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MOUNTAIN STATES HEALTH ALLIANCE JOHNSON CITY MEDICAL CENTER

Mountain States Health Alliance Johnson City Medical Center is a 481 bed not-for-profit, private teaching hospital associated with the Quillen College of Medicine at East Tennessee State University.  Johnson City Medical Center offers primary, secondary and tertiary care services to the residents of Northeast Tennessee and portions of Virginia, North Carolina and Kentucky.  The floor plan of this hospital is such that there are no nursing stations, but instead, outside each patient room in the nursing alcove is a nurserver that contains the patient’s chart, supplies, and other items for the patient that would normally be kept at a nursing station.

Specialized services include:

(1)   The Center for Cardiovascular Health

(2)   The Center for Women’s Health

(3)   The Children’s Hospital

(4)   The Center for Advanced Surgery

(5)   The Regional Cancer Center

(6)   The Quillen Center for Rehabilitative Medicine

(7)   The Stroke Center

Johnson City Medical Center also provides Wings Air Rescue, the first dedicated medical air transport service in Northeast Tennessee as an extension of its critical care units, Level 1 Trauma Center and Emergency Services Department, which treats over 40,000 persons each year.  Johnson City Medical Center also offers Medical Center North, a comprehensive outpatient diagnostic center, four First Assist Urgent Care centers and Health Advantage, the hospital’s industrial and occupational medicine program.

MEDICAL EDUCATION OFFICE:  The Medical Education Office is located on the Seventh floor.  The Coordinator is available to help meet the needs of residents and medical students training at this facility.  Your main contact is Tawana Holland, Medical Education Coordinator.  She can be reached by contacting the Medical Education Office at 431-6431 or on her cell:(423) 512-0126.

ADMISSION/DISCHARGE PROCEDURES: All admissions to JCMC must be done by authorization of a hospital staff physician.  This physician is listed as the physician of record for the admission.  Admission to the hospital system is as follows:

1.

Elective Admission- A hospital staff physician, or his alternate, will telephone the hospital admissions office and make a reservation for a patient to be admitted at sometime in the future.  A preadmission file will be established for this patient.  Information will be entered into our computer and the file will be ready for the patient’s arrival.  On the date of admission, the Admissions Office personnel will secure appropriate signatures and  any other information necessary to service the patient medically and administratively.
2.

Emergency Admission- Emergency patients are admitted to the hospital via the Emergency Department.  These patients will have appeared at the Emergency Department for emergency treatment.  The emergency room physician, consulting the patients attending physician, will make the determination that the patient should be admitted.  Upon receiving this confirmation from the attending physician, the patient will be admitted and assigned a room.
3.

Direct Admission - Because of a patient’s condition, a physician may elect to admit a patient directly from his office.  The physician’s office staff will call the Admissions Department and advise them of the patients pending arrival.  The patient will present in the admissions office, then be taken directly to his/her room.  A family member will be asked to remain in the admissions office in order to complete the necessary paperwork.
4.

Outpatient - Patients may receive outpatient services at JCMC by appearing in the Admissions Office for registration.  The physician of record does not have to be a staff member of the hospital in order for his patient to receive outpatient services.

Discharge of a patient is by chart orders by the patients’ attending physician.

MEDICAL RECORDS:  Hospital bylaws require that a history and physical be dictated or hand-written within 24 hours after the patient’s admission.  This shall include the chief complaint; details of the present illness; relevant past social and family histories; and an inventory of the body systems.  Operative notes are to be dictated immediately following surgery.  Discharge summaries are to be done within seven days following discharge or within seven days after the date the chart is made available to the physician.  At no time is the completion of the discharge summary to be in excess of thirty days.  In cases where patients are transferred to another facility, including nursing homes and skilled nursing facilities, discharge summaries should be dictated within 24 hours.  All records must be completed before beginning rotations at other facilities.  You may access the Electronic Health Record from off-site by using your token to complete any medical record deficiencies if you desire.

COMPUTER ACCESS: All medical records at JCMC are electronic.  Information may be gained by accessing the following programs:  CareLink, Soarian Patient Record, PACS, and Electronic Health Record. All residents will be given on-site access to these essential programs.  In addition, each resident will be assigned a security token that will allow off-site access to the programs.  This access allows the resident an opportunity to complete medical records, check patient status, and verify patient census away from the facility.

Terminals for each of these systems are located in the Medical Education Office on the 7th floor, outside of patient rooms, and in various other areas throughout the hospital.

PAGING SYSTEMS: Two systems are presently used at JCMC for paging:

Hospital system - can be accessed only from within the hospital by dialing 7282 and the three digit individual pager number.  The pager will hear a recording asking them to enter their number.  The caller should key in the number where they can be contacted and also press the “#” symbol on the telephone.  This symbol ”#” activates the pager.  The pager will show a digital display of the number entered.

This system may also be accessed from outside the hospital by using any touch-tone telephone. The access number for this method is 929-2777.  After dialing, the caller will hear a recorded message asking them to enter the pager number.  The caller should then enter the three digit pager number.  The voice prompt will instruct the caller to enter the number they want displayed.  The caller should key in the number where they can be contacted and press the “#” symbol.

Some hospital personnel have “voice” paging units.  Listen to the voice prompt when calling for instructions.

Overhead paging system - JCMC also has overhead paging capability within the hospital.  Simply call the hospital operator and ask her to page the physician or student you wish to contact at the number where you can be contacted.

ORGANIZATION DEVELOPMENT OFFICE:  This office serves medical staff, nursing staff, health professionals and community educational needs in such areas as ACLS, CPR, PALS, Critical Care Courses and various other classes designed to facilitate continuing educational experiences.

CALL ROOMS:  Available throughout the hospital for residents and medical students assigned to overnight call.   Call rooms are available in The Women’s Center, Seventh Floor, ICU, PICU, NICU, and lower level of the hospital.  Rooms are assigned for use to each specialty service.

LOCKERS: Available for all residents and students during their rotations at JCMC.  The resident and on-call student lockers are located on the second floor.  Additional lockers are located on the lower level of the hospital for students to use during days they are not on-call.

DEA NUMBERS: Residents training at JCMC will be assigned a DEA number to use during their training at this hospital.  This number is the hospital pharmacy DEA number with a two digit suffix identifying each resident.  It is to be used only during training at JCMC.

COPYING: Access to a copier is available in the Medical Education Department.  Large volume copying, i.e. journal articles for distribution at lectures can be requested through the Medical Education Office, with reasonable notice.

PARKING: Residents park in the designated area of the visitor’s parking lot.

MEALS: Food services are available at JCMC 24 hours per day in the cafetorium.  Meal vouchers will be distributed by the DME Office.

PHARMACY SERVICES: The Department of Pharmacy, JCMC, provides services 24 hours a day, seven days a week, and is located on the lower level of the hospital.  JCMC does not operate an outpatient pharmacy and all such needs are diverted to the local community pharmacies.  Inpatients currently using multi-dose containers can have these medications relabeled for outpatient use if ordered as such by the physician.

Take Home prescription medications for outpatient use cannot be added to an inpatient bill.  The generic substitution policy at JCMC allows substitution: 1) of injectable route medications only; 2) only on specific medications as approved by hospital policy.  A medication formulary is currently being developed for use in this institution.

SIGN OUT PROCEDURES:  At the end of each rotation, each resident will be required to complete a sign out sheet.  This sheet provides space for official sign out by Learning Resources, Medical Records, Medical Education Office and the Chief Resident.

DIRECTORY: Selected JCMC departmental telephone numbers are listed for your convenience:

Admitting Office 431-6234
Director of Medical Education 431-6431
Organization Development Office 431-6696
Laboratory 431-1305
Learning Resources 431-1691
Medical Records 431-5458
Pharmacy 431-6732
Radiology 431-6760


WELLMONT HOLSTON VALLEY MEDICAL CENTER

Wellmont Holston Valley Medical Center is a not-for-profit hospital located in Kingsport, Tennessee,  that is licensed for 590 beds.  In 2005, Holston Valley reported 136,712 adjusted patient days and 28,245 adjusted discharges.  Serving the people of east Tennessee, southwest Virginia, eastern Kentucky, and northern North Carolina, it is the largest hospital between Knoxville and Roanoke. Wellmont Holston Valley Medical Center employs over 1,900 full-time personnel.  Holston Valley’s medical staff numbers slightly over 350.  Holston Valley Medical Center has served the Kingsport community for more than 70 years.  The hospital was a founding member of the Wellmont Health System in 1996 when they merged with Bristol Regional Medical Center to create the region’s premier healthcare system.

In 2005, Holston Valley was named one of the nation’s top 100 hospitals for cardiac care by Solucient, a nationally recognized healthcare information company.  Holston Valley houses one of six Tennessee Level I trauma centers.  The hospital’s Level II neonatal intensive care unit heals the region’s sickest babies.  A $100 million renovation and expansion of the facility was recently announced.

Centers of Excellence include:

Christine LaGuardia Phillips Cancer Center

Diabetes Treatment Center

Regional Heart Center

Rehabilitation Services

Regional Children’s Center

Women’s Health 

Level II Neonatal Intensive Care Unit

Outpatient Services

Emergency Department & Level I Trauma Center

Neuroscience

MEDICAL EDUCATION: Rita Forrester is the Medical Program Facilitator.  Medical Education offices are located on the first floor of the hospital in the James H. Quillen College of Medicine section.  This section is located at the rear of the hospital in the B building.

ADMISSION/DISCHARGE PROCEDURES: Admission and discharge procedures vary for each residency program.  The attending physician and/or chief resident will discuss admission/discharge procedures in detail.  Under no circumstances should a resident treat a patient whose chart has an orange sticker indicating they do not wish to participate in the teaching program.  These patients may, however, be treated in an emergency situation.

COMPUTER ACCESS:  Computer terminals with census and lab data are located at all nursing stations, resident lounges, and various other locations throughout the hospital.  Residents are assigned computer codes to access patient data and the Internet.  The DME office keeps track of computer codes and provides computer assistance to residents.

PAGING SYSTEM:  Residents may be reached through the hospital’s paging system 24 hours a day. All Family Medicine, Internal Medicine, and Surgery residents carry beepers.  All faculty carry beepers as well.  The paging operator may be reached inside the hospital by dialing 0; the outside number for the hospital is 224-4000.

CALL ROOM FACILITIES: Call rooms are located on the hospital’s first floor in the B building of the James H. Quillen College of Medicine section.  Rooms are private, and each room has a phone.  Surgery resident call facilities are located in the Trauma House.

LOCKERS:  Lockers are provided, but locks are not.  Lockers should be labeled with your name.  Lockers are located in the James H. Quillen College of Medicine section on the first floor of the hospital in the B building.

DEA NUMBERS:  DEA numbers are assigned to residents by the Medical Education office.  Family Medicine residents assigned to HVMC use two DEA numbers - one for hospitalized patients and one for clinic patients.  The hospital DEA number cannot be used when on rotations at other ETSU-affiliated hospitals.  Internal Medicine and Surgery residents should use the number assigned at HVMC only when on Kingsport rotations.  The other three affiliated hospitals will assign DEA numbers when on rotations at their facilities.  When residents acquire an individual DEA number, it may be utilized.  The DEA numbers assigned for training purposes through the University may not be utilized for other purposes, i.e., moonlighting.  The hospital pharmacy, the DME office, and the department have a record of all DEA assignments.

COPYING: Copying should be done in the practice offices whenever possible.  Also, the Medical Library and Medical Records will allow residents to make copies.

PARKING: Family Medicine residents should park on the first level of the parking garage or in the lot adjacent to the Family Practice Center.  Internal Medicine and Surgery residents should park in the parking garage from the lower 7th level to the upper 4th level.  Limited parking for Surgery residents is available at the Trauma House.

MEALS:  Meals are provided through the hospital’s cafeteria.  A $5 limit per meal is suggested.   Food is also provided in the residents lounge for residents and medical students.

LOUNGE:  Lounges for residents and medical students are provided in the James H. Quillen College of Medicine area on the first floor of the hospital in the B building.  The kitchen is stocked with food and drinks.  There are phones, TVs, a VCR, computers, and a small reference library in the College of Medicine area.

NURSING SERVICES:  Nursing services are provided in all areas.

PHARMACY SERVICES:  The Pharmacy is located in the basement, and is open 24 hours a day.  There is a staff of 21 pharmacists and 24 technicians, including 2 clinical pharmacists.  The pharmacy has the Micro-Medex system.  Pharmacists respond to all Code Blues.

SIGN OUT PROCEDURES: Residents completing the program or leaving for other reasons are required to complete a check out form.  The form must be signed by the Medical Records Department and the Medical Education office.  All keys, beepers, and ID badges should be turned in prior to check out.  A forwarding address must be given.

MEDICAL EDUCATION COURSES:  Courses in BCLS, ACLS, and PALS are offered by HVMC through the Education Department.  The Education Department is located in the basement of the West Park Professional Building.  ATLS courses are also offered through the ETSU Department of Surgery.  CME programs are offered through the Education Department of the hospital several times a year.  A Tumor Board is conducted every Friday at noon by the Cancer Center of HVMC.  Lunch is provided for Tumor Board, and residents are encouraged to attend.

WELLMONT ID BADGES:  All residents must have a Wellmont ID badge made in order to access the critical care units and ER.  Badges are made in the Human Resources office located on the 9th level of the parking garage.  They are open from 7:30 a.m. until 5:00 p.m. Monday through Friday.  They can be reached at 224-6451 or 224-6454.

DIRECTORY: Listed below are phone numbers residents assigned to HVMC might need:

Family Practice Center 245-9600
ETSU Physicians and Associates 246-7931, 246-4361
Trauma House 224-5825
Medical Education 224-5075
Hospital - Main Number 224-4000

WELLMONT BRISTOL REGIONAL MEDICAL CENTER

Wellmont Bristol Regional Medical Center, a community healthcare provider for nearly eight decades, boasts the region’s newest hospital facility - a state-of-the-art campus completed in January 1992.  The 348-bed hospital is situated on 125 acres and offers a vast spectrum of cutting-edge medical services and technologies.

In 1996, Wellmont Bristol Regional became a founding member of Wellmont Health System, merging with Wellmont Holston Valley Medical Center in Kingsport to form the region’s premier provider of healthcare services.

A medical staff comprised of more than 170 board-certified and board-eligible physicians administers high-quality medical care at Wellmont Bristol Regional.  More than 1,300 employees work in partnership with physicians to deliver the highest level of patient care.

Centers of Excellence include acute care, cancer care, cardiac care, neuroscience, occupational health, outpatient services, rehabilitation services and women’s health.  One of our latest additions to services is the Cyberknife.  Wellmont Bristol Regional offers a Level II Trauma Center and psychiatric care services to meet the community’s needs, as well as a dedicated pediatrics unit.  The hospital is a member of the Children’s Miracle Network.

Select Specialty Hospital - a hospital within a hospital that provides specialized care for patients who require a longer acute stay - is located within the Wellmont Bristol Regional facility.  Both Wellmont Hospice House and the McGlothlin-Street Hospitality House are located on the hospital campus.

DIRECTORY

Medical Education/Ward Service 844-4610
Family  Practice Center 990-3012
Hospital Main Number 844-1121
Medical Library 844-4440
Medical Records 844-3500
Emergency Room 844-2100

JAMES H. QUILLEN VETERANS AFFAIRS MEDICAL CENTER

The James H. Quillen Veterans Affairs Medical Center is a large facility consisting of 31 buildings located on 206 acres immediately adjacent to the university campus and the Johnson City Medical Center.  The College of Medicine is located on the VA grounds.  In addition to the main 120-bed acute care hospital, there is a 95-bed nursing care unit, a 298-bed domiciliary, and a large outpatient facility.  A new medical school building was completed on the VA campus in March 2001.

MEDICAL EDUCATION:

Birgit Goldfarb is the Education Administrative Officer for the ACOS/E. The Education Office is located in Bldg. 3, Room T138.  The telephone number is 926-1171 ext. 7354.

SERVICE SECRETARY:  can assist you in the following areas-

Leave requests/illness (time cards are kept by the Program secretary)

Pick-up of checks (last working day of month)

Come by or call for any help and/or information you may need.

WORK SCHEDULES: Questions concerning work schedules should be directed to the Chief Resident of each program.

COMPUTER ACCESS: Initial contact by residents for computer assistance should be done through the service Customer Support Specialist.  Please call the following Customer Support Specialist to obtain computer access and training in the Computerized Patient Record Systems.

Medicine Greg Walsh x7160 Pager - 4-794
Surgery Judy McNeil x7330 Pager - 4-734
Psychiatry Bill Whittimore x7137 Pager - 4-657
Extended Care Dave Parlier x7634 Pager - 4-660

If the Customer Support Specialist cannot be reached, please call the Information Resource Management (IRM) Help Desk at extension #6400. Computer access and Computerized Patient Record Systems training has to be completed prior to the rotation at James H. Quillen VAMC.  Background checks and all required education has to be completed prior to receiving access to the computer system.

PAGING SYSTEM: Overhead paging is available in the new part of the hospital only (Bldg. 200).  Between 7:45 a.m. and 4:30 p.m. all paging is done through your Service. Paging is accomplished through the Admissions Office after hours by calling extension 7508 or 7509.  Please instruct your family and friends to limit paging requests to EMERGENCIES ONLY.

CALL ROOM FACILITIES: Four call rooms are available and are located on the second floor in Building 200, _D Wing.

LIBRARY:  The Medical Library for the hospital is located on the 2nd floor of Bldg 8 (Ext. 7453).  In addition to books, periodicals, and electronic resources, the library has a current collection of videos on clinical topics. Computers and a photocopier also are available. For assistance with library searches or interlibrary loans, call Ext. 7452 or 7453.

COPYING: Equipment is available in the Library (Bldg. 8, ext. 7453) for Library material only.

PARKING: Please obtain a sticker for your car from Security (Bldg. 69, Ext. 7197 or 7194).  There are designated Physicians Parking Lots in back of Bldg. 200 (Lots D and E).  You will receive further instructions concerning parking when you visit with Security.

MEALS: House staff, residents, and students who perform scheduled duty (on call) after normal working hours are authorized a gratuitous meal.  Physicians performing such duties for a fee are excluded from this provision even though such physicians may coincidentally hold additional appointments as VA non-career residents.  (Meals provided:  evening meal, late night snack, breakfast; lunch will be provided Saturday, Sunday, and holidays only.)  (MCM 120-04-01) Please sign the check-in list provided in the program office. Dates are posted on the door of the Chief Resident’s office.

PHARMACY SERVICE: The following extensions are provided for various Pharmacy services.

IV Information

x7157

Inpatient information

x7065,7165

Clinical Pharmacy Information

x7158

Quality Assurance/ADP Information

x7158

Outpatient Pharmacy Information

x2332

Procurement Information

x7161

Pharmacy Management

x7162

DIRECTORY:  VA phone books are available on all wards.  An electronic telephone directory is available through the computerized Dynamic Host Configuration Protocol (DHCP) system. Training in the DHCP system will be done during the initial computer training.

MEDICAL RECORDS:  The Physicians Incomplete Area (Reading Room) is located on the ground floor of Bldg. 204, Room L022 (Ext. 7816 or 7472) and tracks all inpatient incomplete medical records.  A patient’s medical record is not complete until all required document are available and signed.  CPRS is set up to provide viewer alerts for unsigned documents. In addition to viewer alerts an Incomplete Medical Record listing is provided as a reminder bout uncompleted documents and signatures.  Delinquent uncompleted documentation is reported to the Chief of Staff.  Please stay current on completing your viewer alerts.

MANDATORY TRAINING: The Health Insurance Portability and Accountability Act (Privacy Training), Compliance training, Cyber Security training and Ethics training must be completed on an annual basis or at the beginning of the rotation at the James H. Quillen VAMC.

BACKGROUND CHECKS: Background checks are required prior to the rotation at the James H. Quillen VAMC.  For information in getting this complete, please call the ACOS/Education Office at 926-1171 ext. 7354.

WOODRIDGE PSYCHIATRIC HOSPITAL

Woodridge Hospital is a JCAHO accredited, 75 bed psychiatric hospital, owned and operated by Mountain States Health Alliance. The hospital is affiliated with the James H. Quillen College of Medicine.  Woodridge provides a broad range of inpatient psychiatric services.  Sixteen of its beds are designated for adolescent care, 35 for adult care, 10 for geriatric care, 14 for intensive treatment including a program for impaired professionals.  Follow-up care for patients discharged from Woodridge is provided through the Frontier Health outpatient sites.

PHYSICIANS LOUNGE: The physicians lounge is available for residents use while on call.  The room has a bed, bath, and desk with computer and dictating equipment.

COPYING: A copier is available for any hospital related copying needs.

PARKING: Due to limited parking space at Woodridge, residents need to park at ETSU Physicians and Associates parking lot.

MEALS: Residents may eat in the hospital cafeteria and are entitled  to  a  40%  discount  on  their  meals. There is a refrigerator and microwave for employee and resident use.

MEDICAL RECORDS: History and Physical Exam must be dictated within 24 hrs. of admission.  Discharge summary must be dictated at the time of discharge.  All dictations must be signed within 30 days of discharge. All dictation is done on the Lanier Voice Writer.

DEA NUMBERS: DEA numbers are assigned to the residents by Woodridge when your rotation begins.  This number can only be used by residents when rotating at Woodridge.

ADMISSIONS PROCEDURES:

1. All telephone calls regarding requests for information or referrals for services are given to the Admission Director or designated staff.
2. The Admission Director and staff are on duty daily; Monday through Friday.  After hours and  on weekends, the Nursing Supervisor receives admission referrals.
3. An Admission Assessment Form is completed on each call resulting in an admission and all  information is referred to the attending psychiatrist for approval.
4. The Admission Assessment Form will contain the following information:The Admission Assessment Form will contain the following information:
a. Date/time of contact, type of contact, and whether emergency, voluntary or judicial.   
b. Name, age, and birth date of client, sex, address, phone number, and next of kin.
c. Informant, referral source, address and/or phone number.
d.

Presenting problems, legal issues, recent hospitalizations, prior treatment, current medication, medical problems and disposition.
e. Financial information to include commercial insurance, Medicare or TennCare numbers, verification and percent.
f. If approved for admission, the date and time of the admission, the unit and the attending physician.
5. Prior to hospitalization, the patient must be assessed clinically by professional staff, either in the outpatient setting or by Frontier Health’s Crisis Team.  The clinician is responsible for obtaining the precept from the insurance company.  The clinician must explain to patients the recommendations for inpatient services or referral elsewhere.  It may be appropriate to explain the recommendations to the patient’s family.
6. If a person is not being admitted to the hospital, it may be appropriate to explain the available emergency services to the person or family.

LEVEL SYSTEM:

Residents should make themselves familiar with the hospital wide Level System.  This policy is to increase the level of safety for ALL patients.  The assessment of level will be evaluated and ordered by the attending physician or on-call medical staff.  Documentation of levels must be made upon admission, as well as, any changes made of the patients level during their stay.  If nursing staff feels there are changes in the stability of the patient, contact must be made directly to the attending physician or physician on-call.  If patient’s safety dictates additional precautions may be instituted by nursing staff prior to contacting physician.  The appropriate color-coded wristband(s) will be placed on the patient.  The Level of Safety System policy and procedure is posted in the Nursing Policy and Procedure Manual on each unit.  Units are to follow Levels assigned.