VA

July 13, 2019

Please note

The information below is a summary for each role. Any info that is not covered below can most likely be found on the VA wiki (www.wikirox.com, password: wikirox).

General Medicine Admission Rules

Teams Alpha, Bravo, Charlie, and Delta

Teams Echo

Alpha & Bravo

Teams Alpha and Bravo are sister teams that have their team rooms on Ward AG and preferentially admit patients to AG and A1.

On weekdays, they will alternate call (admit up to 6) and post (admit the first 2 patients), and on post-call days can sign out as early as 5pm to their sister team who will cross cover them until signing out to the nocturnist at 7pm. Echo team will admit some of the patients assigned to this region as well.

On weekends, the call team will admit 8 and the entire post-call team is off. The post-call team will be covered by either the Dayfloat on Saturdays or the ROD on Sundays.

Charlie & Delta

Teams Charlie and Delta are sister teams that have their team rooms in 2B-142 and preferentially admit patients to AG and A1.

On weekends, the call team will admit 8 and the entire post-call team is off. The post-call team will be covered by either the weekend moonlighter on Saturdays or the ROD on Sundays.

Echo

Team Echo operates independently without a sister team and admits patients all over the hospital without a designated geographic region; their team room is in 2B-120.

On weekdays, they will preferentially admit patients assigned to 3N, A2, and floor-level patients in the PCU. They will also take many admissions on AG, A1, 2N, and 2S depending on when the patients arrive during the day. They will admit up to 5 patients daily on weekdays. Note: If a patient is floor appropriate and no medicine floor beds are available, they can be admitted or called out to the PCU with a medicine floor team covering.

Until 6/29/2018: On weekends, Team Echo will not admit new patients. On Saturday, the interns will be in house without the Team E resident and will round with the attending on their patients. Once the attending has left, Intern 1 will have the Alpha/Bravo call resident as backup, and Intern 2 will have the Charlie/Delta resident as backup. Intern 1 can sign out to the Alpha/Bravo resident and Intern 2 can sign out to the Charlie/Delta resident no earlier than 3pm. On Sundays, the intern is off and the Team E resident manages the patients and signs out to the Alpha/Bravo resident (intern 1 list) and Charlie/Delta resident (intern 2) no earlier than 3pm.

Beginning 6/30/2018: On weekends, Team Echo will not admit new patients. On Saturday, the intern is off and the Team E resident manages the patients and signs out to the Alpha/Bravo resident (intern 1 list) and Charlie/Delta resident (intern 2) no earlier than 3pm. On Sundays, the interns will be in house without the Team E resident and will round with the attending on their patients. Once the attending has left, Intern 1 will have the Alpha/Bravo call resident as backup, and Intern 2 will have the Charlie/Delta resident as backup. Intern 1 can sign out to the Alpha/Bravo resident and Intern 2 can sign out to the Charlie/Delta resident no earlier than 3pm.

Cardiology

Call Scheme

Teams alternate call, q2 – this applies to residents and both interns (7am-7pm).
The on-call team admits up to 8 patients with each intern alternating admissions.
However, there is no cap to daily CCU admission; once the interns are capped, all remaining CCU admissions are done by the on-call resident or overnight resident and will be assigned to the on-call team the following day.
Note the schedule refers to short-call and long-call intern. There is no difference between these positions on weekdays. On the weekend, the long-call intern is on and the short-call intern is off.

Cross-Coverage Responsibilities

The post-call resident can signout to the on-call cardiology resident at 5pm.
The post-call interns can signout to the post-call resident before 5pm at the discretion of the resident.
For interns who are in clinic, their patients will be covered by their team residents. When residents are in clinic, their interns will be supervised by the other cardiology resident. A verbal pass off should be provided.

Weekend Coverage

Until 6/29/2018:

Interns have two weekends with one day off, one “black” weekend, and one “golden” weekend
Each resident gets one weekend day off per week
Weekend coverage is internal with two teams covering for each other
Weekend team is one resident with their late call intern and the post-call intern from the other team. The on-call resident provides back-up for the post-call intern from the other team.

Beginning 6/30/2018:

Each intern gets one weekend day off per week
Each resident gets one weekend day off per week
Both interns will be in house on the day they are long call. They will be covered by the sister team’s resident.
The resident will be in house on the day his or her team is short call. The resident will resintern on his/her team and supervise the sister team’s long call interns.

ROD/Nightfloat

ROD Weekday Duties

Hours: 5pm-1am.
Admitting Cap: 4 from 5-7pm + 1 from 7-10pm
Cross coverage:
- Weekday: The ROD does NOT cross-cover
- Sunday: Covers the two “off” teams (Alpha/Delta or Bravo/Charlie). Does NOT admit. Does NOT write progress notes.
Does not accept any other teams for cross coverage.

ROD Sunday General Principles

Saturday: OFF
Sunday (6:45am – 7pm): Note that the BMC resident covering the ROD shift on Sunday may not be the BMC resident who was ROD during the week.
- The ROD position will cover the two floor teams that are off.
- Covers the two teams who are off that day (Alpha/Delta or Bravo/Charlie). Arrive at 6:45am to receive sign-out from nocturnist. Round on both teams and contact team attendings either by phone or in person. No daily progress notes needed, though event notes should be written for the indications below:
  - Rapid response event or worsening in clinical status
  - Change in status requiring new radiology order
  - Change in status leading to new consult being placed
  - Change in status leading to key medication change
  - Relevant change in physical examination or laboratory data
  - Significant patient/family discussion or goals of care discussion
  - Patient death
  - Transfer to MICU or to another service
  - Procedures (including NG/dobhoff placement)

Nightfloat

Two second or third-year residents work from either 6pm or 7pm until 7am. Residents should arrive at 6pm on their first day, but moving forward the two nightfloats can alternate coming in at 6:00pm and 7:00pm.
Residents will alternate between two roles:
- GMS Junior Night Float: Patient flow manager and admitter
  - GMS receives admitting pages and assigns them to the appropriate admitting physician. They are also expected to send out the holdover email
- CCU Junior Night Float: Cross-cover CCU patients, alternates admissions with GMS nightfloat; admits all CCU patients when possible
Traditionally, each resident covers each role for half the week with a switch day on Tuesday or Wednesday, but the roles can be decided upon between the 2 residents.
There is also a nocturnist at the VA who cross-covers all medicine and cardiology floor patients from 7pm – 7am, as well as admits a few medicine patients

MICU

Weekday Call Scheme (Monday-Thursday)

Residents: day residents alternate short and long call
- Long call: 7am-7pm (leave by 8pm after passoff)
- Short call: 7am-2pm (leave after majority of work is completed)
- Nights: 7pm-9am (stays to listen to new patient presentations, must leave by 10am)
Interns: rotating on a 3 week cycle between 2 weeks of days and 1 week of nights
- Long call: 7am-7pm (leave by 8pm after passoff)
- Short call: 7am-4pm (leave after majority of work is completed including progress notes)
- Nights: 7pm-9am (stays to present new admissions, must leave by 9am).
**no admitting cap, other than filling the beds in the PCU and MICU

Weekend Call Scheme (Friday-Sunday)

Residents: day residents alternate long call and off
- Long call: 7am-7pm (leave by 8pm after passoff)
- Short call: off on Saturday or Sunday
- Nights: 7pm-9am (stays to listen to new patient presentations)
  - Works Sunday-Thursday nights, off Fridays, then works Saturdays
  - Covered by a moonlighter (MNL) every Friday, 7pm-7am
Interns: rotating on a 3 week cycle between 2 weeks of days and 1 week of nights
- Long call: 7am-7pm (leave by 8pm after passoff)
- Short call: off
- Nights: 7pm-9am (stays to present new admissions, must leave by 9am)
  - Covered by intern weekend rounder (WER) every Saturday, 7pm-9am – usually VA Neuro intern
**no admitting cap, other than filling the beds in the PCU and MICU

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