CCU ROTATION GUIDELINES

 

1.                   CALL

a.       Schedule

                                                               i.      Day 1 - Long call

                                                             ii.      Day 2 - Post call

                                                            iii.      Day 3 - Regular day – when residents can take days off

                                                           iv.      Day 4 - Short call – may need to give interns this day off

b.       Short Call

                                                               i.      Will occur on the pre-Long Call day including weekends

                                                            ii.      Will be strictly enforced – no exceptions

                                                            iii.      Time – 6am till noon or 4 admissions, whichever comes first

                                                           iv.      Cap for admissions – 4

1.       Interns cannot admit more than 3 patients on their short call day

2.       RRC guidelines state that an Intern cannot admit more than 8 new patients in a 48 hour period.

                                                             v.      Rounding – you can either round on these patients with the attending the same afternoon, or the next day during your Long Call day.

c.       Long Call

                                                               i.      Frequency – every 4th night

                                                             ii.      Time – after the short call team caps or noon to 6am, whichever comes first

                                                            iii.      Cap for admissions - 10 new patients

1.       Interns can see up to 5 new admits per long call

                                                           iv.      Overflow

1.       After the long call team caps, the Cardiology Fellow on call will admit the excess patients admitted to the CCU and the floor.  These patients will be handed over to the short call team the next day.

2.       For those patients that come in after 6am and if the Short call team is not there, the post call team should quickly eyeball the patient to make sure they’re stable and write whatever orders may be needed at the time.  You do not need to write a full H&P or Admit Orders.

                                                             v.      The residents do not admit those patients who are coming in for elective cardiac caths where the plan is for discharge the next day.

2.                   TEAM CENSUS

a.       RRC guidelines say that when 1 resident is supervising 1 intern, their cap for total number of patients is 16.  If you are nearing or at capacity, the entire CCU team needs to redistribute the patients to help one another out.  The CCU fellow can help with this.

3.                   CROSS COVERAGE

a.       The Resident on call should be familiar with ALL patients in the CCU, regardless of the patient’s attending, for cross coverage in case the fellow on call is busy. The Resident should receive checkout on the White Team patients in the CCU from the White Team fellow.

b.       The CCU Intern on call is responsible for cross coverage of all UT cardiology floor patients, with backup from the CCU resident and fellow. The CCU intern is currently responsible for overnight cross coverage for the White Team floor patients every day from 6 pm to 7 am.  

c.   The CCU Resident and intern are not to provide coverage for routine work, such as discharges, dictations, TPN renewal, etc. for the White Team. They are to manage acute issues ONLY.

4.                   PRIVATE CARDIOLOGISTS

a.       Please refer to the list of attending (private and UT) as posted on the Chiefs Corner.

b.       The White Team

                                                               i.      New service starting July 1, 2007 to manage the private patients

                                                             ii.      Consists of 1 attending, 1 fellow, and 4 nurse practitioners, no residents

                                                            iii.      Role – admit and take care of Private Cardiologists’ patients during the day Monday through Friday. They take admissions from 7 am to 6 pm. The White Team does not admit during the day on Saturday or Sunday. However, if you get a White Team admission on Friday night, or on Saturday, pass the patient off to the Nurse Practitioner the following day. (example: if you get a patient at noon on Saturday, you can't pass it off until Sunday morning.)

                              iv.   Checkout - You must checkout those patients admitted to the White Service Team overnight or over the weekend to the White Service Fellow promptly the next morning. This is to ensure that patients get appropriate follow-up in a timely fashion and are not lost in the shuffle.

c.       Overnight admissions – the resident on Long call will admit the patients of those Private Cardiologists listed and pass them off to the White Team the next day.  These admissions count toward the cap of 10.