Butler Hospital Tracey Guthrie, MD Assistant Unit Chief, Kent Unit Center House W227 phone: 455-6608 pager: 786-2424

Overview

Butler Hospital is a freestanding psychiatric facility with a broad range of treatment settings on and off the Butler Campus.  The hospital contains a number of specialty inpatient units (ITU) as well as general treatment units (GTU).  Regardless of your unit assignment, you can expect to participate in the care of patients suffering with the most common psychiatric illnesses.

The general treatment floor (GT4) admits patients needing acute care (ie, patients needing immediate medication adjustment or who pose safety concerns). The intensive treatment unit (ITU) admits patients who are floridly psychotic, homicidal, or suicidal. The partial hospital (aka Day Hospital) sees patients who need daylong supervision and daily psychotherapy but are safe enough to return home at night.

The First Day
Please report to your preceptor/assigned unit at 9:00am on the first day of your rotation. Students rotating at Butler will need a unit key to access restricted areas around the hospital. To obtain a key, you must fill out the key sign-out sheet in your orientation packet and give it to the psychiatry clerkship coordinator. Students should pick up their badge in the Human Resources Office at Butler Hospital, Sawyer Building, room 213, 2nd Floor (above the main entrance reception desk).

Schedule and responsibilities

Mornings are spent rounding on patients and writing daily progress notes and orders. You also should perform physical exams on new patients within 24 hours of admission. You also dictate discharge summaries over the phone. The daily schedule differs, depending on which unit and attending you are working with. For example:

1. The Kent Unit – arrive 8-8:30am. Round with the staff (including nurses, social workers, mental health workers, pharmacists), which involves reading the overnight notes or the initial assessment (if the patient is a new admission). After rounds, the attending and medical student interview each patient (usually in a common area instead of their rooms, for safety reasons), then write notes and orders. Perform physical exams on new patients and dictate discharge summaries (over the phone) for leaving patients.
2. Partial Program – usually runs from 9am-3:30pm. Morning rounds (with the staff, social workers) start at 8am, and rounds (patient interviews) usually follow at 9am. After seeing all the patients, you write the daily notes and orders. Perform physical exams on new patients and dictate discharge summaries (over the phone) for leaving patients.
3. GT4 – you should arrive by 8am to catch up on any overnight issues, and treatment team meetings start at 8:30. Afterwards, round with attending and resident, interview patients, and write the daily notes and orders. Perform physical exams that need to be done on new patients (check the “physicals to be done” manila folder) or any discharge summaries (dictate over the phone) for leaving patients.

Afternoons are often spent elsewhere – you will have one afternoon for lecture, another afternoon at an outpatient clinic (do it somewhere besides Butler, so you get a different flavor of psychiatry services), and another afternoon for your longitudinal (if applicable). There is also a weekly interviewing class with Dr. Greer (see below).

Psychiatry Grand Rounds occur on the first Wednesday of every month at 11am at Ray Hall (Butler Hospital campus) – a nationally-recognized speaker presents his/her current research.

Interviewing Seminar

On Fridays, you should attend the interviewing seminars from 1:00-2:30pm, given by James Greer, MD. These seminars will take place in Video Studio #364, 3rd Floor Center House, Butler Hospital. (Consent forms are located at the end of this section). Students rotating at Rhode Island Hospital and at the Veteran's Memorial Hospital will attend the interviewing seminars at that site.

Call

Call requirements are 4 weekday nights and 1 weekend.

1. Weekday night call (5-11pm) is spent at Butler PAS (Patient Assessment Service = Butler emergency room).
2. Weekend call is 3-11pm.

The Patient Assessment Service provides a “front door” function for the Butler Hospital system. Patients are referred to PAS from a variety of sources if it is initially believed that the patient will require a level of care beyond that provided by an outpatient appointment.

The most common sources of referral include general medical hospitals, community mental health care centers, concerned friends or relatives, other mental health care or medical providers, and the patients themselves. You will be oriented to PAS by a staff member, and will then follow a clinician through the initial assessment process. After the case is presented to an attending, you will follow the attending in a re-evaluation of the most pertinent aspects of the psychiatric exam.

After observing a few initial evaluations, students should feel comfortable performing the interview independently and assume the role of a clinician.

Other things to do

Students should observe electroconvulsant therapy (ECT) during the clerkship. Observations occur at 7am in the ECT room (Center House, 2^nd floor, room 202) – they start on time, so arrive a little before 7am, and usually end between 7:30-8am. Fridays are usually especially busy.

Preceptors:

Linda Carpenter, MD Unit 4 GTU, 4th Floor

Tracey Guthrie, MD Kent Unit GTU, 3^rd Floor right

Alison Heru, MD Unit 4 GTU, 4th Floor

Paul Lieberman, MD Partial Hospital Goddard Building, 1st Floor

Lawrence Price, MD Unit 4 GTU, 4th Floor

Lisa Shea, MD Partial Hospital Goddard Building, 1st Floor

Alvaro Olivares, MD Unit 3a GTU, 3rd Floor

Butler Hospital Department

Phone numbers 455-6___

ECT	426	x2107
GT4	390	391	392	x1374
ITU	366	367	x1366
Kent Unit	589	x1404
Laboratory	406	474	x2229
Library	248	249	x1263
Medical Records	321	322	x1249
Partial Hospital-ADP	221	212	x2278
Partial Hospital-Psych	224	225	x2274
Partial Hospital-Women’s	407	408	x1382
Patient Assessment Services	214	215	x1151	x1195
Pharmacy	316	317	x2223	x2224
Residents’ voicemail	373
Switchboard	200	x1100