Structure and Call Schedule
Team Structure
CUH wards now follows a call structure similar to Parkland Wards with a long call and a short call team on a q6 day cycle. However, there are still only 4 wards teams. Therefore, every 3 days, there are no general wards teams on call. On days when the wards teams are on call, the short call team will take daytime cross cover and then signout to the night intern at 7pm who will cross cover and admit with the long call resident. On the days the wards teams are not on call, a resident daylighter will be available to take cross cover from 3-7pm (including for the geriatrics team), and the night intern will cross cover overnight starting at 7pm with the help of a hospitalist night faculty. We ask the resident daylighter to start in the Resident Lounge on the 3rd floor in the medical education office on the blue tower side. They will reach out to you if they change locations. The resident daylighter will then sign-out to the night intern when they arrive at 7pm. The night intern will cross-cover overnight with the help of a hospitalist night faculty (located in room 12.315). Please go to room 12.315 to meet the hospitalist faculty who will cross cover with you overnight.
Please see here for listed hospitalist for overnight support: CUH Hospitalist Support
Please see here for resident swing shift (Wards XC 3-7): Resident Daylighter
- The 4 CUH wards teaching teams with a Q6 day call system with solely residents taking 28-hour call.
- Seldin
- Foster
- University
- Southwestern
Seldin and Foster are buddy teams and University and Southwestern are buddy teams.
- Service Caps
- Admission hours: Long Call: 7 AM to 1 AM; Short call: 7 AM to 2 PM; see below for further details
- The CUH Wards team total caps and daily admission caps increase (quickly) as the year goes on, reflecting our interns' dexterity and rapid acquisition of medical knowledge and clinical skills.
- 12 → 16 patients maximum per team.
- Team cap is 16 total patients starting 9/1/23. Exceptions to this rule are below:
- 7/1/2023: Team cap is 12. Long call: 8 new patients (or 7 new patients + 1 MICU transfer between 7AM and 1AM). Short call: 3 new patients (or 2 new patients + 1 MICU transfer between 7AM and 2PM)
- 8/1/2023: Team cap is 14. Long call: 9 new patients (or 8 new patients +1 MICU transfer between 7AM and 1AM). Short call: 4 new patients (or 3 new patients + 1 MICU transfer between 7AM and 2PM)
- 9/1/2023: Team cap is 16. Long call: 10 new patients (or 9 new patients +1 MICU transfer between 7AM and 1AM). Short call: 4 new patients (or 3 new patients + 1 MICU transfer between 7AM and 2PM)
- Additional caps on admissions will occur periodically throughout the day as below. This is to prevent large boluses of admissions over short periods of time that overwhelm teams and prevent adequate supervision and teaching:
- No more than 2 admissions at once.
- If there are 3 or more admissions within 1 hour span, then the team can take no more admissions until 3 hours have passed from the initial admission. For example, if the long call team gets 2 admissions at 1pm and an additional admission at 2pm, then the earliest time they can get another admission is 4pm.
- For all teaching teams:
- at least 2 admissions to all teaching teams (short call, long call, and Geriatrics) before 12pm.
- For long call:
- From 7am – 12pm: at least 2 admissions
- From 1pm – 7pm: no more than 4 admissions
- From 7pm – 1am: no more than 3 admissions, with only one admission after midnight
- No more than 2 admissions at once.
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- Bouncebacks:
- A teaching team will only accept a bounce back (a patient who was discharged and is readmitted within 48 hours) if the resident who last took care of the patient is still on the same team AND is physically present in the hospital AND not post-long-call. There will be no bounce backs on post-long-call days and a team cannot over-cap with a bounce back (above the total team cap). Continuity with the attending or the intern does not count. The bounce back admission should be for the same chief complaint. Any bounce back admission felt by a resident to be inappropriate for the teaching team should be discussed and addressed at the attending level.
- Teaching teams can accept symptomatic COVID+ patients.
- The teaching team should not be approached to discuss transfer of patients off of the teaching service and onto the hospitalist service (ie to offload space for greater admitting capabilities). In the rare circumstance that the teaching attending deems it beneficial to transfer a patient from the teaching service to a hospitalist service, this conversation should be initiated by the teaching attending.
- Bouncebacks:
- Rounding Times
- Suggested attending rounding times on post call days is 7 AM and for non-call days should be 10 AM.
Call Days
Call Cycle
- A Q6 long-call/short-call cycle. Residents do 28 hour in-house call on Long-call day and day call on short-call day.
- Long call—Post long—Post-post—Short-call—Post-short—Pre-long
- Day 1: Foster is long call and Seldin is short call
- Day 2: Southwestern is long-call and University is short call
- Day 3: No one is long call or short call
- Day 4: Seldin is long-call and Foster is short call
- Day 5: University is long-call and Southwestern is short call
- Day 6: No one is long call or short call
- The on-call interns for that team will take new admissions up to 6:00 PM. After that, they should work on sign-out and finish orders and H&P’s. Also, the on-call interns should sign out the other teams’ patients to the night intern at 7:00 PM. The on-call interns should leave no later than 9:00 PM. If the intern leaves later than 9:00 PM, the intern must come back to work no earlier than 8 hours after the time the leave the hospital to ensure an 8 hour break per ACGME rules (ie,if they leave at 10:00 PM, they cannot come in earlier than 6:00 AM the next day.
- 1st 6 admissions of the day (by the ED) should go to the teaching team. Please let the CUH Chief know if this is not occurring. This is to allow for an adequate number of day admissions for the medical students.
MICU Transfer policy
- Patients transferred to MICU can return to the team any time during the rotation if the same wards upper-level resident who transferred the patient to the MICU is physically present on the day of return. Also, the transfer must be called in before 12 PM and have a floor bed. If it comes during your call day, then it counts as a hit to your admission cap.
Note: All admissions and lateral transfers must go through the hospitalist admitter and not directly from one team to another to allow for optimal workflow and communication. If an admitting team determines that an admission would be better served on another service, this must be discussed with the hospital admitter to ensure a safe transition of care.
Bounce Backs
- A bounce back will be defined by a readmission for a patient who was discharged by a teaching team within 72 hours, who is presenting with the same complaint. The resident must be the same resident as when the patient was discharged. The patient can be admitted to that resident's team if that resident is present and if the team is not capped. If this criteria is not met, the patient will be admitted to another medicine team or the hospitalist service for the hospitalization.
Hold Over Patients:
The overnight CUH hospitalist team will “hold over” admits from the ED from 5am-7am for the teaching services. These patients should be stable and the responsibility of the hospitalist admitter until 7am. Once the on-call resident is at the hospital, the resident will be notified by the hospitalist about this patient and hand-off will occur. This will ensure that each team get at least one morning admission. Please keep in mind that this patient will have been waiting in the ED, so it would be beneficial to see this patient sooner rather than later.
Communication with Hospitalist Staff:
We would like to keep an open dialogue between residents and hospitalist team to ensure that both teams know the workflow and admission numbers. That will allow hospitalists ease in distributing patients and will allow residents to candidly talk about their workflow and admission rate. To start, residents should page the hospitalist admitter to notify them (a) who they are and (b) how many patients they can accept in the call cycle. The long call resident should also reach out once more at 6PM to the night hospitalist to let them know how much space they have available. This way, both the resident team and the hospitalist team will be aware of each other’s workload.
Problem Based Notes
The new notewriter at CUH uses problem-based charting. Using this note format is encouraged by CUH leadership, but it is not mandatory.
Pharmacy Rounds
Starting 8/29/22, a clinical pharmacist will be rounding with Southwestern and University. She will be responsible for both teams but will alternate which days she rounds with each. If you are on Southwestern or University, please contact her at prior to the start of your rotation.
Days Off
- All residents and interns should take 4-5 days off averaged over the 4-week rotation (minimum every 8th day off).
- Days off can be established between the resident, interns and supervising attending at the start of the rotation.
- Suggested: Resident off post-post.
- Intern A off post-short, Intern B off pre-long (alternating)
- Example: Interns take 4-5 days off for the month and will alternate taking the post-short and pre-long days off. - If intern A is off the post-short day on the first week of the rotation, they will take off the pre-long day the second week of the rotation, and so on.
- Example: Residents take 4-5 days off for the month, taking the post-post day off.
Work Hours
- Q6 day call cycle with 28-hour call for the resident and day call for the interns.
- Non-call Interns / Post-call intern – 6:00-7:00 AM to 5:00-7:00 PM; should come in no earlier than 5:00 AM on post-call
- Non-call resident: arrive no later than 7 AM. When covering team alone, e.g. pre-call day, arrive no later than 6:45 to receive sign-out from overnight intern.
- On-call intern – Should come in before 7:00 AM to pre-round prior to 1st admission and leave no later than 9:00 PM.
- On-call resident – 7:00 AM to no later than 11:00 AM on post-call
- Night intern - 7:00 PM to 9:00 AM (next day). Admits patients with on call team (maximum 5 admissions) and does cross cover from 7:00 PM - 7:00 AM.
The on-call interns will admit up to 6 PM, after which interns then work on sign-out, finishing H&P's, and entering orders. At 7 PM the on-call interns should sign out cross-cover on the other teams' patients to the night intern. The on-call interns should leave no later than 9 PM and come back to work no earlier than 5 AM on the post-call morning. Non-call teams: please go to the post-call team rounding room to receive brief overnight sign-out; please do so earlier than 7 AM to facilitate the overnight intern presenting for post-call rounds at 7 AM.