (by 8 or 8:30am at the latest). This goes to HMED, residents, and the case manager list serve.
**Expectations for Residents and Medical Students**
- **Patient Care:** Interns will see each patient at least once in morning and once in afternoon to update the patient on results and plan. They will update patient families as appropriate.
- **Resident Involvement:** Interns will promptly alert the resident of a trigger or significant change in clinical status, or if they need any help.
- **Rounds:** Residents will run rounds and support the learning and appropriate independence of the interns.
- **Orders/Consults:** Interns will place orders/consults before 12pm. They will alert their resident if there is a delay.
- **Discharges:** Interns will review discharge plans with the resident. It is a best practice to have a discharge time out and review key discharge information (medications/services/follow up) on the day of discharge. Try to plan for 1 early discharge/day and prep the day prior to discharge. You can see this patient before rounds and round on the patient on the earlier side. The intern for the patient can then finish the orders by 10am while you are rounding with the second intern.
- **Signouts:** Interns will update and edit signouts daily ("Internal Medicine" Handoff). In the beginning of the year, residents will oversee and give feedback on this process.
- **Learning:** Trainees will be agents for their own learning. For example, they should actively read about their patients and work with resident/attending to identify potential learning topics for team attending rounds.
**Tips on Working with Residents and Medical Students**
- On the first day of service, set expectations for all members of the team. Provide guidance on medical students’ roles/expectations (ex. expect students to present their patients, participate in patient care, and educate the team). Include expectations about feedback. Elicit the team's input/goals. Discuss content for the Tues/Wed/Thurs teaching sessions.
- Provide constructive feedback early and often. Meet one-on-one with each team member on a weekly basis (ex. Feedback Fridays) to provide more formal feedback, specifically on notes, signouts, presentations, and medical decision making.
- Help the team members identify areas of improvement and offer targeted suggestions on how to improve.
- Try to walk round with your team at least 5x/week, incorporate bedside teaching, and give 5 min teaching pearls before rounds begin.
- Emphasize communication with patients, PCPs, other providers. PCPs should be notified of admission, major change in clinical status or code status, discharge, and deaths. This role should be explicitly delegated.
- Be an advocate for the trainees. Be their teacher, get them to conferences, make sure they eat, support them when things become busy, and encourage them to leave the hospital at an appropriate time.
Contact the chief medical residents or program director regarding any problems related to the team or the ward.
# Teaching Service Rounding
Published 1/27/2026
On this page:
- Logistics
- Workflow
- Additional Notes
- Overnight Cross-Coverage
- Extra Roles
- How to Divide on West Weekends
- Expectations for Residents and Medical Students
- Tips on Working with Working with Residents and Medical Students
_All of the inpatient medicine teaching services are in the Farr building. The residents also staff non-medicine services/patients in the Farr building with the specialists (Geriatrics, Hepatology/ET) and the cardiology services in the Klarman building with the cardiologists._
**Logistics**
**Firm Teams (Traditional Teaching Teams)**
_(Named after former BIDMC physicians)_
**Teams/Floors:**
- Blumgart: Farr 2
- Tullis: Farr 2
- BT: Farr 3
- KR: Farr 3
- Kurland: Farr 9
- Robinson: Farr 9
**Team Members:**
- 1 attending
- 1 resident
- 2 interns
- 1-2 medical students
**Weekends:**
- Cover your team
- Cover patients from other lists (see morning distribution email)
- Interns will be off 1 weekend day. Residents will be off 0 or 1 weekend day.
**Sub-Intern Resident Services (SIRS)**
**Teams/Floors:**
- SIRS 1: Farr 10
- SIRS 2: Farr 10
- SIRS 3: Farr 10
**Team Members:**
- 1 attending
- 1 resident
- 1 sub-intern medical student
**Weekends:**
- Cover your team
- Cover patients from other lists (see morning distribution email)
- The resident will be off 1 or 2 weekend days (and there will be a covering resident or you manage patients directly with sub-Is).
**Additional Notes:**
- Given the lighter census, attendings will often have additional roles (see below)
- Medicine teams may have a few off-service patients (ie Geriatrics, Hepatology/ET), for whom the residents will round with the respective specialty attendings each day at some point during the day.
- The Epic lists are called “BIDMC [team name].”
- Where to work:
- W/Span 2
**Herrmann Blumgart**
First person to use radioisotopes to study the heart (forerunner of interventional cardiology).
**Stephen Howard Robinson**
Hematologist who researched porphyria, sickle cell disease, and stem cell maturation.
**James Lyman Tullis**
Hematologist who focused on the treatment of ITP, TTP, and leukemias.
**Workflow**
**Before starting service**
- There is an information session reviewing expectations for teaching attendings while on service. Invitation will be sent via email.
- There is a scheduled orientation/expectation meeting at 8:15am on day one of the resident switch day for a new block. You should receive an email reminding you about this meeting in Deac 315 by the residency administrative staff.
- Review your schedule for any additional roles (specifically for SIRS attendings).
**Rounding Structure**
_Weekday_
- Typically, teaching attendings arrive by ~8am. Sign in process as below.
- Coordinate with your team about rounds start time, typically 830am-9am. At 9:05am, the residents have MAP (quick touchbase with RNs about any questions for their patients), so coordinate rounds around this.
- Run the list in the afternoon in-person or via phone.
- Can leave in the afternoon once patients are settled, everyone is seen, list has been run.
- Remain available by page/text/Epic Chat until ~7pm.
- Teaching schedule:
|Mon|Tues|Wed|Thurs|Fri|
|---|---|---|---|---|
|730a: Resident intake rounds|8-9a: M&M|730a: Resident intake rounds|8-9a: Internal Medicine Grand Rounds|8-9a: General Medicine Grand Rounds|
|12-1p: Noon conference|12-1p: Noon conference|12-1p: Noon conference|12-1p: Noon conference|1145a-1245p: Noon conference|
|4p: Intern teaching|4-445p: Teaching attending rounds|4-445p: Teaching attending rounds|4-445p: Teaching attending rounds|None|
_- Teaching attending rounds: small group teaching sessions run by the teaching attending/hospitalist and resident on the topics of your choice_
_- Consider using Friday afternoon for Feedback Friday_
_Weekend_
- The number of teaching attendings/hospitalists decreases from 9 to 6.
- Each teaching attending/hospitalist covers their team plus parts of other teams with the respective residents/interns of the other teams.
- Half the interns and residents are off on the weekends, so the patients may have both a covering attending and a covering resident team.
- The distribution is made in the morning by a previously assigned senior hospitalist and emailed out daily on Sat and Sun by 830am.
- Coordinate directly with the residents/interns regarding rounds start times (look at the “First Contact” for the patients you are covering).
**Signing In Daily**
_Weekday_
1. Sign into your pager.
2. Sign in to Epic Chat.
3. Change yourself to the "Attending” for your patients if it is your first day on service.
1. Make sure not to change the attending for any off-service patients on the resident lists.
4. Review the resident morning distribution email for new patients and major overnight events.
1. Change yourself to the "Attending” for new patients.
2. You can see the resident handoff/overnight event signout in the “Internal Medicine” Handoff (rather than “Hospital Medicine”).
_Weekend_
1. Sign into your pager.
2. Sign in to Epic Chat.
3. Change yourself to the "Attending” for your patients if it is your first day on service.
1. Make sure not to change the attending for any off-service patients on the resident lists.
4. Review the West Weekend distribution email for the patients you are covering.
1. Change yourself to the "Attending” for the patients you are covering for the weekend.
5. Review the resident morning distribution email for major overnight events.
1. You can see the resident handoff/overnight event signout in the “Internal Medicine” Handoff (rather than “Hospital Medicine”).
**Signing Out Daily**
_Weekday_
1. Consider filling out the “Hospital Medicine” Handoff with a one-liner.
2. Sign over your pager to MedED (p31926).
1. In general, there is no need to reach out to MedED when signing out.
2. If there are any sick/complicated patients, consider reaching out to the MedED attending via Epic chat, page, text, call, or in person to give signout for those patients.
3. Sign out of Epic chat (change status to “Offline”).
_Weekend_
1. Consider filling out the “Hospital Medicine” Handoff with a one-liner.
2. Sign over your pager to MedED (p31926).
1. In general, there is no need to reach out to MedED when signing out.
2. If there are any sick/complicated patients, consider reaching out to the MedED attending via Epic chat, page, text, call, or in person to give signout for those patients.
3. Sign out of Epic chat (change status to “Offline”).
4. On Sun, if you were covering a team just over the weekend, update the Handoffs with “Weekend Updates.”
1. Update the full Handoff for any new patients from over the weekend who do not already have a Handoff.
5. On Sun, if you were covering a team just over the weekend, send a sign out email to “HMED-Signout” with the team name and patient names and MRNS you were covering (a screenshot of the Epic list is sufficient) and include which patients may be discharged the next day.
**Multidisciplinary Rounds**
During the week, the senior resident and teaching attending will attend MDR together on their primary floor. The senior resident will lead. Discuss every patient on your list. Check in with the residents that they have been able to update CM regarding any off-geography patients.
During the weekend, the teaching attending will update the charge RN in the morning for the floors on which they have patients re: patients who are being discharged on Sat/Sun/Mon and any complex clinical cases that will require coordination/communication with nursing over the weekend (ie sick patients, staffing for IVIG infusions, etc).
*The residents may also do this, so check in with them to avoid duplicating work.
Patients who have extremely challenging discharge situations or long hospitalizations are assigned to a specialized team called the **complex transitions care team.**
See [CM and Charge RN Phone Numbers](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Case-Management-Rounds\(1\).aspx?csf=1&web=1&e=5LbGd2)
**Signing Out Your List on the Last Day of Service (or if off for the weekend)**
1. Complete the “Hospital Medicine” Handoff for each patient. Include a list of “To Dos.”
2. Call/text/email the oncoming provider to offer a verbal signout.
3. Send an email to the “HMED-signout” email with your list (patient names and MRNs; can take a screenshot of the Epic list) and list out patients who may discharge over the next few days.
**Additional Notes**
**Overnight Cross-Coverage**
- Overnight, the teaching team patients are cross-covered by 2 interns with oversight by a senior resident.
- The day residents will give in-person verbal signout to the night team.
- Cross-coverage events are documented in the resident hand offs ("Internal Medicine-Teaching").
- Overnight triggers are staffed by the Night MedED attending.
**Extra Roles**
- Check your schedule on OnService for any additional roles while on teaching service rounding.
- SIRS attendings will often cover consults, procedures, and back-up on the weekdays (see below).
- One senior hospitalist will be assigned as the divider for each weekend. The divider will assign the consults and procedures roles for the weekend.
- **Consults (CST):** Staff medical consults on West Campus with the consult (CAT) resident. Note, the Flex person will cover this role if they are not pulled to do a different shift. See [Medicine Consults](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Medicine-Consults.aspx?csf=1&web=1&e=SjsJs4).
- **Procedures (PRC):** Performs medical procedures (abdominal paracenteses, ultrasound guided IVs, and lumbar punctures) and teaches and supervises a procedure resident (if there is one for the block). Procedure attendings are part of the Core Proceduralist group who have additional procedure skills and training. Please contact the leader of the service, Dr. Josephine Cool, with any questions or if you wish to be a core proceduralist.
- **Back-Up (BCK):** Serves as an additional back-up if needed for East Campus and West direct care. The back-up role is only assigned if there are 3 SIRS attendings on service. If a SIRS attending is pulled, they will be notified by the Hospitalist Administrator on Call (HAOC) and their SIRS team will be covered by the other SIRS attendings.
- **Divider (DIV):** Distributes all the medicine teaching service patients among the teaching attendings/hospitalists for the weekend.
**How To Divide for West Weekends**
1. **Friday afternoon/evening:** Identify the weekend hospitalists. Assign each attending at least 1 teaching team for the weekend. If a weekend hospitalist was on service the prior week, keep them with the same team. If a weekend hospitalist will be on service the following week, give them the team that they will be seeing during the coming week. Email the weekend hospitalists their preliminary team assignments along with any additional role/duty assignments as below.
1. Procedures: Ideally a hospitalist on the Procedures Team.
2. Consults: Could tentatively be covered by Flex if they have no other additional role over the weekend.
2. **Friday evening (after ~8PM):** Create an Excel Sheet with all teaching service patients separated by team. Include the West consult patients as well (can touch base with the consult attending or resident about patients who will need to be seen over the weekend). Find the patient lists by reviewing each Epic team list and cross referencing them with any signout emails sent by the off-going attendings. This will give an accurate account of the “old” patients before adding new admissions from overnight. See previous West Weekend distribution emails for the Excel template.
3. **Saturday morning (~630-7AM):** Review the Epic team lists to ensure that the list from the previous evening remains accurate for “old” patients (i.e. nobody went to ICU, expired, self-directed discharge). Review the resident morning distribution email for overnight teaching service admissions and their team assignments. Review the West Consult list for new consult requests. Add the new patients to the Excel sheet. Assign the patients to each of the weekend hospitalists, keeping the following in mind:
- Try to distribute the patients as equitably as possible by numbers across the weekend providers.
- Try to keep continuity for the teaching attendings who were/will be on service during the weekdays.
- If the teaching attendings for a team for the preceding and following weeks are both working over the weekend, consider giving the preceding attending the old patients and the oncoming attending the new patients for the team.
- Hospitalists with additional roles should generally be given 1-3 fewer patients to see, if possible.
- Since dividing the patients is a very time-consuming task, it is reasonable for the divider to carry 1-3 fewer patients as well.
- Try to geographically co-locate patients and attendings as able.
4. Send the distribution/list via email to the address to "BIDMC-Hospitalists West Weekends" as soon as it is complete (by 8 or 8:30am at the latest). This goes to HMED, residents, and the case manager list serve.
**Expectations for Residents and Medical Students**
- **Patient Care:** Interns will see each patient at least once in morning and once in afternoon to update the patient on results and plan. They will update patient families as appropriate.
- **Resident Involvement:** Interns will promptly alert the resident of a trigger or significant change in clinical status, or if they need any help.
- **Rounds:** Residents will run rounds and support the learning and appropriate independence of the interns.
- **Orders/Consults:** Interns will place orders/consults before 12pm. They will alert their resident if there is a delay.
- **Discharges:** Interns will review discharge plans with the resident. It is a best practice to have a discharge time out and review key discharge information (medications/services/follow up) on the day of discharge. Try to plan for 1 early discharge/day and prep the day prior to discharge. You can see this patient before rounds and round on the patient on the earlier side. The intern for the patient can then finish the orders by 10am while you are rounding with the second intern.
- **Signouts:** Interns will update and edit signouts daily ("Internal Medicine" Handoff). In the beginning of the year, residents will oversee and give feedback on this process.
- **Learning:** Trainees will be agents for their own learning. For example, they should actively read about their patients and work with resident/attending to identify potential learning topics for team attending rounds.
**Tips on Working with Residents and Medical Students**
- On the first day of service, set expectations for all members of the team. Provide guidance on medical students’ roles/expectations (ex. expect students to present their patients, participate in patient care, and educate the team). Include expectations about feedback. Elicit the team's input/goals. Discuss content for the Tues/Wed/Thurs teaching sessions.
- Provide constructive feedback early and often. Meet one-on-one with each team member on a weekly basis (ex. Feedback Fridays) to provide more formal feedback, specifically on notes, signouts, presentations, and medical decision making.
- Help the team members identify areas of improvement and offer targeted suggestions on how to improve.
- Try to walk round with your team at least 5x/week, incorporate bedside teaching, and give 5 min teaching pearls before rounds begin.
- Emphasize communication with patients, PCPs, other providers. PCPs should be notified of admission, major change in clinical status or code status, discharge, and deaths. This role should be explicitly delegated.
- Be an advocate for the trainees. Be their teacher, get them to conferences, make sure they eat, support them when things become busy, and encourage them to leave the hospital at an appropriate time.
Contact the chief medical residents or program director regarding any problems related to the team or the ward.
# Flex Shift
Published 7/10/2025
On this page:
- Logistics
- Workflow
**Logistics**
- This shift was started in July 2024 as a flexible day shift to help other HMED service lines. The Flex hospitalist will be the first call for last-minute needs for high census or sick calls. They may also help cover 9-HOSP or ED triage if needed.
- The Flex hospitalist will work every scheduled day. They should be available to work 7a-7p.
- Default role is as a daytime West Campus admitter and covering West Campus Medicine Consults with the consult resident.
- If the need arises, the Flex hospitalist will be assigned instead to cover any daytime shift on East or West campus.
- The “Flex” shifts are counted as part of your annual target FTE. It will be reimbursed at the standard rate of a direct care shift.
**Workflow**
- For every scheduled Flex shift, plan to work on West Campus doing admissions and covering West Campus Medicine Consults with the consult resident. Expect to work roughly the same hours as the ED Day shift, ~7/8a-5p.
- The admin on call will notify you as early as possible if you will be assigned to work a different day shift. This may be a few days in advance up to the morning of the shift. They may reach out to you via text/call/email; usually it will be via text/call the closer to the shift time. If you are uncertain, you can reach out to the admin on call the day before your shift to check in.
- If you are assigned to a different day shift, the SIRS attending who is assigned consults (CST on OnService) will cover consults that day.
# Back-Up Shift
Published 4/23/2025
On this page:
- Logistics
- Workflow
**Logistics**
- Day Back-Up can be called in to work any Boston shift between 7am-7pm on the scheduled day.
- Night Back-Up can be called in to work any Boston shift between 7pm-7am starting the scheduled day.
- Treat back-up shifts as you would any other clinical shift.
- Make sure you are aware of the back-up shifts on your schedule.
- Make arrangements to ensure you can work if called in. Do not travel far away, do not schedule immovable commitments, notify the admin if you are sick and cannot serve as back-up.
- If you are aware of conflicts with your availability and/or responsibilities for these shifts ahead of time, please make accommodations as you would any other clinical shifts – look for trades or coverage from our group or let the HMED leadership team know if you have a conflict you cannot resolve.
- Every effort is made to NOT pull back-up. As soon as the admin is notified of a possible call-out, every effort is made to find someone to cover the shift for moonlighting. Even if the back-up person is called in, the admin will continue to try to find a moonlighter to relieve the back-up person as appropriate.
- If you are called in to work, you will be paid for the shift.
**Workflow**
- The admin will try to notify you of any need or potential need as early as possible.
- You will be called and/or texted if you need to come in. As such, keep your phone charged and nearby.
## Orientation Shift
Published 7/10/2025
On this page:
- Overview
- Rounding Orientation
- Admitting Orientation
**Overview**
Your orientation shift will generally be the day prior to the first autonomous or full day on service. These are listed as “moonlighting” or “extra” roles in OnService.
You will have 2 half days of orientation: 1 rounding orientation and 1 admitting orientation.
At least one week in advance of your orientation, please make sure you have the following ready to go for your work in Boston:
_(These tasks can also be found in the Boston Orientation Checklist)_
- ID Badge
- Pager
- IT systems login and access (Test it!)
- Read/Review **ALL** the relevant Boston-specific orientation documents
If you have trouble with any of the above, please contact our administrative staff for assistance **immediately**, so that we can resolve any issue **PRIOR** to your orientation day.
**Rounding Orientation**
The orientation day will be a half day (8AM-2PM) for the person being oriented (the orientee). You will receive an email assigning you your orienter and with a reminder of how to prepare for your orientation shift. The goal is to practice managing patients while becoming familiar with the computer system, the surroundings, the workflow, and the service. It is also an opportunity to begin to learn about patients you will be taking over when you start service. PLEASE NOTE: There may be times when your “orienter” (or experienced provider) will NOT be the provider who will be signing out to you. This may occur early in the year (due to continuity issues regarding grouped Medicare patients for billing purposes prior to insurance credentialing) and/or when the orientee is scheduled to take over for an equally new provider to the system.
**On your orientation day:**
1. Arrange to meet your orienter at the beginning of the shift, around 8AM.
2. Your orienter will give you 2 patients to manage for the day, ideally one patient for follow-up and one patient who can be discharged. Review with the orienter every element of their day from the beginning until some point where you feel you have an understanding of the shift responsibilities and processes (see example below). Take over the care of your assigned patients, round on them, place orders, and write progress notes. Go through discharge process with at least one of these patients and complete discharge if able.
3. Take time on your own to review the system and surroundings, practice using the system (notes, orders, looking up information, etc), ask questions, familiarize yourself with the floors and staff, etc.
4. Around 10-11AM, attend patient progression rounds (PPR - aka Case Management Rounds) with your orienter for your assigned patients. This is a great opportunity to observe how PPR works and meet the nurses and case managers in person.
5. Following PPR, complete the management of your covered patients and cover them for the rest of your orientation shift.
6. At 2p, sign out the patients to the orienter. Complete the end of the day "Check-in" to answer questions, etc.
7. You will be paired with someone for the week on service to serve as your first contact for question/issues etc. There will be 1 orienter per orientee. This weeklong orienter will also be included in the orientation shift email.
**Admitting Orientation**
The orientation day will be a half day (1PM-6PM) for the person being oriented (the orientee). You will be paired with one of the admitters on either campus. You will receive an email assigning you your orienter prior to the shift. The goal is to practice admitting patients prior to your admitter/swing shifts.
**On your orientation day:**
1. Arrange to meet your orienter.
2. You will meet the admitter and gets a broad overview of shift and the admitting process.
3. You will be given up to 2 patients to admit during shift - ideally from ED.
4. Admit a new patient from “soup to nuts” by reviewing and accepting the patient in the ED, placing Admission Orders, doing the medication reconciliation, writing the admission note, and writing the signout with pertinent “To Dos.”
5. Admitter will check in with you and provide guidance, etc.
6. You will also be paired with a co-admitter for your first shift (included on your orientation email) in case you have questions during your first admitter shift.