- 3 day teams (1 resident/1 intern) + 1 night team (1 resident/1 intern)
- Total: 4 residents, 4 interns
- The CCU teams alternate call days (once every 3 days) with the call intern taking cross-cover and signing out to the CCU night float intern when they arrive at 7:30pm.
- CCU call resident is back-up Dr. Cart in CCD/DCAM 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 may vary depending on Attending.
- Day admitting: Resident & intern team admits from 7:00 AM – 7:30 PM
- Night admitting: Resident & intern team admits from 7:30 PM – 7:00 AM
- NF will take cross-cover
- 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.
- 7:30 PM – 7:00 AM: CCU Night Float resident will be back-up Dr. Cart for CCD/DCAM.
- 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.
- The day resident and day intern will alternate taking pre-call days off for a total of 2 days off per 2 week block
- 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.
Transfers to floors
- There are multiple options that the CCU fellow and CCU attending will dictate 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)
- CCU resident should place an order and specify in the transfer order which service is required. If it is among the first 3 services above, the resident can page 9100 to let them know and then again after patient is assigned a bed. If going to HF APN or LVAD APN, the resident can page the service directly when patient is assigned a bed.
- Please always clarify with the attending which service best suits the patients needs
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:
In the case that there is more than one crashing patient at once or more than one emergent line is 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.
- Page MROC (Monday – Thursday) / Weekend Float (Sunday) – pager 1212
- First half of the year (July – November): MROC will be in-house and able to provide immediate assistance
- Second half of the year (December – June): MROC will need to be called in from home
- While awaiting MROC to arrive, see below for additional help
- Reach out to Cardiology floor team resident and intern
- Reach out to the MICU NF or overnight resident
- 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)
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
- I need an emergent line done, but I have to be with a different patient (admit, decompensating, etc)
- See escalation plan above