A Day In The Life Of A Nursing Home Medical Director
**Discussion with GCC Nursing Home Administrators-to-be**

Robert S. Stall, M.D., Medical Director
Beechwood Residence and Nursing Home/Schofield Residence/Kresge Residence
August 2, 1995

I.   Administration--Pushing papers/Improving systems/Watching the bottom line
     A.   Cosign telephone orders
     B.   Review incident reports
     C.   Review/revise policies and procedures
          1.   Infection control
          2.   Medical Staff bylaws
     D.   Medical Staff Development and Organization
          1.   Staff models                                                1-3
          2.   Medical Staff visit schedules/on-call/billing/dictation
          3.   Arranging specialist services (ophthalmology, psychiatry, infectious
disease, neurology, dermatology, gynecology, general surgery, urology, gastroenterology,
cardiology, nephrology)
          4.   Medical Staff credentialing
          5.   Cost containment (medications, labs and tests)              
Handout A
     E.   Dealing With the NYS Department of Health
          1.   New survey process as of 7/95
          2.   Seeking Advice from the DOH
          
II.  Communication--Putting In My Two Cents
     A.   Team Meetings
     B.   Messages from the Medical Director                          4
     C.   Medical Director Reports
     D.   Medical Staff Meetings                                      5
     E.   Quality Assessment and Assurance/ 
          Quality Improvement Committee                          6-14
          1.   The Zones of Quality                                        33
          2.   Aspects of Care/Quality Indicators                     34
          3.   Medical Staff Profile                                       35
          4.   Incident Tracking and Evaluation                       36-38
     F.   Ethics Committee
     
III. Education--Up On the Soapbox
     A.   Staff Inservices                                            15-16
     B.   Jrnl Articles, Book Excerpts, Newspaper Clippings 17
     C.   Teaching Rounds
     D.   Resident/Family Talks
     E.   Community Lectures                                          18
     F.   Newsletter Articles                                         Handout B

IV.  Direct Care Duties                                     
     A.   Scheduled (30d/60d) visits                                  19-20
     B.   Interim/Emergency visits; Use of telephone order triggers             
                                        Handout C
     C.   On-call availability
V.   Staying Current and Looking Toward the Future
     A.   Continuing Medical Education
          1.   Medical Practice in the Nursing Home Conference (September, 1995?)
          2.   Geriatric Psychiatry Conference (April, 1996?)
          3.   NYSDOH Best Practices Conference
          4.   Medical Directors Training Program                     21-23
          5.   Nursing Home Medical Directors meetings           24
     B.   Use of Technology
          1.   Computerized Drug Interaction Profiles                 25-30
          2.   Computerized Event Tracking                       Handout D
     C.   Clinical Research
          1.   Medication Use In the Elderly                     31-32
          2.   Schofield Dementia Study                               Handout E
     D.   Nursing Home Managed Care                              Handout F
     E.   Subacute Care                                               Handout G