Team Structure

  • 3 day teams (1 resident/1 intern) + 1 night team (1 resident/1 intern)
  • CCU day teams are on call every 3 days. Call intern will take cross-cover from non-call teams and hand off sign out to the CCU NF intern when they arrive at 7:30 pm
  • CCU call resident is back-up Dr. Cart in CCD/DCAM/tunnels from 7am – 7:30pm. CCU NF resident then takes over from 7:30pm – 7am.

Call Day Workflow

Hours for every day except Wednesday

  • Call Day resident and intern: 7:00am – 8:00pm
  • Night Float resident and intern: 7:30pm – conclusion of presenting overnight admissions or 8:30am, whichever is earlier
  • Night Float resident should hand-off overnight HF patients to post-call unless continuity is needed for patient safety

Hours for Wednesday morning (CCU conference)

  • Call Day resident and intern: 7:00 AM – 8:00 PM
  • Night Float resident and intern: 7:30 PM – conclusion of presenting overnight admissions or 9:30 AM, whichever is earlier*
  • *Rounding times will vary depending on Attending.

Admitting Flow

  • Day admitting: Resident & intern team admits from 7:00 AM – 7:30 PM. 
    • Intern will write up to 5 H&Ps. Any patients admitted by the day admitting team after the 5th one should have an H&P written by the call resident. The intern may otherwise assist with new admissions after the 5th patient.
  • Night admitting: Resident & intern team admits from 7:30 PM – 7:00 AM
    • The Night Float team will take cross-cover on all CCU patients. They may receive sign-out from the call day team starting at 7:30 PM at earliest.
    • Intern will write up to 5 H&Ps. Any patients admitted by the night float team after the 5th one should have an H&P written by the night float resident. The night float intern may otherwise assist with new admissions after the 5th patient.
    • Patients admitted overnight will be preferentially given to the previous day’s call team unless significant imbalance exists. Patients can be given the next day’s call team at the discretion of the CCU fellow.

Back-Up Dr. Cart

  • 7:00 AM – 7:30 PM: CCU Call Day resident will be back-up Dr. Cart for CCD/DCAM/tunnels.
  • 7:30 PM – 7:00 AM: CCU Night Float resident will be back-up Dr. Cart for CCD/DCAM/tunnels.
  • Please coordinate with the Cardiology Day Call/Night Float residents. If 2 simultaneous Dr. Carts are called, CCU resident will go to the second Dr. Cart as default.

Days Off

Day teams: The day resident and day intern will alternate taking pre-call days off for a total of 2 days off per 2 week block

Night float

  • The Night Float resident will take Saturday night off. Weekend Float resident will cover the CCU on Saturday night with the CCU NF intern.
  • The Night Float intern will take Sunday night off. It is expected that the Weekend Float resident discuss with the Night Float resident regarding splitting tasks to help cover the CCU.

Transfers to the Floor

  1. Page 9100 once the patient is ready to be transferred
    1. There are multiple options for transfer out of the unit:
      • Housestaff Cardiology: complicated patients and patients who will need more intensive evaluation by a Cardiologist while on the floor.
      • Hospitalist Cardiology: post-procedural monitoring or patients who will only be in the hospital for 1-2 more days
      • General Medicine (Housestaff or Hospitalist): patients have no additional active cardiac issues requiring attention this hospitalization
      • HF APN: most patients on the Advanced HF service
      • LVAD APN: patients with LVAD (managed by CT surgery APN)
  2. Once 9100 calls back, place transfer order to the team as discussed with 9100
    1. Make sure the transfer note is completed prior to transfer
    2. 9100 will reach out to receiving team
  3. Receiving team will call you and take over FCP once verbal sign-out is given EVEN if the patient is still physically located in the CCU
    1. Please keep the patient on the CCU master list and include brief one-liner in sign-out until the patient has left the CCU

Exception: Patients going to LVAD/HF APN teams – as these patients are not triaged by 9100, please place the transfer order without reaching out to 9100, once a floor bed is assigned, please page out this patient to the respective team directly

End of Service Sign Out

  • Signout 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.

Escalation Plan for overnight help:

If there is more than one crashing patient at once or more than one emergent line needed simultaneously, we recommend the following escalation plan. Remember that the PGY-1 is a core member of the team: they can and should go to STEMI alerts, help stabilize crashing patients and help do an initial CCU evaluation depending on time of year and comfort. Make sure they have the fellow’s phone number to help during these more complicated tasks, especially for when the PGY-1 and senior resident are physically separated. It is also helpful to discuss with the CCU fellow (early!) as they can often be a good resource for triaging emergencies.

  1. Page MROC (Monday – Thursday) / Weekend Float (Sunday) – pager 1212
  2. Reach out to Cardiology floor team resident and intern
  3. Reach out to the MICU NF or overnight resident
  4. Page CROC (p2762) if you think jeopardy needs to be utilized
  5. Ask the fellow to come in (remember to communicate with them over the phone as early as possible when questions arise and as clinical situations evolve). If patients are sick and you need help, it is completely reasonable to ask the fellow to come in

FAQ for decompensating CCU patients:

  • My patient is crashing and they have a device that I’m not comfortable managing, what should I do?
    • Call your fellow
    • Page VAD on-call team: 4823
    • If escalation of device support is needed: Page the ECMO/shock MCS pager at 7722
  • I have a simultaneous STEMI alert and decompensating patient overnight, what should I do?
    • One team member should go to the STEMI alert (make sure they have the fellow’s number and consent form) while the other team member stays with the decompensating patient, depending on experience and comfort level. See escalation plan above
  • I need an emergent line done, but I have to be with a different patient (admit, decompensating, etc)
    • See escalation plan above

 

Updated: 6/2025