UW Medical Center Montlake Emergency Department

This is unpublished

UW Medical Center - Montlake

At UW Montlake, the attendings work on a waterfall schedule. Attending shifts begin at 0600, 1000, 1400, 1600, and 2200. You can staff your patients with whichever attending is available – if an attending is approaching the end of their shift, they may ask that you staff with the other attending or wait until the oncoming attending arrives. If you patient is sick or clinically unstable, notify an ED attending immediately. Depending on the shift timing, you may be staffing with the EM R4 resident instead. They will notify you if this is the case.

Dyad shifts are from 6a-2p, 2p-10p, and 10p-6a
Senior Dyad (SD): generally an emergency medicine senior resident except for Thursday mornings when the EM residents have didactics
- The SD resident typically will see the high-acuity medic patients and a large volume of the patients in the department. Depending on whether or not the SD resident is an EM R3 or R4, they may also be responsible for staffing patients who are seen by medical students and interns. SD residents staff directly with the attendings.
Junior Dyad (JD): generally an emergency medicine R1 or R2 except for Thursday mornings when the EM residents have didactics
- The JD resident may see the high-acuity medic patients depending on their comfort level. If the JD resident is an intern, they may staff with the SD resident if the SD is an R4; otherwise, they will staff with the attending.

Non-dyad shifts include the following: 10a-6p, 3p-11p, 5p-1a, 10p-6a
Non-dyad residents function similarly to the junior dyad residents. They can pick up any patient that is available to be seen. They will staff with any available medicine attending.
ND residents will sign out to either an on-coming non-dyad resident or the senior or junior dyad resident if there is no on-coming ND. Sign-out for ND residents occurs one hour prior to the end of their shift. The last hour is meant to be used for finishing documentation, performing any necessary procedures, discharging any patients who are ready to discharge, and finishing up any other tasks. If you are nearing the end of your shift, make sure you have been able to staff your patient with an ED attending before signout and have an appropriate plan in place for the patient.

Discuss with your attending or senior resident before calling a consult as the consult triage tree is complicated at UWML
To page a consultant, call the ED operator using the work phone (passcode 2240) and ask them to page the team you would like to reach. They will ask you for your name, the number you are calling from, and the patient’s MRN. Document within the ED course when you page.
Consultants are expected to call back within 20 minutes and to have seen the patients within 45 minutes unless there are extenuating circumstances. If you still have not heard back from the consult team within 30 minutes of the initial page, re-page them. Notify your attending if you have not heard back from the consultant within 1 hour of the page so the attending can escalate appropriately.

When your patient’s work-up is complete, and they are safe for discharge (please check in with your attending to discuss this), mark them as “Discharge” on the Dispo tab, insert their clinical impressions, order any prescription medications and place appropriate referrals, and attach discharge instructions. Once this is complete, scroll to the bottom of the Dispo tab and click “Ready to Go,” which will mark the patient as Ready to Discharge for the nurse.
Please make sure you check in with your patients, explain the results of their workup, care instructions, follow-up instructions, and return precautions with them before discharge
Enter all applicable Clinical Impressions in the disposition tab before you sign your notes

Once your patient’s work-up or presentation makes it clear that they need to be admitted to the hospital, discuss with your attending what team should be contacted for admission.
Page the admitting team, and they will call you back to receive sign-out. Once you have discussed the admission with this team, navigate to the Dispo tab, mark the patient as “Admit,” and then place a bed request by clicking the “Bed Request” button and selecting the appropriate team. During your conversation with the accepting team, clarify which service is accepting the patient so you can choose the correct team when ordering the bed request.

You may be asked to transfer your patient to UW Northwest (if they require admission, do not have Montlake-specific needs, and UW Montlake has limited beds) or HMC by either the ED attending or admitting service. Unless the transfer is medically necessary (ie. Trauma patient going to HMC), you must have a conversation with your patient about whether or not they consent to transfer.
If your patient is being admitted to a medicine service, the medicine triage provider will perform the transfer process. For all other services, you will perform the transfer.
If your patient verbally consents, place an order for “Transfer to Other UW campus”
- This will ask you to enter your phone number, patient’s diagnosis, whether or not it is an emergent transfer, the reason for transfer, and what team is accepting.
- Once this order is in, the transfer center will contact the appropriate team at the other hospital campus and call you in order to connect you by phone for sign-out.
- If the patient is accepted for transfer by the other hospital, please let the bedside RN and the charge RN know so that once a bed is assigned, they can arrange transport for the patient.