MGH: Blake 11

Renee Snow

Patient Population

Blake 11 is a 21-bed unit specializing in patients with active medical as well as psychiatric issues. ECT is a particular focus.

Patient Load

Residents carry 5 or 6 patients at one time.

Medical students follow 1 to 3 patients.

Team Organization

The unit is divided into two teams. Patrick Smallwood supervises two residents and together they carry 10-11 patients. Donna Digoia and John Matthews split the second team, with Dr. Matthews supervising 3-4 patients. Two residents are assigned to Dr. Smallwood, one resident to Dr. DiGoia, and one is split between Drs. Matthews and Digoia

Rounds

Rounds are held with the attendings and team from 8:15-10:30 daily. Specific styles of rounding are attending-dependent. On Wednesdays, residents leave for didactics no later than 10:15 am for T group.

10:30-11 is rounds with Nursing. Relevant issues and overnight events are briefly reviewed. This is followed by a wrap-up session with Dr. Matthews and staff. The DOC needs to attend wrap-up for daily admissions info.

Supervision

Residents have one hour of supervision per week outside of rounds with their team attending.

DOC Coverage/ Admissions

Each resident will be responsible for one day of DOC duty each week. As DOC, the resident covers patient emergencies on the unit when other residents are inaccessible (i.e. in clinic) from 8:00am to 6:00pm. DOC also attends the “wrap-up” meeting at 10:30 am when the day’s admissions are planned and delegated. The DOC is informed when new patients are scheduled and when patients arrive on the floor. Wed DOC duties are covered by the Chief & attendings.

Conference schedule

Conferences generally occur in the Blake 11 conference room, with Chief Rounds in the Chief Resident’s office.

Med-Psych Conferences

At the end of the three month rotation, residents will present a case with 1-2 discussants for the Med-Psych conference. Twice a year, 2 lucky residents will present their cases at Grand Rounds Wed at 11.

Admissions

New admissions are done by whichever resident has an open bed. There are three major sources of admissions: APS, outpatients, and transfers from other services. After 6pm, admissions come through the APS. The APS resident will write a brief admission note and admitting orders, to be elaborated upon by the Blake resident the following day. Admissions for the resident in clinic will be done either by the DOC or the other resident on the team, depending on work load.

Beeper Call/ Sign Out

Each resident will take beeper call coverage from home for one week each month. Duties include calling nursing staff (from home) at 10:00 pm every night to answer any questions, trouble-shoot, and give telephone orders. The APS resident covers Blake overnight. The DOC signs out with the APS resident at 6 pm each day to identify potential probs, labs to be checked etc. & then back in at 8 am the next day to discuss overnight events, admissions

APS Call

Each resident is on call in the APS from 6:00 p.m. to 9:00 a.m. on either a Friday or Saturday night once every two weeks. The morning after each call night, the resident has one hour of rounds in the APS from 9-10 am with the Senior on call, and then goes home.

Documentation

Residents write progress notes daily except on Wednesdays and clinic days (if time does not permit this). The attending is required to write a progress note daily.

Discharge Summaries

Residents are expected to dictate within 24 hours of discharge. Charts are then taken off the unit & sent to medical records. Remember to note which attending you are dictating for, and get their input regarding summary format. STAT dictations are needed for transfers to certain facilities. Transcription (6-2473) can help clarify the status of your dictation once you have dictated it.

Vacation coverage

Each resident gets one week of vacation during the 3 month rotation; and vacations the first and last week of the block are not permitted. The schedule is coordinated by the Chief and with the attendings to ensure coverage. In general, only one MD can take vacation at any given time. When a resident is on vacation, the resident on the same team assists the attending with coverage, but is not required to write progress notes.

Tips

· Scheduled admissions and transfers should not arrive late in the day. If this becomes a problem, ask to discuss it at wrap-up.

· Blake 11 provides a unique opportunity for residents to learn about ECT while following patients clinically during their hospitalization. Observe at least 2-4 treatments; more intensive training is readily available. Discuss scheduling with Chief & Dr. Charles Welch

· If you are DOC on Friday and also on call in the APS, be sure to delegate responsibilities so you are able to go to the ER by 6pm.