Locum Physician - Emergency Inpatient

**Position Overview:** The role involves sole provider coverage encompassing both Emergency Medicine (EM) and Inpatient Medicine. Candidates must possess a minimum of 2 years of EM experience and be proficient in performing all relevant procedures. The orientation is scheduled for July 24, with subsequent shifts from July 25-27, running from noon to noon for handoff.

**Logistics:** On-site lodging is available.

The provider's responsibilities will focus exclusively on the Emergency Department (ED) and the Inpatient floor, with no outpatient clinic duties.

**Schedule and Coverage:** -

**Shift Structure:** 24-hour shifts - **On-Call Requirement:** 24/7 call coverage -

**Facility Type:** Critical Access Hospital

**Operational Metrics:** -

**Average Daily Census:** 4-6 patients on the medical floor - **Average Length of Stay (LOS):** 1-3 days for acute/swing beds, 8-10 days for transitional care -

**Daily ED Encounters:** 6-8 - **Morning Rounds:** Begin at 8 AM with an interdisciplinary team, including a social worker/case manager, pharmacist, and nursing staff.

• **Swing Bed Weekly Rounds:** Conducted weekly to address transition of care for swing bed patients.

*Clinical Acuity and Resources:** - Patient diagnoses include Congestive Heart Failure (CHF), Cellulitis, Chronic Obstructive Pulmonary Disease (COPD), and Gastrointestinal complaints.

• Subspecialty support is available via telemedicine in Cardiology, Pulmonology, and Infectious Diseases.

- Electronic Medical Record (EMR) system in use is Thrive, facilitated by Trubridge. - Annual ED Volume: Approximately 2,500 - 2,700 visits. - Available Ancillary Services: Laboratory and Imaging.

*Qualifications:** - A minimum of 2 years practicing autonomously in Emergency Medicine is required.

• Must demonstrate proficiency in all procedures relevant to the Emergency Department and inpatient setting.

**Hospitalist Scheduling:** - **Shift Length:** 24-hour on-site shifts (typically includes 12-15 hours of active work plus night call).

- **Admission and Rounding Protocols:** - Shifts generally run from 12 PM to 12 PM (handoffs can occur between 12-3 PM).

**Rounding Protocols:** - **Morning Rounds:** Conducted between 7:00 AM and 8:00 AM, specific to facility needs. - **Informal Evening Rounds:** Engaging with ED and nursing staff between 9:00 PM and 10:00 PM to proactively identify and address potential issues may minimize night disturbances.

**Admission Strategy:** - Recognizing the variances in ED skillsets and the constraints of rural settings, the goal is to minimize unnecessary admissions that would lead to immediate transfers post-evaluation.

• Transition orders are employed during peak times to enhance ED throughput, ensuring an emphasis on active patient evaluations.

**Overnight Admissions:** - From 11:00 PM to 6:00 AM, transition orders initiated by ED physicians will facilitate admissions to streamline processes and reduce the administrative burden on hospitalists.

• Immediate bedside evaluations are crucial for all high-acuity ICU admissions, regardless of the admission time.

**Discharge Management:** - Awareness of patients scheduled for discharge is essential at the start of rounds. Discharge planning should be established during interdisciplinary team meetings the prior day, with case management addressing all needs beforehand.

• Patients are informed in advance about their pending discharge to facilitate a streamlined process, targeting mid-day discharge whenever feasible. Prioritizing discharges allows nursing staff to complete necessary documentation, enables patients to leave promptly, and ensures that Environmental Services can prepare rooms for incoming patients from the ED later in the day.