Team Structure

  • 4 cardiology DAY teams (B1, B2, B3, CHF). Each B team (and CHF team) is composed of 1 resident and 3 interns. (2 interns on days and 1 intern on twilight at any given time)
  • The CHF team will also carry some general cardiology patients (goal: maximum 4-5 pts) with a separate, non-CHF attending/fellow
  • 2 cardiology twilight residents (one for B1/B3, one for B2/CHF)
  • 1 cardiology NIGHT team (composed of one resident and one intern)

Workroom Locations/ Bed Assignments

Workroom locations

  • B1: 10W conference room. Exiting elevator area, turn right and it’s the large glass enclosed room.
  • B2: 10th floor interior, near the restrooms
  • B3: 8W Consult 1 room. Exiting elevator area, turn right and it’s the second glass enclosed room.
  • CHF: 9w Consult 1 room. Exiting elevator area, turn right and it’s the second glass enclosed room.

Bed Assignments

  • B1: 1001-1017 (n=14)
  • B2: 1018-1027 (n=10), 927-930 (n=4)
  • B3: 8W (n=14); these beds may fluctuate dependent on vascular surgery needs and B3 may overflow onto 7 (ex: 10 pts on SH8 and 4 pts on SH7).
  • CHF: 911-926 (n=14)

Team Members

Day Interns

  • On weekdays, both interns on all teams work from 7 AM to 5 PM (and sign out to twilight following teaching from 4-5 PM)
  • Covered by twilight intern while in clinic
  • The team will take 1 admission between 4-5PM
  • On weekends, work from 8 AM to 5 PM on one day, and have the other day off

Twilight Interns

  • Weekdays, 4 PM to 2 AM (10 hrs), admit until 12:30 am. Can sign out to night intern at 12 AM (but must remain in house to receive admissions until 12:30 AM)
  • Comes in at 12pm when either of the Day Interns has clinic. If you need to come in early more than twice per week for clinic coverage, please contact the CMRs. (see “Clinic” below)
  • On B1/B2, twilight interns are off Sunday
  • On B3/CHF, twilight interns are off Saturday
  • Transition Days:
    • If a twilight intern is switching to a day rotation, the twilight resident is expected to ensure the twilight intern is out by 10 pm.

Night Intern

  • Weekdays: 11:59 PM to 10 AM; weekends: 11:59 PM to 8 AM
  • Off Sunday night
  • Accepts sign out from all four twilight interns
  • During the week, expected to attend morning report from 7:30-8:30 AM and then present admissions (as many as possible, time permitting) to day teams (night intern/resident should coordinate with day teams to devise a plan for presenting holdovers each morning, as the night team will likely have done admissions to multiple different teams overnight)
  • May not stay past 10 AM to present admissions

Day Residents

  • Weekdays: 7 AM – 5 PM
  • Covered by either dayfloat or the twilight resident while in clinic depending on the number of residents in clinic (see “Clinic” below)
  • On one weekend day, res-iterns half of list
  • Covered by WER on one weekend day
  • Responsibilities:
    • Triages and supervises admissions until 5 PM
    • Leads morning huddle and rounds
    • Interdisciplinary rounds
    • Signs out to twilight resident

Twilight Residents

  • One twilight resident for B1/B3, one twilight resident for B2/CHF
  • Shift is typically from 4PM – 2 AM
    • Comes in at 12pm when both of the residents (i.e. B1 & B3 or B2 & CHF) have clinic. (see “Clinic” below)
  • B1/B3 Twilight is off Friday and covered by WER
  • B2/CHF Twilight is off Saturday and covered by WER
  • Responsibilities:
    • Takes over responsibility for admissions from 5 PM – 12:30 AM
    • Observes sign out from twilight interns to nightfloat intern (at midnight)
    • Try to balance admissions between both interns, especially on CHF/B2 (since CHF rarely admits, the CHF twilighter should take some B2 admissions)
    • If the Cards twilight intern is switching to a day rotation, the twilight resident is expected to ensure the twilight intern is out by 10 pm.

Night Resident

  • Monday-Friday: 11:59 PM – 10 AM
  • Saturday: OFF
  • Sunday: 11:59 PM – 8 AM
  • Responsibilities:
    • If the Cards twilight resident is switching to a day rotation, the nightfloat resident is expected to come in at 9:30 pm to ensure the twilight resident is out by 10 pm.
    • During the week, expected to attend morning report from 7:30-8:30 AM and then present admissions (as many as possible, time permitting) to day teams (night intern/resident should coordinate with day teams to devise a plan for presenting holdovers each morning, as the night team will likely have done admissions to multiple different teams overnight)
    • Supervises night intern
    • May not stay past 10 AM to present admissions

Weekend Rounders

  • Cards Weekend Rounder 1: Covers residents’ day off for B1 and B2
    • Takes pass off at 8 AM
    • On both Saturday and Sunday, will res-itern to cover interns who have the day off
    • Can sign out to twilight resident at 5 PM
  • Cards Weekend Rounder 2: Covers residents’ day off for B3 and CHF
    • Takes pass off at 8 AM
    • On both Saturday and Sunday, will res-itern to cover interns who have the day off
    • Can sign out to twilight resident at 5 PM
  • Cards Twi/Float Weekend Rounder:
    • 4 PM – 1 AM on Friday (note shorter than usual twilight shift, on Friday night), 5 PM – 8 AM on Saturday
    • On Friday, acts as twilight resident for B1/B3 overseeing admissions. Oversees twilight interns for B1/B3, including sign out to nightfloat intern.
    • On Saturday, acts as twilight resident for B2/CHF as well as night float resident. Will cover two B teams and supervise one twilight intern. Will then supervise nightfloat intern.

Admitting Structure

Admitting structure

  • Daily admitting by regionalized pod.
  • Admissions during the day may be distributed between the two day interns at the resident’s/team’s discretion. Some teams may choose to alternate a long call/short call-type pattern, others may choose to admit to both interns’ lists daily based on intern censuses.
  • The team will take 1 admission between 4-5PM.

Census Caps

  • B1, B2, B3: Team cap of 14 patients in normal census; increases to 16 in extreme census.
  • CHF: Team cap of 16 patients in normal census; increases to 17 in extreme census.
  • Intern cap of 9 patients.

Extreme Census Rules

  • Criteria for activation: Combined cardiology housestaff census reaches 62 (increased from 58 in April 2018 after creation of the new CV-PA Team).
  • It can be activated by admitting, cardiology, or the phys if the above criteria are met.
  • Applicable during the week AND on the weekends.

Clinic

  • If both team residents covered by a twilight resident (i.e. B2 & CHF or B1 & B3) have clinic, then that twilight resident should come in at 12pm. If only one team resident within a twilight dyad has clinic, Dayfloat covers. However, if there are several Dayfloat needs in the Tower and Shapiro, the CMRs may request that one or both twilight residents come in at 12pm, regardless of the above. Cardiology twilight residents are expected to look at Amion ahead of their block to identify days when they will need to come in early.
  • If one of the team interns has clinic, twilight intern comes in at 12pm. If as the twilight intern you need to come in early more than twice per week for clinic coverage, please contact the CMRs.