The Patient Comes First

Junior Resident Responsibilities
Inpatient Teaching Service --- (including float)

Emergency Department (ED)
 

1. Junior Resident (JR) will primarily evaluate patients in the ED and consult with the Senior Resident (SR) before making a disposition.  The SR will see all patients in the ED.
    
2. The JR will not accept transfers from other ED’s; this is an ED responsibility.

Inpatient Service
 

1. The JR will dictate an H&P on all patients and write all orders.
    
2. A progress note will be written daily after a daily evaluation.
    
3. The SR and/or attending will be notified of any major changes in patient status.
    
4. ICU and unstable patients should be seen before 8:00 a.m. conference or residents clinic.
    
5. The JR will take care of the patient on an as needed basis and hospital presence is not time-limited to when the float team or next team on call shall arrive.  THE PATIENT MUST BE CARED FOR FIRST.  A smooth, safe, seamless transition of care must take place.
    
6. The JR will attend arrest codes and emergencies of many descriptions when in possession of the code pager.
    
7. All procedures should be recorded in a procedure book and promptly turned into the department.  A procedure note should be dictated or written for all procedures and copies to the department office.
    
8. Procedures should only be performed with supervision, after competency is assured and the requisite number have been performed appropriately under supervision.
    

   Stress Tests	low risk 25 high risk 25
   Lumbar Puncture	3
   Thoracentesis	5
   Paracentesis	5
   Subclavian lines	5
   Jugular lines	3
   Femoral lines	3
   S-G/R Heart Cath Temp. Pacer line	10
   Bone marrow aspiration; disc crest.	3
   Bone marrow biopsy	3
   Elective cardioversion	10
   Arterial line	5
   Vascular dialysis catheter	5
   Foley catheter	5
   Venipuncture peripheral	10
   Peripheral intravenous catheter	10
   Punch skin biopsy	3
   Chest Tube	5
   Flexible sigmoidoscopy	20
   Culposcopy w/biopsy	15
   Elective intubation	20
   Arthrocentesis of knees	3
   Other joint aspirations	2
   Nasogastric intubation	3

   9. JR will attend morning teaching report at all times (excepting residents clinic); responsible JR will succinctly present case with appropriate x-rays, EKG.
       

   10. All discharge summaries involving deaths will be copied to the department.
        

   11. An off -service note will include a detailed itemized diagnostic and treatment plan (as for discharge summary).
        

   12. Residents will be called upon to see inpatients in consultation.  The SR will see the consultation if it appears that the consult is “short term,” ie. pre-operative, specific problem not requiring total care (diabetes management, hypertensive treatment, etc.).  The JR will not follow the patient.  The JR will see and follow more involved consultations.
        

   13. Report all deaths and autopsies to the Chief Resident (CR).
        

   14. Consultants
        

       The JR should confer with the SR and/or the attending when requesting consultations   The JR must see that the consultant is personally informed about the case by the JR, SR or attending.   Specifically ask the consultants to page you, a member of your team or the resident covering your patients so that you may write all orders on your patient (excludes orders for a procedure)   The consultant must not write orders.   You are not required to do what a consultant suggests. The patient is yours and you are a member of a team - rely on your team.

       
        

   15. You must notify a resident of the admission of his continuity patient at convenient hour.  Notify the continuity resident or attending directly, verbally and copy the discharge summary to continuity clinic.
        

   16. Your must at least say hello to your continuity patient if that patient is admitted to any hospital service other than your service.
        

   17. You must check weekly the EMR to complete your charts when on an inpatient service and thereafter until all records are complete.  If at all possible complete discharge summaries at the time of discharge.
        

   18. The library in the WVU building is available to you on a 24-hour basis.  Call the CR or me if you get any grief from security.
        

   19. The SR is there to help you whether it is the team resident or a float resident.  Please let me know if you feel you are receiving too much responsibility.  You must recognize your limitations.  Macho attitudes have no place in patient care – the welfare of the patient supercedes all considerations.
       
       There is no penalty to the patient for asking for help when you do not know what to do; not asking for help is not acceptable.
        

   20. The JR should make sure that the correct attending is properly recorded initially and at time of discharge.
        

   21. Patient’s discharge should have follow up appointment arranged prior to leaving the hospital.