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Gold Copper Nickel Guidelines

Page history last edited by Charles Pizanis 1 year, 4 months ago

GOLD/COPPER/NICKEL TEAM DETAILS

 

The following is an outline of team structure and processes for Gold/Copper/Nickel.

 

Gold/Copper/Nickel Team Structure

 

Gold 

Team makeup: Gold attending, 1 or 2 APPs

Team cap: 16 patients (14 patients as of 11/5/19 at 0700) when 1 APP; 20 patients (18 patients as of 11/5/19 at 0700) when 2 APPs

Patient assignments: each APP follows 8 patients, attending follows 8 patients (6 patients as of 11/5/19 at 0700)

 

Copper

Team makeup: Copper attending, 1 or 2 APPs

Team cap: 16 patients when 1 APP; 20 patients when 2 APPs

Patient assignments: each APP follows 8 patients, attending follows 8 patients

 

Nickel

Team makeup: locums, 1st backup attending (PRN), 2nd/emergency backup attending (PRN), ward attendings (PRN)

Team cap: n/a

Patient assignments: locums follows up to 14 patients, backup attending follows up to 8 patients, 2nd/emergency backup attending follows up to 8 patients. Ward attendings follow up to personal cap (usually 1-2 patients)

 

Admissions/Transfer Flow to Gold/Copper/Nickel

Patients will be admitted/transferred to Gold and Copper according to admission/transfer flows found here (Admission Protocol  / Transfer Protocol).  

 

Transition of Patients from Silver to Gold/Copper/Nickel

Patient admissions intended to be admitted to Gold/Copper/Nickel teams according to admission flow will remain on Silver Medicine team census on the day of admission.  Silver Medicine team members will follow patients until 7:00p of the day of admission.  At the end of the clinical day after patient/provider assignments have occurred, the Gold attending will transfer these patients onto the respective Gold/Copper/Nickel team list by contacting Admitting (x22418) and placing a "transfer to" order.  Silver Medicine team members will be responsible to sign out these patients to the appropriate cross cover provider. Gold/Copper/Nickel team members will assume care of these patients the following morning (hospital day 2) at 7:00a.

 

Care Management Rounds

The following describes the times for care management rounds, Monday-Friday (non-holidays).  Care management rounds will be held in 5 West team workroom.

Gold – 9:30a

Copper – 9:45a

Nickel (PRN) – 10:00a

 

Backup Thresholds

Backup Thresholds with Locums Providers Present

The following outlines backup cutoffs for call in of backup attendings when locum tenens providers are present.  Cutoffs may be different if there are additional APPs on service. In general, locums providers can see 14 patients independently (unless on first day of clinical service in which case they can see 10 patients). As such, when the Nickel service exceeds 14 patients, backup should be called in. Discretion for backup call in is ultimately up to Gold attending and circumstances may exist when these cutoffs should be lower. The Gold attending will coordinate communication of backup need to oncoming backup attending.

 

Nickel census >14 patients -> 1st backup

Nickel census >22 patients -> 2nd/emergency backup

 

The backup attending should follow at least six patients daily.  In circumstances in which there are fewer than six patients not already being followed by Gold/Copper/Nickel providers, the backup attending should offload a number of patients being followed by the Gold and/or Copper attending to achieve this. 

 

In general, no greater than six new admissions should be given to backup attending(s).  As able, Gold, Copper and backup attendings should try to distribute patients being personally followed to allow for this.

 

Backup Thresholds when Locums Providers Not Present

The following outlines backup cutoffs for call in of the backup attending when locum tenens providers are not present. Discretion for backup call in is ultimately up to Gold attending and circumstances may exist when these cutoffs should be lower. The Gold attending will coordinate communication of backup need to oncoming backup attending.

 

Nickel census 1-8 patients -> 1st backup

Nickel census >8 patients -> 2nd/emergency backup

 

The backup attending should follow at least six patients daily.  In circumstances in which there are fewer than six patients not already being followed by Gold/Copper attendings and APPs, the backup attending should offload a number of patients being followed by the Gold and Copper attendings to achieve this.

 

In general, no greater than six new admissions should be given to backup attending(s).  As able, Gold/Copper/and backup attendings should try to distribute patients being personally followed to allow for this.

 

 

Silver Attending Role in Backup

The Silver attending may be able to help with backup coverage of up to four patients on weekends and holidays. How to handle this most effectively depends on the make up of the Nickel and Silver services and staffing available. The Silver attending should consider assisting with backup coverage if the Silver service census is less than 10 (consults + CF patients). This is a guideline, only the Silver attending can assess their service needs and their ability to assist in backup. In general Silver should only provide assistance if doing so prevents a backup attending from being called in and the Silver attending believes he/she can devote adequate attention to both backup patients and to Silver. It is recommended that the Silver and Gold attending talk on on the night prior to Silver potentially taking some backup patients so that Silver can communicate whether or not they can help, and if they can help, how many patients they can cover.

 

 

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