INCOMINGANESTHESIOLOGISTSSURVIVALGUIDEBAYCARE-GFA/ENVISION

SUMMARYWelcometotheGFA/Envisiongroupofanesthesiologists,CRNAs,andAAsprovidingcoverageforMortonPlantHospital,MeaseCountrysideHospital,MeaseDunedinHospital,BaycareAlliantHospital,OrthopedicSurgeryCenter,CPMA,WestbaySurgeryCenter,andDunedinSurgCenter.ThehospitalsareBaycarefacilitieswhilethesurgerycentershaveseparategovernanceandprocedures.CredentialingisviatheCVOatBaycarefortheirfacilities,andthroughtheindividualsurgerycentersfortheircredentialing.Youwillprobablybestepwisecredentialedintofacilitiesdependingontheneedsoftheanesthesiologygroup.EnvisionCredentialingDepartmentwillhelpfacilitatecredentialing.OnceyouhavecompletedtheapplicationviaBaycareCVO,youmustbeapprovedbytheboard,thenwillbescheduledforcomputertraining,andwillreceiveyourMSIDnumberandpasswordviaemail.ThisisthespringboardforsettingupseveralotheritemsincludingPyxisaccess,securitybadge,Iconnectforrequiredvideotrainingmodules,andothers.Separately,thereareEnvision/Sheridan/GFAphoneapps,emails,andcomputermodulesthatmustbecompletedasdescribedbelow.Summaryoftheprocessesthatneedtobecompletedbeforebeginningwork:1.CVOandHospitalBoardapprovalofyourapplication(Baycare)2.ObtaintheMSnumberviaemailsenttoyou(Baycare)3.SecurityBadge(Baycare)4.PyxisaccessbyfillingoutthePyxisformandfaxingtoeachhospitalpharmacy(Baycare)5.SetupSheridanemail,KronosandQGendaapps(ENVISION)6.SetupEnvisionwebsites(ENVISION)7.SetupIconnectandDocconnect(Baycare)8.Computertraining(Baycare)OnthefirstdayofworkatMeaseCountryside,youmayobtainyourparkingdecalforuseintheparkinggarage.Afterbeginningwork,onlinetrainingmaybecompletedforENVISIONviaHealthstreamontheEnvisionwebsiteorathttps://lms.envisionhealth.com/rem/Dashboard/SitePages/Home.aspxandforBaycareviatheOnlineLearningCenter(OLC)intheIconnectwebsite.Approximately2-3weeksafterbeginningwork,apackageofbenefitsfromEnvisionwillbereceivedandyouneedtoquicklycompleteyourbenefitselections(includingHealthinsurance,Dentalinsurance,401Kcontributions,etc.)

INITIALSTEPSAbbreviations:MortonPlant=MPorMPH;MeaseCountryside=CS;MeaseDunedin=Dun;Westbay=WBOSC;OrthopedicSurgeryCenter=Ortho;PainCenter=CPMA;IT=InformationTechnology;GFA=GreaterFloridaAnesthesiologists;BA=BaycareAlliantHospital;DS=DunedinSurgeryCenter

UsefulDocumentstoKeepCurrent:1.UpdatedCVwithlistofallhospitals,surgerycenters,andgroupsyouworked.Includephonenumbers,emails,contactpersonforcredentialingandaddresses.ThisdocumentwillbeusefultosupplyinfotocredentialingagenciesatvarioustimesduringyouremploymentatGFAsinceyoumaybelatercredentialedinotheranesthesialocations.Itisalsohelpfullaterinyourcareerwhenyouneedtoaccesstheinformationabouteveryfacilityyouhaveeverheldprivilegesalongwithcontactinformationsincethisisoftenarequirementforcredentialingatallfuturefacilities.2.CMEDocumentsandenterintotheCEBrokersystemhttps://cebroker.com3.Digitalcopiesonyourcomputerofyourmedicallicense,anesthesiatrainingcertificate,boardcertification,DEAregistration,FLmedicallicensure,driverslicense,andACLScertification.4.CAQHattestation(usedforinsurancecompanyverificationofcredentials)https://proview.caqh.orgBaycareIDYourMSnumberisthekeytomanyBaycareaccesspointsincludingDoctorconnect,Intranet,Cerner/Beacon,Pyxis,andisusedbyEnvisionasanidentifierforourqualityassuranceforms.ThereareothercomputerprogramsatBaycarenotnormallyaccessedbyanesthesiologists,buttheBaycareIDwillopenincludingIDX(imagingsystem),PACS,Dragon,HIEandothers.TheMSnumberisassignedbyBaycareandisnecessarytoobtainaBaycareSecurityBadge.ThispermanentMSnumberbeginswiththeletters"MS"andisfollowedbya6digitnumber.WHERETOOBTAINTHEMSNUMBER:YouwillreceivetheMSnumberatthebottomofalongemaildetailingITcontactsandcomputertrainingfromStephanieLawatBaycare.IntheemailyouwillalsoreceiveatemporarypasswordforCerner-BeaconandIconnect-DoctorconnectthatshouldbechangedontheinitiallogininIconnectorDoctorconnect.BaycareSecurityBadgeThesecuritybadgeisusedtoaccesstheOR,ED,OB,IR,permitparkinglots,andmanyotherplaces,andadditionallyfunctionsasatapinforCerneronthemobileWOWworkstationslocatedthroughoutthehospitals.Inordertoobtainanewbadge,yourinformationmustalreadybeenteredinthesystembyBaycare,andanemailverifyingemploymentbyStephanieLawordesignee(Stephanie.Law@baycare.org)senttoeithertheSecurityOfficeatMortonPlantoratMeaseCountryside.Youmayobtainyoursecuritybadgeateither

location,howeverthereismorestaffavailableatMortonPlanttohaveasecuritybadgecreated.Inanycase,youmustbringyourdriverslicenseforIDverification.

MORTONPLANT:Newbadgesarebestcreatedduringweekdayworkinghours9am-3pmatMortonPlantHospitalbyGarraShapiro(emailgarra.shapiro@baycare.org)ordesignee.CallthesecurityofficeatMortonPlant(727-462-7095)toarrangeatimetohaveyourphototakenonsiteandthebadgecreated.Lostbadgescanbecreatedanytimebysecurity,buttheinitialbadgemustbecreatedduringthetimesabove.

MEASECOUNTRYSIDE:Newbadgesarebestcreatedduringweekdayworkinghours8am-3pmatMeaseCountrysideHospitalbyShawnStackordesignee.Call727-462-6053duringthesehourstosetupatimetohaveyourphototakenonsiteandthebadgecreated.Lostbadgescanbecreatedanytimebysecurity,buttheinitialbadgemustbecreatedduringthetimesabove.

Cerner:CerneristheEMRusedbyBaycare.Itcontainspatientinformationincludinghistory,physicalexams,labstudies,ECGs,consultations,radiologyresults(andsomeviewableimages),prioranesthesiarecordsandanesthesiologistevaluations.

SurgiNetP30isthepatientinformationpartofCernerthatinvolvesanesthesiology.Ouranesthesiologypre-opnotesandordersareplacedinSurgiNetthroughoutallBaycarefacilities.SurgiNetinfoonpatientsisavailablethroughoutthehospitalsinallunitswherethereiscomputeraccessandisavailableathomethroughiconnect.baycare.org.

AnesthesiaP30istheanesthesiachartingmodulethatispartofCernerthatislinkedbyinterfacestoouranesthesiamonitorsandmachines.Bothpastandpresent(realtime)anesthesiaelectronicchartsmaybeviewedusingthismodule,andithasinternallinkstoSurgiNettoallowquickaccesstopatientinformation.ThisanesthesiachartingmoduleisusedintheMainORsandObstetricsatMP,MC,MD(minustheObstetrics).SatellitelocationssuchasIR,MRI,CT,Endoscopy,EP(atMP),Lykins(atMP)allusepaperchartingfortheAnesthesiamodule.Non-Baycaresites(OrthopedicSurgeryCenter,DunedinSurgCenter,WestBaySurgeryCenter)usepapercharts.

TraininginCerner/Surginetisrequired,evenifyouhaveuseditpreviouslyelsewheresinceeachinstitutionconfiguresCernerdifferently,andthesetup/templatesvary.Thetemplatesareusuallysetupalongwiththepasswordduringtheinitialtrainingsession.CASS(ClinicalApplicationSupportSystem)formerlyknownas“Beacon”,nowdoesthetrainingforCerner.Thetrainingis1-on-1andisnotagroupclass,thereforethetrainersfocusdirectlyonthefewmodulesneededbytheparticularpersoninCerner.Trainingtimeisapproximately2hours.AssoonasyoureceiveyourMSnumber,calltoarrangefortraining.CASSTRAININGforCERNER: MORTONPLANT:callClint(727-462-7951)orAngela(727-462-7954) COUNTRYSIDE:callChristineMuren,GaylePeters,orJeffLoveringbetween0600-1800M-Fat727-443-8370

MEASEDUNEDIN:callCloieBeauregardorJeffLoveringbetweenthehours0700to1530M-Fat727-734-6272AfterCernertraining,ananesthesiologistwillhelpyousetupMacrosfordifferenttypesofanesthetics.CernerisalsoavailablefromhomeonaPCorMaccomputerthroughtheiconnect.baycare.orgwebsite(hoverover"Patients"thenselectCerner,thentheSurginetP30icon,thenclickthedownloadedfile).AtthistimeCernerisnotavailableforaccessviacellphone.PyxisAccess:InordertoobtainPyxisaccess,thePyxisformunderthe"NewHires"menutabonmpanesthesia.commustbeprinted,filledoutandfaxedtoeachoftheindividualhospitalpharmacieswherePyxisaccessisneeded.ThesecondrequirementisthatISsendtothepharmacyverificationinformationthatyouareintheirsystem.TheCVOautomaticallyprovisionsyourvalidationtodifferentdepartmentswhenyourMSnumberisassigned,includingtoInformationServices(IS).TypicallyISsendsthepharmacytherequiredverificationandISinformationwithinafewdaysofreceivingtheMSnumber.Oncebothofthesearecompleted,youwillhaveaccessinonehourorless.NoemailoptionsforsendingthePyxisformareavailable.MortonPlantHospitalPharmacyFax:727461-8262MeaseCountrysideHospitalPharmacyFax:727725-6287MeaseDunedinHospitalPharmacyFax:727734-6311Non-hospitalsitesusenarcoticboxes,individualnarcoticaccess,anddrugtraysthatmayneedtobestockedbeforestartingacase.MortonPlanthasPyxisaccessinmostORsandinseveralotherlocationsincludingtheAnesthesiaWorkroom,intheCentralCore,OB,IRandotherlocations.MeaseCountrysidehasPyxisaccessinafewORs(6and7)andineachEndoscopyORbuttheplanistohavePyxisplacementeventuallyinallORs.ThereisalsoaccessintheAnesthesiaWorkroomandCentralCore.MeaseDunedinhasPyxisplacementonlyoutsidetheORsinthecentralcore.AllotherlocationsoutsidethehospitalsdonotusePyxis.

GOINGDIGITALListofItemstoDownloadtoYourPhone:1.QGenda.ThisistheanesthesiaschedulingappdownloadablefromtheAPPSTOREonyourphone.QGendaisusedeverydaybyallanesthesiologistsinourgroup.Itisusedtodeterminewherewewillbeworkingeachday,ourdirectorduties,andcallassignments.Qgendaallowsyoutocheckallotheranesthesiologist'sworkscheduleandgivesyoudirectaccesstotheircellphonenumbers.QGendaispopulatedwithvacationsforanentireyear,callassignments3-6monthsinadvance,numberoutassignmentafewmonthsinadvance,anddaily

assignmentsusuallypostedtheeveningbefore.QGENDANEEDSTOBECHECKEDDAILYunlessonvacationthenextdayorhaveaweekenddayoff.QGendaallowssynchronizationwithgoogleandothercalendarssoyoucanshareyourpersonalschedulewithothersinyourfamilyoryoucanalsosimplyinstallQGendaontheiryourspouse'sphones. TOCREATEAQGENDAACCOUNT:usethelinkhttps://app.qgenda.com/Account/User/CreateTheaccountislinkedtoyournamethathasbeenenteredbySheridan/GFA.Youwillbeaskedtosubmitanemailaddyandcreateapasswordonaccountcreation.ItissuggestedyoucreateapasswordthatisunrelatedtoyourEnvision/Sheridan/KronospasswordandyourBaycare/Cernerpasswordsinceeachofthesehaveaforcedchangefromtimetotime.TheQGendapasswordisapparentlypermanent.ThehelpdesknumberforQGendais855-399-9945ext2. USINGTHEMOBILEAPP:QGendamobileappsareavailableforseveralmobilephoneplatformsintheAPPSTORE.Thedefaultmodeviewisyourownscheduleatweeklyintervals.Toviewtheschedulesofothersforaparticularday,tapthe"Schedules"buttonrightlowercorner,thenthe"ScheduleByStaff"link.Therightandleftarrowsfastforward/backbyweekandthedownarrownexttothedateatthetopwillallowmonthlycalendarstobeused.Theheading"Schedules/QGenda"belowinthispaperdescribestheabbreviationsandentriesinQGenda. USINGTHECOMPUTERAPP:Thisapphasmoreversatilityandisdescribedbelowunderthe"listofitemstodownloadtoyourhomecomputer"2.Kronos.KronosMobileisourelectronictimeclockappdownloadablethroughyourAPPSTORE.Althoughwearesalaried,Envisionasksthatweclockinandoutusingthissystemthatiswonkyattimesandinaccessible.Ifyoucan'tclockinoroutduetomalfunctionofthesystem,itwillnotaffectyourpaycheck.YourusernameandpasswordforKronosarethesameasyourSheridanemailasnotedbelow.Theusernamewillbe<firstname.lastname>OnceyouhavesignedintotheKronosapp,therearefouroptions:(a)Punch(usedtoautomaticallyenteryourarrivalordeparturetime:manualtimeentryisnotallowed,thereforeifyouforgettoclockinoroutthattimewillbeblankorthenextclockintimewillbeplacedinthelastclockoutslot,messinguptheentiresystem).ThePunchfeaturealsotracksyourlocationandentersthatinthedatabasetopreventpeoplefromclockinginathome.OncethebuttonPunchhasbeenselected,amapappearsshowingyourlocation,thentaptheword"Punch"atthebottomrighthandsideofthepage.IfthePunchisaccepted,aconfirmationmessagewillbenoted.Thereareoptionsto"buildatransfer"underPunchbutislargelyunnecessary(andcumbersome)giventhatwearesalaried(b)Timecard(youcanviewyourtimesenteredviapunchherebutcannotchangethem),(c)Schedule(onlythepredictableschedulessuchaswhenyouarePMorCallareenteredthereforethiselementofKronosisnotallthatuseful),and(d)Accruals(alsonotthatusefulgivenwearesalaried).TOSETUPKRONOSAFTERDOWNLOAD:Afteropeningtheapp,enteryour<Firstname.Lastname>,password,andastheserveraddressenter

https://Kronos.shcr.com/wfc/Afterthesetup,onlythepasswordneedstobeenteredforfuturelogons.ThepasswordisthesameforKronosasyourSheridanemail.3.BaycareApp.TheBaycareHealthSystemAppallowsforsecuretextcommunicationofpatientinformationtootherphysiciansintheBaycaresystem,particularlythoseaffiliatedwithBaycareHospitals.YourpersonaltextmessagingoremailisNOTHIPAAcompliant,thereforeanypersonalhealthinformationaboutapatientmustbetransmittedviatheBaycareapp.Youmayalsoreceiveotherinformationaboutpatientsincludingsomebloodgasesandcommunicationsaboutissueswithspecificpatientsfromotheranesthesiologists.TheBaycareHealthSystemappalsohasalistofoncalldoctorsforthehospital,andviaDoctorConnecthasaPhysicianPocketGuide.WHERETOGETTHEAPP:TheBaycareHealthSystemappmaybedownloadedviatheAppleStoreorGooglePlay.Theeasiestwaytoaccessitisviaa4numberPINyouenterwhensettinguptheapp.4.Baycarewirelessaccesslogon.ITcanprogramthispasswordintoyourphonethatwillallowyourphonetodefaulttotheBaycarewirelessnetworkinthehospital(differentthantheguestwireless).Thewirelesssystemisnecessarytouseyourphonetoaccesstheinternetinthehospital,butBaycareblocksemailsotherthantheBaycaretext/emailsystem.WhereasMDhas4Gaccessinmostofthehospital(thereforewirelessisnotneeded),bothMC(manydeadzones)andMP(nearly100%deadzones)havealmostno4Gaccessandmustrelyonthewirelesssystem.PhonecallsarefrequentlyimpossibleinsideMortonPlantandtextmessagesbothatCountrysideandMortonPlant.WHERETOFINDIT:Locatedinthephysicianslounge/cafeteria2ndflooratMortonPlantHospital.5.SheridanEmail.KKR/Envision/Sheridan/GFAcommunicatestoyouviaSheridanemail(arelicemailsystemusedbackwhenthecompanywascalledSheridanAnesthesia),notyourpersonalemail.SheridanemailcannotbeaccessedviayourphoneusingthehospitalwirelesssystemsinceBaycareblocksbothSheridanemailsandpersonalemails(e.g.Yahooemail)YourSheridanemailshouldbecheckeddaily.TheformatforyourSheridanemailaddressusernameis<firstname.lastname@shcr.com>althoughwhenusingtheOutlooklinkbelow,yourusernameis<firstname.lastname>AccessyourSheridan/Envisionemailathttps://webmail.shcr.comHOWTOSETUPSHERIDANEMAIL:CalltheSheridanITservicedesk934-838-2544ifyoudonotreceiveinstructionsviayourpersonalemailonsettinguptheSheridanEmailaccount.YourpasswordforSheridanEmailandKronosarethesame.FromtimetotimeyouwillberequiredtochangeyourpasswordforSheridan,thereforeyourKronospasswordwillchangeatthesametime.ListofItemstoDownloadtoYourHomeComputer:1.SheridanEmail.SinceSheridanemailcannotbeaccessedinsidethehospitalsusingthewirelesssystem(BaycareblockstheIPaddress),someanesthesiologistsbookmarktheURL(https://webmail.shcr.com)intheircomputers.ThesetupfortheSheridanemailcanbedoneonacomputerormobile.Instructionsforsetupareaboveinthemobiledownloadsection.

2.EnvisionWebsite.ThissiteisthemaingatewaytoEnvisionanduses2factorauthenticationviaSMStextingtoyourphone.ItcontainsaccesstotheEVHCMyPortaltabthatcontainsyourpaystubsandpermitssubmissionofexpenses.Thiswebsitealsocontainsatablabeled"Healthstream"thatfromtimetotimehasmandatoryon-linetrainingmodulestocomplete.UsuallyyouwillreceivenotificationbySheridanemailofthesemodules.TheEnvisionwebsitemaybeaccessedathttps://evhc.okta.comhowevercontainsanumberofbuttonsthatarenon-functional. OfgreaterdailyutilityistheMyPortalsitethatmaybeaccesseddirectlyviatwofactorauthenticationathttps://myportal.evhc.net.The"Resources"linktakesyoutoConcurTravel&ExpenseManagementwhereyoumaysubmitcertainexpenses.The"MyPay"linkgivesyouanupdatedaccountingofyourincome,taxes,401Kdeductions,medicalanddentalinsurancedeductions,etc.Changesinaddressandtelephonenumbermaybeperformedunderthe"MyInfo"link.The"MyTimeOff"linkisnotusedsinceweemployaseparatesystemforthis. ITsupportforEnvisionsiteislocatedattheITservicedesk(833)893-4357. Atthistime,Envisionhasnoappforphysicianuseavailable.3.BaycareDoctorConnect-thisprogramisasubsetofIconnectandisyourgatewaytoaccessingCernerandSurginetathome.https://iconnect.baycare.org/doctorconnect/secureauth.aspxUserequiresyourMSnumberusernameandthesamepasswordusedforBaycare/Cerneraccess(atemporarypasswordisusuallysentbyemailwhenyoureceiveyourMSnumber).InordertoaccessCerner,hoverover"Patients"inthemenu,thenclickonthe"CernerAccess"dropdown.DownloadtheappropriateCitrixReceiver,install,thenrefresh.Scrolldownandclickon"SurgiNetP30".OnaMacthiswillpromptadownloadinyourtaskbar.ClickonthedownloadandeitherSurginetapplicationwillopenoryouwillbepromptedtoenteratwostepauthenticationcodereceivedfromatextmessagefromyourphone(thishastobesetupthefirsttime). AshortcuttoCernermaybeplacedontheDoctorconnecthomepagebyhoveringovertheProfiletabinthemenu,thenclickonthedropdownentitled"ConfigureApplicationsandTools",thenclicktheboxforCernerthenthe"Submit"buttonatthebottomofthepage.4.BaycareIconnect-TheIconnectprogramcontainspathwaystoDoctorconnect,butalsohasaccesstotheOLC(OnlineLearningCenter)whereyouwillcompleterequiredBaycaremodules,andaResetPasswordlinkforchangingyourBaycaresystem-widepasswordlinkedtoyourMSnumber.Note:thisisnotapasswordresetforyourEnvision/SheridanEmail/Kronospassword.Iconnectalsocontainssometabsthatarenotconfigured(andthereforenon-functional)foranesthesiologyusesuchasCitrixReceiver,Halogen,andOffice365.TheBaycareIconnectisaccessedfromthelinkhttps://iconnect.baycare.org5.QGendaTheQGendacomputerappisdownloadablefromhttps://app.qgenda.com/Account/LoginUnderthe"View"button,thematrixforallanesthesiologistsschedulesmaybeseenatonetimeinanexpansiveviewnotpossibleonthemobileapp.Theabbreviationsarediscussedinthesectionbelowentitled"SCHEDULES/QGENDA"

HOWTHINGSWORKSCHEDULES/QGENDAQGendadesignations:Eachworkday,QGendahasatleasttwolistingswithyourQGendaidentifierthatdesignateyourclinicallocation(usingtheabbreviationsatthetopofthispaper),on-callduties,rank-orderofleavingfortheday(peeloutsystem),anddirector/managerialroles.EachanesthesiologistfrequentlyhasmultiplelistingsundertheirQGendaidentifiertospecifythesedifferentroles.AbbreviationsusedinQGenda:AM=Daycallonaweekend;Call=dayshiftcallduringtheweek;Card=Cardiaccall@MortonPlant;CDD=Clinicaldirector;CPMA=PainCenter;CS=MeaseCountrysideHospital;DorDun=MeaseDunedinHospital;Late19=lastpersontoleavebeforetheCallperson;Late18=secondtolastpersontoleavebeforetheCallperson;MPH=MortonPlantHospital;N=NorthCampus(MeaseCountrysideHospital);Note=notesregardingcallswaps,splitshifts,etc.;Ortho=OrthopedicSurgeryCenter;Out=numbersystemorderofleavingfortheday;PC=post-call;PM=NightCall;PNi=Postnightcall;Req=requestbyanesthesiologistforspecificschedulefortheday;S=SouthCampus(MortonPlantHospital);Vac=Vacation;Therearealsooneortwoletterabbreviationsforeachphysician'snameLocation:Qgendaspecifiesthelocationwhereyouwillworkeachday.Thelocationassignmentsmaynotbemadeuntillateafternoontotheeveningbeforesincesurgeryschedulesmaybeinfluxuntilthatpoint.Alwayscheckthelocationthenightbeforesinceassignmentsmadedaysearliermaybechangedwithoutnotice.Locationtrumpscallcoveragelocation.IfyouareassignedtoMortonPlantinthemainOR,CernerhasencodedtheanesthesiologistdesignatedforspecificORsuites,thereforethephysicianmaypreviewthepatienthistoryandmaypre-completepartoftheanesthesiahistorythenightbeforeiftheysochoose.UsuallyonlyonephysicianisassignedtoMeaseDunedinsopreviewofpatientsisalsopossibleonCerner.AtMeaseCountryside,typicallyroomassignmentsarenotencodedontoCernereventhoughwehavethatcapability.CallCoverage:Ingeneral,weareon-callforhospitalcoveragebutnotforsurgerycenters.Callissplitintoroughly12hourshiftswitheachcampusN(northo=Countryside)andS(south=MortonPlant)havingtheirowncallteam. "PM"onQGendameansnightcall(6:45PMuntil6:30ishAMatCSandDunor7:00PMuntil6:30ishAMatMP).ThePMpersonisoffduringthedaystheyhavePMcall,andtypicallytakenightcall5-7nightsinarow.Therearealsoalternatingcallteamsontheweekendsin12hourshifts.PMwillbelistedinQGendaasPM-NorPM-Stodistinguishwhichcampusisbeingcoveredbythephysicianthatnight.PManesthesiologistswillalwayscovernightcallonthecampusdesignatedonQGenda. Theterm"Call"onQGendaiseffectivelythedayshiftpersonworkingthelongesttimefrom6:30AMuntilatleasttheyarerelievedbythePMpersonoruntilsufficientlyfewanesthesialocationsarerunningtoallowtheCallpersontoleave.TheCallpersonisalsothebackupon-callanesthesiologistforthatnightforthe

designatedcampus.EachcampushasaCallpersonassignedandisdesignated"CallN"and"CallS".TheNorthcall(designated"N")coversMeaseCountrysideHospitalwhereasSouthcall(designated"S")coversMortonPlant.Mostofthetime,theCallanesthesiologistwillbeatthedesignatedcampusbutthisisvariablegiventheneedsofthegroupatotherlocations.Attimes,theCall-NandCall-SwillbeworkingattheoppositecampusscheduledonQGenda.DailyassignmentstrumpthecampuslocationsinQGendahierarchy. MeaseDunedinHospitalisdesignated"Dun"or"D"andthecallresponsibilitiesforDunedinalternatebetweentheNorthandSouthcallteams.QGendamaylistapersonsinitials,thenPM-N.AsecondlistingjustbelowthatmayalsolistthesamepersonsinitialsthenPM+DunorPM+D.ThismeanstheyarethenightcallpersoncoveringbothCountrysideandDunedin.Ifbothhospitalsarebusyatnight(uncommon),thenthepersondesignatedCallforthecampuscoveringDunedinthatnightwouldserveasthebackupanesthesiologistandmaybecalledintoworkatthesecondhospital.DunediniscurrentlycoveredM-FatnightbythealternatingNorthorSouthPM/Callteam.Duringtheweekends,DunediniscoveredbythepartnersinGFAbuttheymayoffertopayforanyanesthesiologisttotaketheircall. Onweekends,callisfor48hourswhenyouhaveacallweekend.Thecallforweekendsissplitintoa12hourcallshifts,thena12hourbackupcallshift.Forinstance,yourcallonaSaturdaymaybedesignatedasN-AM-BUpandPM-N.Thiswouldmeanfrom7amto7pmyouareonbackupcallatthenorthcampus(rarelyhavetocomeintothehospital)andareonnightcallfrom7PMto7AM.ThissequencewouldthenrepeatonSunday.Alternatively,youmaybedesignatedS-AMandS-PM-BuPtoworkthe7AMto7PMshiftatMortonPlantandbackupcallfrom7PMto7AM.Sundaywouldrepeatthissequence.AstheAMcallperson,youwillalwaysbeworking,butasthePMpersononweekends,youmayhavenocasesorrarelyworkallnight.MortonPlanttendstobebusieratnightthanMeaseCountryside.Dunedincallontheweekendisviaaseparatepersonthatisoncallfor48hours. CardiacAnesthesiologyhasitsowncallsystem.PEELOUTSYSTEM:UnlessapersononQGendaisonvacation(listedas"Vac"inQGenda),theneveryonefromallcampusesandsurgerycentersarepartofthepeeloutsystem.Thissystembalancestheoverallamountofworkperformedbyalltheanesthesiologistsbyallowingthemtoleaveeachdayinanapproximaterankorderfashionwith0.5beingthefirstoutfollowedby1-10orso,thentheLatedesignations,thenCall.TheCallpersonisthelasttoleavebeforePM,althoughmaycontinueworkingatthesametimethePMpersoniftherearetoomanycasesorhospitalstobehandledbythetwoPMs.Thepeeloutsystemisnotanexactrankingofwhenapersonmightleavesincewecover4hospitalsandmultipleotherlocations.Sendingapersonwithahighernumbertogetoutapersonwithalowernumbermayattimesrequiresomuchtraveltimethatthehighernumberpersonmayactuallyleavebeforethelowernumberperson.Sometimestheuseoflocumtenensorcontractanesthesiologistsisnecessary,andtypicallythesewillworkforthecontracted6-8hoursthenwillbereplacedbyapersoninthepeeloutsystem.

DETAILEDPEELOUTSYSTEMEXPLANATIONPM:thePMpersonisautomaticallyoffthefollowingday(whethertheyhadtoworkduringthenightornot),sincetheyusuallyarescheduledtoworkthefollowingnight(5-7nightsinarow).PC-Off:TheQGendadesignation"PC-Off"meansscheduledoffthatdaybecausetheywereoncardiaccallor"Call"thedaybefore.Eachday,twoanesthesiologistswillhavethenumber“1-2”inQGendaandonemaybealsodesignatedPC-Off.Whichpersongetsthedayoffdependsonwhetherthepersonisapartnerornot,withthepartnerreceivingthedayoffoveranon-partner.Iftwopartnersareranked1and2,thenthepersongettingthedayoffwillbethepartnerwiththeleastpercentageofPC-Offcallsinthepastyear.Attimes,both“1-2”anesthesiologistswillbePC-Off,dependingonstaffingneeds.Becauseoffluctuationsinthenumberofstaffneededatdifferenttimesofthedayandduetoadd-oncases,a"PC-Off"maybetoldtheyare"OntheHook".Thismeansyoumaystartoffwiththedayoff,butmaybeneededsometimebeforenoontotemporarilystaffORsshouldtheneedarise.PCNi-Offmeansgettingthedayoffafteraweekendnightcall.EEjsignifiesan"earlyeject"meaningyoudon'thavetocomeinforclinicaldutiesinitially,butneedtoremainavailableforthemorningsinceitispossibleyoucouldbecalledintowork,butwouldbetheveryfirstpersonoutifyoudidhavetocomeinandworkthatday.Withadditionalstaffing,itispossiblethe“3”personmightgetanEEj.0.5meansyouarethefirstpersontoleaveaftertheEEj.Sequence:Followingtheabove,thesequenceisOut1-2,Out3,etc.upto"Late18"then"Late19",then“Call”.Becausewedeliverservicesatseveraldifferentcampuses,theCDD(clinicaldaydirector)maydecidetomovepeoplefromonecampustoanotherinordertomaintaincontinuityofthepeeloutsystemLate:Therearetwodesignatedlatepeopleeachday-Late18andLate19.TheLate19personistheonethatleavesjustbeforetheCallanesthesiologist.Newincominganesthesiologistsaredesignated"Late"foraperiodoftimeinordertofamiliarizethemselveswiththeoperations,locations,andprocessespriortoeithertakingcallorenteringthepeeloutsystem.Call:TherearetwocallanesthesiologistsdesignatedN(MC)andS(MP),andadditionallyacardiaccallatMP.CallisthelastpersontoleaveeachcampusbeforePM,andthisisusually6:45PMatMPand7:00PMatMC.However,ifMeaseDunedinhospitalhascasesthatoverflowbeyond7PM,oneoftheCallanesthesiologistswillbedispatchedtoDunedinortooneoftheothercampusestocontinuecoverageuntilwearedowntotwocampuses.CallandPMaredesignatedas+DwhenthatparticularcallteamiscoveringDunedin,andDunedincoverageduringweekdaysalternatesbetweenNandScampuses.Attimeswemaybeworkinglateoratnightatthreemaincampuses(MP,MC,MD)inasingleday,althoughthisisuncommon. DirectorRoles:IfyouaredesignatedasCDD,youareinchargeofmanagingtheanesthesiologistsschedulesinyourcampusforthedayandmakingcaseassignments.TheCDDforCSandMPworkcloselytogethertocoordinatethe

schedulesofallanesthesiologistleavingtimesforcontinuityofthenumberingsystem.FlexibilityinWorkSchedules:Thevastmajorityofthetime,ouranesthesiologistswillworktheentiretimeperiodrequiredfortheday,butthereareprovisionsforgettingtimeoffearly(e.g.forappointmentsthatareimmovable)byoneofthefollowingmechanisms:1.Swapscheduleswithanotheranesthesiologist.InthismethodtheanesthesiologistneedingtobeoffearlywillswapwithananesthesiologistscheduledwithalowpeeloffnumberinQGenda,andwillreciprocatewithanotherreverseswaponanotherday.2.Payananesthesiologisttocover.Thisworksbestwhenonlyafewhoursofcoverageareneededandisdonewithananesthesiologistscheduledtobeofforoffearlythatday.Itisalsousedwhenanearlyflightmaynecessitateanearlydepartureinthemorningwhenoncall.3.InformalarrangementsPaySystem:SalaryispaidbiweeklyviaEnvision.

(a) Additionalpayfornon-partnersispossibleforanesthesiologistswhoarenotpartnersbyworkingDunedinweekendcallforthepartnersresponsibleforcoveringthoseweekends.

(b) Additionalpayispossibleworkinganentireorpartofoneofyourvacationweeksforanotheranesthesiologist.

(c) Theremaybeadditionalincomeforbeinginchargeofoneoftheservicelines.

(d) Workbeyond7pmfornon-PMphysicianscanbecompensatedonanhourlybasisbysubmittingtheproperforms.

(e) IfyouareskippedinthePeelOutsystemandhavetoworkhoursextra,theremaybecompensationavailable

Ifeither(a)or(b)occur,downloadandprinttheform"GFACallTransferForm"locatedunderNewHiresthenForms,fillitout,thensendtoDonnaShowerattheemailbelow.If(d)or(e)occur,oftheseeventshappen,contactDonnaShowerviaemail(DShower@GFAMED.com)ortelephone727-210-8194tonotifyhergivingheryourname,facility,dateandhoursworked.Thereisnoformfor(d)or(e)events.VacationSystem:Onceayearthereisalotteryforvacationschoicenumberswithanesthesiologistsreceivinganumberfrom1to20-something,dependingonthenumberofanesthesiologists.Thefollowingyear,thelownumberswillreceiveahighernumber,inlinewiththeegalitarianphilosophyofthegroup.Thenon-partneranesthesiologistsreceivesixweeksvacationthefirstyear,seventhenext,andafterpartnershipuptotenweeksayearwiththesevacationweeksincludingtimeoffduringtheweekendbeforeandaftertheweekoff.Inordertomaintainasystemtodeterminevacations,eachvacationselectionisforoneweekSaturdaythroughthefollowingSunday,althoughtwoweeksinarowarealsopossible.

Onceayearalltheanesthesiologistsortheirproxiesgatherinaroomtoselectvacationweekswiththelowestlotterynumberanesthesiologistchoosingfirst,thenthechoicesrotatethroughtheanesthesiologists.Inordertomeetstaffingneedsforourseverallocations,weneedapre-definedminimumofstaffavailability,thereforetherearetypically4-5anesthesiologiststhatcanbeoffduringagivenweek,althoughthisisdependentonthenumberofanesthesiologistsonstaff.Usuallyeveryonegetstheirfirstandsecondchoiceofweeksoff,thenwhenspecificweeksbegintofillup,youmayhavetoadjustfurtherchoicesslightlytoaccommodatetheminimumnumbersneededforstaffing.Post-vacationselectiontradesmaybemadeandweekssplitintopartsbytradingwithotheranesthesiologists.NewanesthesiologistscomingonboardpriortoestablishingvacationsfortheyearwillbeabletorequestvacationtimesviaDr.Tomenywhowilldetermineifthereisavailabilityfortherequestedweek.TimeofArrival:Mostphysiciansarriveforworkat6:30AMatthehospitals,althoughitisusuallypossibletoascertainyourassignmentsandthereforeplananyearlierarrivaltimefromSurginetatMortonPlantandMeaseDunedin,butonlysporadicallyatMeaseCountryside.ThephysicianfromthedaypreviousatWestbayoftenwilltextyoutheinitialstarttimes.Starttimesatthehospitalstypicallyrangefrom7:00to7:30forthefirstcases.WestBaystartsat7:00-7:30formostinitialcasetimes.Rarely,therearestarttimesatMortonPlantandCountrysidepriorto7amforonecase.OrthopedicSurgeryCenterstarttimesvaryfrom7:00amuntilafternoonforthefirstcase.TheCDDatMortonPlantisgiventhatinformationthedaybefore.OnCallAvailability:PhysiciansarepermittedtogohomeatnightiftherearenocasesrunningintheORornoanesthesiacasesanywhereinthehospital.AtMortonPlantandMeaseCountryside,OBanalgesiacoverageviaepiduralcatheterplacementandinfusionisperformedbyCRNAswithouttheattendanceoftheanesthesiologist,unlesstherearisesacomplicatedsituation.Anesthesiologistson"PM"mustbeavailablewithin30minutesduringtheirschedulednighthours,butmostareavailableinlessthan30minutes.Theanesthesiologistdesignatedas"Call"duringthedaybecomesthebackupcallatnightandmustremainavailablebyphoneuntilthenextmorning.SupervisionofCRNAs/AAs:Nearly100%ofthetimeatMP,youwillbesupervising,includingnightcall.AtMCoccasionallyyouwilldoyourowncaseslatenightifyouarebackupcall,otherwiseitis100%supervision.AtMeaseDunedin,supervisionoccursduringthedaybutafter5-8pm(varies)duringweekdaysandalwaysonweekendsyouwillbepersonallyadministeringanesthesia.Westbayissupervision100%ofthetimeforORcases,evenifthereisonlyoneORrunning.AtCPMAyouwillbepersonallyadministeringanesthesiaforpaincases.AtOSS,itdependsonhowmanyORsarerunning(theyhave4)astowhetheryousupervise(2ormoreORs)ordocasespersonally(1OR).

Parking:AtMeaseCountryside,parkingisonthefirstflooroftheparkinggarageacrossMeaseDriveforphysicians,andaparkingdecalISnecessary.Accesstothe1stfloorareaofthegarageisviayourBaycareSecurityBadgeandtheentranceisonMilRayDriveontheEastsideofthegaragelabeled"PermitParking".DownloadtheCSPhysicianParkingPermitfromthe"NewHires"menudropdownatmpanesthesia.com,fillitout,andturnitintosecuritywhenyouarenextatCS AtMortonPlant,theparkingareaacrossJeffordsAvefromthehospitalisusedwithsecuritybadgeaccess.NoparkingdecalisrequiredforphysiciansatMortonPlant.Technicallyweshouldparkinthisarea,butsecuritywillallowphysicianstoparkinanyopenparkingarea.AccesstotheORisthroughthesidedoortothehospital(badgeentry)anduponeflightofstairs,emergingintheDaySurgeryareanearthelockerrooms. AtMeaseDunedin,parkingistechnicallytobeinadesignatedphysician'slot.Nodecalisrequired. Westbayhasparkinginthefrontandback.Theaccesscodetotheentranceislistedinthepasswordprotectedareaofthisdocument. OrthoSurgeryCenterparkingisinthelotadjacenttothecenteroryoumayparkintheJeffordslotusedforMortonPlantandwalkthere.Lunch:Availabilityvaries.Someofthelocationsrequireyoutobringallyourownfoodanddrinksfortheday.BA(BaycareAlliantHospital)isattachedtoMeaseDunedinHospitalsotheMDfacilitiesareused.Physician'sloungefoodisfreeandcafeteriafood(withafewexceptionssuchasspecialtyfoodatMC)isfreebydisplayingyourphysicianbadgeandsigningthereceipt.Note:MortonPlanthasaGroundfloor(mainentrance)thena1stand2ndfloor.LOCATION PLHOT

FOODPLSNACKS

CAFETERIA COMMONBREAKROOM

BRINGYOUROWNFOOD

ALSOHAS

MPH 1stFloor

YES 1stFloor 2ndFloor No Starbucks

MC 1stFloor

YES 1stFloor No No SweetCarolines

MD No 1stFloor 1stFloor 2ndFloor No BA No MD MD MD No WB No No No 1stFloor YES Ortho No No No Yes YES DSS No No YES

LockersandDressingRooms:AtMortonPlant,youwillbeassignedalockerbythesurgerynursedirectorsecretary.Otherlocationsyoumaybringyourownlockanduseanunoccupiedlockerifavailable.Atthistime,youmaywearscrubsfromthehospitalsintoeachofthesurgerycenters,sincetheydonothaverequirementstochangeintotheirscrubs.Communication:AllthreemainhospitalsuseVoceraforinternalhospitalcommunicationtosomedegreebyanesthesiologists.However,asofthetimeofthisdocumentcreation,MortonPlantAnesthesiadepartmenthasreceivedapprovaltorevertbacktoSpectralinkphones.SomeanesthesiologistsuseSpectralinkatMortonPlantwhereasothersuseVocera.CRNASprimarilyuseVocera,howeverthereisaSpectralinkOBphoneandChargeCRNASpectralink.AtCountrysideandDunedin,VoceraisinusebyanesthesiologistsandCRNAs.VoceraaccessisavailablethroughITateachcampus.CellphonecommunicationworksonlysporadicallyinCountrysideandnotatallatmanyMortonPlantlocations.Onthewww.mpanesthesia.comwebsite,thereareinstructionsforusingVocerawithacommandlistunderthe"Staff"tab. Communicationwithanesthesiologistsathomeisusuallybycellphonebutsomeanesthesiologistsusecellphonesinlocationswithpoorreception.Theseindividualshaveeitherpagers(muchwidercoverage)orlandlines.CellphonenumbersarelocatedinQGendabytouchingtheanesthesiologistsidentificationinitials.Cellphonenumbersarealsolocatedonthempanesthesia.comwebsiteunderapasswordsecureddocumentlocatedundertheStaffmenuheading.SurgeonPreferences:Alistofpreferencesbysurgeonsforthetypeofanesthesiamaybelocatedonthempanesthesia.comwebsiteunderthetab"Protocols"forMortonPlant,underthetab"iMease"fortheMeaseHospitals,andunderthe"CardiacTab"forheartsurgeryprotocols.TherearealsoprotocolsforERAS,neuroanesthesiacasesincludingMRIcases,etcundertheProtocoltab.EmergencyProtocols:TheMHdiagnosticandtreatmentalgorithms,LASTalgorithm,Emergencybloodtransfusionalgorithm,Anticoagulationreversalprotocol,andothersarelocatedundertheemergencytabatmpanesthesia.comMAPYOURWORLDGiventhatthereare4hospitals,eachwithmultipleanesthesiaareasandalsoseveralsurgerycentersbeingcovered,someofwhichareBaycareaffiliatedandsomearenot,thereisadizzyingarrayofadministrativepolicies,locationstosuperviseoradministeranesthesia,differentmedicationaccessmethods,sterilityandinfectioncontrolpolicies,andmanyotherdifferences.

FACILITIESCOVEREDBYENVISION/GFA

ADDRESSESANDPHONENUMBERSOFCOVEREDFACILITIES:MortonPlantHospital-300PinellasSt,Clearwater33756,727-462-7000MeaseCountrysideHospital-3231McMullenBoothRd,SafetyHarbor,34695,727-725-6111MeaseDunedinHospital-601MainSt,Dunedin34698,727-733-1111BaycareAlliantHospital-601MainSt,Dunedin34698,727-734-6748DunedinSurgCenter-980MilwaukeeAve,Dunedin,34698,301-326-2921WestBaySurgeryCenter-1401WestBayDr,Largo33770,727-585-9500OrthopedicSurgeryCenterofClearwater(OSCC)-402JeffordsSt,Clearwter,33756727-448-0822ClearwaterPainManagementAssociates(CPMA)-430MortonPlantStreetSuite210,Clearwater,33756727-446-4506

ANESTHESIALOCATIONSWITHINFACILITIESMORTONPLANTHOSPITALAnesthesialocations:MainORs(2ndfloor)ORs1-22and26(iMRI) Endoscopy(2ndfloor)5ORs MorganORs(3)usedforCVandsomeNeuroanesthesia EPLab4thFloorMorgan(3ORs) InterventionalRadiology(2mainORs1stFloor) MRI/CT1stFloor OB(2ORs)locatedon3rdFloor ICU(2ndand4thFloors) Lykins(oneORusedforbrachytherapy-GroundFloorinLykins)MEASECOUNTRYSIDEHOSPITALAnesthesialocations:MainORs(10)2ndFloor Endoscopy2ndFloor(2) InterventionalRadiology(2)1stFloor MRI/CT1stFloor Cardiac(1)1stFloorinRadiology OB(2)5thFloor ICU2ndFloor(TravelEndoscopy/TEEcases)MEASEDUNEDINAnesthesialocations:MainORs(4)2ndFloor Endoscopy2ndFloor(1) MRI/CT1stFloor InterventionalRadiology1stFloor ICU4thFloor(TravelEndoscopy/TEEcases)WestBaySurgeryCenterAnesthesialocations:MainORs(4)1stFloor Endoscopy1stFloor(2)ORTHOPEDICSURGERYCENTERAnesthesialocations:MainORs(4)2ndFloorBAYCAREALLIANTHOSPITALAnesthesialocations:ICU(TravelEndoscopy)

MAINORMAPSMORTONPLANT2ndFloorDoyleTower

TheMortonPlantORlayoutinDoyleTowerisexpansive.ThemapaboveshowsthelayoutwiththreeverticalcorridorsrunningalongtherightsideofORs[1-2,14-15],betweenOR3-6downto12-19,andtotheleftof20,26.Therearethreehorizontalcorridorsareabove26/6/3,below2/8/5,andbelow12/19.AccesstoeachORis

availablefromthecorridororfromsubsterileontheothersideoftheOR.Duringimplantcases,wearetoaccesstheORviasubsterile.