Hello and welcome!

If you are here it is because you are rotating in our MGH Emergency Department during the upcoming month.  We are excited to have you!  Please find a brief introduction below, including how to view and manage your schedule.

Introduction

First, welcome (or welcome back) to the ED! We are so excited to have you rotate with us. If this is your first ED rotation, we recommend reading through the section “Day One” below and arriving 15 minutes early to your first shift.  (In general, it’s a good idea to physically arrive in the department ~10 minutes before your shift is scheduled, so that you can be logged in and ready for action when your shift starts.)

The ED environment is great for hands-on learning, but it is tough to orient in a busy shift, and the context can be really different from other services. Coming prepared will be a huge help to you and your team. 

To that end, here is a video recorded by the 2021-2022 HAEMR Chiefs that goes through some common questions:https://link.haemr.life/EDChiefsOrientation2021

Schedule

Your schedule is posted on ShiftAdmin, which is public and can be synced to iCal, Google Calendar, etc. Please see below for resident-username pairings. The password to every account is “12345678”. Please do not change it!  If you notice any work-hour violations or any dates that appear to be in conflict with your other rotations, please notify us right away. The schedule as now published may still undergo small changes as it is finalized.

A note on shift names/conventions:  TL;DR = All of the shifts on your schedule are intended for you!

“Jr” Shifts: “Junior” in the ED means PGY-1 or PGY-2 (both “interns” and “junior residents” in the traditional IM parlance), as opposed to “Senior” which is PGY-3 or PGY-4. Jr shifts are split by PGY-1 and PGY-2 residents.  Do not be alarmed if you have been assigned a “Jr” shift, regardless of year, you are supposed to have it!

“PGY-X” Shifts: The ED tends to have a slightly more fluid structure than other services in terms of which year residents work which shifts, and PGY-2 residents do not work in supervisory roles.  Thus, shifts are sometimes labeled for the PGY year that commonly covers them, but may be filled by anyone that year or higher. 

  We aim for a balance of PGY years in the ED at any given time, which means that sometimes the “Junior” shifts are filled by PGY-1s and the “PGY-1” shifts are filled by PGY-2s, depending on who is available when.  So, if you are a PGY-2 and have been assigned a “PGY-1” shift, don’t worry! You are supposed to have it! It is the same as your other shifts, just at a slightly different time.  Proceed as you usually would, and have a great shift! 

For reference, your name and ShiftAdmin IDs are reproduced below.  (Anesthesia and Ortho IDs are also available here).  IM weekly block schedules are available on AMION; PGY1s take role ‘IM-1A’ and PGY2s take role ‘IM-2a’ for their assigned ED blocks.)

ASSIGNMENTS –> SEE EMAIL YOU GET 

Shift Trades

If you would like a particular day off, the best way to accomplish this is to swap! We are happy to help facilitate these, and they are common among EM residents. To arrange a swap: 

  1. Find a buddy: Look at the group schedule to identify a swapping partner.  This should be a another resident at a similar level of training who can trade with you without duty hour violations.
  2. Ask: Ask them to swap! (Note that swaps are voluntary, so please do not pressure somebody into a swap they’d rather not take, and let us know if you are feeling unduly pressured by someone else.)
  3. Submit through Shiftadmin: Once you and your partner agree on a swap, request the swap through ShiftAdmin and we can approve it. If you’re having difficulty processing the swap through ShiftAdmin, you can email us (EMChiefs@partners.org) and make sure to cc the resident you’re swapping with.  This is often the fastest way to process multi-resident trades without confusing the chiefs.
  4. Confirm in ShiftAdmin: Your partner will receive a swap request through ShiftAdmin that they must accept/confirm.
  5. Enjoy Your New Schedule!: Once your partner has confirmed the swap, we can process the shift through ShiftAdmin and your new schedule(s) will become official. 

 “Day One” Overview

DAY ONE IN THE EMERGENCY DEPARTMENT

Welcome! The goal of your shift is to work hard, learn a lot and keep on top of your patients. The ED is great for getting exposure to procedures and resuscitations. A key learning point is the balance of pushing yourself to see more patients (encouraged) and not feeling overwhelmed by your patient load (discouraged). Don’t be afraid to ask for help – EM is a teammate sport. The attending and senior EM resident want to know about sick patients in the department; it’s better to err on the side of oversharing than sit on a patient you’re uncertain about. Here’s your guide for the first day:

  •     Arrive to your pod with enough time to stash belongings (under desk/in cubbies or in the break room) and sign in before the start of your shift. For your first shift, we recommend 15 minutes early. Find a free computer (ask which ones are OK to use). Make sure your pager is on you and working. If at MGH Acute, sign into Voalte. 
  •     Introduce yourself, your year/residency and your shift to the attending and senior resident if they’re available. If they’re not at the workstation, make sure you know the attending’s name so you can find them later. Tell them it’s your first shift. 
  •     Log in to Epic under “Emergency Medicine Context” and open the trackboard.
  •     “Sign in” on Epic for your shift – the button may be under “More” at the far right (see below). 
  • Check in with “Current role” as an “ED Provider: Resident.” (hit 1 or start typing the word to navigate to Resident). Pick your Care Area and hit the closest button at the bottom to your shift length (usually 10), then hit “Accept.” 

 

  1. Pick up a patient! The EPIC ED Trackboard will show all patients in your unit of the department. Organize the list by “LOS” or length of stay (shortest at the top). Look down the list of providers (column “P”) and see if there is a recent patient without an assigned provider. If that box is empty (blue, without initials), you can take the patient! 
  2.       “Sign up” for the patient by right clicking on their name and selecting “Assign Me”.
  3.       Look at the patient’s triage note and vitals but do not try to review the whole chart before entering the room – ED patients are undifferentiated. Some patients may have evolving or unstable clinical pictures or be in significant pain or distress, and triage is only a snapshot. Our goal is always to see patients soon as possible. If a patient has no triage vitals documented, ask an ESA or nurse to obtain or document them, but don’t delay entering the room. 
  4.       See the patient. Be systematic but succinct. If you walk in the room and think “oh no,” trust that instinct and go get a senior/attending.
  5.       Go back to a computer, gather your thoughts and document (<5 min) a short HPI & PE, then present to the attending ( or the PGY4 in Acute). As you get more comfortable you can put in orders before presenting.
  6.       Once the plan is decided, enter the patient’s orders and touch base with their nurse if the nurse is available to make sure you’re on the same page
  7.       As soon as you’re confident of your patient’s likely disposition – discharge, admission, observation – start getting the wheels in motion to get your patient out of the ED. Talk to your senior and prep the discharge instructions/prescriptions, enter obs orders, etc. 
  8.       Review the ED trackboard and repeat with the next new patient.
  9. We recommend using the “Workup” tab in the ED Trackboard view
    •       To access this, click the arrow on the right side of your screen in the trackboard view
    •       Select “Workup”
    •       There is a place to update the ED course
    •       This can be pulled into your notes using “.edcourse” and is a great way to document your MDM in real-time.  

 10. Once you are carrying multiple patients, remember to take 5-10 minutes between seeing new patients to review data on your current patients, including labs, imaging, and consults. 

11. When there is one hour left in your shift, review your patients for the oncoming team. Pass off upstairs who you can, prep obs/discharge orders, and make sure you know the next steps for each patient’s clinical course. If it’s very busy you can still pick up patients, but it’s overall more important for flow at this point to tuck the patients you have.

12. Sign out your patients to another provider (preferably a provider who is early in their shift to decrease handoffs). Don’t be surprised if you get a lot of questions – this is just part of a safe passoff. 

13. Sign out of Epic. Finish & sign your notes. Go home! Congrats on completing your first ED shift!