UCI BLOCKS 15-17
15: INTERNS 4/25-5/15; SENIORS 4/26-5/16/16
16: INTERNS 5/16-6/5; SENIORS 5/17-6/6/16
17: INTERNS 6/6-6/30; SENIORS 6/7-6/30/16
Important Dates/ Scheduling Considerations:
- 5/10: Research Day (afternoon)
- 5/13: Semi Annual Reviews day 1 of 2
- 5/13-15: R3 Vegas Retreat (12P 5/13 to 6P 5/15)
- 5/20: R2-3 Transition Retreat, 9A-5P
- 5/23: First day for brand-new third year medical students
- 5/27: Semi Annual Reviews day 2 of 2
- 6/10: UCI IM Residency Year-end Party
- 6/20: First day of intern orientation for 2016-17 interns
- 6/23: Last day for Prelim interns
- 6/24-28: No days off can be taken by any UCI ward team, MICU or CCU interns or residents. Only exceptions:
see MICU Senior schedule (6/28) and inpatient call schedule (6/26 for seniors on teams B and D). It is therefore
imperative that you plan accordingly and take your designated 3 days off BEFORE 6/24.
- 6/28: First day of work for 2016-17 interns, last day of work for Categorical interns (released at noon)
- 6/28-30: R1-2 Transition Retreat in San Diego
- Multiple dates:
o EM didactics Wednesday AM
o FM intern clinic varies (see UCI call schedules; black-out dates are designated in bold with a *)
o MICU Nutrition Lecture at 2 PM in team room on following dates: 5/3, 5/24, 6/14
o UCI/LBMMC Joint MICU Conference 5/12/16 and 6/3/16
Updated schedules can be found on the residency website www.medicine.uci.edu/residency under schedule.
Educational Opportunities
 Conference is optional for ICU residents, mandatory for all other residents (CCU—conference is mandatory!)
(Only exception: multisite electives, night float—talk to the chief if this applies to you)
 Morning Report: Tuesday, Thursday, Friday 8-9AM (Tues/Thurs is mandatory for seniors, Friday mandatory for
interns)
 Noon conference: Every weekday – see posted conference schedule on website.
 Ward teams: Best case conference – last Thursday of the block
 Memorial/UCI ICU joint conference
 The Academy of Internal Medicine: Every Friday at 8:00 AM (interns) or 9:00 AM (seniors join) in Douglas
Hospital room 7843. All residents on elective MUST attend. If you need to be excused for whatever reason,
please notify the chiefs in advance. If you fail to do so and are absent from Academy, you will be assigned extra
back up/coverage.
 Mini-lectures: 5-10 minute lectures are available on the residency website for teaching interns and medical
students while on wards/ICU.
Duty Hours
 Record your duty hours daily using New Innovations website (https: //www.new-innov.com/login) or phone app.
 R1: maximum 16 hr shifts (i.e., start at 6:30 AM, signout by 10:30 PM).
 R2/3: maximum 24 hr shifts (+4 hrs if necessary for handoffs/signout), but then need 14 hrs off.
 All residents: 10 hrs off between shifts (i.e., signout at 8:30PM, return at 6:30 AM).
Revised 4/25/16
Code Blue/Rapid Response Team
 Day 6 AM-6 PM: MICU senior and fellow, and Team H residents
 Night 5 PM- 6 AM: All night float residents & the MICU team (senior, intern).
BACKUP RESIDENTS
 If a resident is sick or can’t come to a scheduled shift for another reason, contact the on-call Chief Resident via
pager 6666. If any resident is overwhelmed, e.g., at night with admissions or cross-cover, they should seek
assistance first from their colleagues, including on night float, as well as supervising fellows and attendings,
including the noctensivist. If more assistance is needed, please call the on-call Chief Resident pager (p6666) to
sort out a solution.
 Home backup call occurs from 7 AM to 7 AM (24 hours). During this time, on-call residents must keep their
pager with them at all times and be within 30 minutes (not miles) of all three hospitals.
Anonymous Feedback
If you have concerns that you would like to express anonymously, please go to the resident website
www.medicine.uci.edu/residency .
Click on “Resident Resources” in the left-hand column. At the top of the next page right under words Residency
Portal, you will see the link to “Anonymous Feedback”. Click on that link. The system removes your identity and
you can post your concerns anonymously. If you want a response, provide your actual name (obviously not
anonymous) or an outside, non-uci email address which does not identify you (and therefore is anonymous).
Contact the chief residents if you have any concerns:
Daytime: Heather Hofmann & Billy Graham
After hours: Chief pager, 714-506-6666
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WARDS
Typical Ward Day
 6:30-7AM = Morning signout
 7AM-8:30AM = Teams pre-round on all patients
 AM Report = Tues/Thurs/Friday 8-9PM (Senior vs Intern)
 9:15 or 9:30 = Case management interdisciplinary rounds
 9:30-12:00 = Walk rounds with the attending on new patients
 12 Noon-1 PM = Noon Conference / Grand Rounds
 5PM = “No-call” and “short call” teams are able to start signing out to cross cover resident
 7:30PM= Long call teams are able to start signing out to cross cover, goal to leave by 8:30PM
Call System
 Four teams will be “on-call” and accept patients in a modified drip system based on bed assignment. Two teams
will be “no call” and not accept patients each day
 Admissions for the day teams take place from 6:30AM-5PM for two short call teams, and 6:30AM-7:30PM for
two long call teams
o Team Caps = 15 patients (ACGME cap 20)
o Intern Caps = 8 patients (5 new H&Ps in a 24-hour period per ACGME)
o Senior Caps= 20 patients (10 new H&P’s in a 24-hour period, plus an additional 4 transfers per ACGME)
Days Off
 Senior residents should take one “no call” day off per week
 Interns off days are to be assigned at the discretion of the senior resident & team attending, and should be
planned during the first few days of the block. Interns should not take long call days off unless permitted by
senior and attending.
 All team members must get at least 3 days off per block (4 during July).
 Please include the MS4 sub-interns and MS3 students when planning your rotation days off.
Nursing Huddles
Team workrooms in the Tower are a shared space with nursing staff. Due to the lack of rooms, daily nursing
huddles occur in the center team rooms of each floor in the Tower from 7-7:15am. In addition there will be
hour-long meetings from 7-8am on the 2nd Thursday of the month on 5T and from 6:45am-7:30am the last
Thursday of the month on 4T. Please be courteous and kind with our nursing staff during these shared times.
Please minimize phone calls/conversations and if needed can use the adjacent nursing station during this time.
Ancillary Services on Weekends
 If needed, call early in the day to go over discharges that require transport, SNF admission, DME orders, home
health orders, etc.
o Case Manager: pager 7242
Social Worker: pager 7246
Medical Students
 Notes in Quest
o MS3’s write medical student notes that are cosigned by the intern.
o MS4’s write medical student notes that are cosigned by the senior.
o If either the intern or senior is unavailable, the student’s note can be signed by the next level
supervisor—senior or attending for MS3, and attending for MS4.
 Schedule
o 1 day off per week, just like residents. Must be released by 5 PM the day before the shelf exam.
o Do NOT get the weekend off between site rotations unless they have accumulated their days off.
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Days off do NOT include School of Medicine holidays.
New Patients (Admissions/Transfers/Bouncebacks):
 All admissions/transfers will be assigned to team and attending based on their bed assignment by SPPO.
 You will learn about new admissions via your team pager, which the senior resident should carry. The patient
will then be assigned to an intern.
 If any team has 15 patients, they will be out of the drip until they either drop their team census to less than 15
or all the teams have 15 patients, in which case, all teams will re-enter the drip.
 You must call the SPPO at x 8455 or pager 6000 to let SPPO know you when you are capped or uncapped. If you
fail to let SPPO know you are capped and you get an admission that “overcaps” you, you will still have to take
the admission.
 If one or both of the long call teams are at the ACGME soft cap of 15 going into long call, long call teams will
admit up to 3 patients until 6:30 when the night float admitting residents arrive and can start admitting. The
ACGME official cap is 20 patients. Essentially if a team’s census is at 15 or greater at 6:30 PM, long-call ends. If
census is less than 15 at 6:30 PM, call continues until 7:30 PM.
o Example: Team A is long call and has 15 patients at 5 PM. They get called for 2 patients before 6:30 PM.
They have 17 and sign out at 6:30 PM.
o Example 2: Team B is long call and has 14 patients at 5 PM. They get called for 2 patients before 6:30
PM. They have 16 and signout at 6:30 PM.
o Example 3: Team C is long call and has 15 patients at 5 PM. They don’t get called between 5-6:30, but
get called with 3 between 6:30-7:30 PM. They have 15 patients and signout at 6:30 PM. The 3 admits go
to the overnight admitting residents.
o Example 4: Team D is long call and has 12 patients at 5 PM. They take up to 3 patients until 7:30 PM.
 All pending admits coming from outside hospital or clinic will be entered into sharepoint (link on residency
program website) and assigned to the drip immediately. This may mean that you are assigned a patient that
does not come until later that evening or even the next day. No matter the case, the patient will be yours (even
if the senior if off the day of arrival).
 Bouncebacks from the ED or MICU will follow the senior resident for the current block EXCEPT if the senior is
absent, no call, the team is capped OR if it is the first or last day of the senior’s block.
o If the team receiving the bounceback is admitting and not capped, the patient should go back to the
original team to preserve continuity and the team doing the H&P or accept note should get credit for
the admission.
o If the senior is not present, not admitting, or is capped, the patient should go to another team as
assigned by SPPO, and the admitting/accepting team will get credit. The patient should then be
transferred the next morning with no credit. If the team remains capped the next day, the patient will
remain on the admitting/accepting team for the duration of the hospitalization.
o If the senior is there but not admitting, act as if the senior is not present.
 During the daytime, if a senior resident is called about an admission and realizes the patient is a bounceback to
another team, that resident will contact the team senior who is receiving the bounceback. The senior who is
receiving the bounceback is responsible for calling SPPO and getting credit for the admission and removing
credit from the team who was originally assigned the patient. This will preserve the drip, and avoid the first
team getting credit for the admission and skipped in the next round of admissions.
 MICU transfers:
o Bouncebacks: The MICU resident is responsible for figuring out which team the patient is bouncing back
to (if applicable). The MICU resident will call SPPO and get the patient assigned to the team it came
from if the senior is there, AND the team is not capped AND it is not the first or last day of the senior’s
block.
o If a patient is assigned a bed & short call ward team before 5 PM, the patient will be cared for by the
MICU team until the patient is physically out of the unit. This should occur within 1-2h, but there is no
guarantee. However, it is the responsibility of the accepting ward team to assess the patient, write an
accept note, and sign the patient out to the ward cross-cover. If the patient is transferred out of the unit
between 5 PM and 6 PM, the ward cross-cover is responsible for the care of the patient overnight. If the
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patient is transferred out of the unit after 6 PM, the ICU cross-cover is responsible for the care of the
patient overnight. If this happens, the ICU cross-cover must sign-out overnight events to either the ward
day team or ward cross-cover in the morning.
o If a patient is assigned a bed & long-call ward team before 7:30 PM, the patient will be cared for by the
MICU team until the patient is physically out of the unit. This should occur within 1-2h, but there is no
guarantee. However, it is the responsibility of the accepting ward team to assess the patient, write an
accept note, and sign the patient out to the ward cross-cover. If the patient is transferred out of the unit
before 7:30 PM, the ward cross-cover is responsible for the care of the patient overnight. If the patient
is transferred out of the unit after 7:30 PM, the ICU cross-cover is responsible for the care of the patient
overnight. If this happens, the ICU cross-cover must sign-out overnight events to either the ward day
team or ward cross-cover.
o If a patient is assigned a bed & any ward team after 7:30 PM, the patient will be cared for by the MICU
night team. The ICU cross-cover must update the ICU day team just as in any regular morning sign-out,
and it is the responsibility of the accepting ward team to contact the ICU day team to get sign-out of the
patient.
o The only exception to the above rules is when the MICU census is 18 or higher. In this case, the ICU is
then "open" and the patient will be assigned a team without having a bed assignment. The ward team is
responsible for the care of the patient regardless of where they are physically located. This includes,
then, that the ward cross-cover manages the patient overnight.
Transfers from non-medicine services
o All requests for transferring a patient to a medicine ward service MUST go through Team H as a formal
consult. If deemed appropriate for transfer after staffing the consult with the Team H attending, SPPO
will assign the patient to the next admitting ward team and the Team H resident AND referring team
should discuss the case with the new medicine ward team.
o Do not be confused if the patient is currently in a non-medical ICU. Aside from the exceptions above, for
MICU transfers to the floor, the expectation is that the MICU team will continue to manage the patient
until the patient is physically moved to a floor bed. The same is NOT true when Team H transfers patient
from non-medical ICU to floor team. The transferring team will not continue to manage the patient in
the ICU until they are physically moved to a floor bed. If you are assigned the patient by SPPO, take over
as primary service regardless of if the patient is in ICU or lower level of care.
During the night shift, do not contact SPPO about reassigning patients until the end of the night shift.
Admissions can be redistributed by the night float residents without contacting SPPO. To restart the drip fairly
every morning, the crosscover resident is responsible for calling SPPO at 6:30AM to let them know what team is
up next based on how many admissions each team got during the night.
Family Medicine Policy
o Cap at 15 patients (including pediatrics and OB)
o Once the cap above is hit for the FM service, the next patient with a senior health center PCP will go to
Internal Medicine service and the next patient with a PCP at the FQHC will go to Family Medicine
service. Once FM hits 15 adult patients, then all patients will go to the IM teams until the FM team
uncaps. If all teams are capped above 15 then everyone will share the overflow and continue to take
admissions.
o Please remember that patients are to be admitted to FM if they meet both of the following criteria:
 Identifies a UCI family medicine or UCI geriatrics provider as their primary provider, and with
whom the patient intends on following up with upon hospital discharge.
AND
 Has been seen on 2 visits during the previous 2 years by any family medicine resident or family
medicine or geriatrics attending at their outpatient family medicine/geriatric sites (FQHC Santa
Ana, Anaheim, Orange or Irvine). These 2 visits are to be continuity visits and not just urgent
care visits.
o As a reminder, do not transfer patients between services after the day team has already seen a patient
(to avoid disruption in continuity of patient care)
Visit the residency website for more complete guidelines on admissions for family medicine and orthopedics.
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Guidelines for Notifications and Other Processes
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Notify all primary care physicians at Gottschalk, the Senior Health Center, and Pavillion III when their patients
are admitted and discharged. On admission, a brief email (encrypted), phone call, or page with call back
information will suffice. On discharge, an encrypted email should be sent to the PCP with a description of
hospital course and important follow-up information.
For community primary care physicians, please fax a copy of the discharge summary. This can be done
electronically (see attached handout), or old-fashioned way.
Notify the Primary Oncologist for every Heme/Onc patient to a ward team or Team O. If the primary oncologist
wants or the patient needs an oncology consult, then notify the heme/onc service. Also, all goals of care
discussions regarding heme/onc patients need to be decided upon between attending physicians or fellows and
should not be initiated by residents. This is not the same as assessing code status on admission—as with any
admission, code status can be asked by the admitting team.
Notify the MICU/CCU fellows (day) or noctensivist (night) for every MICU/CCU admission and transfer.
Notify the Renal fellow about every dialysis patient or renal transplant patient being admitted.
Notify Transplant Surgery for all transplant patients being admitted; may only need to have nephrology follow
(they will guide you on the correct consult)
Consult Cardiology fellow for all admissions for acute decompensated heart failure. This policy was recently
reviewed and patients must have a formal cardiology consult for co-management of the heart failure.
See attached handout regarding cardiology pacemaker/AICD representative contact information.
Interventional Radiology
- There are a number of procedures that need 4 hour tele monitoring. They are the following: Renal
biopsies, Liver biopsies, Lung biopsies (between 2 - 4 hours), Fresh nephrostomy tube placement, Fresh
biliary drain placement
- The goal is to get these patients a tele bed order from the primary team to manage the patient after
Phase I recovery is completed in IR. The difficulty lies in getting the tele bed available for the patient to
transfer to. A majority of the time there are no beds available and this is where PPCU comes in. If the
option of getting a tele bed is not available, instead of delaying the case until a bed becomes available
(which could mean rescheduling the patient to the next day), IR does the procedure, perform Phase I
recovery then send the patient to PPCU for the rest of the 4 hour recovery time then send the patient
back to their original bed. PPCU just asks that the patient original 4T bed is saved for the patient since
the patient will be off the unit for 4 - 6 hours. At this point the tele order should be discontinued and
that should be communicated between the IR nurse and the patient's primary 4T nurse.
Night medicine rotation website has some great resources, including links to UCI protocols clinical & pathways:
http://www.medicine.uci.edu/NOC/Residents.asp
Documentation when patient’s pass away
- There are no longer red packets.
- There are 2 separate notes for physicians to complete in Quest upon a patient’s death:
i. Reports of Death of Stillbirth
ii. Death Summary Note – replaces the discharge summary for the hospitalization
- There are 2 numbers to call:
i. One Legacy - 1-800-338-6112
ii. Coroner – 714-647-7400
- Completing Death Certificates / Cause of death
i. We have noticed an increasing number of death certificates with “cardiopulmonary arrest,”
“cardiac arrest” or “cardiac death” being listed as the immediate cause of death. These
diagnosis not accepted as the cause of death. The cause of death is a disease or pathologic
process that led to the cardiopulmonary arrest. Directly from the County of Los Angeles Public
Health Department “this should be a disease, condition, or injury that directly resulted in death.
A common error is to list a mechanism of death (for example, cardiac arrest) rather than a
disease (myocardial infarction). Vague terms such as “brain dead” or “pulmonary arrest” cannot
be used on the death certificate.” For more information or instructions on how to complete the
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certification, we have attached a PDF file from the CDC titled “Physician’s Handbook on Medical
Certification of Death.” The most relevant section has been highlighted in yellow for your use. In
addition you can go to the following links:
1. https://admin.publichealth.lacounty.gov/wwwfiles/ph/media/media/rx-may2014.pdf
2. http://www.cdc.gov/nchs/data/dvs/blue_form.pdf
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Follow-up appointments:
- For UCI follow-up appointments, place an order in Quest. This is a new policy. The appointment
schedulers will request an appointment in the time frame requested but are not allowed to over book. If
the appointment is not scheduled prior to the patient's discharge, the patient will be called with the
appointment date/time. Lack of an appointment at discharge should not delay the discharge.
- This process replaces the notification of the CM and calling the appointment hotline at x6666.
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Evaluation of a patient by the ICU
- During the day, when the ward team resident contacts the MICU resident for a potential transfer:
i. the ward team resident will evaluate the patient and recommend transferred to the ICU or
continued ward team management. If the floor resident agrees with a recommendation for
continued floor management, then the MICU resident will document the evaluation and
recommendations in an event note.
ii. if the ward team resident believes that the patient should still be in the intensive care unit, the
ward team resident must contact their attending physician and the ICU fellow. If the ICU fellow
still feels that the patient does not belong in the medical intensive care unit, a direct discussion
should occur between the ward team attending and either 1) the medical intensive care unit
fellow or 2) the MICU attending. The results of this discussion need to be documented as well in
an event note.
iii. if in these discussions the patient is transferred to the medical intensive care unit, the transfer
note will suffice, and event notes are not necessary.
- During the evenings (after 6 PM / MICU night shift hours)
i. the ward team resident will evaluate the patient and recommend transferred to the ICU or
continued ward team management. If the floor resident agrees with that recommendation, then
the MICU resident will contact the nocturnist covering the MICU to present their
recommendation and obtain nocturnist concurrence, and will document the evaluation and
recommendations in an event note.
Professionalism
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You cannot refuse the admission when called by the ED. If you feel that accepting the admission would
jeopardize patient care or keep you in the hospital past the duty hour limits, contact your attending.
To avoid overwhelming the night float residents, if you are called for a late admission and feel that you can
admit this patient without violating duty hours, please do so.
Do not argue with the emergency department, other services, or your colleagues. Any issues should be brought
to the attention of your attending or a chief resident.
If you ever feel like you are overwhelmed, ask your chief resident and/or attending for help.
Please respond to your pages in a timely manner, ideally within 15 minutes.
You are accountable for checking your emails at a minimum of every 24 hours.
On days off or when leaving the hospital, please leave an out of office message on your pager with the
appropriate contact information of the covering physician. If any pages accidentally come through -- please try
to provide callers with the appropriate person to call. To leave an out of office message:
o Go to the intranet as if you are going to page someone.
o Enter your pager number or your name as if you are going to page yourself.
o Rather than submit an actual page to yourself, look at the menu options on the left of the webpage.
Select the bottom option: “Out of Office”
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Adjust the end date (often the next day) and leave an away message, e.g., “I am away from the hospital.
Please contact the on-call medicine night float team or Dr. [senior resident] for patient care issues.”
Consults
 Call consults early in the day.
 There have been issues of consults being placed and the attending redacting them after consultants have
evaluated and staffed the case. Be sure to set expectations with your attending with regard to when to call
for consults.
Quality Care Issues
 Medication Reconciliation: Complete accurate medications on admission, transfer and discharge in Quest.
 DVT prophylaxis: For every patient that you admit, assess his/her DVT risk and order the appropriate DVT
prophylaxis. Please do not use the emergency bypass. If there are contraindications to starting chemical
prophylaxis, select that option instead of bypassing it.
 Hypoglycemic Events on Medicine Wards: The number of hypoglycemic event is on the rise on the Medicine
Wards. If you have a patient NPO for procedure or surgery, please make sure you review all orders, hold or
adjust insulin as appropriate and/or order the appropriate fluid replacement.
 Heart Failure—Try your best to use the Cardiology order sets in Quest, for HF, afib, etc. They are evidence-based
driven and use of the order set will activate notifications/orders for diet, PT, social work, case management,
nursing…all the other care providers that are important for these patients.
 HIV screening is no longer a UCI requirement—do it as indicated for your patients, not because of UCI policy.
Notes/Documentation:
 On wards, when you are not sure who the attending will be to sign a note, leave the note unassigned
 On ICU/CCU rotations, please assign the notes to the attending covering the service. This is how the attendings
keep track of the patients they have seen so they rely on you to assign them notes.
 Get one documentation evaluation completed by your attending, review and get feedback from your attending,
and then submit the form to Brianne (tsunezub@uci.edu).
Handoffs
See attached handout for a great, easy way to format your signout in Quest.
A few comments on Team H / Hospitalist / Medicine Consult Service
• AM signout & transfer of new consults at 6:30AM from the Ward Crosscover NF resident • Signout at 6:30PM to the ward nightfloat cross cover resident. The last consult you can start during a day shift is
at 5 PM—e.g., if you get called for a consult at 6 PM, it is deferred to the night resident or your team the next
day (if non-urgent). • Attend all day Code Blue/Rapid Responses • Obtain formal orientation from service attending • Again - all requests for transferring a patient to a medicine ward service MUST go through Team H as a formal
consult. If deemed appropriate for transfer after staffing the consult with the Team H attending, SPPO will assign
the patient to the next admitting ward team and the Team H resident AND referring team should discuss the
case with the new medicine ward team.
A few comments regarding Ward Night Float
 ADMITTING: Two residents will do new admissions from 6:30 PM- 6:30 AM with admissions being accepted in an
alternating fashion between the two Ward NF residents. Both of these residents will hold clones of pager 1763.
 CROSS COVER:
o One resident will cross cover for all teams starting at 5PM until 6:30AM. This resident will hold pager
6575.
o He/she will also hold the Team H/medicine consult pager (p6555) from 6PM to 7AM, and perform any
overnight Medicine consults and staff with the consult attending at the time of the consult (pgr 2112). If
that attending doesn’t respond, page the service attending. If the service attending doesn’t respond,
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page Dr. Dangodara.
The cross cover resident will also carry the admission pager (p1763) from 5PM-6:30PM and distribute a
maximum of 6 to the long call teams. If one long call team is capped, ony distribute 3 patients to that
team between 5:00-7:30PM. If both long call teams are capped, call the on-call chief resident at p6666.
o At the end of the shift, the cross cover resident will also update SPPO with which team is up for the next
admission if patients were redistributed during the night shift
The pagers and binder will be held in the team C room.
All night float residents are responsible for Code Blues/Rapid Responses.
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Sleep Room Assignments
NUH 3834
rd
(3 Floor East Side)
NUH 4838
(4th Floor East Side)
Sleep Trailer (Bldg. 58)
Room 113-Keys located in a
box at the 4T nurses station.
Resident
Telephone Extension
Ward Night Float (ACE)
1115
Ward Night Float (BDG)
1158
Ward Cross Cover Resident
unknown
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MEDICAL INTENSIVE CARE UNIT
Typical MICU/CCU Day
 6:00 AM = AM signout with all MICU/CCU, Unit NF residents, nocturnist & Team fellow present.
 6:00 AM-6 PM = MICU/CCU work day
 6 PM = signout with all MICU/CCU, Unit NF residents, nocturnist, and Team O fellow present.
 On the weekend, Team O will sign out after the fellows are done with their work.
Caps
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MICU
o Each intern is capped at 6 patients
o When the MICU team census is at 19 patients or higher, the senior will function as an intern with a cap
of 6 patients per housestaff, and the fellow will take on all supervising responsibility
o
CCU
o Same as ward teams (see page 3).
Days off
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Days off are pre-assigned to interns and senior residents in the MICU. CCU days are not pre-assigned however
interns should not take the seniors post call day off. In MICU, we try to avoid Wednesdays as days off because
of EM didactics
Typically, one senior resident from the ICU and CCU will take 24 hour call once a week.
Night residents in the MICU will get the first Friday and Saturday off, then Wednesdays and Thursdays unless
otherwise specified in the schedule. When there are anesthesia or ED residents rotating in the ICU, they will do
24 hour calls. Night interns in the MICU will get Friday and Saturday off unless otherwise specified in the
schedule.
Post-call days can be counted as days off (reserved for special circumstances). If you are post-call from a night
shift, you will have a 24 hour period of no clinical responsibilities (i.e. 7am to 7am off), and you will get a
minimum of 2 other days off for a total of 3 days per 3 week block.
See pages 6-8 for more information that pertains to MICU/CCU, not just wards.
Policy on Transferring Patients from the MICU
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We operate a “closed” ICU, meaning that any patient physically in the ICU is the responsibility of the ICU team
only. However, if the patient is ready to be transferred out AND has a bed ASSIGNED on the medicine floor, the
accepting medicine team should evaluate the patient. The MICU team will continue to be the primary team for
the patient while the patient is in the unit. If there is no bed assigned to the transferred patient, the MICU will
manage the patient until one is assigned and patient is ready to be transferred.
If the MICU census is at 18 or more patients, and a patient is stable for transfer, the MICU attending and on-call
chief resident should be notified. At that time, the care of the stable patient can be transferred to the ward
team even if no floor bed is assigned at the time of the transfer. This also means that the ward cross-cover
manages the patient overnight.
If a patient is assigned a bed & short call ward team before 5 PM, the patient will be cared for by the MICU team
until the patient is physically out of the unit. This should occur within 1-2h, but there is no guarantee. However,
it is the responsibility of the accepting ward team to assess the patient, write an accept note, and sign the
patient out to the ward cross-cover. If the patient is transferred out of the unit between 5 PM and 6 PM, the
ward cross-cover is responsible for the care of the patient overnight. If the patient is transferred out of the unit
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after 6 PM, the ICU cross-cover is responsible for the care of the patient overnight. If this happens, the ICU
cross-cover must sign-out overnight events to either the ward day team or ward cross-cover in the morning.
If a patient is assigned a bed & long-call ward team before 7:30 PM, the patient will be cared for by the MICU
team until the patient is physically out of the unit. This should occur within 1-2h, but there is no guarantee.
However, it is the responsibility of the accepting ward team to assess the patient, write an accept note, and sign
the patient out to the ward cross-cover. If the patient is transferred out of the unit before 7:30 PM, the ward
cross-cover is responsible for the care of the patient overnight. If the patient is transferred out of the unit after
7:30 PM, the ICU cross-cover is responsible for the care of the patient overnight. If this happens, the ICU crosscover must sign-out overnight events to either the ward day team or ward cross-cover.
If a patient is assigned a bed & any ward team after 7:30 PM, the patient will be cared for by the MICU night
team. The ICU cross-cover must update the ICU day team just as in any regular morning sign-out, and it is the
responsibility of the accepting ward team to contact the ICU day team to get sign-out of the patient.
When transferring a patient to the medicine floor, the MICU resident is responsible for determining which team
the patient is bouncing back to (if applicable). The MICU resident will call SPPO and get the patient assigned to
the team it came from if the senior is there AND the team is not capped AND it is not the first or last day of the
senior’s block.
Admissions/Transfers/Bouncebacks:
See the extensive section above (pages 4-6 under Wards -> “New Patients (Admissions/Transfers/Bouncebacks)”
for many of the policies on patient team assignments and notifications.
Other
 Evaluation of a patient by the ICU
- During the day, when the ward team resident contacts the MICU resident for a potential transfer:
i. the ward team resident will evaluate the patient and recommend transferred to the ICU or
continued ward team management. If the floor resident agrees with a recommendation for
continued floor management, then the MICU resident will document the evaluation and
recommendations in an event note.
ii. if the ward team resident believes that the patient should still be in the intensive care unit, the
ward team resident must contact their attending physician and the ICU fellow. If the ICU fellow
still feels that the patient does not belong in the medical intensive care unit, a direct discussion
should occur between the ward team attending and either 1) the medical intensive care unit
fellow or 2) the MICU attending. The results of this discussion need to be documented as well in
an event note.
iii. if in these discussions the patient is transferred to the medical intensive care unit, the transfer
note will suffice, and event notes are not necessary.
- During the evenings (after 6 PM / MICU night shift hours)
i. the ward team resident will evaluate the patient and recommend transferred to the ICU or
continued ward team management. If the floor resident agrees with that recommendation, then
the MICU resident will contact the nocturnist covering the MICU to present their
recommendation and obtain nocturnist concurrence, and will document the evaluation and
recommendations in an event note.
ICU Night Float – pertains to 24hr shifts!
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For more extensive information, refer to your nocturnist rotation materials.
The ICU and CCU will be covered by one senior resident and one intern assigned to nights
Unit NF senior resident holds the Unit admit pager (p6207), which covers both ICU and CCU admissions AND
Team O (Hem/Onc) admissions & cross-cover
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Unit intern holds cross cover pager (p3704)
All CCU admissions must be discussed with the cardiology fellow (day and night) and noctensivist (night), and all
MICU admissions must be staffed with the pulmonary fellow (day) and noctensivist (night) at the time of
admission
Unit NF resident will manage old Team O patients and admit any new Team O patients and communicate the
admission to the oncology fellow at the time of admission. The night float resident is not responsible for
completing the full oncology history in the H&P, and it will be completed by the daytime Team O fellow.
Call Rooms
Sleep Room Assignments
NUH 7241
th
(7 Floor, CCU)
NUH 7243
(7th Floor, CCU)
Resident
Telephone Extension
Unit Night Float
1120
Unit Intern Night Float
1121
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