Kia's Guide to Bayview

[Kia Afshar]

Hey everyone,

 

I just finished 6 weeks of continuous Bayview love and I decided to pass on some of the stuff that will help those who havent had the experience (at least help you on the first few days working there or your first night on call). If people want to add stuff to it and continue to pass it on (or put it in the Osler manual), that is perfectly fine and there is no copyright on it. I have also attached it as a word file. Take out the vulgarity if one decides to disseminate this widely (or at least take my name off of it).

 

Hope this helps,

 

-Kia

 

 

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IDIOSYNCRACIES OF BAYVIEW COMPARED TO DOWNTOWN

-The extension for almost everything at Bayview is 410-550-xxxx. So you will get numeric pages that are either 3494 or 03494. The four digit pages are supposed to be five digit pages with a 0 in front (but they will leave that out 50% of the time). The five digit numeric pages are equally as the annoying as they are in JHH, so that isnt any different.

 

-The nurses are actually helpful, supportive, and nice. It is the freaking twightlight zone. Some of them actually like their job. The MICU has Paul and Kristy... two of the most pathologically nice nurses ever. Then there is their arch-nemesis - Doug - he is a dick. But almost everyone else is great. There is a respiratory therapist that competes with Doug in who is a bigger a-hole... but be careful if you decide that you want to walk into the nurses conference room and announce to everyone that you think he is a total prick because he happens to be married to one of the MICU nurses (whoops!). Otherwise, the nurses are overall great and pleasant and total team players.

 

-When you thought that the ER couldnt be less helpful, they continue to surprise you at being less helpful than one can phathom.

 

-You are less of a consultant as the Unit resident because admissions are determined by the hospitalist running around with their head chopped off. You can convince him/her and/or the ER attending that the patient doesnt need an ICU bed, but it is a fine line and should only do it if you really really really think it is absurd or that they patient would benefit from the other Unit. Blocks can happen and diplomacy helps. The hospitalist is known as triple-O-nine because his/her pager is 30009. They sometimes see the patient but usually dont - they trust the ER's triage.

 

-EPR labs are not as updated as quickly as they do in Meditech. The most recent labs are 10-30 minutes delayed. So if you are waiting for a lab, check Meditech, not EPR.

 

-You still get panic value pages in all capital letters - these people need to take an online module on "Communication - How to Not Piss Off People". You still need to repeat and spell your name, but you dont need to repeat all the other shit.

 

-Collection of labs - Phlebotomy collects labs at 0500 and 1230 (1230 only on monday to friday). In the case that you want phlebotomy to collect labs, type in these times and place a "N" for no in the "nursing to collect" box when in the details box of that lab. If the patient has a central line or it is not around these times.... just do "Y" under "nurse to collect". Otherwise... if you need to stick the patient near 0500 or 1230 have phlebotomy do it so the nurses dont hate you.

 

-There are two 1st floors. The lobby floor is M01 and that is where the cafeteria is. The 1st floor has the ED (seems like it should be the 2nd floor). Follow the signs to the ED.

 

-The code to get in the MICU supply room is 1 and 2 (together) and then 5. I forget the code for the CCU I think it is 2, 3, 5.

 

-The code for the call room (which is located between the MICU and CCU) is 2121313.

 

-Starting soon (11/2007), the H&Ps will need to be done through the computer (kinda like EBMC). No more paper H&Ps. I have no info on that since I did not have the displeasure of having to go through that.

 

PARKING

In order to get parking at Bayview you need to email Eileen Bolcer and give her your JHH ID number. It is the 7 digit number about your name on the ID.
 
The way to get to Bayview and park is that you drive down Eastern Ave and when you go over the I-895 overpass the second light is Bayview Blvd. Turn left at that light and then veer on your first right towards the East Parking Garage (follow the signs). Drive a little bit. You are not allowed to park in the East Parking Garage (covered lot). You need to park in the East Parking Lot (outdoor lot)... which is about 100 feet further. You need to drive by the East Parking Lot to the point where you are almost passing it and the road is veering right to get to the street that leads you to the entrance. Slide your JHH ID and you are in. 
 

LOCATION OF CCU/MICU
To get to the MICU/CCU you walk into the side of the hospital under the big ass metal blue awning (which is across from the East Parking Garage (covered lot). Walk around the information desk and turn left. Walk all the way to the end - turn left at the dead end and walk by the ATM machines. Then turn right at the dead end and walk down to the end of the hall towards the cafeteria. Near the entrance to the cafeteria are the Red elevators. Go up the elevators to the 4th floor and turn left when you get out. The Cardiac ICU is the first thing on your right once you get through the double doors and the MICU is a little bit further on the right. 
 

RADIOLOGY

Unlike JHH, radiology reads are not in EPR until 2 weeks after later. You either need to go down to radiology and read it with them or call this dictation line. I started off doing neither - I just read them on my own because the other options were intolerable. You still get the panic phone calls if there was a pneumothorax or perfed bowel... but then came the week of GI bleeds and tagged red scans when I learned how to call the dictation line. The dictation line and reads can be obtained by:

 

1) Dial 04480 or 04481 or 04482

2) #1 (after you hear a beep)

3) 6789 (after it asks you for your doctor's number)

4) Dial the patient's MRN as a 9 digit number. If the MRN number is less than nine digits... fill it in with zeros at the front. (eg 000454123)

5) To control the dictations.... 5 is next and 4 is rewind/previous. I think you need to push 5 at the end of each dictation to go to the next one, it doesnt do it automatically.

6) Try to figure out what language the dictation was in and see if there is translator on the floor to help you.

 

They have ultravisual but the username is your Hopkins email username and your password is your Hopkins jhed account. So it is not the same as your Hopkins Bayview login and password. You cannot access downtown Hopkins radiology except through EPR (not ultravisual).

 

MEDITECH 

1) when you log onto Meditech (which consists of many programs) you will basically only use the EMR program in the top left corner. The one exception is when you first log on to Meditech you need to get a PIN (which is your electronic signature). That icon is located in the bottom and is self explanatory. Your PIN is basically your signature that needs to be typed in whenever you want to activate an order. No order goes through unless you have signed your PIN.

 

2) On Meditech/EMR to find a patient you have three options (EMR is a single click program - no double clicks):

a) Click on "Any Location" on the right which is basically like the "In" button on EPR which just gives you a list of floors.

 

Or you can....

b) Click on "Any Record" which is the same as "find patient" on EPR.

 

Or you can....

c) Click on "Recent Access" which is basically the last 20 patients you have looked at.

 

When you click on a patient (single click)... it will give you a list of all the admissions and diagnoses and you can go into any of those hospitalizations. You basically click on the top one which is the current admission. The first time you access an admission for a patient it will worn you that you are looking at a new patient's record and this will be logged and Big Brother is watching you. Click "Yes, screw you HIPAA."

 

Once you get into a certain patient's record you basically will use 2 to 5 of the tabs on the right. The main tab that you will use 90% of the time you are on EMR is "ORDERS" which is towards the bottom of the list on the right. When you click on ORDERS you will get a view of all the MEDS (including ones D/C'd in the last 24 hours and those given once). You can sort it by ACTIVE meds by clicking the "Status" bar at the top. You can see which LABS, IMAGING, NURSING ORDERs, DIET....etc...etc by clicking the + box and expanded the list. It is self explanatory once you see it.

 

The easiest way to order something is to go to the bottom of the screen and click either on MEDS or ORDERS depending if you want a medication/fluids vs labs/nursing/imaging..etc..etc. From the stuff to the right of it click on NAME which gives you a search bar to type what you want. The search bar functions like the "%" sign in POE where whatever you type searches everywhere for that thing. Just type what you think and it will likely show up. You do not need to use the "%" sign.  

 

For example: you search: echo. You get a list and you want the 2d Echo. You click on 2D Echo once and it highlights it. Then you click on it again and above the list of choices you will see the "0 selected items" change to "1 selected items." At that point to go into more detail in the echo order... you click select at the bottom... to basically expand your selections. Another option is to search more orders and increase the number of selected items and then go into more detail of all the orders at once. For example, instead of typing BMP and changing the # of selected items from 0 to 1 and then clicking select to go into the timing...etc..etc. You can type BMP and make it a selected item and then search CBC and make it a selected item (increasing the total to 2). At that point, click select and it will go into more details for both. 

 

For MEDS things are a little more difficult. So search glipizide and you see glipizide or glipizide XL with empty check boxes to the left of the choices. Click on the empty box to put a check box in it and make it a selected item. At that point I click on "select" right then. When you do that you will get a list of dosages. place a check mark where appropriate. That will highlight the choice. At that point click the "EDIT" button on the way right. After entering your desired route (PO)...etc..etc. You click "SAVE" at the bottom. At that point something illogical happens... you go back to the list of dosages and need to click SELECT again to make the order a pending order. All pending orders are lit up in GREEN font under Status. To make any green order active... you need to click SAVE and then input your PIN number and click FILE AND REFRESH. During MED orders you will sometimes get drug interactions pop-up. Just click OVERRIDE.

 

Labs are funky. Check the dates after the orders to make sure it is right. Sometimes you have to justify ordering a lab twice in one day.

 

A few wonderful options under ORDERS. You can order ADD ON to add on labs instead of calling pathology. There is also COLLECT which you can say "please get q6 crits". It is like a free text but cannot be used for something like, "please hold Lasix dose." it is generally used for collection stuff.

 

When in doubt on what to do.... click on SAVE or SELECT. It will never be a mistake to do so and usually leads you to the next appropriate screen.

 

ORDER SETS for "CICU admission" and "cardiac isoenzymes" (q6hrs markers) and "heparin protocol" are important to know that they exist.

 

The other things not within the ORDERS tab that you will use are the VITAL SIGNS, LABORATORY, MICROBIOLOGY, and maybe MEDICATIONS and ORDER HISTORY. They are self explanatory.

[Ganesh Muthappan]

Dude. Awesomeness.