Team Structure

  1. 3 day teams (1 resident/1 intern) + 1 night team (1 resident/1 intern)
  2. 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. 
  3. 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 

  1. Call Day resident and intern: 7:00am – 8:00pm
  2. Night Float resident and intern: 7:30pm – conclusion of presenting overnight admissions or 8:30am, whichever is earlier (Rounding times may vary depending on Attending)
  3. Night Float resident should hand-off overnight HF patients to post-call unless continuity is needed for patient safety

Admitting Flow

    1. Day admitting: Resident & intern team admits from 7:00 AM – 7:30 PM
      1. 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.
      2. Daily PM Run The List: Day fellow/attending will Run-The-List on each patient in the afternoon around 3-4PM to ensure there is a clear plan in place for the rest of the call day and overnight (timing may vary depending on attending/fellow). 
      3. PM Fellow Sign-Out: Call resident to be present when day fellow signs out to night fellow to ensure the outstanding action plans and escalation plans are congruent with the residents’.  
    2. Night admitting: Resident & intern team admits from 7:30 PM – 7:00 AM
      1. The Night Float team will take cross-cover on all CCU patients. They may receive sign-out from the call day team starting as early as 7:30 PM.
        1. Night fellow will run the list with both day and night call team/with NF team after NF team receives sign out from the day call team to help identify/clarify urgent tasks, establish contingency plans for high-risk patients, and set the expectation that the resident should be calling with any questions/ concerns or patient updates. 
      2. Patient Status Updates: NF resident will reach out to overnight fellow for any patient care concerns, including but not limited to: 
        1. Escalation or new requirement of pressors/inotropes 
        2. Acute respiratory decompensation (e.g., impending or urgent intubation)
        3. New or sustained arrhythmias 
        4. Significant clinical deterioration or acute change in status
      3. 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.
      4. 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.

Escalation Plan for overnight help: 

If there is more than one decompensating 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. You should also discuss the patient cases with the CCU fellow (early!) as they will assist in triaging emergencies or creating a treatment plan. 

  1. For immediate needs/additional support, page MROC (Monday – Thursday) / Weekend Float (Sunday) – pager 1212. You can also consider reaching out to Cardiology floor team, the MICU NF or on call resident
  2. If patients are decompensating quickly and you need help, 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). 
  3. Page CROC (p2762) if you think jeopardy needs to be utilized

Back-Up Dr. Cart

  1. 7:00 AM – 7:30 PM: CCU Call Day resident will be back-up Dr. Cart for CCD/DCAM/tunnels. 
  2. 7:30 PM – 7:00 AM: CCU Night Float resident will be back-up Dr. Cart for CCD/DCAM/tunnels.
  3. 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.

Procedures

Before starting any procedures, the resident will discuss with the fellow (day fellow vs on-call/overnight fellow) whether the procedure is indicated and whether the resident needs or prefers any supervision/help from the fellow. Residents should only perform procedures without a fellow if they are signed off and feel comfortable performing said procedure independently. If the resident is not signed off or does not feel comfortable performing the procedure independently, the resident will ask another senior resident/MROC or the fellow to assist. 

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

  1. The Night Float resident will take Saturday night off. Weekend Float resident will cover the CCU on Saturday night with the CCU NF intern.
  2. 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 floors

  1. Page 9100 once the patient is ready to be transferred
    1. There are multiple options for transfer out of the unit:
      1. Housestaff Cardiology: complicated patients and patients who will need more intensive evaluation by a Cardiologist while on the floor.
      2. Hospitalist Cardiology: post-procedural monitoring or patients who will only be in the hospital for 1-2 more days
      3. General Medicine (Housestaff or Hospitalist): patients have no additional active cardiac issues requiring attention this hospitalization
      4. HF APN: most patients on the Advanced HF service
      5. 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

  1. 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.

FAQ for decompensating CCU patients:

  1. My patient is crashing and they have a device that I’m not comfortable managing, what should I do?
    1. Call your fellow
    2. Page VAD on-call team: 4823
    3. If escalation of device support is needed: Page the ECMO/shock MCS pager at 7722
  2. I have a simultaneous STEMI alert and decompensating patient overnight, what should I do?
    1. 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
  3. I need an emergent line done, but I have to be with a different patient (admit, decompensating, etc)
    1. See escalation plan above

 

Updated: 6/2025