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Medical Students can put a table of contents here with tips for future students.
Record Collateral in Epic
Residents will often ask students to help gather collateral information by calling family members or close friends of the patient. Use the free app Doximity or one of the hospital phones to make these calls. Do not use your personal cell. The information collected in these conversations should be recorded in a Medical Student Collateral Note. Use the dot phrase .psycollateral to get the template. You will need to add this dot phrase to your own smart phrases in order to be able to use it.
In order to add a dot phrase in Epic: click Tools–> drag Smart Phrase Manager in to the tool bar–> Open Smart Phrase Manager–> change the user to someone that has the desired dot phrase (ie any of the residents in the format Last name, First name)–> scroll through their dot phrases and select the one you are looking for (possible to add multiple at once)–>Click add Smart Phrase.
As you are gathering collateral, pay special attention to the social history. You can use the dot phrase .socdoc to access a social history template. The social history can then be copied from the collateral note into a separate tab on epic (see section on Social Documentation). Copying the social history in to this separate tab is helpful because then that information can be autopopulated in to future progress notes.
If you need a translator to talk to a family member, use one of the hospital phones and dial 9-210-358-1100 before calling the family member. Follow the telephone prompts. The translator can then dial the person you are trying to reach.
Update signout
- Signout a list of the patients with a summary of their scheduled and prn medications. Students can really help the residents by making sure that signout stays up to date.
- Signout (labeled as Database1) is located on S:\managed\Psychiatric Services\ed materials\Handoff\Database1. To get to the S drive, go to Documents\data (\\uhsdata)(S:). If you do not have access to this file, you can ask Melissa Holmes, the Care Coordinator, for help.
- Once you have access to Signout, be sure to add yourself as the student to the appropriate team. In order to do this, open Signout and click the button that says “Edit Team Assignments.” Pick your team color. In the row that says “students,” click “add” and add your name and year (ie Suzy Que, MS3). (If you do not have a color team assigned yet, a resident will assign you to a team on your first day).
Social Documentation
- In Epic, open the appropriate patient's chart, and press the triangle button near the top right of the screen to get to the history menu. (If you do not see it once you click the triangle, check and see if it is already one of you tabs.)
- You can add in the social history information in the social documentation section.
- You can pull in the social history with the .socdoc dot phrase.
- In order to find a dot phrase in Epic: click Tools–> drag Smart Phrase Manager in to the tool bar–> Open Smart Phrase Manager–>change the user to someone that has the dot phrase (ie any of the residents) in the format Last name, First name–> scroll through their dot phrases and select the one you are looking for (possible to add multiple at once)–>Click add Smart Phrase.
Hospital Course
- Please update in s drive. In order to get to the s drive: click the windows icon–> click the paper icon in the left corner (if you hover over it, it will say documents)–> click this PC–> click data(\\uhsdata) (S:)
- Hospital Courses are located on S:\managed\Psychiatric Services\ed materials\Hospital Course under your team color and Month. Use the hospital course summary template found in the S drive titled “HCRA ss version.”
- The resident can copy the hospital course into epic. The hospital course section is hidden above the problem list.
- Click the problem list tab and scroll up to reveal the hospital course section.
Hospital Course tips
You do not need to include every prn and order. The hospital course needs to communicate the major events during the hospitalizations. This often includes consults, medical issues, and a general idea of patients response to medications. A risk assessment should also be included (it is a part of the template).