TGH Fly-In Call Resident Orientation 2026-2027

👋 Welcome to Toronto General Hospital

Please reach out if you have any questions that are not answered by this orientation!

tghcmr@uhn.ca�226-339-9860

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These slides and other resources including �admission guidelines are on the TGH Linktree

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I am more than happy to meet prior to your first�call shift to orient you to the site and/or Epic

Linktree

🏥 CTU structure

🌙 JMR call

🌙 Overnight call - SMR

There is an internist (AIM staff) who covers ED referrals daily from 12-5 PM (including weekends)

☀️ Weekend call - SMR

ED/med consults

Ward senior

Meet in ED consult room at 08:00. Responsible for ED referrals from 08:00-12:00 and med consults until 17:00. Handover to AIM staff at 12:00.

Meet in team room at 08:00. Round on team with staff/clerks.

Hold code blue pager (second code blue).

Back up for ED/MC resident if high volumes.

🌙 Overnight call - SMR

• Admission guidelines are found on the Linktree
• Referrals after 5 AM can be held for the day team; please assess and stabilize
• You do NOT cover medical consults to other services for admitted patients; please re-�direct to the medicine consults staff on call

Linktree

🌙 Overnight call - SMR

• There is an in-house nocturnist who admits patients followed by PMH medical, radiation, or heme oncology presenting with an issue appropriate for medicine admission
• They admit to the non-CTU teams (team 10, 11, DMOH)

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Sliding scale for nocturnist admissions:

• 15 or fewer total consults – nocturnist can admit up to 3
• 16-25 total consults – nocturnist can admit up to 5
• 26 or more total consults – nocturnist can admit up to 6, plus one additional for every 5 additional consults

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If any questions about nocturnist admissions overnight, please page the CMR on call

👥 Paging & communication

PerfectServe paging – You must have PerfectServe downloaded and sign into the team you are covering at the start of your shift. Please sign out when you leave the hospital. If you are senioring, sign into the ED referrals and med consults roles as needed.

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EPIC secure chat – Used for non-urgent communication. �Please sign in to your team on EPIC to be added to chats �and sign out when you leave the hospital.

🌙 FAQs

What should I do if volumes are high?

Where do I get coffee?

If volumes are high and you are feeling overwhelmed or unsafe, page the CMR on call through locating

How do I get in touch with the nocturnist?

Page them through locating

Jimmy’s Coffee **NEW**�Tim Hortons (closes 8PM, 6PM on weekends)�Danish Pastry House (closes 7PM, 4PM on weekends)�Robot Coffee in food court (24/7)

PerfectServe?!

Please see the separate orientation slides on the Linktree

🖥️ EPIC - Team list and signing in

Add your team list

Sign in to your team to be added�to EPIC secure chats

🖥️ Intro to EPIC – Team List

Available lists → Toronto General Hospital → Provider Care Teams → TG Medicine Team → Right click “Save as Favourite”

Make sure to set a log-out time

Click sign in at the top of your team’s list

Add your team and ensure all patients are selected

🖥️ Admitting

Update Most Responsible Physician

Admission Orders

Attach Consult Order to Note

Update your handoff

🖥️ Intro to EPIC – Admission Workflow

Add ED consults list

Available lists → Toronto General Hospital → New Consults - Provider → TG Medicine Consults → Right click “Save as Favourite”

1) Click on MRP physician name on left-hand side

2) Update MRP (your staff) under Attending and your team�under Provider Team

Use the Admission tab → Admission Orders OR the Orders tab�Search for “General Adult Admission”

Make sure to attach consult order to your consult note

Update handoff for day team

🖥️ Discharging

📝 Discharging at TGH

• Arrange post-discharge follow up (if needed)
• Medication reconciliation
• Print copies
• Fax copies

📝 Discharging at TGH

• GIM Post Discharge Clinic
• Place discharge order “Outpatient Referral to Internal Medicine” then select “Discharge Clinic”
• Enter any required labs or imaging as separate discharge orders
• If bloodwork is entered as a discharge order in EPIC, the patient will need to come to the TGH Lab (Elizabeth street entrance, ground floor) prior to their appointment to have blood drawn (no physical requisition required)
• Ensure patient has clinic phone number (will be included in AVS automatically)

📝 Discharging at TGH

• Medication reconciliation
• You can ask your team pharmacist for assistance
• You can select if you want prescriptions faxed or �printed. If fax is selected, ensure the pharmacy information �is up to date (ask the patient!).

📝 Discharging at TGH

• Print discharge summary and/or After Visit Summary for patients
• The After Visit Summary contains clinic contact information for all referrals made as well as upcoming appointments, so highly recommend printing this
• To print discharge summary: Chart Review → Notes → select discharge summary → select

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• Fax discharge summary to family physician and relevant specialists
• This is NOT done automatically
• Chart Review → Notes → select discharge summary → select