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Bounce Backs

Page history last edited by Patrick 1 year, 9 months ago


The rule is 21 days for ward teams (if there a resident, intern or subintern on the team who cared for the patient during their previous admission) and 14 days for Gold. We are running a pilot from 10/19/18 to 11/16/18 as follows:

To enhance continuity, Gold bounce backs will remain at 14 days, but ONLY if an advanced practice provider (APP) discharged the patient. To determine if an APP discharged the patient, look at the discharge summary for one of the following names (also see additional important language under this list):


Malerie Mock (Noll)

Husayn BIn-Bilal

Krystle Apodaca

Amanda Lechel

Radha Denmark

Amanda Woodards

Karla Enriquez

Barbara (Balin) Aronson

JoAnne Clinton

Lucas Miltenberger

Nikolitsa Varvaresou


**If one of the above APPs discharged the patient, then the patient will bounce back to Gold. If anyone other than those listed discharge the patient, then the patient will fall into the regular flow of admissions.


 The Bounce Back rules will apply to both MICU transfers and admissions from the ER. 



Bounce-back admissions are to be admitted by the admitting service on call.  The admitting service on call can contact the bounce-back team for an admission which occurs before 3pm to see if the bounce-back team is able to perform the admission. Decision to perform the admission is at the discretion of the bounce-back team.  If the bounce-back team elects to not perform the admission, then a verbal communication between the bounce-back team and the admitting team on call should be performed to convey any pertinent items related to the patient's clinical situation.


If the medicine attending had seen and staffed a patient who is subsequently admitted to the ICU, then the patient would bounce to the respective team of that attending (with all bounce back rules above in effect - ie bounce backs follow residents, not attending physicians).


MICU Transfers:

If a bounce back occurs before 3pm from the MICU back to a ward team, this patient is given to the bounce-back team for writing a note and transfer; bounce backs go to the respective bounce back team, even if that puts this team above 14 patient cap.  At that point the attending physician for that team will follow any number of patient(s) above 14 to be decided by that team.


All MICU bounce-back policies remain in place (if the receiving team is called before 1500 they are responsible for the MICU transfer)


When Bounce-Back Rules do NOT Apply

If a patient has been admitted by silver, and transfer to the MICU occurs on the day of admission, Bounce-Back rules do not apply. The patient will then follow the regular flow (ie, will be given to the MOT when the patient is coming out of the MICU to medicine).


MICU Bounce-back policy:

    1. All bounce-back patients follow the 21 day bounce back rule for the teaching services and 14 day rule for Gold.
    2. If a patient is admitted by the night float residents and subsequently transferred to the MICU before being staffed in the morning by the medicine team and attending, the following bounce-back policy will apply:

                                                               i.      Bounce-back policy: Once this patient is ready to be transferred back to the medicine service from the MICU, this patient will NOT be a bounce back to the medicine team that night float had admitted the patient to originally. Instead, the patient should be transferred to the appropriate medicine team based on the ward system flow defined on the wiki.

    1. All other bounce backs from the MICU to Medicine should go back to the team/attending the patient was originally staffed by regardless of the time that patient spent on their team. There is no minimum specified time for a patient to be on a team that qualifies a patient to be considered a bounce back. If it was staffed by the team/attending, that patient should bounce back to that particular team.



More information on bounce backs can be found here.




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