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Sunnybrook CTU JMR Orientation

Mario Corrado PGY4

Sunnybrook Chief Medical Resident 2026-2027

Chiefresident@Sunnybrook.ca

Cell: 514-708-0114 Pager: 4727

Office – D416B

Join the Block 2 WhatsApp group and text Mario (514-708-0114) if you haven’t already!!

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Introductions

  • Name

  • Level of training

  • Program

  • Colour (CTU) Team

Please pick up your CTU Team Lanyard!

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Outline

  • Introductions → Juniors stay in E325, after intros seniors head to D4
  • GIM at Sunnybrook
  • Logistics
  • Daytime Ward/Call Processes
  • Overnight On Call Processes
  • Code Blues
  • Illness/Support

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GIM @ Sunnybrook

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GIM Teams Structure

C4

C6

C4

D2

4 Clinical Teaching Units

Staff physician +/- Junior Attending

Senior resident (2 per block – 2 weeks)

2-3 Junior residents (GIM + off service)

2-3 Medical students

D407 (1324)

Back of C6 (4321)

Back of C4 (4947)

D240 (1530)

Non-CTU Teams

C6

K3E

K3E

Silver Team – Short Stay Unit + Flex offload

  • 11 beds Short Stay (C6)
  • 7 beds offload (anywhere)
  • Attending staff +/- GIM PGY4-5 +/- Hospital Fellow

Orange Team – Hospitalist Team

  • 16 beds (K3E)
  • Attending staff + Hospitalist Fellows

Purple Team – Family Practice Team

  • 16 beds (K3E)
  • Attending Family Medicine staff

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Level 1 Beds

          • 6 “Level 1” (aka “Step-Up”) beds on C4 (beds 32, 34, 36, 38, 40-1 and 40-2) to be shared between Blue and Green Teams (3 patients each)
          • Every IM resident will split time between the different teams so will care for Level 1 patients for 1 or 2 blocks (juniors) or 2 blocks (seniors)
          • Transfers in and out to be handled at staff-to-staff level
          • YES – BiPAP, HFNC, close monitoring, frequent labs, suctioning
            • e.g., hypoNa, DKA, ALS, COPD, severe CHF, seizures, EtOH withdrawal
          • NO – vasopressors, intubated patients, arterial lines

C4

C4

If you have concerns with these patients, or there are any admissions/transfers, INVOLVE YOUR SMR!

NEW as of March 2026: New start HFNC or BiPAP on patients who are full code are EXCLUDED (i.e., cannot come to a L1 bed)

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GIM Allied Health Professionals

  • Team Based
    • Pharmacists

  • Ward Based
    • Nursing colleagues
    • Physiotherapists
    • Occupational therapists
    • Social workers
    • Speech Language Pathologists
    • Dieticians
    • Team Leaders
    • PAAs

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Teaching on GIM

Monday

Tuesday

Wednesday

Thursday

Friday

9-945AM

GIM Orientation (1st Monday)

Morning Report

Morning Report

Morning Report

QI Rounds (FKA M&M) or Special topic (wellness, equity etc.)

Level-specific Morning Rounds

12-1PM

Grand Rounds

*no rounds July-September

+Team-based teaching

Post-call residents excused!

Attendance at Morning Report is mandatory. You are highly encouraged and expected to attend all noon rounds as well

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Logistics

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How to Get Here

  • Driving
    • ~ 20-30 minutes from downtown, ~10-15 midtown
    • Routes - Mt. Pleasant or Bayview Ave
    • Parking – several lots, rates variable (Ex: $133/mo)

  • Shuttle – departs Sunnybrook from H wing
    • 7 days / week (excluding holidays)
    • Picks up from WCH (Grosvenor St.) and HOAC

  • TTC – TTC buses from Lawrence and Davisville subway stations
    • Bayview 11 Bus
    • Lawrence 11C/52G Bus

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Where to go, what to wear

  • Where to go?
    • Morning Report → 9AM
    • Team Rooms
      • Yellow Team = D2 (D240 – code 1530)
      • Green Team = C4 (Team Room back of C4 – code 4947)
      • Blue Team = C4 (D407 – code 1324)
      • Red Team = C6 (Conference Room at back of C6 – code 4321)
    • Where can I leave my stuff? Resident Lounge – D477 (code 2351) or request a locker through NIRVsystem

  • What to wear
    • Scrubs → Scrub machines can be found on H-ground, M wing (G,3,5,7)
    • Not Scrubs (business casual)

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Call Rooms

  • Located on C8 (take B, C, or D elevators to 7th floor then stairs up to 8)

Room #

Occupant

Passcode

C844b

C8 lounge

Keycard access

C845b

SMR (ED resident)

543

C845c

Resident Yellow

251

C845d

Resident Green

243

C845e

Resident Blue

421

C845f

Resident Red

8456

C856a

MCR

524

C856b

CNG

253

D407

Blue team room

1324

D416

Door outside CMR and James’ office

2145

D477

D4 resident lounge

2351

D470

Med consults meeting room

James has key

 

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Backup/home call

  • When on backup call, you are on call – if you are on backup call and are sick, you need to let us know ASAP.

  • Activation for illness/absence
    • We try to avoid if absence known ahead of time by arranging cross coverage/arranging a swap if possible (if appropriate based on trainee level/experience)

  • Activation for volume
    • Current trigger is 5 unassigned consults in the ED should prompt discussion with staff +/- CMR
    • Underutilized, activated colleague does not need to stay all night

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Communication

  • Pagers → Please ensure you have a valid Sunnybrook pager for the duration of the rotation. We do not have team phones, on call all pages regarding team patients will come to your pager.

  • Whatsapp → Non-secure, but monthly Block group chat used to communicate about food (!), call, on the fly updates.

  • Email → Always use you @sunnybrook email for any communications related to patient information. Login is the same as your computer login.

  • Remote Access → Through VDI Horizon, can be setup and used if need to access email or Sunnycare remotely.

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Dragon Dictation

Download PowerMic Mobile

Click on the appropriate link:

Apple Powermic Mobile link: dmic://config_?NmsToken=NTMxOTk1RjktRDUxRS00NjVELUI1NjMtRjA4RkUxMDRCMTNF&NmsBaseUrl=nms-ca.nuancehdp.com

Android Powermic Mobile link: http://config_/?NmsToken=NTMxOTk1RjktRDUxRS00NjVELUI1NjMtRjA4RkUxMDRCMTNF&NmsBaseUrl=nms-ca.nuancehdp.com

Create a new profile (first name.last name as in your Sunnybrook email)

Add auto-texts (for templates) if you wish

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Food and Drink

  • Coffee/Tea
    • Monday to Thursday on CTU – courtesy of Division of GIM
  • Free Weekly Lunches
    • Tuesday, Friday – courtesy of Department of Medicine
  • Daytime (closing between ~3PM – 7PM) – M wing food court, Harlequins (E wing, open 11:30am-1:30pm) Odette Cancer Centre (full service Tims)

  • Overnight caffeine/food needs – Second Cup, 24/7 Pizza Vending Machine

Pearl – download HeyChef app to order ahead

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Daytime Ward Processes

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GIM as a Junior Resident

  • Typical CTU Daytime

8:00-9:45AM

Morning report, review cases, team teaching + handover

9:45-10:00AM

Patient care

10:15-10:30AM

Bullet rounds

10:30-12:00PM

Patient care

12:00-1:00PM

Lunch +/- GIM Rounds

1:00-2:30PM

Patient care

2:30-4:00PM

Review patients (“run the list”), team teaching

4:00-5:00PM

Finish up notes and outstanding tasks

+/- attend all Code Blues if on call that night

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Documentation

  • Sunnycare – All of our patient care notes are documented and found in Sunnycare
    • Progress Notes
    • Consult Notes
    • Discharge Summaries
    • Procedure Notes
    • *Advanced Care Planning* - if you have a GOC conversation with your patient on admission or during hospital stay, use ACP note to document.

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Documentation

Documentation Pearls

  1. Do NOT Copy and Paste → Leads to outdated/erroneous information being carried forward, and lack of fresh thinking about existing patient issues.

  1. Write as you go → Do not save until the end of the day/after rounds. Can wait to sign off your note after reviewing plan with the team.

  1. Keep discharge summaries up to date →Don’t save D/C until the last minute - it will save you so much time to keep them up to date on a day to day basis.

  1. Be mindful → Other healthcare professionals, consultants, and most importantly patients read your notes on a day to day basis (MyChart). Use professional and respectful language, and think about how others will interpret what you are documenting.

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Order Entry

  • Paper Orders → Bulk of order entry
    • Medications – new order, change, discontinuation
    • Investigations – bloodwork
    • Nursing communications (EX: Please remove foley catheter)
    • Discharge orders “Discharge to Rehab @ 10AM”
    • Special forms → GOC forms, MRI reqs*, EMG/NCS etc.

*MRI forms now have to be filled out electronically (form on Linktree) and then printed + faxed

  • Sunnycare Orders → Mostly used on admission/transfer/discharge
    • Admission order sets
    • Transfusion orders
    • Admission/transfer/discharge medication reconciliations
    • Admission labs

When admitting overnight, please try to do as much order entry on the computer as possible!

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“EPR” Orders

  • At Sunnybrook the majority of our imaging orders/IR procedures are entered through “EPR” which is accessed via Sunnycare:

  • Once you are in EPR you need to select the “provider” aka your GIM staff. The specific imaging orders (ex: CT Chest) can be found via the “search” function or manually. Select by double clicking. 🡪

  • Before signing any orders ensure you are in the right patient’s chart to avoid incorrect order entry.

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Order Entry

  • Pearls for writing orders:
    • For each new order/list of orders you write include the following:
      • Team (i.e Green Team)
      • Date/Time
      • Clear instructions (ex. “Lasix 20mg IV daily – first dose now”.)
      • Avoid abbreviations (ex: Lantus 20 UNITS QHS, not 20 IU QHS)
      • Signature + designation (M. Corrado PGY4 GIM)

    • Flag all new orders in the chart

    • For any urgent/stat orders - communicate these directly with the RN.

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Reviewing Medications

  • The most up to date patient Medication Administration Records (MARs) are found on paper hardcopies in the medication rooms on each ward (D2,C4,C6 nursing stations)

  • Pearls
    • Review the hard copy MAR for each of your patients every day (Sunnycare Meds list may not be up to date)

    • Reach out to your Team Pharmacist for any med questions

    • Ensure home medications are accurate when admitting patients - check Connecting Ontario, nursing/retirement home MAR, call family/community pharmacy etc.

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Medication Reconciliation

Mandatory for all inpatients!

What is it? A way to reconcile in-hospital medications with home medications, based on the BPMH taken by the pharmacy team

Who can do it? Anybody on the team (including medical students - must save as draft + review with resident/staff). Ask your pharmacist for help!

How to do it?

When looking at team list on Sunnycare, look for red exclamation marks and click on them

Complete the med rec (decide what to continue, what to hold, re-order missing home meds) - see next slide

Sign and print - and place in patient’s chart in Orders section to flag to nurse (copy sent to pharmacy automatically)

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Medication Reconciliation

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Patient Communication Tools

  • Language Line (real time remote access to professional interpretation)
    • All wards have interpreter phones available + you will be provided the language line client IDs at the beginning of every rotation to use on your personal cell phone.
    • All wards also have iPads (larger screen for video interpretation)
    • There is also the Language Line Insight app that can be downloaded to your phone for instant audio or video interpretation
      • Sunnybrook GIM username: SHSC General Medicine
      • Sunnybrook GIM authentication code: 9F8HBGW8BT
  • See CMR Link Tree for more details on how to access professional interpretation!

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*MANDATORY* Buddy Badge System on D2 and C6

Current units:

  • K3C
  • D2
  • D7 (RTBC)
  • D4IC
  • C5
  • C6

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Expectations on E-monitored units

1. Scan QR code at kiosk upon entry to unit

Personal code (registered staff)

Generic code (guest staff)

2.Provide patient care

Green light confirms clean

Buzzing signals moment missed (in future)

3.Return badge to kiosk when leaving

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Consults

  • Reaching Consultants
    • Page through Sunnycare → start with 1st call. Will include patient MRN/name + allow you to enter call back number + short message.
      • Alternatively can page through Sunnynet or by calling locating (#4244)

    • Pearl → Call consultants early in the day.

    • Not hearing back? Page again, if still having issues then let SMR/staff know – can escalate to 2nd call etc. Do not wait until the afternoon to let your team know you haven’t heard back.

    • Please liaise with your SMR/Staff about the need for

a consult before calling!

Rad Onc consults

  • Fax paper referral to x6002
  • Request will be triaged and patient seen within 24 hours

Addictions consults: page 2389

On weekends, all subspecialty consults for GIM patients go directly to the fellow/staff (not MCR)

Geriatrics consults

  • Call 63194 and leave a message with patient info, team/staff, and background/question

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Rapid Response Team (call 5555)

  • Call if your patient is sick… but not Code Blue
  • Staffed by ICU
  • Typically 5-10 minute response time
  • Examples:
    • SBP 70s, appears sick but still awake and responding 🡪 Rapid
    • SBP 70s, not responding 🡪 Code Blue
    • Tachyarrhythmia 180bpm but maintaining blood pressure 🡪 Rapid
    • Tachyarrhythmia 180bpm with worsening HoTN, altered LOC 🡪 Code Blue
    • Concern for possible inpatient Code Stroke 🡪 Rapid

If ANY uncertainty at all or unable to reach Rapid, just call a Code Blue

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Procedures

  1. Thora, para, LP kits in clean supply rooms on wards
  2. Review the Procedure Manual (in CMR GoogleDrive)
  3. Ask for help (SMR, CMR, staff)
  4. Grab cart U/S in Blue Team room (D407, code 1324) or the butterflies (located on D2, C4, C6, and K3E)
    • YOU MUST SIGN IT OUT, and make sure to clean it and plug it in when you return it

Want to get in touch with (Interventional) Radiology? Access the schedule here:

https://app.qgenda.com/landingpage/sbmi

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Discharging Patients

  • Discharge Summaries are completed in Sunnycare – can be saved while in progress (start as early as possible during admission).

  • *Medication Reconciliation* Review with senior, team pharmacist. Be thorough and think critically about what you are prescribing/deprescribing. Don’t forget mitte, LU codes, PRN instructions.

  • Follow Up Instructions – for providers/patients. Be as detailed as possible + always remember to include the following:
    • “If you have questions about your admission or do not hear about any follow-up appointments, you can email GIMclinic@sunnybrook.ca.”

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Post-DC Rapid Referral Clinic

  • If you are arranging GIM rapid referral clinic follow up for your patient, complete the following steps:
    1. Send an email to postdischarge.rrc@sunnybrook.ca with the patient’s name, MRN, date and time you would like to see them in follow up (1:00 – 2:30PM), and the associated attending physician/resident who will be seeing the patient.

    • Bloodwork pre-visit → Provide the patient with a Sunnybrook requisition (or outpatient req) with the investigations you want.

    • At time of discharge include the following instructions
      • “You are booked for a follow-up in the GIM Post-Discharge Clinic on _______ at _____. The clinic is located at CG-13 (C wing, Ground floor, room 13). If you have questions about your admission or need to call about your appointment, you can either email postdischarge.rrc@sunnybrook.ca or call 416-480-5108”
        • There is a Dragon Dictation guide on the CMR Linktree with a template for this!

*Patients seen in RRC must be reviewed with staff prior to leaving*

Special note for Geriatrics referrals: Please ensure the referral includes complete details including staff doctor’s name, extension and fax number, otherwise it will not be booked!

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Bridging Care Clinic

The DFCM has a new clinic in B1 where they are seeing patients without a family doctor that are discharged from hospital (within 1-3 weeks) for:

  1. Follow up on acute issues
  2. Preventative care
  3. Attach patients to a family doctor and bridge that care to a new GP

How to refer: Fill out and fax referral form. The PAA will call the patient with their appt date and time.

*See Dragon Dictation Templates in CMR Link Tree for what to copy/paste into DC summary!

Criteria:

  1. Patient does not have family physician
  2. Valid OHIP coverage
  3. They live in the Sunnybrook catchment area, which is north of St. Clair, west of Don Valley Parkway, South of Shepherd and East of Bathurst Street

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Redirecting GIM Patients to KMH (New 2026)

Starting July 2026, a patient could be redirected from Sunnybrook ED to KMH Cardiology/GIM Clinic if ALL are met:

  • Hemodynamically stable:
    • SBP ≥ 100 mmHg
    • HR 50–100 bpm (or baseline)
    • SpO₂ ≥ 94% on room air (or baseline)
  • No active ischemia, shock, syncope, or altered mental status.
  • No IV inotropic support required.
  • Patient is able and capable to attend KMH Cardiology Clinic within 24–72 hours, with reliable follow-up, and understands return-to-ED instructions.
  • If patient has cardiologist, GIM assessment is that they cannot be seen reliably within 48 hours
  • GIM senior resident and staff physicians agree that the patient fits the criteria.

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Redirecting GIM Patients to KMH (New 2026)

Patient could be redirected to from Sunnybrook ED to KMH Cardiology-GIM Clinic if ALL the inclusion criteria are met, and NONE of the exclusion criteria is met:

SMR can approach the PAA in the ED who can book a follow up directly at KMH (after reviewing with staff)

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Feedback while on CTU, subspecialty, and life

  • As part of your residency training, you will be receiving plenty of formal and informal feedback through various mechanisms:
    • Mid/End of rotation verbal feedback
    • EPAs
    • ITARs
  • As a resident, you will also be asked to provide formal, anonymous feedback through POWER at the end of the rotation for attendings (and medical students)
    • This is important since it helps to ensure that everyone is at their very best!
  • Tips on feedback
    • Almost all feedback that you receive is informal and purely for your development as a trainee. Not every evaluation will be “glowing” - that would be doing you a disservice
    • Learning how to provide feedback constructively is a skill/art and we will discuss this throughout the rotation.
      • “Staff X can change their teaching in this way” vs. “This staff is a terrible teacher”

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Overnight On Call Processes

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GIM as a Junior Resident

  • Typical CTU Nighttime

5:00PM

Overnight call starts

6:00PM

Night meeting @ Second Cup– SMR, JMRs, CC3/4s, Orange Fellow, MCR

5:00-~6:00AM

See and review overnight consults with the SMR

5:00-8:00AM

Manage overnight ward issues

~7:00-10:00AM

Review new admissions with Attending Staff

Overnight Responsibilities

  • See new consults + admit to your own team
  • Manage ward based issues
  • Junior member of Code Blue Team

Call Team

  • SMR – reviews admissions from ED, covers CTU team, Code Blue leader
  • JMRs – 3 total (one covering each CTU team)
  • CC3s
  • MCR – Silver and K3E admissions
  • Orange fellow – K3E and K3C

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GIM as a Junior Resident

Weekends

  • At Sunnybrook weekend call starts at 9:00AM
  • Daytime
    • Meet your Attending Staff +/- overnight resident in Team Room to review the list of patients and decide on plans for the day
    • ~9:00AM – ~5:00PM (usually finish earlier) round on assigned patients
      • Please note that all juniors are expected to start a consult before 5 PM
    • No bullet rounds on weekends, but some Allied Health members will be present
    • Attend all Code Blues
  • Nighttime
    • Meet your SMR at 6:00PM at Second Cup
    • See assigned new consultations and admit them to your overnight team
      • New consults may be assigned to junior residents on call on the weekend early in the day depending on ED and ward workflows
    • Manage ward issues
    • Attend all Code Blues

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ED Basics

Green Zone

Monitored stretcher area

Continuous monitoring possible

Rooms 14-28

Blue Zone

Monitored stretcher area

Continuous monitoring possible

Rooms 1-12

Orange Zone

“Ambulatory” medical patients

NO continuous monitoring

Rooms 29-38

Purple Zone

“Minor” patients�EENT, extremity and skin issues

Rooms 39-47

*Colours have no association with GIM Teams!

Consult room in hallway between Blue 2 and Blue 3!

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JMR Responsibilities

  1. Consults
    • SMR will assign and review consults
    • After reviewing must do the following:
          • Post consult note
          • Write “General Internal Medicine Advance Care Planning/Goals of Care” note in SunnyCare + fill out paper orders (blue and green sheets)
          • Complete admission order set on SunnyCare, print the orders, then place in orders bin
          • Add new patients to team list (this is NOT automatic) and ensure sign-out is updated
  2. Ward coverage for your team
    • Ask SMR for help if needed. If SMR unsure or unavailable, contact staff
  3. Part of Code Blue Team for 24h (unless flying-in, then start at 5:00PM)

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Completing Consults

Internal Medicine Consult Note Structure:

  • ID
  • RFR
  • PMHx / PSHx
  • Medications
  • Allergies
  • Social History
  • HPI
  • Examination
  • Investigations
  • Impression/Plan

Approaching Your Overnight Consults – Workflow

  1. Chart Review (pre-seeing patient)
    • PMHx/PSHx 🡪 Sunnycare (if previously at Sunnybrook), Connecting Ontario, patient/collateral
    • Home medications 🡪 Connecting Ontario, patient list, nursing/retirement home MAR. Can always try calling community pharmacy if unsure

  • Patient assessment → See and examine the patient/obtain collateral history
    • Note 🡪 Vitals/meds administered in ED are in paper ED chart

  • Review/Admission → Order investigations, discuss case with SMR, admit

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Admitting Patients

  • Patients at Sunnybrook are admitted through Sunnycare. Steps will include the following:
    1. Orders tab → Search “admission” and select “Admission – Internal Medicine Standard”
    2. Enter the “Responsible Provider” aka your attending staff
    3. Complete all sections of the Order Set including diagnosis, monitoring, activity, diet orders, VTE prophylaxis etc.

    • Enter allergies
    • Enter home meds through Sunnycare + complete medication reconciliation
    • Can order additional investigations via Sunnycare (or on paper), imaging via EPR
    • *paper orders if needed 🡪 EX: insulin, delirium order set, Goals of Care
    • Copy the patient to your respective Colour Team list in Sunnycare

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A Note on Paper Orders

  • The following come up frequently overnight so be aware that these will need to be completed on paper:
    • Insulin orders → for any patient on home insulin, or for whom you are ordering a sliding scale this will need to be done on paper (found in ED consult room)

    • MRI requisitions (MRI forms now have to be filled out electronically (form is on Linktree) and then printed + faxed)

    • Goals of Care forms

    • Delirium order sets

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Delirium Order Sets

Fill out a delirium order set!

Created with input from our geriatrics team based on Choosing Wisely recommendations

Includes:

Investigations (metabolic work-up, imaging, etc.)

Non-pharmacologic management

Pharmacologic management

Available on C4, C6, D2, and in ER (blue and green zone)

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L1 Transfers Overnight

Example scenario: Red team patient needs a L1 bed, open L1 bed under Blue team, Green team staff is staff is on call

Steps:

  1. Red team resident discusses with SMR + Red team staff +/- ICU (if involved) about need to move patient to L1
  2. Red team resident writes L1 transfer orders and hands over to Blue team resident
  3. Blue team resident assesses the patient once in the L1 bed, writes a new consult note (as MRP has changed), and amends orders as necessary
  4. GIM on call staff (I.e. Green team staff in this case) should be made aware of the transfer by SMR

Reminder that all ins/outs of L1 should be discussed with on call staff!

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Reviewing Consults in the Morning

  • In the morning, you will review all admitted patients with your staff as well as handover any overnight ward issues
    • It is helpful to print out your consult notes so you have it on you during your case presentation, but this is optional
    • It is also helpful to write ward issues on a patient list as they happen so you do not forget�
  • NOTE: As a JMR, you may be asked by SMR to admit a patient to Orange and/or Silver
    • If this happens, page the staff of that team at 7AM to review the case, usually by phone. Reminder that this is a full review just like any other consult

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  • Please support the use of our CHASM non-pharmacological care protocol for the prevention and management of delirium

https://sunnynet.ca/Default.aspx?cid=124366&lang=1

  • Antipsychotics should only be used for severe behavioural symptoms that are not manageable with non-pharmacological interventions alone. Remember to reassess the patient’s response and antipsychotic dose every 24 hours

https://sunnybrook.ca/content/?page=dept-med-div-geri-senior-friendly-antipsychotics

  • A Behavioural Support Specialist can be consulted for the management of patients with high risk behaviours

Contact: Lynne. Downey @ Sunnybrook.ca

  • Use language that is specific, objective and respectful when describing responsive behaviours

Vague Language

Specific Language

agitated

“person leaning over bedrail, voice getting louder”

aggressive

“ while being assisted to a standing position patient pulled PT’s hair”

confused

“ unable to recognize family members “

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Antimicrobial Stewardship

  • The Sunnybrook Antimicrobial Stewardship website is an excellent resource for antibiotic information, dosing, treatment guidelines.

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Thrombosis Resources

  • The Sunnybrook Thrombosis service has several great resources available on Sunnynet → can be accessed by searching “Thrombosis” and selecting ThromboEmbolism and Anticoagulant Management at SUnnybrook (TEAMS).

  • Examples include
    • VTE Management Toolkit
    • Cancer Associated Thrombosis Treatment Guide
    • Peri-procedure Management
    • Reversal of Anticoagulants
    • many more!

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Code Blues

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Code Blue

  • Cover all units and wings of main building except ICU/ED (ABCDEFGHJMSTU)
  • A separate team covers K-wing
  • Code team leads:
    • Weekday: PGY2/3 or hospitalist fellow on med consults
    • Weekend day: Hospitalist fellow on Silver team
    • Nighttime (7 days per week): Senior Medicine Resident On Call
  • Junior members are all residents/students who will be on call that night (24 hours unless flying in from off-service rotation)

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Code blue pager

SENIOR

  • Day: Member of med consults team (weekday) or Silver fellow (weekend day)
  • Night: On call SMR

Handover at D416 alcove at 8am (9 am on weekends/holidays) and 5pm

JUNIOR

  • Usually held by medicine junior, but can be held by any PGY1 who has done ACLS if there are no medicine juniors
  • Attend all code blues even if you are not physically holding code pager
    • Exception: residents flying in start as member of code team at 5 pm

There is a SBK Code Pager WhatsApp group that Mario will update every month to facilitate smooth transfers for SMR pager

All cardiopulmonary arrests are protected

(i.e., droplet + contact precautions + N95 mask).

No CPR/AGMP = routine precautions.

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Code Blue Locations

*Must go through Ground Floor to get to F- and T-wing!

Cover all units and wings of main building except ICU/ED (ABCDEFHUMST)

A separate team (ICU) covers K-wing

Info on dedicated “second Code Blue” team coming soon

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Tracheostomy Decannulation

The complete Sunnybrook Decannulation drill for patients with tracheostomies can be found here on Sunnynet.

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GIM JMR FAQs

Who do I ask for help?

    • Daytime -> your ward senior, Staff physician, Chief resident
    • Nighttime -> overnight SMR, call your staff, overnight MCR, Rapid response
    • Anytime + worried about patient stability -> Code Blue or Rapid Response!!

Do I go to Morning Report post call?

    • Not required. Overnight residents are not expected to attend morning report. You will meet your staff at a mutually agreed upon time to review new cases and handover overnight issues.

Do I do subspecialty (EX: Respirology) call?

    • In general, no: Unless you are on Cardiology or Nephrology, on subspecialty rotations you will be part of our CTU Call Pool.

What does back up call mean?

    • On days that are you are scheduled for back-up, you do not need to be in the hospital overnight unless you are called in.
    • You must be available to come in to work in the event that a member of the call team is unable to attend their shift (e.g. due to illness) or if patient volumes are high and additional support is needed -> keep your phone and pager on you at all times!

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Illness and Support

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What if I feel unwell?

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Want to debrief/need support?

Have questions or concerns about something that happened on-call?

Make a mistake or wonder if something should have been done differently?

It happens to all of us!

No matter how big or small, come find your friendly CMR to chat ☺

Other Wellness Supports

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Key Contacts

Site Director: Kevin Singh

416-689-8215 kevin.singh@sunnybrook.ca

CMR: Mario Corrado

514-708-0114 Chiefresident@Sunnybrook.ca

Education Coordinator: James LeBlanc

sbdom.education@sunnybrook.ca

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Key Resources

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Questions?

Come say hi and grab snacks, D416B