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
  • 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/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 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 page again after patient is assigned a bed (look at the screen in the CCU workroom to identify when a bed is available). 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 or fellow which service best suits the patient’s 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: 

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