Team structure

  • 4 day teams (1 resident/1 intern), 1 night float team (1 resident/1 intern)
  • Call day every four days

Hours

  • Day call (resident/intern): 7:00am-8:00pm
  • Post-call: arrive no later than 7:00am, attending rounds at 7:30am
  • NF: 8:00pm-8:30am (or when presentation rounds on overnight patients is complete)
  • NF Intern is off Saturday night (covered by MIOC), NF Seniors 7 days on/ 7 days off

Admitting flow:

  1. Day call admitting (7:00am-6:00pm)
    • Start admitting at 7:00am & hear admissions from cardiology night float team (presented directly on attending rounds starting at 7:30)
    • Can admit up to a maximum of 7 patients per call day (this includes a combination of the admissions from the night float, CCU transfers, and ED admits) to a team cap of 10 patients. The maximum number of new H&P’s on a given call day is 5 (i.e: all ED admits and direct admissions require H&P’s whereas CCU transfers and night float admissions do not need H&P’s). ALL cards admissions and CCU transfers must be triaged through 9100. If you get paged directly about an admission, make sure you let 9100 know, as they track all admissions.
    • Cover adult cardiac arrests from 7:00am-8:00pm: coverage areas here
    • Stop admitting at 6:00pm.
    • Depart hospital at 8:30pm after signing out to cardiology NF team.
  2. Short call on post-post call day (weekdays only), rounds at 7:30 am
    • Receive up to 3 holdovers from NF team, to total team cap of 8
    • The night team should always give admissions preferentially to the short call team first, to fill the short call team before filling the long call team.

Distribution of patients from night float to long-call/short-call teams in the morning:

  • Monday thru Friday:
    • Short-Call takes first 3 patients (max of 3, up to cap of 8)
    • The remainder of NF admissions go to long-call (max of 4, up to cap of 10)
    • In the rare event that short-call is open for no patients, long-call should take a max of 4 patients from NF and the 5th patient should be handed over to the hospitalists
  • Weekends (Saturday and Sunday):
    • There is no short call
    • The first 4 patients should go to long-call (max of 4, up to cap of 10)
    • Any remaining patients should be handed over to the hospitalists.
      • For example: if long-call has 5 patients on their list (open for 5), they should accept 4 patients from NF, and the 5th NF patient should go to hospitalist. The long-call cardiology team will then be open for 1 more admit during the day.
      • Another example: If long-call has 7 patients (open for 3), they should accept 3 patients from NF (to cap), and the 4th and 5th NF patients should go to hospitalist. The long-call cardiology team will be done admitting for the day.

Night float (8:00pm-8:30am) – ALWAYS open for 5 admissions each night

  • Start admitting at 8:00pm, NF resident signs into ‘4278’ admitting pager. You are open for 5 patients every night (regardless of long/short call census). Please inform 9100 how many patients will be handed over to the hospitalist in the morning.
  • Adult cardiac arrest coverage in designated areas (see above) from 8:00pm-7:00am
  • Cross-cover Cardiology and Housestaff Solid Oncology patients from 8:00pm to 7:00am
  • Only admits Cardiology patients overnight. No Oncology admissions overnight.
  • Cap 5 new admits. NO new admissions after 6:00am
  • The Cardiology Night Float team may accept Cardiology OSH transfers, CCU and MICU transfers overnight. Transfers from other floor services, such as hospitalist or housestaff floor teams, should NOT occur overnight. Please call CROC with questions.
  • Present to on-call/short-call teams during attending rounds at 7:30am. If you admit 5 (should always be open for 5!) and there is not enough room on the housestaff teams to accommodate all 5 patients (see examples above) page 9100 before 7am to hand off the overflow patients to hospitalists.
  • Please note: short call should always be filled before long-call. Short call can accept a maximum of 3 holdovers (to cap of 8), and long-call can accept a maximum of 4 holdovers (to cap of 10). There is no short call on the weekends.
  • If > 4 admissions Friday through Saturday night, patient number 5 goes to the hospitalists as a holdover in AM as there is no resident short call on the weekend.
  • Cards NF senior is now a 7-day experience combined with elective-I done twice throughout the year. Switch day is Wednesday.
  • Cards NF intern has Saturday night off (covered by MIOC)

Transfer policies 

  • ALL Cards admissions, including OSH transfers and MICU/CCU transfers, must be triaged through 9100.
  • OSH Transfers and CCU / MICU transfers can occur at any time, day or night.
  • Cardiology/General Medicine Transfer Policy: Every effort should be made to limit transfers onto and off of the Housestaff Cardiology teams, given the impacts these transfers have on continuity of patient care and system capacity. However, we understand that there are rare circumstances when a patient may be better medically served on a different service. Transfers are allowable in these circumstances after an attending to attending conversation, following the guidelines outlined below. These transfers should only occur during the day (7a-6p) unless an exception is made in consultation with 9100 and the Chief Resident on Call.
    • Transfers FROM Cardiology to General Medicine: Transfers from the Housestaff Cardiology service to General Medicine or Hospitalist Medicine require a discussion between the Cardiology team attending and the hospitalist triage attending covering the 9100 pager. Based on this attending-to-attending discussion, the hospitalist triage attending can either accept the transfer or provide a formal General Medicine consult. A transfer to medicine can then be initiated if deemed appropriate by the hospitalist attending after formal consultation. Transfers from Cardiology to General Medicine or Hospitalist Medicine should be reserved for medical indications only. Discharge planning and placement issues are not reasons to transfer patients between services. 
    • Transfers FROM Other services to Housestaff Cardiology: A patient may be transferred from another floor service to the Housestaff Cardiology service at the recommendation of the Cardiology Consult attending. If the primary service attending is requesting transfer to Housestaff Cardiology, they should initiate a Cardiology consult, if not already called. If the Cardiology consult attending agrees with or independently recommends transfer, there must be an attending to attending discussion between the Cardiology consultant and the hospitalist triage attending (covering 9100) regarding the reasons for and appropriateness of transfer. After this discussion, if the decision is made to transfer the patient to Housestaff Cardiology, the Cardiology Consult team (resident, fellow, or attending) should relay the plan of care to the on call Cardiology resident and service attending; this hand off should be in addition to the normal sign out that occurs between the primary service and accepting Cardiology team. Of note, patients in Mitchell cannot be accepted by the on call Cardiology team until they have a bed in the CCD due to geographic limitations of Housestaff Cardiology. Patients in the CCD can be accepted at any time, though transfers should be limited to the daytime when appropriate. 
    • For all Gens-Cards transfers: While in general, at this time, trades will not be made, if transfers create an uneven distribution between patients on housestaff and hospitalist services, 9100 should page the Chief Resident on Call to discuss a possible trade. 

Rounds

  • Long/short rounds
    • Cardiology night float resident/intern present directly to on call team on attending rounds
    • If night float team admits 2 or less, will present directly to short call team on attending rounds.
    • Attending rounds start at 7:30am to allow NF residents to leave in a timely manner
  • Non- call rounds
    • Start time to be determined by attending; should not be so late that rounds are extending past MDR and morning report

Cross-cover

  • The cards call team will take sign out from the other cardiology teams and cover their pager until cards NF arrives
  • The cards call team will take sign out from the oncology teams on days oncology teams do not admit (Wednesday, Saturday, and Sunday) and cover their pagers until cards NF arrives
  • The cards call team will give signout on the cardiology teams +/- the oncology teams to the NF team at 8pm

Days off

  • Day residents: Pre call days (weekdays); Post-post call and pre call days (weekends)
  • NF intern: Saturday night
  • NF resident: works 7 nights in a row, switches on Wednesday; followed or preceded by elective-I

End of Service Sign-Out

  • Sign-out emails at the end of your service should always be sent to both the oncoming team member you are signing out to and the intern/resident remaining on service when you leave

Examples of common conditions encountered on the cardiology service:

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
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
Atrial fibrillation/flutter with symptomatic rapid ventricular response
Admission for initiation of anti-arrhythmic drug therapy
Scheduled EP procedure
Symptomatic bradycardia
Sustained VT
3rd degree heart block
Second degree heart block, type 2
Symptomatic SVT
Pacemaker dysfunction or infection
ICD shock requiring admission

CHF
New onset CHF
CHF exacerbation
CHF requiring inotrope
Dyspnea thought to be CHF
Pulmonary Hypertension or RV failure
Suspected prosthetic valve dysfunction

General
LV thrombus requiring IV anticoagulation
Hypertensive urgency
Anticoagulation complication / bridging requiring admission in patient whose warfarin is managed by UofC cardiologist
Endocarditis
Pericarditis
Pericardial effusions requiring admission
Aortic dissection
Chronic aortic dissection with recurrent pain or uncontrolled HTN

Updated 6/25/2025