Service Details – Cardiology  – Updated 1/10/17

A. Team structure

  1. 4 day teams (1 resident/1 intern), 1 night float team (1 resident/1 intern)
    1. Total 5 residents, 5 interns
  2. Resident/intern Q4 day call + resident/intern night float

B. Hours

  1. Day call (resident/intern): 7:00am-8:30pm
  2. Post-call: arrive no earlier than 7:00am, attending rounds at 8:30am
  3. NF: 8:00pm-8:30am (off Sat night)

C. Admitting flow:

  1. Day call (7:00am-8:30pm)
    1. Start admitting at 7:00am & hear holdovers (if any) from cardiology night float team (presented directly on attending rounds)
    2. Up to 5 new admits + 2 holdovers/transfers
    3. Depart hospital at 8:30pm
    4. Dr. CART (see coverage areas in separate Dr. CART document) from 7:00am-8:00pm
  2. Short call on post post call day (weekdays only), rounds at 7:30 am
    1. Receive up to 2 holdovers from night float team
    2. Depending on # of night admissions, may be “cold” hand-offs (relatively straightforward cases, no CCU transfers)

D. Admitting order during the day

  1. 1 patient: presentation to short-call team
  2. 2 patients: presentations to short-call team
  3. 3 patients: 1 presentation to long-call team, 2 “cold” handoffs to short call
  4. 4 patients: 2 presentations to long-call team, 2 “cold” handoffs to short call
  5. 5 patients: 3 presentations to long-call team, 2 “cold” hand-offs to short call

E. Night float (8:00pm-8:30am)

  1. Start admitting at 8:00pm, NF intern signs into ‘4279’ pager
  2. Cap 5 new admits (CCU transfers held until following morning)
  3. Weekdays, give short call up to 2 holdovers, Present to on call team during attending rounds at 7:30am
  4. If > 3 admissions F-Sat night, pts 4 and 5 go to hospitalists as holdovers in AM
  5. Dr. CART coverage from 8:00pm-7:00am

F. Saturday (night float resident/intern off)

  1. Day call resident scheduled for Saturday call stays overnight (24+4) & admits with MIOC
  2. Patients admitted with MIOC are presented by MIOC as holdovers to the on-call resident/intern team following morning during attending rounds.
  3. If > 3 admissions, pts 4 and 5 go to hospitalist service as holdovers in AM
  4. If day or night teams cap, new admissions roll over to the hospitalist (except advanced heart failure, heart transplant, & PH).

G. Rounds

  1. On call rounds
    1. Cardiology night float resident/intern present directly to on call team on attending rounds
    2. If night float team admits 2 or less, will present directly to short call team on attending rounds.
    3. Attending rounds start at 7:30am
  2. Post call rounds
    1. Start at 8:30am (post call team cannot arrive earlier than 7:00am)
  3. Short call rounds
    1. May involve “cold” handoff of hold overs from NF team. Attending will perform bedside rounds for these “cold” handoffs
    2. Attending rounds start at 7:30am
  4. Pre call rounds
    1. Start at 8:30 am or at time agreed to by attending and team

H. X-cover

  1. Day call intern receives signout and passes it on to night float intern (double hand off)

I. Days off

  1. Pre call days (weekdays)
  2. Post post call and pre call days (weekends)

J. Night float day off

  1. Saturday- night resident and intern off
    1. Day call resident scheduled for Saturday call stays overnight (24+4) & admits with MIOC

K. Pagers

  1. Senior resident’s pager should be covered by the intern on the senior’s day off
  2. Intern’s pager should be covered by the senior on the intern’s day off

K. Other Important Points:

  1. Dr. CART coverage
    1. Day resident/intern- CART coverage from 7:00am-8:00pm
    2. Night float- CART coverage from 8:00pm-7:00am
  2.  Resiterning
    1. If an intern is resiterning and requires assistance, he/she should contact the GENS-DF (on-call) resident or the cardiology resident on call for assistance. The intern should also reach out to his/her attending for management decisions.
  3. CHF pathway patients
    1. As of 8/10/15, both hospitalists and housestaff teams are admitting CHF pathway patients. Once the housestaff teams cap, patients admitted on the pathway may be admitted by hospitalists similar to other general cards overflow admissions. Please contact the CHF pathway pager if any questions arise.

Cardiology Service Patients:

Patients with cardiovascular symptoms/signs/diagnosis to be directed to housestaff general cardiology services based on this agreed list of diagnoses:
Coronary Artery Disease
Chest pain  – possible ACS
Chest pain with abnormal troponin
ESRD with elevated troponin and an acute chest pain syndrome
Chest pain with ST&TW change, not previously documented
Chest pain requiring heparin,  IV nitroglycerin or platelet receptor blocker
Classic angina
Atypical chest pain with history of CABG
Atypical chest pain with documented new LBBB
Atypical chest pain with recent (<6 mo) revascularization

Syncope
True syncope (loss of consciousness and postural tone) without focal neurologic exam or readily identifiable non-cardiac cause
Near syncope with medical complications / mitigating factors
EP
New onset atrial fibrillation/flutter (Unrelated to acute exacerbation of a medical condition)
Atrial fibrillation/flutter with symptomatic rapid ventricular response (unrelated to acute exacerbation of a medical condition)
Admission for initiation of anti-arrhythmic drug therapy
Scheduled EP procedure admit
Symptomatic bradycardia
Sustained VT
3rd degree heart block
Type 2 second degree heart block
Symptomatic SVT
Pacemaker dysfunction /  infection
ICD shock requiring admission

CHF
New onset CHF (other than isolated edema related to acute exacerbation of a medical condition)
CHF exacerbation (Unrelated to acute exacerbation of a medical condition)
CHF requiring inotrope
Dyspnea thought to be CHF
PA HTN patients followed PH
Suspected prosthetic valve dysfunction

General
LV thrombus requiring IV anticoagulation
Hypertensive crisis
Anticoagulation complication / bridging requiring admission in patient whose warfarin is managed by UofC cardiologist
SBE with CHF or documented new AV block
SBE with prosthetic heart valve
Pericarditis
Pericardial effusions requiring admission
Aortic dissection
Chronic aortic dissection with recurrent pain or uncontrolled HTN
Digitalis toxicity