To start, you will be fine, we all survived this and you will too, just try to get better

everyday.
Thank you to Dr. Grasso for creating the bulk of this document. This will be a living document so
if anyone else wants to add to it go ahead. I will try to add things as I remember them.

Useful websites
SLRchiefs: https://sites.google.com/site/slrchiefs/ I usually just google slr chiefs
Useful for transfer lists, what tubes to use to get labs, all kinds of stuff, look at this before
the first day.
SLRchen: https://sites.google.com/site/slrchenzhao/ google slr chen
Great for surviving night float, starting floors, tackling basic floor issues out of the gate.
Night float survival guide is extremely valuable for nights and days.

Needed before you start:

Every rotation:
Prism Access
Documentation room code: 315#
Seamless Access: Different from Psych seamless account and there is separate for St. Luke’s and
Roosevelt. You can order the night before up until I think 930 the same day. Will be delivered to noon
conference at 1215.
Clinic: Access to ECW

Things that will make your life a lot easier:

Floors/Night Shift: Access to EmStat; Access to Forms on demand
Asking residents/co-interns for help

Floors(Colored team names-they are all basically the same):

Weekends: 2 Gray, 1 gold, 1 black
Arrival: 7 AM(645 Jitny-if the jitney is 10 minutes late that’s fine)- Meet in the Med Lounge to get signout
from night team-(SL-7th floor near, Roosevelt 10thfloor)
Signout: 445-515(Realistically plan on staying later, at first)
Call Q4 days. Weekday Calls: signout 830 (Again plan on staying later in the beginning)
Weekend Non Call 7-230, Call 7-830

This is the hardest block by far. Good news is everyone is super helpful, the seniors and attendings
understand the struggle and expect very little actual medicine knowledge from you. I asked my senior
about 100 questions a day and they are always happy to teach/help out. Your main job is basically to be
the eyes/ears/hands/feet of the attendings.

Before 1st day: Make sure Prism is working. Get signout the night before-the person should reach out to
you but if not reach out to them. This way you have a teeny idea what’s going on with your patients.

1st day-Will be a shit show but that’s okay.

-Meet in the med lounge to get signout from the night team at 7 AM. Meet your resident and update them
if any events overnight. Get their number.
-Then from like 715-915 is when you will go and see your patients(brief <5 minutes/patient). For
attending rounds you expected to have the overnight events, how patient was that morning, vitals, labs,
any recs from consults you called the day before, some idea about what you want to do and questions.
Morning report occurs during this time as well. Monday is intern report usually at 7:15, Tuesday is
resident report, Grand rounds are Thursday at 8:30 and yes Kay, they service breakfast, the chiefs will
announce changes at signout to this schedule.
- 915 Is Interdepartmental rounds (IDR’s aka social work and nursing rounds). They take place on each
unit so you stop by each unit. “Mr._____ in room ____ admitted for _____. Comes from nursing home.
Plan to go back to nursing home in _____ days. _____are the barriers to discharge“ Talk to your
resident and ask what to say for everyone)
-Rounds: SOAP format for old patients. Residents will present any new patients. Obviously attending
dependent but for the most part not too bad. You’re not expected to be an expert on your patients on the
first day but do what you can.
-After rounds: Make a plan with your resident-(they’ll show you how to put in orders/call consults etc.)
Afternoon:
-Follow plan with your resident.
-Update signout and contingencies. This is done in an online at listrunnerapp.org (Ask your resident for
help and for log-in info to LIST-RUNNER, try to use SBAR format- basically 1 liner about patient, anything
major that happened that day. Code status. And what to do in case stuff happens overnight. (IE-preferred
meds for pain, sleep, agitation, fever, SOB, CP, and any likely emergencies).
-445-515- Meet long call person for signout. In one of the Documentation rooms. They don’t need to know
about every patient. Just sick ones and anything they need to do.

Noon conference: 12:15-1:15. This is where seamless will be delivered to. Attendance encouraged
however I missed a lot because I was too busy. Or went late.

Other General Info:

Call Shifts: Get signout in the Documentation room(SL7th floor) (3-4 other lists). Pagers will be
forwarded to you. You can sign out to night float at 830. (Forward your pager and then finish up whatever
work you have left)
Weekend Shifts: you will cross cover 1 other list from one of the other teams. You can find the cross
cover lists on the chiefs website. Usually yellow covers blue and vice versa. This list will stay the same
throughout the month. Ask your resident or co-intern which list it will be. Get the contact info of that
person. When they cover for you, send them a signout the night before with anything that they will need to
follow up that day. (if you are following anything). They will do the same for you. After a shift that you
cover for them email them with any pertinent updates. (Patient was anemic so transfused, not patient
burped twice).

For each patient daily:

See patient
Write Note
Check AM labs (usually don’t get back until you are in rounds)
Order AM labs for the next AM(Resident will help you at first)
Update Signout and contingencies

Discharges:(Again have resident walk you through the first time)

Discharge summary with Follow up appointments made via. Pt navigator(operator).
MD Discharge instructions(Under Orders)-
Med Reconciliation and prescriptions(hardest part(for me) not intiutive-have resident walk you through-
ask as many questions as needed
Place discharge order- Order-”discharge once”
If you know that a patient is going home the next day, place an “intent to discharge within 24 hrs” order.
This activates the hospital’s logistical team to push things that need to get done like PT/OT evals, SAR
paper work, all kinds of stuff that might be a barrier to discharge get done all of a sudden. This is only if
your patient is medically ready to leave.

Admissions: Your resident will come with you to ED. Print ED note from EmStat to help you out. You’ll get
history etc. You’ll write H&P. Take a stab a assessment and plan and work with the resident to flesh it out.
Resident will put in all the orders including the next days AM labs.

Morning report: For interns monday morning from ______________. Attendance highly encouraged. But
again missed some days because shit is crazy sometimes.

HIV/Geri/Red team 2-weeks:

Weekends: 2 Grays
HIV (Pink team) - two week block, cross cover is with your co-intern (makes so much more sense than
covering some other team you know nothing about, in this situation you at least hear about the patient
day to day). Basically your four person weekday team splits in half, one intern and the resident one day,
the other intern and the attending the next day.

Dedicated social worker so no IDRs on this team. Dedicated pharmacist because the drugs are
complicated and ever changing, utilize these people.

Weekday call is called orphan call. No resident. No admissions. Cover the stroke, red, and other pink list

Cardiac (Red) - similar setup to HIV except more of your patients are on 10 east and 9 east (aka the
telemetry floors). Call is the same as HIV.

Neuro:
Make sure you have a pen light, reflex hammer, tuning fork 128hz, stethoscope, wooden q-tips for
sensation testing, pager.

Weekends: Alternate 1 Golden and 1 “sick coverage” (Off but should stay within an hour of the hospital:
You only get called in if someone gets call in sick-(4 weekends neither Richard or Jesse was ever called)
Weekdays: 8 or 9AM to 5 PM(No set AM time, just have to be ready for rounds 1015 or in the afternoon
usually.)

How it works: It’s a consult service, you and the Attending(and maybe a student). As teams have
questions they’ll ask you for consult. Which basically means a full H&P and then Recs. You’ll carry pager.
Be sure to call the operator on your first day and ask them to make the Neuro Consult pager for either SL
or RH your pager number for the next two weeks.

As new consults come in send a 1-liner to the attending. Then generally, you go see them yourself(or with
student) and do full history(with social/family/ everything) and physical(cardio/resp/gi/complete neuro)(for
follow up patients just neuro exam is fine).

Diamond: Nice, new, less formal. Loves teaching, very helpful for getting more confident about the neuro
physical exam. Morning rounds. Usually left at 4:30.
Patterson: Nice, will usually round in the afternoon and often staying past 5. Writing notes very late (had
to write notes remotely every night!) since she publishes her notes around 8-9 PM.
Kepecs: Nice, slow, will never sign off on patient’s so as the list grows(>10), ask her which patient see
wants you to see each day. Usually in afternoon. She takes up a lot of time to go to the radiology room
and review scans with the radiologist.
Delfiner: Head of neuro, old school, great teacher

Before First day : Get signout the night before from whoever was on before you. Find out which attending
you’ll have, and get their number. Text to introduce yourself (or do it morning of).

1st Day: Some attendings round in the morning others in the afternoon.
-See follow up patients on the floors.
-ICU patients: Usually just get vitals, any drips, Ins/Outs and overnight events-usually just the attending
writes notes for ICU patients.
-As consults come in, return the page- get the information and then text the attending with a one liner.
-Attending to attending is different on whether they want you to prioritize new or old patients.

New Consults: When consults come in make sure to at least get: Pt. Name, room number, 1 liner. Neuro
workup so far. Neuro workup planned. Consult question. Then basic info to attending and see patient.

Consults only make recs, do not put orders in. Occasionally you will see an attending put an order but
most things are supposed to go through the team.

Neuro has an independent Listrunner that is used by the attendings as well. Someone has to add you to
the list who is already a part of it. Usually the person signing out to you will do this if you ask. Keep it
clean and up to date. Also used by weekend attendings who are covering so Fridays put in instructions on
which patients need to be seen and what we are following.
Subspecialty Clinic:
Asthma, Endo, GI, Rheum, Chest, Pulm, Smoking cessation, Sickle cell
Weekends: 1 Golden/ 1 Saturday Night float shift (aka WARP)
Full day: 9AM to 5 PM
Thursdays is lecture so you get out a little earlier
2 days of the week you have afternoon “sick coverage” ie only get called in if someone calls out. (Tues/Fri
for me). Richard never got called in.

How it works: Show up, get your own room. Log-in to ECW and PRISM. Ask the nurse where your charts
are. Grab a chart, look up patient in the computer. (ECW for old notes and Prism for labs/tests). Then call
patient. See patient. Minimal physical. And then present to preceptor in preceptor room.
It’s a much slower pace. I saw 1-3(usually 2-3) patients per clinic.

Before First day: Get access to ECW (E-clinical works)

1st day: 845 Jitney: St. Luke’s Clinics on 2nd floor. Roosevelt-”specialty clinics” on 2nd floor. Have a
resident quickly show you the basics of ECW.

Endo/GI basically: Mostly just pick up a chart, spend some time reviewing it in ECW. If it’s a follow up
look at old notes, see why they’re here. Google it if you forgot all medicine like me. Then call patient. See
patient. Minimal physical. Then present to preceptor and have a LITTLE idea of next step.

Asthma/smoking/chest-talk to fellow or preceptor first before you start taking patients.

Rheum: Check in with the resident/fellow. Sometimes there is a pulm fellow who is there to see the
complicated cases.
Sickle: Talk to preceptor before you start taking patient.

Thursday Lectures: In the afternoon. Start at 130 Roosevelt in the Medical education office. Attendance→ We’re
supposed to go and there is a sign in sheet with our names on it. Yes, you really have to go.
Night Float
Weekend: Off Saturday night
Start 830 PM (815 Jitney)
Signout: 7 AM
Leave: Monday/tuesday leave 915 AM after morning report. Otherwise leave after you signout.

How it works:
You’re covering the floors for stuff overnight. Sleep/pain/anxiety meds + in case stuff happens.
You can also get up to 3 admission. You have a second year to do admissions with and to ask
questions and stuff comes up overnight. Schedule is wacky but it’s a pretty good rotation and
there are a lot of colleagues around so it’s not a lonely as CPEP nights.

1st Day: Show up, wait for people to sign out lists to you. Meet your residents. Get their
numbers so you can ask questions. Follow up anything the day team asked you to and wait for
pages/admissions.

Random Stuff:
Personal Days- should be asked 1 month before (not always necessary). Shouldn’t be on Call
floor days. Easiest to take on clinic. Usually can’t be on monday or friday

Generally they get psych people to cover psych people so if you call out or take a personal day
it will usually be one of your fellow psych intern (on clinics or consult) covering.

Eric(Intern Chief) is super nice. Sometimes he gets busy and doesn’t answer but he’s very
nice/good.
Cheat Sheet for Floors:
Doc rooms Code: 315
Roosevelt med Lounge: 123#
Stuy 9 call rooms: 2 and 4 together then 3
SL Med Lounge:_________
Forwarding/Unforwarding Page: Dial 05…..Then pager #.....then 01234 and listen to menu
From cell phone: dial 212-523-2828 and follow prompts.

List runner: www.listrunnerapp.com

SL: MSSLGenmed@gmail.com Password MSSLGenMed
(Mount sinai st. lukes)
Roosevelt MSWGenmed@gmail.com Password MSWGenMed

Daily Task:
-Make pager available
For each patient:
-Check vitals
-See Patients
-Check labs/tests
-Write Note
-Order AM labs
-Update Sign Out

Discharge tasks:
-Discharge Summary with Follow up appointments (Call operator then ask for pt. navigator)
-MD instructions “order” with appointments and placement
-Med Rec/PDI
-Discharge Once order (send documentation to jones,james)
-If it won't let you D/C b/c patient needs flu vaccine- there is an order set under orders. Have
someone show you how to get around it.

Running Question section