Welcome to the LLU ED. Whether you're a new EM resident or an off-service rotator, this guide will help you hit the ground running.
Arrive 10–15 minutes early for your first shift and ask for a quick department tour — treatment areas, supply and equipment locations, and the ultrasound machines.
Make sure your Epic login works. The Epic context is MC EMERGENCY.
Introduce yourself to the charge nurse and the attending/senior you're working with.
Stay in the shared documentation area ("doc box") so you're easy to find and can staff patients quickly.
A reasonable pace is roughly one new patient per hour.
✅Core Expectations
Never clear a patient off a backboard or remove a cervical collar without attending supervision.
Do not miss shifts or leave without letting your senior know. Schedule non-emergent appointments on your days off.
Once the schedule is posted, you are responsible for arranging your own coverage for any conflict — through the scheduling app (below).
If you're sick: call the ED at 909-558-4444 ext. 42828, then email the scheduling chief (Thien Nghiem) and the program coordinator as early as possible.
🗓️Schedule & the Scheduling App
How shifts work
Every shift is aligned with one attending and one senior resident. You work directly with that attending for your entire shift — you start and leave at the same time.
Shifts are 9 hours long.
16
Off-Service Rotators
21
EM PGY-1
19
EM PGY-2 & PGY-3
Shift counts per block.
MedRez — the official schedule (primary platform)
MedRez is the main, authoritative scheduling platform for the LLU ED. Everything else — including the EM app — mirrors MedRez, so if the two ever disagree, MedRez is the source of truth.
To view your schedule: open the MedRez link below. There is no username — just enter the password Resident.
LLU EM Schedule — a companion to MedRez, in your pocket.
View your calendar and the whole team's, request and track shift swaps and sick-call swaps (with the rules checked for you), get shift reminders and notifications, and export your schedule. You can add it to your phone's home screen so it opens like a real app.
Remember: the app mirrors MedRez, but MedRez always has the final say for any discrepancy (see above).
Logging in: use your LLU email — or just the part before @llu.edu — as your username. Your default password is LLU2026!
Take patients from the top of the board (the screens above the resident work area). Before you pick one up, check the treatment team tab to make sure they aren't already assigned.
Board colors show acuity:
Red — criticalOrange — emergent / severe painYellow — urgentGreen — low acuityBlue — stable
Workflow for each patient
Up to ~5 min of chart review, then ~15 min for your history & physical.
Present to your attending, then discuss the plan with the patient and their nurse.
Move toward a disposition — admit, discharge, or ED observation.
💬Presenting to Your Attending
Keep it concise and organized. A good presentation covers:
Chief complaint & a focused history
Pertinent review of systems and physical exam
Your Medical Decision Making (see below)
Be proactive — lead with your assessment and plan rather than asking "what do you want to do?" It's fine to say "I'm not sure," as long as you follow it with your best hypothesis and next step.
🧠How to Write an MDM
Your Medical Decision Making should tell the story of your thinking:
State 2–3 differential diagnoses — lead with the worst-case ("can't-miss") diagnosis, then the most likely one.
Give your rationale for excluding the dangerous alternatives.
Lay out your workup and any therapeutic interventions.
State the disposition and how it depends on the results.
Note template: use .EDHPADULT (from Brian Wolk's smartphrases). Keep the ED Course section in Epic updated as the workup evolves.
📝Documentation
Document with the .EDHPADULT smartphrase and keep the ED Course updated with new results and reassessments.
Give clear discharge and follow-up instructions; work/school notes are limited to 3 days max.
Stickers: most attendings don't need one — the few who do will let you know.
🚪Disposition
Admit: place orders promptly to "stop the clock" for the ED's quality metrics.
Discharge: complete your documentation and get the attending's signature on prescriptions and discharge paperwork, with specific follow-up instructions.
ED Observation: for placement coordination, IV antibiotic courses, or short observation periods — place the ED-obs order and stay responsible for the patient.
🔁Sign-Out
Spend the last hour of your shift organizing and updating — not picking up new patients. Sign out to the latest-arriving EM senior using the ED-PASS framework:
Print the track board and give a clean one-liner per patient with any outstanding tasks. Don't sign out pending results you forgot to mention, and don't hand off procedures you could reasonably finish yourself (procedural sedation and similar exceptions aside).
Medical students: they present to EM seniors — pull them into interesting cases.