Henry Ford Hospital’s Internal Medicine inpatient services are geographically and subspecialty based. This means an inpatient rotation on each specialty is confined to that specialty’s inpatient floor and follows a specific curriculum and reading list based on diseases seen on that floor. Inpatient rotations are done in conjunction with an attending specialist on all teaching services. The following subspecialty floors are required for rotation:
Inpatient services: The inpatient services allow for a wide exposure to care for hospitalized patients. A broad spectrum of pathology is encountered. Selected senior staff are assigned to each house officer team comprised of a senior resident, 2-3 interns and 1-2 medical students. Residents have the majority of responsibility for patient care. Senior Henry Ford staff are responsible for overall supervision of patient care and teaching during the rotation and teaching rounds are conducted daily. Complete ancillary services ensure residents obtain a focused medical education and experience.
All inpatient floors have night float coverage Sunday through Thursday, with admitting shifts until 8 p.m. every fourth night. Fridays and Saturdays are covered by the floor team with on call residents taking 24+4-hour overnight calls. ICU rotations have overnight call every 4-5 days (interns do not rotate in the ICUs). No assigned call occurs while on electives.
General medicine: On general medical floors, residents will encounter medical problems like urinary tract infections, cellulitis, pneumonia, gastrointestinal conditions including pancreatitis, gastrointestinal bleeding, diverticulitis, cholangitis, and others.
Pulmonary: Patients with cardio-respiratory problems and DVT are the most frequent. Clinical care pathways have been generated for these management problems. Common diagnoses: pneumonia, asthma, COPD, pulmonary embolism/DVT, pulmonary hypertension and lung transplant.
Hematology/Oncology: Commonly encountered conditions include oncology emergencies, cord compression, febrile neutropenia, leukemia/lymphoma, solid tumors, bone marrow transplant, and infections in an immunocompromised patient.
Nephrology: Commonly encountered conditions include acute and chronic renal failure, malignant hypertension, and complications of end-stage renal disease, dialysis, and kidney transplant.
Infectious diseases: Commonly encountered conditions include endocarditis, meningitis, HIV disease, and tuberculosis.
Cardiology telemetry floor: Commonly encountered conditions include acute coronary syndrome, congestive heart failure, syncope, arrhythmias, and valvular disease.
Night float: Night Float (NF) is a system to cover patients admitted at night and allows the inpatient teams to have much less overnight call. The night float resident works Sunday through Thursday night from 8 p.m. until 10 a.m. the following morning. Residents on NF cover 1-2 floors and are responsible for all cross-coverage and admissions in the overnight period. They stop taking admissions at 6:30 a.m. to allow time to complete work and present their patients on teaching rounds.
Coronary intensive care unit (CICU): Overnight call is every 5th night. Residents shall also be assigned to be a cardiology float every 5th day. Cardiology float stays till 7pm helping the on-call resident with admissions and coverage.
Medical intensive care unit (MICU): Overnight call is every fourth night. Commonly encountered conditions are septic shock, ARDS, ventilator-supported patients, and multi-organ failure. Patient management rounds occur daily for 2 to 3 hours. Didactic lectures are held for 30 minutes prior to morning teaching rounds. This is a great opportunity to develop skills in procedures (central lines, airway management, arterial lines, etc.).