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Night Time Procedure

Page history last edited by Patrick 6 years, 7 months ago

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Week One Call Flow 


Algorithm for Call Schedules


Night Float Responsibilities and Expectations

3 residents assigned to each NF month: 2 doing 19 nights, 1 doing 18 nights instead of 14 nights (if there is interest, could offer OCD shifts to cover 2 nights each month to leave all at 18?)

2 Upper Level residents admit overnight from 1900-0700 the next morning (NF residents can take names for admission after 0630)

Admissions will be split evenly amongst the two senior residents during the night

Handoff to Silver will occur at 0700 in the Jemez room. 

For the most part (with few exceptions), "patients to be seen" should only be those that the night float resident(s) receives between 0600 and 0700 from the ER.

Each night float resident should attempt to admit to a specific team (for example, NF resident #1 admits to Gold only, NF resident #2 admits to ward teams only) when able.  There needs to be ongoing communication between the two NF residents

There will be one night admit pager that will be left in the ER.  One person carrys the pager.  Admissions will be alternated between the two (not yet established). The current procedure is that one resident is listed as NF Resident #1, and the other as #2.  NF#1 handles calls from the ED.

Post Call Rounds take place at 0700 (should be faster with only upper levels) in the Jemez room. Residents may split up (one presenting to the resident team and other to Gold for example).

Presenting to the same team each day will allow for feedback on previous day's admission




Night Admission Protocol

*To determine the following, use the census at the start of the next day.

Both night float residents start at 1900.  They take hand off of patients to be seen from the late call team in the ER.   Admission Triage Sheets will be passed from late call team to the night float team as part of hand off.

Also, to determine the flow of patients, use the assignments for the next day.  For example, if you are admitting on Friday night, use the team colors assigned for Saturday.  Details can be found above for week one.


 "Night admits" vs "overflow"

-Night admits = those patients admitted overnight.  Follow the procedure below for distribution the next day

-Overflow = those patients outside the normal night admits where we may deviate from the protocol

At the start of the shift, first print the census for 4 West and 5 West

In general, Night Float admits patients to the teams listed on amion for tomorrow's assignments. 



Admission Flow

Night Float first admits up to 4 patients to Gold or cap at 16 (whichever comes first).

-For example, if Gold has 13 patients, admit 3 patients to Gold. If Gold has 6 patients, admit 4 patients to them.

Then admit patients to the Night Accept Team up to a census of 14 patients, but no more than 6. 

-If for example, a team is at 7, they would only be eligible for 6.  A team at 12 would be eligible for 2 patients. 

Then admit patients to the oncoming early call team up to 12, but no more than 6.

Then admit patients to the oncoming backup team up to 12, but no more than 6.

Then all patients admitted thereafter go to Gold.  Gold expands as needed.


The next morning, handoffs will occur with the Night Accept Team (NAT) at 0630, with Gold at 0700 in the Jemez room.

The early call and backup teams will meet with night float at 0730. 


Please keep track of calls for admissions from ED using the Admission Triage Sheet for Ward Redesign.  Extra sheets can be found in ED work room as well as here: Admission Triage Sheet for Ward Redesign.docx . These will be collected in the morning at Night Float signout to the AM teams.  At a minimum, after receiving a call for admission, please document the patient's name, MRN, team evaluating the patient (e.g. Night Float) and team to which patient admitted (e.g. Red, Blue, Gold, etc.).  If patients are deemed not warranting Medicine admission, please document dispo (e.g. FP, discharge, MICU, etc.).



OCD will now cross-cover ALL medicine and Heme/Onc teams (this needs to be discussed again during and after the pilot)

Will continue to staff consults with the Silver attending if a non-medicine team has requested a consult.  

OCD will staff consults for transfer with the oncoming early call attending.




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