This is a brief overview of how patients should flow through the emergency department (ED) & your responsibilities in the department.  

1)   Orientation: will be at 9 am the first day of the rotation at the UCIMC ED and will be led by Irma Castañeda.  If you are scheduled for a shift the first morning, you do not need to arrive at 7 am as your shift will start after orientation is complete. 

2)   After the patients are triaged and put in a bed, their charts are placed in the rack in the Resident Room. The chart number on the upper corner of the clipboard indicates the room/bed in which the patient is located (beds 1-10; room CD, CPU 1 & 2; special care rooms 19-26, and ED3 rooms 27-36). Generally, charts on top are more emergent cases and should be seen first. When you initially pick up a chart, please note the vital signs. Do not spend more than 5-10 minutes with a patient before telling the R-3/Attending about the patient.
 

are 3)     On the ED Computer Grease Board write your name and the R3’s name you are working with under the “Resident” Column.

4)      Please introduce yourself to the patient as the fourth year medical student. H&P's should be focused on your patient's chief complaint which should be double checked. Document the initial time that you see your patient in the section of the chart marked "PHYS EVAL TIME." Also write your name, the attending name, the name of the primary care provider (PCP), and the name of the R3 on the chart in the spaces provided.

5)      After completing the initial assessment of your patient, please discuss the case with an R3 to formulate a plan and then you can inform the nurse assigned to the patient of this plan. Do not order tests or administer medications without first discussing the plan with the R3 or the attending. Fill out the order sheet & place it in the rack at the nurses' station in the appropriate slot under the direction of the R3. The R3 or attending will need to co-sign your orders before it is placed in the rack.  Check off the boxes for any lab work & radiographic studies in addition to entering the requests for these studies into the computer. Orders for medications, IV fluids, x-rays bedside tests or interventions to be performed should be indicated on the order sheet.  Almost all cat scans (except CT head and CT abdomen without contrast) and ultrasound tests will need to be immediately communicated to the radiologist so they can make appropriate arrangements with their radiology technicians.

6)      If at any time you feel that a patient is very sick, or you do not feel comfortable managing a patient, please let the senior resident (R3) or attending know right away.

7)      Reassess your patient periodically and give updates on care frequently; note any change in your patient's condition on the chart and inform your R-3 immediately.

8)      If any consultants are called, note the name of the consultant, their department, beeper number, and the time they were called.  Consults and Admitting Residents should preferably be spoken to by the R3 or attending.

9)      If your patient is to be admitted, an admission form must be filled out, reviewed by the R3 and the attending, and then given to the unit secretary. These forms are located at the nurses' station. Make sure you write the name and pager number of the admitting resident and service name on the Computer Grease Board.

10)      You should not take on more than two acute ongoing patients at a time unless you feel comfortable with the patient load and it is approved by the R3.

11)      You must complete your charts before the patient leaves the ED. This includes filling out the portion labeled "Medical decision making" (MDM).  The MDM should be filled out after discussion with the R3 or Attending.  The section mainly includes your differential diagnosis of the case and the life-threatening conditions you considered and the ones you excluded before discharging your patient from the emergency department.  Furthermore, you can also discuss reasons for admission (surgery, IV medications, etc…).  This section can also include the reasons why you did what you did for the patient and why you didn’t need to do more workup at this time.  This section is as important as the H+P section of your chart and should be completed with the help of your R3. 

12)  Don’t forget to sign your charts.

13)  Shift completion:  You will need to stay until all work-up with your patient(s) is complete and a final disposition (Admit, Discharge, Transfer, Etc…) has been made. When appropriate, the R3 or attending will indicate when you may leave or may discuss that with them if your shift time is over.

14) Schedule requests: The ED uses a template system for scheduling but prior requests can be considered if handed in ahead of time. All students must promptly attend orientation at 9am on the first day of the clerkship. Requests are limited to 2 days and must be emailed to Ms. Castaneda (iccastan@uci.edu), the clerkship coordinator, 30 days before the start of the rotation. The Emergency Medicine Clerkship follows guidelines set by the UCI School of Medicine, which does not allow for days off during Core Clerkships for interviews. You will receive your schedule approximately one week before the start of the rotation by email.

15)  Shift attendance: Before you miss a shift for medical reasons please call the senior resident on duty at 714-456-5705.  All absences will subsequently need to be excused by the Course Director prior to completion of the rotation by email notification to allow completion of the Clerkship.

16)  Shift Times: The rotation has three shifts, 7 am–5 pm, 5 pm–3 am, and (11 pm–7 am) for the 4 week students only). The Emergency Department has 2 shifts 7a – 5p and 5p – 3a. When there are 4 week students on rotation they will be assigned to the night shift (11p – 7a)

17)  ED 3 Patients: ED3 patients are similar to the main side but do not require cardiac or hemodynamic monitoring. 

18)  Schedule changes:  Schedule changes can be done by exchanging with peers.  Please keep the following in mind when considering schedule changes:

• Student lectures require attendance by students
• Students cannot do more than one shift per day and cannot follow the evening shift by a morning shift.
• All schedule changes should preferably be completed by the end of Orientation.  Changes should be e-mailed to Ms. Irma Castañeda (iccastan@uci.edu) and are subject to approval.

19)   Journal Club: is usually scheduled for the third Thursday of the month from 6:00 PM – 10:00 PM and attendance is encouraged for all students.  The location varies and is usually the house of an ED attending or resident.  You are excused from your shift to attend Journal Club but need to return to your shift as soon as it has ended.  If you are interested in attending please RSVP with Ms. Castaneda know so she can also get you a reading packet of articles.  You will need to have read the articles prior to attendance at Journal Club.

20)  Patient Sign-Out: patient sign outs go directly to the R3 and not to the oncoming student.