{"id":1399,"date":"2015-07-10T10:26:45","date_gmt":"2015-07-10T14:26:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=1399"},"modified":"2015-07-10T12:18:38","modified_gmt":"2015-07-10T16:18:38","slug":"transitions-of-care","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/","title":{"rendered":"Transitions of Care"},"content":{"rendered":"
\"\"<\/a>

Andrew Ip, MD, is a 2015-16 Chief Resident in Internal Medicine at Emory University in Atlanta, Georgia.<\/p><\/div>\n

Brief HPI:<\/u><\/strong> 3rd<\/sup> year resident, Asian-American male, from Philly, presented to Emory University as a wide-eyed intern July 2012, currently admitted to become a new Chief resident at the VA<\/p>\n

Meds<\/u><\/strong>: see EMR<\/p>\n

Pertinent Labs<\/u><\/strong>: see EMR<\/p>\n

Top Active Problems<\/u><\/strong>:<\/p>\n

    \n
  1. Computer Codes \u2013 missing but awaiting IT approval<\/li>\n
  2. Awaiting MRI of brain past 48 hrs \u2013 syncope work up<\/li>\n
  3. Psychosocial \u2013 extremely anxious to start chief-ing and leave behind a transformative experience in residency<\/li>\n<\/ol>\n

    Sign-out:<\/u><\/strong> NTD overnight<\/p>\n

    Anticipatory Guidance:<\/u><\/strong> If starts to have a panic attack about being chief, ok to give Haldol 2 mg IM<\/p>\n

    Medical transitions of care are never easy \u2013 just the thought of signing out patients to a night float resident frightened me as an intern. Even as an upper-level resident, I was unsure at times of my ability to properly hand off patient care. \u00a0The above example follows a standardized format to give a cross-cover provider a succinct overview of a patient\u2019s care, but things do get lost<\/em> in translation<\/em>. There is no better example of this at my residency program then the ICU month at our public safety-net hospital, Grady. Below is a graphic of our ICU sign-out structure:<\/p>\n

    \"ICU_Signout_structure\"<\/a><\/p>\n

    Our ICU signout process<\/em><\/p>\n

    This format keeps a team (1 resident, 2 interns) intact by avoiding any 24 hour calls; however it was extremely prone to sign-out mishaps and fragmented patient care. One case I will never forget ended up with a patient coding, likely due to hypoglycemia. During verbal sign-out rounds at 8pm, no one mentioned hypoglycemia; in fact, the call team (day team 1 in above graphic) did not even know much about the patient\u2019s history or reason for ICU admission. The written sign-out also left out the critical information that patient had a blood glucose of ~25 on arrival to the ER. This was the infamous sign-out of a sign-out we all dread from multiple departments, let alone in the MICU.<\/p>\n

    While medicine transitions of care sometimes leaves a sour taste in my mouth (thankfully, iCompare<\/a>, the flexible arm, will allow for a MICU 24-hour call system and hopefully address these sign-out issues), I want to now focus on a much different, non-medical transition \u2013 leaving residency.<\/p>\n

    As I signed out in the beginning, I\u2019m going through the initial pangs of transitioning to my new role as a chief resident. It is a wonderful opportunity to teach, mentor, and work on the administrative side of academic medicine. But leaving behind the wonderful class of 52 residents I\u2019ve worked with, laughed with, and cried with has made this transition so bittersweet.<\/p>\n

    \"EMORYMED-147_edited\"<\/a>

    Graduation June 17, 2015 for Emory Internal Medicine residents. Photo taken by Terrance Mason<\/a> \u2122<\/p><\/div>\n

    Many in my class will move away from Atlanta, GA — in fact, will move to 13 other states by my count. \u00a0The time I\u2019ve spent the past 3 years with these individuals has been transformative, a thorough \u2018through-the-fire\u2019 refining.\u00a0 Residency launches many of us into a maelstrom of clinical duty mixed with scholarship and rounded out with lifelong bonds formed from shared experiences that only other co-residents can understand. My experience was so intricately tied with who I worked with that I know the friendships and memories made will endure much longer than my career. So if you\u2019re a graduated resident, a graduating resident, or even a budding student doctor, remember to cherish the people you work with and the memories you make along the way.<\/p>\n

    \"Emory<\/a>

    At wedding of 2 Emory medicine residents!<\/p><\/div>\n

    One part of me is excited to transition to my new role as a chief resident, but the other part of me, ironically, doesn\u2019t want to sign out of residency. Is that so wrong?<\/p>\n

    I would love to hear other people\u2019s thoughts on transitions in their medical training, or even thoughts on transitions of care within the hospital!<\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

    \u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    Brief HPI: 3rd year resident, Asian-American male, from Philly, presented to Emory University as a wide-eyed intern July 2012, currently admitted to become a new Chief resident at the VA Meds: see EMR Pertinent Labs: see EMR Top Active Problems: Computer Codes \u2013 missing but awaiting IT approval Awaiting MRI of brain past 48 hrs […]<\/p>\n","protected":false},"author":1254,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[17,29,37],"class_list":["post-1399","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-chief-resident","tag-internal-medicine","tag-resident-experience"],"yoast_head":"\nTransitions of Care - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Transitions of Care\" \/>\n<meta property=\"og:description\" content=\"Brief HPI: 3rd year resident, Asian-American male, from Philly, presented to Emory University as a wide-eyed intern July 2012, currently admitted to become a new Chief resident at the VA Meds: see EMR Pertinent Labs: see EMR Top Active Problems: Computer Codes \u2013 missing but awaiting IT approval Awaiting MRI of brain past 48 hrs […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2015-07-10T14:26:45+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-07-10T16:18:38+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2015\/07\/AU000_ip_andrew.jpg\" \/>\n<meta name=\"author\" content=\"Andrew Ip, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Andrew Ip, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/\",\"name\":\"Transitions of Care - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2015-07-10T14:26:45+00:00\",\"dateModified\":\"2015-07-10T16:18:38+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/7ea2be628b2a6358367252390eef77c6\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/07\/transitions-of-care\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Transitions of Care\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/7ea2be628b2a6358367252390eef77c6\",\"name\":\"Andrew Ip, MD\",\"description\":\"\\\"In west Philadelphia, born and raised \u2026\\\" \u2014 OK, not really, but very close! 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