Inpatient Rotations

Geographic Floors

Henry Ford Hospital’s Internal Medicine inpatient services are geographically, and subspecialty based. Each rotation 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.

All patients are located proximally to the resident work rooms and call rooms. You will work with the same nurses, medical assistants, and case managers during your time on each rotation.

Subspecialty Exposure

Our unique model allows for dedicated exposure to multiple subspecialty floors. On every floor you will practice general medicine (for instance, you will manage hypertension, diabetes, and common general medicine problems) but with a focus on one specialty at a time.

Team-Care

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 1 senior resident, 2-3 interns and 2-3 medical students. There are no private practice physicians that supervise residents.

Residents have the majority of responsibility for patient care at Henry Ford Hospital. Senior Henry Ford staff are responsible for overall supervision of patient care and teaching during the rotation and teaching rounds are conducted daily. Senior staff are available to residents at all times. In addition, we have in-house cardiology and medical ICU fellows available 24 hours a day, along with a rapid-response team consisting of ICU-trained nurses.

Additional staff to help care for your patient’s needs include on-site pharmacists, on-site case managers, on-site clerks, physical therapist, and nutritionists.

Schedule

All inpatient floors have night float coverage every day of the week. Residents typically arrive by 6:30 am and sign out at 4:00 pm on non-admitting days. Admitting shifts occur every 4th day and run from 7 am until 8 pm. Residents will have 4 weekend days off per 28-day block.

Procedural Skills

You will have the opportunity to do procedures on the floors and in the intensive care units including central lines, arterial lines, blood draws, paracentesis, thoracentesis, lumbar puncture, and arthrocentesis. We have ultrasound availability on every floor, and ultrasound and procedural training using our simulation center where you will get training which occurs throughout your residency training. We have dedicated Procedure and Point of Care Ultrasound (POCUS) rotations during your second and third year of training.

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 removes overnight call from inpatient rotations. Residents on night float will work 4 days on, 2 days off, and will rotate between 2 floors during the duration of night float. They work from 8 pm until 10 am the following morning. Interns do 1 week of a combined night float and medical ICU experience to prepare them for second year. Second- and Third-year residents each do 7 weeks (about 1 and a half months) of night float, which are divided into 3 separate blocks. Residents on NF cover 1 floor at a time and are responsible for all cross-coverage and admissions in the overnight period. The residents stop taking admissions at 6:30 a.m. to allow time to complete work and present their patients on teaching rounds. There is no continuity clinic during night float.

Coronary intensive care unit (CICU): This rotation offers exposure to advanced heart failure, care for patients with acute myocardial infarction, and interventional cardiology patients (such as those with TAVR). Overnight call is every 5th night. Residents are also assigned to be a cardiology float every 5th day. Cardiology float stays till 7pm helping the on-call resident with admissions and coverage. There is no continuity clinic during this rotation.

Medical intensive care unit (MICU): We have one of the largest intensive care units in the nation and the MICU rotation is highly rated among residents. The medial ICU is divided into 3 pods, with a hospitalist shift work type model. 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.) There is no continuity clinic during this rotation.

Inpatient Rotation Expectations

The following videos will inform you about some of the expectations during your inpatient rotations

• General Practice Unit Expectations
• Medical Intensive Care Unit Expectations
• Cardiac Intensive Care Unit Expectations
• Hospitalist Unit Expectations

Inpatient Rotation floor walk throughs

The following videos will provide insight into the daily routine and layout of the land during your Inpatient Rotations

• Internal Medicine Walkthrough – B1/B4/F4
• Hospitalist Walkthrough – F1
• Infectious Disease Walkthrough – F6
• Cardiology Walkthrough – I5
• Pulmonology Walkthrough – F2
• Hematology/Oncology Walkthrough – P2
• Nephrology Walkthrough – H2/I2
• Cardiac Intensive Care Unit Walkthrough
• Medical Intensive Care Unit Walkthrough

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