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VUMC Rotations

Structure Overview

Teaching Service Structure Patient Cap
Morgan 1-6 (Gen med) 1 resident, 1 intern 10
Geriatrics 1 resident, 1 intern 10
Rogers (Hep, ID, Pulm, Renal) 1 resident, 1 intern 10
Heart Failure (CHF 1 & 2 ) (one team) 1 resident, 2 interns 8 per intern (16 total)
Cardiology (Harrison 1 & 2) (two teams) 1 resident, 1 intern 10
Hematology (Brittingham A & B) (one team) 1 resident, 2 interns 8 per intern (16 total)
Oncology (Onc A & B) (two teams) 1 resident, 1 intern 10
VU MICU 1 & 2 (two teams) 3 residents, 3 interns no cap (typically 10-12)
VU Night: Admitting Morgan/Rogers 1 resident, 2 interns 10
VU Night: Admitting Harrison/Heme/Onc 1 resident, 1 intern 10
VU Night: Crosscover 1 resident, 1 intern N/A
VA Wards 1-5 1 resident, 2 interns 8 per intern (16 total)
VA Wards 6 2 residents 8 per resident (16 total)
VA MICU 3 residents, 3 interns no cap (typically 10-12)
VA Night: Admitting 1 resident, 2 interns 10
VA Night: Crosscover 1 resident N/A

Non-comprehensive list of non-teaching services you may interact with:

Non-Teaching Service Type
Riven General medicine
Scoville General medicine (NP, night admitting)
Page Campbell Cardiology
Advanced Lung Disease Service (ALDS) Lung transplant
Browning Hematology (benign + malignant)
Stem Cell Transplant Stem Cell Transplant

Morgan (1 – 6) (General Medicine)

  • Team: 1 Res, 1 Intern with patient cap of 10
  • Pagers: Morgan 1: 831-4765, Morgan 2: 831-4766, Morgan 3: 831-4767, Morgan 4: 831-4768, Morgan 5: 831-8481, Morgan 6: 831-4781
  • Pick up list at 6 AM in res library on 8N (code 431), admit until 5:30 PM, sign-out 6 PM
  • Admitting: Teams 1-3-5 & 2-4-6 alternate admitting days (just like VA)
  • Non-admitting teams can sign out once their work is complete as early as 2PM on weekdays and 12PM on weekends
  • Rounding time and meeting location varies by attending (typically between 7 to 8 AM)
  • Work room: team-specific rooms labelled on hall behind 7N Nursing station (Code 24300)
    • Morgan 5, 6 7755 (no code)
  • Huddle
    • Morgan 1
    • Morgan 2
    • Morgan 3
    • Morgan 4
    • Morgan 5 - 1340 on Teams
    • Morgan 6 - 1350 on Teams
  • Tips: get pharmacist's phone number 1st day, get case management/social work phone numbers, place consults as soon as possible (preferably before rounds once consult teams arrive at 7 AM)

Geriatrics

  • Team: 1 Res, 1 Intern with patient cap of 10
  • Rounds at 8 AM, team meets in the Round Wing workroom
  • Work room: 7434

Rogers (Subspecialty Services)

All Rogers services

  • Team: 1 Res, 1 Intern with patient cap of 10
  • Pick up list at 6 AM, admit daily until 5:30 PM, sign-out 6 PM
  • Each HPI usually requires special info about the patient’s subspecialty diagnosis; refer to primer documents that are available for most subspecialty services in the chief's "welcome to the wards" email, and see tips below

Rogers Hepatology

  • Rounds typically at 8 AM, team meets on 6MCE
  • Pager: 831-4782
  • Work room: 6MCE, room 6755 near the elevators (no code)
  • Review: Hepatology Section, Paracentesis (Procedures), and 'Surviving Rogers Hep' primer
  • Tips: structure one-liner as “cirrhosis secondary to ___ decompensated by ___ (EV bleed, ascites, SBP, HE, or HRS) who follows with ___ (hepatologist) and is ___ (listed / undergoing workup for / not listed) for transplant”; know patient MELD-Na scores (use the MELD-Na dot phrase or patient list column); anticipate at least diagnostic paracentesis on admission if any concern for SBP (abdominal pain, AMS, etc.)

Rogers ID

  • Rounds typically at 8 AM, team meets in Resident Library (8N)
  • Pager: 831-4779
  • Work room: 6 Round Wing, 2nd door on left after coming out of elevator (no code)
  • Tips: Each HPI for pt with HIV should include most recent CCC provider, CD4/Viral Load, prior AIDS-defining illnesses and compliance to ART; Use ‘Notifications’ tab on main screen in Epic to keep track of lab orders as patients can have long stays with send-out labs that can take up to two weeks to result (can also hit ‘Notify Me’ in dropdown box of Order)

Rogers Pulmonology

  • Rounds typically at 8 AM, team meets at 8N nursing station
  • Pager: 831-4777
  • Work room: 8 South 8216 (code 2430)
  • Tips: Each HPI should include most recent PFTs (FEV1% most important, include other relevant data or recent changes); For CF, Use the CF admission order set, know typical organisms in patient’s sputum (ex: MDR Pseudomonas, Burkholderia, MRSA) and consult CF team; for PH know the therapies they are on (typically Flolan or Veletri)

Rogers Renal

  • Rounds typically start 7-7:30 AM, team meets at resident/fellow work room on 6MCE
  • Pager: 831-4783
  • Work room: 6MCE 6772, behind nursing station with renal fellows (no code)
  • Tips: Each HPI should have renal transplant history with year, type of transplant, PRA, Ag MM, CMV D/R; 6MCE charge nurse can get pts transferred there; alert the night cross-cover resident to patients with recent renal biopsy and low threshold to contact renal fellow; transplant pts should have daily tacro level one hour before AM tacro dose (5:00 am), regardless of pt’s home schedule and be cautious with first dose timing of immunosuppression to keep on schedule

Cardiology Services (CHF, Harrison, and CCU)

CHF - Heart Failure (1 & 2)

  • Team: 1 Res, 2 Interns on one team with pt cap of 8 per intern (16 total)
  • Pagers: CHF-A: 831-6485, CHF-B: 831-6486
  • Pick up list at 6 AM, admit daily until 5PM (alternate admissions, resident to help assign)
  • Rounds typically at 7 AM, team meets at 7MCE nursing station
  • Workroom: 7N room 7024 right before bridge to 7MCE (code 145)
  • Tips: Know each patient’s dry weight (usually found in outpatient cards notes or at last discharge), know current outpatient diuretic regimen, know most recent TTE, RHC, and LHC results (keep this info accessible on rounds), order strict I&Os; Daily Standing Weights, and fluid restriction of 2L/day, obtain iron studies to assess need for IV iron, perform volume exams on patients before rounds

Harrison (1 & 2)

  • Team: 1 Res, 1 Intern on each team with patient cap of 10
  • Pagers: Harrison 1: 831-4769, Harrison 2: 831-4770
  • Pick up list at 6 AM, admit until 5 PM (Long) or 2 PM (Short)
  • Alternate long and short days with other Harrison team
  • Weekends: Only long team admits new patients
  • Rounds typically at 7 AM, team meets at 7MCE Nursing station
  • Work room: 5MCE 5181 (code 0701); hard to hear stats so keep door propped
  • Tips: To order heart cath, must be in the cardiology context in Epic “VUMC Cardiology VIR” (order listed as “Case Request Cath Lab” and use provider “Surgeon, Generic”)

CCU

  • Team: 3 Res, dedicated cards fellow, no specific patient cap
  • Pager: 831-6487
  • Rounds start at 7 AM on 5N with Interventional rounds, then Advanced Heart Failure rounds
  • Call room: 5229AA, on 5S behind the nursing station (code 1234#)
  • Supply room: on 5N (code 512), equipment/US room: on 5N (code 512)
  • Tips: make sure you have access to the Swan sheet folder, have someone show you how to fill in Swan numbers, make a new Swan document daily, make a schedule so you stay on top of q4h Swan numbers and frequent I/O assessments, familiarize yourself with IABP monitors and Impella care, have pre-call update any hospital courses the post-call resident wasn't able to do since post-call is busy presenting on rounds

Hematology (Brittingham) & Oncology

Hematology (Brittingham)

  • Team: 1 Res, 2 Interns with patient cap of 8 per intern (16 total)
  • Pagers: Brittingham 1: 831-4785, Brittingham 2: 831-4788
  • Pick up list at 6 AM, admit daily until 5 PM (alternate admissions between interns)
  • Rounds at 8 AM, team meets on 10T
  • Work room: 7MCE conference room (code 0701)
  • Tips: Each HPI should include malignancy history (dx, prior tx, current tx), utilize the 'treatment' tab to keep on track with chemo cycle/day, know the febrile neutropenia algorithm, if possible, enter orders/write notes while the other intern and attending are at bedside, low threshold to work any complaints up as bleeds, infections, and fevers are common and can be rapidly lethal

Oncology (A & B)

  • Team: 1 Res, 1 Intern on each team with patient cap of 10
  • Pagers: Oncology A: 831-4786, Oncology B: 831-4787
  • Pick up list at 6 AM, admit daily until 5 PM, sign-out 6 PM
  • Rounds at 8 AM, team meets on 11N at nursing station
  • Workroom: Varied; typically resident library, 11N or 10T, or 7MCE Conference room
  • Tips: Each HPI should have Onc history (Dot Phrase “.onchist”) including dx, prior treatments, most recent imaging; 10T and 11N charge nurse can get pts transferred there, know that patients admitted from infusion clinic must be seen and have orders placed (write delayed admission orders in advance of their arrival to floor bed)

VU MICU

  • Team: 3 Res, 3 Interns, no specific patient cap
  • Pagers: MICU 1 Intern Pager: 831-4759, MICU 2 Intern Pager: 831-4757. Need to also carry the team phone
  • Day Intern: 8 AM - 10 PM; Night Intern 9 PM - 11 AM
  • Rounds at 8 AM (start with half hour teaching most days)
  • Work areas: team 1 sits at computers across from pt room 8641; team 2 sits at computers across from pt room 8613; ultrasound/equipment room code is 4321#; break room code 4321
  • Tips: Day 1, figure out if you're the code team and where the I/O kit is. Night intern presents all the old patients in the morning and signs the notes. The day intern owns the A&P of the notes by keeping them updated. Trust the nurses and never hesitate to relay info to your resident overnight if you’re concerned (wake him/her up!)

VU Nights

  • Start on Sunday night for interns, Wednesday night for residents; off Saturday night
  • Team: 1 Res, 2 Interns with patient cap of 10 for Morgan/Rogers admitting; 1 Res + 1 Intern w/ cap of 10 for Harrison/Heme/Onc (Res and Intern split admissions)
  • Harrison/Heme/Onc: Start at 6 PM, admit until 5 AM, sign-out by 6 AM
  • Morgan/Rogers: Start at 6:30 PM, admit until 5:30 AM, sign-out by 6:30 AM
  • Cross cover: Start at 6 PM (Be on time!), sign-out 6:30 AM
  • Tips: ensure you communicate all orders and plans with the resident, writing “To do” boxes on the first pages of each printed H&P might help you communicate the important aspects of each plan to the day intern when they arrive the next morning, cafeteria closes at 2 AM. For cross cover, make sure to document any significant events in Epic. Useful to follow-up on pts admitted previous nights to reflect on your diagnosis and workups.
Last update: 2022-07-08 18:35:38