Clinical Services - Internal Medicine

While it is common for patients admitted to the medical service to come through the emergency room, a significant number of patients are admitted by subspecialists for diagnostic and therapeutic interventions, particularly in the areas of Cardiology and Medical Oncology. Fletcher Allen Health Care serves as the regional referral center for a population base of approximately 800,000 people, allowing trainees to care for patients with a wide spectrum of common medical illnesses, as well as evaluate and manage patients with more unusual illnesses from the referral population.

To ensure educational priorities are not diminished by service needs of the hospital, a number of valued resources have been developed. These include night float systems, work hour restrictions, non-teaching services on general medicine and cardiology services to prevent excessive numbers of admissions, and excellent ancillary services. Residents rotate call every fourth night on the medicine ward services, the MICU and Cardiology services. There are no in house call responsibilities when not assigned to an inpatient rotation.

The Department of Medicine is especially proud of its Night Float System. This has existed on the general medicine services since 1980. Five nights per week the night float teams assume total patient care responsibility at 10 pm. This means that all cross coverage, as well as admission of new patients between 10 pm and 7:30 the next morning, is the responsibility of the night float intern and resident. On call teams are thus eligible to go home once their work has been completed. We have found that this night float system greatly improves the ability of the interns and residents to participate fully and effectively in educational sessions which occur during daylight hours. We are also concerned that the night float rotations remain educational, and all night float house staff look forward to attending and participating in morning report before leaving the hospital the next morning.

After daily admission limits are met, additional admissions are directed to the Non-Teaching Services and cared for by Attending Physicians. Such services also provide an opportunity for residents to direct the most educational and clinically interesting patients to the Teaching Service.

Teams are assisted in their daily work by a network of ancillary personnel who provide services such as phlebotomy, intravenous line insertion and maintenance, patient transport and respiratory therapy.

The Infectious Diseases Unit is responsible for all ID related clinical care, teaching and infection control for Fletcher Allen Health Care. The unit performs approximately 1100 inpatient consultations yearly. In addition the outpatient clinic operates five days per week including care for those with HIV/AIDS, international travelers clinic and general ID consultations. The staff also coordinates three other HIV specialty clinics in Vermont.

Teaching responsibilities include medical students of the University of Vermont, medical residents of FAHC and attending physicians of FAHC and throughout the state.

Unit members chair the Hospital Infections Committee, Antibiotic Pharmacy Committee and the Bioterrorism preparedness committee.

The Rheumatology and Clinical Immunology outpatient service at the UHC Campus consists of ten exam rooms, two consult rooms, a nurse's station, and the Osteoporosis Center, which is equipped with Lunar dual photon x-ray for analysis of bone density. The rheumatology outpatient service operates from 8:00 am to 5:00 pm, Monday through Friday, with between 25-50 patients seen daily and approximately 10,000 patient visits per year. Satellite outpatient services are offered at Central Vermont Hospital in Montpelier, Copley Hospital in Morrisville, Northwestern Medical Center in St. Albans, and Alice Hyde Hospital in Malone, NY.

The patient mix is excellent, and includes rheumatoid arthritis, psoriatic arthritis, spondyloarthropathy, systemic lupus erythematosus, other connective tissue diseases, vasculitis, osteoarthritis, regional musculoskeletal problems, and fibromyalgia. The clinical service operates like a private group practice, so that the trainee's experience is similar to what one would experience in a private rheumatology office.

The yearly clinical responsibilities of the Pulmonary Disease and Critical Care Medicine Unit include more than 1,100 inpatient consultations and visits, over 1,200 outpatient visits, more than 2,000 pulmonary function tests, and over 200 fiberoptic bronchoscopies. We are participants in the Vermont Regional Sleep Disorders Center.

The Pulmonary Disease and Critical Care Medicine Service is responsible for the direction and supervision of a 21-bed Medical Intensive Care Unit (MICU) for the intensive management of patients with acute respiratory failure and othe critical medical problems. This unit also serves critically ill cardiac patients. The MICU admits over 1,200 patients yearly.

Outpatient care is an important aspect of training in our program. Trainees devote increasing amounts of time and responsibility to the care of outpatients throughout their training. Office-based ambulatory-care experiences develop expertise in general pulmonary medicine and long-term continuity of care. Specialty clinics provide focused experiences in cystic fibrosis and sleep-disordered breathing.