Montefiore is the largest hospital in the Bronx and the Emergency Room is routinely ranked as one of the busiest in the country, with many more than 100,000 Adult visits per year. At any given time, it’s not unusual to have at least 100 patients actively in the ER. While Montefiore is not a Level 1 Trauma Center, it is a referral center for other emergent medical problems such as acute strokes, ST elevation MI’s and cardiac arrests.
Montefiore Medical Center
111 East 210th Street
Medical Student Coordinator
Dr. Albert Izzo
Layout of the ER
North/South: The North and South side are the main areas of the Emergency Room that you will work in. Each side is staffed by at least one attending overnight and two attendings during the day. There will also be 3-4 residents or physician assistants working per side.
West: All critically ill patients are triaged to the West side of the Emergency Room. This may mean patients with unstable vitals, severely altered mental status, as well as patients who require a higher level of monitoring. Each nurse takes care of fewer patients on this side of the ER (as they are often required to give many medications and perform multiple procedures). Residents do not work on the west side until their PGY2 year. It is definitely worthwhile to work 1-2 shifts on this side. While you may not take care of patients on the West side primarily, shadowing an attending or resident here will give you a feeling for the pace and acuity of a (very) busy ER.
All “notifications” come directly to the west side. While they do not get announced overhead like they do at Jacobi, the charge nurse will pick up the call and let the attending physician know what is coming in. The attending is a good source to ask if there are any interesting patients to follow or help out with.
Getting a Patient via The Whiteboard/CareCast
The whiteboard at Montefiore is available on every computer and it is used by everyone to keep track of patients and the nurse, provider and attending assigned to them. As patients are brought in from triage, they will appear on the white board without a physician’s name. You can click “update” and see the initial complaint and pick up that patient by placing your name and your attending’s name on the patient. The whiteboard is also how you place orders, view labs, and admit patients. Discuss which patients you should pick up with the attending you are working with.
While patient charts are supposed to be kept on shelves in each respective area of the ER, you will often find them lying around the desks where the physicians and nurses sit. They are color coded according to zone and contain the triage information, vitals, and your H&P sheet. Any medication orders are computer entered but MUST be passed on to the nurse.
You may spend a lot of time at Monte looking for your patient’s chart. Here are some tips:
– Look on the shelf first.
– Look for the nurse taking care of the patient. They may have the chart in their hands or in front of them.
– Look for any consultants who may be seeing your patient
– If the patient just came in, the chart may not have been made yet.
When you begin your shift, ask for the attending in charge on the side of the ER that you are assigned to. Before you pick up a patient, you should ask your attending if the patient is appropriate. Find the chart (see above), read through the triage vitals and information, and go find your patient.
Tips on Finding Your Patient
– Ask the nurse assigned to that patient, look on the triage sheet in chart.
– Look for the patient’s name written on a sheet in front of the stretcher
– Look at the tech board, where a nurse may have written the patient for an EKG or fingerstick (and indicated where the patient is)
– When all else fails, shout the patient’s last name as loud as you can
Kathy L. Chuang, MD 2011 (modified by @em_stevemcguire)