Audio Coursesby JellypodLesson 14 of 17
Overview
Mark Krause: Welcome back to Starting Strong, everyone. Today we’re diving into the med private teams at KUMC—how they tick, why they’re different from the med-teaching teams, and, you know, what you need to know before your first day. So, just to set us up, there are some key workflow differences, right? Med private tends to be a target census of 12 but up to a max of 14 patients based on the overall group needs. This is different than med-teaching teams which is usually higher but won't flex if the hospital is extra busy. Anyway, for med private, some good news is you don’t have to do admissions in the afternoons. The afternoons are a little less chaotic in that regard, but don't worry, there is still plenty of work to do.
Beth Blimmer: And I think that makes a huge difference for how you pace your day! The official workday starts at 8 so you need to be onsite by then so the nocturnists can go home. Similar to med-teaching teams, folks come in early to get ahead, check things before the real craziness happens. You will see a lot of people rolling in between 7 and 8 to get settled. It’s like a little quiet before the storm, and honestly, it helps me feel ready for anything. A lot of people will chart review at home so they are ahead when they arrive.
Vicky Muller: Exactly, Beth. And I’ll share—I remember this one day, pretty early on, I showed up right at 8:00, thinking I had my life together. But by the time I got settled, there was a backup of pages, consultants had already started sending messages… I was playing catch up all day. From then on, getting in a bit early gave me just enough breathing room to scan overnight updates, check out any urgent labs, and I could do those small things before the handoffs started. It made the rest of my day actually manageable.
Mark Krause: When arriving early, it's important to think about taking over the first-call role from the nocturnists. Some people will come in and chart review a bit before taking over the first-call role. Sometimes that is okay as it offers a quiet time to review things before you start taking messages. But, this can lead to trouble if you start putting in orders before taking over the the role. Or you may not realize they are putting in new orders after you have already moved on to the next patient. recommendations here are to do similarly to the med teaching service sin that once you are ready, go ahead and take over the first-call role so you know what orders are being placed.
Beth Blimmer: Rounding in general is a nice change of pace. Resident teams have a specific start time and the large rounding group can make it hard to be efficient. Med private teams are a bit more free in their approach. If you are ready to start seeing patients, you can just go. It's sort of like pre-rounding but you don't have to rush. You can take your time and move through your list at your own pace. You can even split it up, such as seeing your sickest patients and then taking a break to work on a few of their notes before moving on.
Mark Krause: So, do residents pre-round on these services?
Beth Blimmer: No, that's another benefit of these teams. It's the real-deal experience. Chart review prior to rounding, absolutely, but the residents don't need to worry about seeing their entire patient list before 9 am or something like that. Usually the steps are chart review, prioritize the patient list, and then just go see patients! Practice may vary on some services, the attending may round with the resident in real time together or may ask them to see their patients and then have a set meet up time to review their plans. So, that may feel similar but the 9am deadline is gone. This allows the resident to also be flexible without worry. Patient in the bathroom when you went by? No worries, just swing by after you see a few others.
Mark Krause: I love that, Vicky. Let's talk about after rounds are done and people are wrapping up for the day. A big concept change is being available on Voalte until 5pm, even after you officially hand off. Consultants can still reach you, so if you’re thinking, “Oh, I’m done with my patients at 2,” nope, don’t turn off your phone. I learned that the hard way when a nephrologist messaged me down at 4:40. You gotta keep an eye out for those messages! But, there’s flexibility—once you’ve handed off and you’re tying up documentation, you’re less disturbed. Going to a movie, though, that’s for after 5pm, alright?
Vicky Muller: Honestly, you can sometimes get extra admin work done post-handoff. It’s funny, but I kind of like it then, since most folks have already left and you can actually find a chair. Other times though the offices can get quite loud so having the option to leave is nice.
Mark Krause: And if you need to put in an order after your checkout, like a last-minute thing from a consultant, just Voalte the cross-cover person or sometimes, ask the consultant if they can help directly. Communication is key, right?
Beth Blimmer: Switching gears a bit, let’s talk about pharmacy and therapy! This caught me off guard my first time on med private—there’s no pharmacist rounding with you, you guys. It’s all about that huddle. You’ve gotta make the most of running your list with the pharmacist at the end of huddle, and honestly, if something’s urgent, just reach out to pharmacy beforehand. I used to think this was just a KUMC thing, but apparently, it’s super common on med private services in general.
Vicky Muller: It is, and with how busy pharmacy folks are, using huddle efficiently is critical. But therapy’s a different story—they’re not at huddle, not in person, so it’s all Voalte all the time. If you want updates on your patient’s mobility progress, or you need to get someone cleared fast, Voalte is your friend.
Beth Blimmer: Right, and here’s a pro tip: just add PT and OT columns to your patient list—under "properties," if anyone is, like, not sure where that is in EPIC. That way, you know right away which therapist is seeing your patient. I was rounding once and realized a patient was about to get delayed for discharge because PT eval hadn’t happened. Five seconds after Voalting therapy, they popped over, and the patient got discharged before noon. Sometimes, tech really saves the day!
Mark Krause: That is so true. And I think one of the nice things is, when you get in the habit of checking those PT/OT columns daily, nothing slips through the cracks. Sometimes you even get a friendly emoji from the therapist, which...I mean, is it unprofessional if I get a little excited about that? But bottom line, communication isn’t passive here. You gotta actively keep therapists and pharmacy in the loop all day, even when they’re not physically with you.
Mark Krause: So, the grand finale: handoffs and cross-coverage. This part seriously makes or breaks how smoothly your patients are managed overnight. You've got a swing cross-cover from 2pm to 10pm, then a night cross-cover from 10 till morning. And instead of a giant verbal handoff session, it’s all about the Med-General Handoff tab in EPIC at KUMC—super tailored, no fluff.
Vicky Muller: Yeah, it’s crucial. Because your cross-cover might be juggling patients on several different teams and admissions, so you want them to have all the key info in one place. Critical stuff, like capacity concerns, who the patient’s DPOA is—honestly, just put their phone number front and center. And if a patient might leave AMA, don’t make them dig for that detail, put it right up top.
Beth Blimmer: Plus any follow-up items, like if you ordered a BMP at a specific time, note the reason—like “potassium check on bumex drip.” And, if the plan should change depending on results, spell that out. Otherwise, they’ll just call you—or, worse, make a guess. A big shift for residents is not putting in routine follow up items in handoff. I'll often see residents ask a colleague to follow up on an echocardiogram but that information, while important, is not likely to change the plan for cross coverage. So, always ask yourself "what will I ask them to do if the result comes back abnormal" and if the answer is nothing, then probably not a good item to ask for follow up. If your diuresis management will not change if the ejection fraction is 60% or 20%, then you can follow up on the morning.
Vicky Muller: Exactly, or even set the orders to ping you when completed. If you get the echo results back and review them, then you can decide if the cross coverage person may need to be updated. Otherwise, you save them time in interpreting the report and trying to figure out what changes need to be made.
Mark Krause: Alright, in that same mentality, can I throw in a pearl here? Finish your notes before you sign out. Seriously, I know we’re all tempted to check out at two and catch up on notes at home, but it leaves the cross-cover flying blind. One time, I handed off early and my note for a complicated GI bleed patient wasn’t done. The cover clinician got called about low hemoglobin, had no plan documented, and...well, I got a several Voaltes that evening. Prioritize notes for anyone likely to be an issue, or at least tell your colleague who to keep a special eye on. Makes everybody's lives better.
Beth Blimmer: That’s the stuff that you only hear from someone who’s been there, honestly. It just streamlines patient care and makes your night so much less stressful—for both sides of the handoff.
Vicky Muller: Alright, we’ve hit the key points. There’s probably so much more we could unpack, but this is a solid foundation for anyone jumping into med private at KUMC. Definitely stick with us for more tips and stories next episode. Thanks for joining, Mark and Beth, and see you all soon!
Beth Blimmer: This was so much fun! Bye, Vicky, bye Mark—can’t wait for the next one!
Mark Krause: Thanks guys—I’ll bring more stories, and maybe, fewer mistakes next time! Take care everyone!
