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Bounce Backs

Page history last edited by Mary Lacy 1 week ago


  • Bounce-backs follow all residents (R1, R2, R3), externs, and Sub-Is for 14 days after discharge.  If any one of these people was on service on the day of discharge and is still on service, regardless of who writes notes or "knew" the patient, the patient bounces.  Bounces do not follow Phase II medical students or attendings on teaching teams. 
  • For heavy metals, the patient "bounces-back" to the discharging APP or attending (provider, not team) if the patient is re-admitted within 14 days after discharge and that APP/attending is currently on any metal service.
  • New admissions that happen to also be bounce-backs are admitted by the on call team like any other admission, and this is irrespective of the source of the patient (ER, clinic, direct admit, etc).  If the team that is receiving the bounce is up for admissions on that day in the call cycle, this should be done as one of their admissions if the receiving team chooses. If the team has already received other admissions (i.e. gray admissions), then those stay on their team and are not redistributed due to a bounce-back. However, if a team learns about a bounce and gray patients at the same time, then the "unknown" patient should be redistributed to allow them to take the bounce-back without super cap. The team that will receive the bounce-back is not responsible for this patient's care until the patient has been fully worked up, stabilized, H&P completed, staffed, and after the end of the on admitting residents on-call period (i.e. triage at 5pm, long-call team at 7pm, etc).  A verbal communication between the admitting service and the bounce-back team should be performed to convey any pertinent items related to the patient's clinical situation. 
  • If a bouncing patient SUPER CAPS a team (i.e. >14pts), the attending should be direct call and manager for any patients >14 on the team (does not have to be the bounce patient). If the attending has managed the patient for the entire clinical day, then the patient does not count towards the team touch cap.
  • Examples (times in the below examples have been arbitrarily chosen and have no bearing on practice):
    • A patient who should bounce is received through Triage/Gray at 4pm from the ER and is staffed with the Long Call attending at 5pm.  The day call team provides cross coverage and care for the bounce overnight and until the bounce recipient team accepts the patient at 7am the following day.
    • A patient who should bounce is received through Triage/Gray at 1pm from the ER and is admitted/staffed by the triage/gray resident and the triage attending.  The gray/riage resident provides cross coverage and care for patient until their handoff at 3-4pm and the bounce recipient team accepts the patient at that time and completes signout.
    • A patient who should bounce is seen in the ER. The ER resident calls night float for admission at 6am.  The night team is unable to evaluate the patient before rounds and passes the patient off to the gray/triage team.  The gray/triage team should admit the patient that morning and complete handoff and transition of care from 3-4pm. The recipient team should resume patient care after the handoff and complete sign out.
    • A patient who should bounce is seen in the ER and is admitted by night float at 1am.  The night team admits the patient to the bounce recipient team's service. If this supercaps the team (>14 patients), then the attending should take over care of one patient (does not have to be the bounce).
    • A patient presents at 9am and should be a bounce to the pre-call/protected team. The triage/gray team should admit this patient and keep the patient until 7p signout. The receiving team resumes care the next day.



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