- 4 interns and 3 residents.
- 1 attending.
- Interns have a 4 day call cycle (long call/post call/swing/pre-call). The long call/post call shift will be 28 hrs long.
- Residents will have a 3-day overnight call structure with 28hr call days followed by a swing day: (On-call overnight / post-call until 11am / swing).
- Long call/post call
- Hours (maximum): 7a (day 1)-11a (day 2)
- 7 am (day 1): start shift
- 7 am – end of rounds (day 1): Preround as needed, attend rounds (not responsible for any admissions that come before or during rounds)
- End of rounds (day 1) – 7 am (day 2): responsible for all new admissions to the unit
- 7 – 11 am (day 2): Preround, present patients, depart *note: departure by 11 am is required, regardless of the length of rounds. Earlier departure is encouraged if possible.
- Swing and pre-call
- Hours (maximum): 7a-5p
- 7 am: start shift
- 7 am – end of rounds: preround, rounds (admissions that come in before rounds or on rounds go preferentially to pre-call intern, though this can be altered depending on team’s preference)
- End of rounds – departure: Help out with team tasks
- 2 pm – 5 pm: Sing out to long call intern, depart *note: OK to sign out earlier if workload allows; encourage sign out at 2 pm at least one day per 4 day cycle; latest sign out allowed is 5 pm
- On-call / Post-call
- 7a-11a (28h)
- 7a-5p (10h)
Supervision of Interns
- Unit residents supervise unit interns during the day.
- The on-call resident supervises the long call intern after the other residents leave.
- No admission cap – total census cap defined by number of available beds.
- Daily admitting.
- Sub-Is to have caps as deemed fit by supervising resident. No more than 3 admissions per sub-I per shift.
- Interns – Day off when Swing day falls on a Friday, Saturday, Sunday or Monday.
- Residents – Day off when Swing day falls on a Friday, Saturday, or Sunday.
- AM Rounds: 7am – 10:30am daily with whole team.
- PM Rounds: 8pm – 9pm daily with on-call resident and intern
Rounding guidelines for interns
Speak up! There are ~10 people on rounds, all with computers, and lots of RNs or other staff coming in and out while you speak.
- 1. One liner (post-call intern): Establish early if your attending wants this. Once they are familiar with the unit, a lot of attendings prefer that you jump into overnight events.
- 2. Overnight events (post-call intern): Post-call intern should basically prep the next morning’s progress note over the course of the night. For convenience, you can paste this into the “treatment team sticky note” which shows up in the Summary tab so that it’s right in front of you during rounds.
- 3. Run the board (post-call intern): Most of this is in the Comprehensive Flowsheet. Say: “To run the board, temperature has ranged from X to X, currently X. HR has ranged from X to X, currently X. BP has ranged from X to X systolic over X to X diastolic, currently X to X, with MAPs ranging from X to X with a current MAP of X.” Same format for RR and O2. Then current vent settings, then current drips. Then, as appropriate, switch over to each several tabs in the vertical left sidebar: 24 hour and since-midnight I/O’s [can toggle 24hr view], ventilator settings, IABP, CVVH, hypothermia protocol.
- 4. Labs, micro, other studies (resident)
- 5. EKG (pre-call intern)
- 6. CXR (pre-call intern will read, but whoever has the big screen WOW should pull up the images)
- 7. Meds (pharmacist)
- 8. **TO BEDSIDE** Exam: Long call intern will lead and present
- 9. **BACK OUTSIDE** Plan by problem: Back to post-call intern, standard style…
- 10. LCU bundle, as in progress note — be quick here.
Progress note guidelines
Use Scott Lee’s excellent template .lcuprog (go to Personalize > My SmartPhrases > Open… > User > Scott Lee) which follows the format that presentations go in (see below for details). Use the copy forward function once you have made an initial progress note for a patient on the first day they are admitted (the goal is to finish all the progress notes on rounds). Add “.today” to the date row at the top of the first progress note or update the template so that it auto updates.