NOTE: for AY 2018-2019, the non 24 hour call schedule in the LCU for inerns will be modelled after the MICU intern schedule. The important differences are that: 1. the night intern hours will be 8p to 11a and 2. the day interns will start at 7a.
- 4 interns and 3 residents.
- 1 attending.
- Interns 1 and 2 alternate between long and short days
- Interns 3 and 4 each cover 7 nights shifts and 3 short-help shifts over a 2 week block
- 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).
- Day long
- 7a-9p (14h)
- Day short
- Night call / Post-call (on first day of rotation “post-call” interns should be present as an additional “short” intern if they are not post-nights)
- Short Help
- 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 day-call intern and the night-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.
- 1 and 2: Day off when Short day falls on a Sunday or Monday
- 3: Fridays
- 4: Sundays
- 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, day-call intern, and night-call intern.
Rounding guidelines for interns (roles are subject to change as this schedule is new in the LCU for AY 2018-2019)
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 (night 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 (night intern): Night 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 (night 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 (day intern)
- 6. CXR (day intern will read, but whoever has the big screen WOW should pull up the images)
- 7. Meds (pharmacist)
- 8. **TO BEDSIDE** Exam: Day intern will lead and present
- 9. **BACK OUTSIDE** Plan by problem: Back to night 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.