What your night float resident wants to tell you, but is too tired at 7AM to articulate
David Rometo ~2008
1. Orders: when admitting a patient, include PRN orders for the following
a. Pain (mild and severe)
b. Fever
c. Nausea, vomiting
d. Constipation
e. Insomnia
f. Itch
g. Indigestion/GI prophylaxis ***Remember, not all PRNs are benign!***
2. Consents: if patient will or might get procedure or blood product transfusion, obtain consent
before leaving.
3. Patient/family updates: communicate to patient (or family if patient not “with it”) the updated
plan before leaving.
4. Inform patient and family they are not to expect immediate non-urgent physician attention
between 7pm and 7am.
5. Touch base with charge nurses on your main floors about any anticipated nursing issues before
leaving. Remind him/her of which night float to contact, to send informative text pages, and to
leave non-urgent issues until the AM.
6. Most important tool for night floats for patient safety is an accurate progress note with relevant
and recent problem list and plan. Hospital course in the A/P section creates a redundancy in the
documentation and makes it difficult for cross-cover issues to be quickly and safely resolved.
7. Update Rounds Report on WebCIS before printing. Leave NO out-of-date information on this
list! Include attending and house staff contact info.
8. Print list compact with 2 pages per sheet. 1 list/team. Stapled.
9. To do list: if you want something followed up, include why you got it, and what you want done
depending on foreseeable results.
10. If patient may die, include cause of death. If cause is rejected, paper work will be saved until AM
for day team to correct.
11. Sign-out should happen as close to 7PM as possible so night floats can handle nursing pages
appropriately. Remaining work can be finished after sign-out. Continuing cross cover duties past
7PM will delay your departure.
12. To help with appropriate patient distribution, please include current patient load of team and
each intern, along with their call rotation status (ie Dr. Smith is pre-call tonight with 11 patients)
13. Since on-call intern can stay in house until 8:30 PM without violating work-hours (the 10 hr
rule), they should do so if there is any more work or admissions (called in before 7PM) to do.
The night float resident can staff late admissions so ward residents can leave earlier and avoid
breaking the 80 hr rule.
14. The day team utilizing the post-call admit promotes appropriate team placement, intern/team
familiarity with patients, and takes stress off evening/night floats (especially on days when
teams are capping before 5pm). It is not mandatory to take one every day.
15. Lastly, reserve the evening float resident (between 5-7PM) for procedures, dealing with crashing
patients, and admitting when on-call teams are capped or have many admits waiting. There is a
firm cap on admissions for the day team at 6pm [Mon – Thurs]. All admissions called after 6pm
will be the responsibility of the evening floats and night floats.