Housestaff Patients That Cross Pavilions

Updated June 16, 2017

We try to avoid this scenario as much as possible in parternship with the Hospitalist Section covering 9100

GENS/T-TEAM

  • High-acuity admissions through the ED that end up in CCD – Cross-cover these patients (with help of MROC if patient is high risk) until the following morning. These patients will can potentialy be signed out to the Hospitalist in exchange for patients in the Mitchell pavilion if no beds are available for transfer and dispo is not imminent.
  • Note: If the hospitalist cannot accept the patient, page the CROC pager for further guidance. Unfortunately, you will likely need to continue to care for these patients for the duration of hospitalization.
  • Low-acuity admissions through the ED that end up in the CCD – If the patient is of low acuity and is expected to discharge within 48 hours of admisison, avoid unnecessary handoffs and continue to care for these patients in the CCD until discharge.
  • MICU transfers that are assigned a bed in the CCD – The MICU team should see if the leukemia or heme-oncology hospitalist (pager 5662) has space for these patients. If the leukemia hospitalist has no space, they will need to be covered by the housestaff GENS team.
  • Direct admits that end up in the CCD after 5 pm – The GENS team will be responsible for this admission with the MROC being available as back-up cross-cover.

 

HONC

  • Solid tumor patients in Mitchell – Call OGEO (pager 6436), but these patients should be admitted by the Hospital Medicine team (pager 9100).
  • Multiple myeloma and lymphoma patients in Mitchell – These patients should be rare. If the GENS team has space to accommodate the patient, the GENS team will accept the patient with a Heme-Onc consult. Otherwise, the patient will be admitted by the MROC and signed out to the following day’s on-call GENS team.
  • HONC admissions in CCD – If newly admitted patients arrive to floor after the housestaff team has capped butbefore the moonlighters have arrived, these patients are generally admitted by the Oncology / Leukemia hospitalists (not the “9100 pager”). The MROC may be asked to “eyeball” these patients and assess the patient’s stability; this triage is indeed the MROC’s responsbility. However, the MROC must not be admitting these patients.
  • Moonlighter admissions of bone marrow transplant, planned chemotherapy, or leukemia patients in Mitchell– Page OGEO for guidance. These patients are generally not staffed by our housestaff services or Hospital Medicine services.

CARDS

  • All patients admitted to Cardiology who get a CCD bed – These patients are to be admitted to the Hospital Medicine service in virtually all circumstances. When the hospital is at capacity, there is no need to call Bed Access to advocate to have your patient relocated.
  • Exceptions to this rule include advanced CHF patients and transplant patients (Fedson, Kim) and PAH patients (Gomberg, S. Rich) in the CCD. These patients may need to be admitted by the MROC, but please notify CGEO (pager 2436) and the CROC when this situation arises. Housestaff Cardiology teams should not be caring for these patients in the CCD because of their Dr. Cart responsibilities in Mitchell.