managing senior phone: (646)887-5933
Role of AM Managing Senior
Patient Care
1. Receive sign out on patients being admitted to CHAM from:
a. ED
b. PACU
c. Transport attending (schedule on Qgenda)
d. PICU transfers
2. Assign patients being admitted/transferred to the floors to appropriate team based on patient diagnosis, patient acuity, team census, and team staffing and give sign out to team senior. In cases of patients with complex courses, the managing senior will direct the transferring provider to the correct team senior to give sign out.
a. Sign out all pending admissions to the appropriate team senior prior to change of managing senior shift.
3. Keep track of census on each of the 5 floor teams, including number of complex patients, acute patients, and team staffing. Sign out these aspects of the teams to incoming Admitting senior at the change of shift.
4. During morning sign-out and morning rounds, admit patients to assigned teams.
a. Supervise or distribute admissions with intern jeopardy from 4pm-6pm.
5. During the rest of the day, provide assistance with procedures, accompany patients to imaging/procedures off the floor. Help out with clinical questions that come up on the floors, or with PRRTs.
6. If there is a concern based on signout received, or per admitting attending request, assess patients in the ED/PACU for appropriate admission location (floor vs PICU). If there is a discrepancy between bed assignment and level of patient acuity or a potential mis-assignment of admitting service (e.g. PHM vs subspecialty), discuss with back-up PHM attending (Yellow attending).
7. The Managing Senior should NOT be involved in bed assignments or isolation.
8. Provide any consults that are needed for patients admitted to the Epilepsy Monitoring Unit on CHAM 6. These consults can be discussed with the PHM attending providing support to the managing senior (back up PHM attending). 5:30pm - Check in with floor seniors to see which patients have already arrived and which patients still have to be admitted. Any patient who has not yet been admitted needs to be signed out to the PM Admitting team.
Role of PM Managing Senior
Patient Care:
Receive sign-out from AM Managing Senior at 6PM, sign in as responsible providers and Yellows team.
Admit patients who still need admission prior to 6PM
Continue to receive sign-out throughout the night on new patients to be admitted to PHM service
Interns should primarily admit patients and Senior should review medical chart, examine every patient and review management plan.
For subspecialty patients and PICU transfers, floor teams will do their own admissions.
If the admitting team reaches 10 patients, if many patients arrive at once, or if there are many high-acuity patients on the admitting team, the senior can make the judgment to sign the admissions out directly to the overnight floor seniors.
5am: Senior starts making final decisions about which patients will go to which day teams, assigns interns to sign out some of these admissions, and reviews the Handoffs in Epic and signouts on these patients with those interns.
If an admission arrives to the floor after 5:30am, you should eyeball the patient and put in orders, then sign the patient out to the AM Managing Senior so that they can do the admission at 6am for a floor team.
Managing Senior Orientation Slides
Managing Senior Checklist and Grid (Print Version)
New Guidelines for Consultation to Adolescent Medicine Service (updated 6/2024) and Admission Criteria for Adolescent Medicine Service (updated 6/2024)
List of Patients Who Arrived without Signout (must sign into Monte Outlook)