The Hospitalist Admitting Resident (HAR) serves as "Bed Czar" for all Children's National Hospitalist Teams including PHAST.  After an initial orientation period, the HAR is expected to perform all activities needed to ensure safe and seamless transitions onto the inpatient teams and perform additional actions to facilitate subsequent care.  A large portion of this job is communication and delegation.  This role is essential to ensuring safety during an extremely vulnerable time during a patient's hospitalization.

Responsibilities include:

 determining team patient load 
 triaging patients' appropriateness for the acute care setting by phone prior to assessing them in person
 determining whether a patient should be assigned to a hospitalist team or PHAST 
 facilitating ED throughput for admitted patients
 protecting patient safety during times of transition 
 generating a diagnostic and therapeutic plan while proactively considering factors which may improve inpatient care, safety, cost of care, and length of stay 
 ensuring effective hand-offs


RECOMMENDED RESOURCES   Obtain from All BedCzar Files, download to your desktop

Admission Tracker: please use for all admissions

Bed Czar TOP 10 most frequently asked questions


PRE-ROTATION ESSENTIALS

  1. Residents are provided a lot of autonomy during this rotation so make sure to prepare beforehand by reading the online materials!
  2. All Bed Czar's should use the Admission tracker to ensure no patient care items are inadvertently incomplete and the process flows well.
  3. Please briefly review the Hospitalist resident supervision policy.  The hospitalist carrying the Bed Czar devices (p57738, a7738) will be your direct supervisor and must hear about all admissions. Please notify them as admissions come. Please do not batch admissions.  It negatively impacts their workflow.
  4. You will be handing off patients frequently during this rotation. Review and utilize the I-PASS structure prior to beginning the rotation.
  5. Please review the admissions algorithm and discuss with the overnight attending if you disagree or have questions regarding an admission.


ON YOUR FIRST DAY OF EACH ROTATION

On your first day, you will huddle with and discuss team caps with the day-time Bed Czar, who is a Hospitalist Attending. Please call them at x7738 and notify them that this is your first day. Review the first day checklist in the How to be the HAR document together so you have the opportunity to ask questions before it gets too busy.  


DAILY CHECKLIST

Atul Gawande reminds us that checklists can be transformative (click to read more about that) and ensure that processes happen as planned.   It is important to follow a checklist for exceptionally busy roles such the HAR.  Please follow the start and end of shift checklists below. 

Start of each shift

  • 5:00 - 6:00 PM Receive Sign Out on Your Team
  • 6:00 PM Forward the HAR pager p50531 to your personal pager and unfoward the HAR ascom phone *x8297
  • 6:00 PM Huddle in Doc Box - Goals are:  1 determine team caps, current team census, and identify the team for the next 2 admissions. 2 Assess resources together (i.e. resource senior, is Bed Czar shift ending at 5:30p or 11:30p tonight, etc) 3 Ensure devices are properly forwarded 4 Divide & conquer. If > 3 admissions are pending, then divide with the Bed Czar and fellow residents.

6:00AM - End of each shift
  • Sign out pending admissions (those not yet arrived, arrived but without orders (no new H&Ps after 5:30AM, or those not yet discussed with an attending) to the attending overnight (weekdays @ 6am p57738) or incoming HAR (weekends/ holidays). 
  • Sign Out to your daytime team
  • Forward the Bed Czar phone (x8297) --> attending phone (weekdays) (x7738).  Sign in the attending to forward the Bed Czar pager (p50531) --> attending Bed Czar pager (p57738). This step is often missed resulting in back up of admissions in the ED.
  • Get home safely and enjoy a restful sleep. :)

Last modified: Monday, December 17, 2018, 2:35 PM