WakeMed Internal Medicine Teaching Service Night Float System
Nuts and Bolts:
- Code to get into 3C callroom 1-5-4
-Your ID badge will get you into the employee parking lot. If your badge does not work/ you have no badge, park in the visitor lot & get your parking validated in the morning from public safety & your bade updated or new badge made.
Four patients will be seen by the night resident & distributed one each to on-call, post-call, & short call Monday-Friday. If there is wide variation in team size, the night float has the discretion to send the 4th patient to the team (on-, post-, or short) that has a disproportionately low census. If the censuses are roughly equal, the fourth patient should be assigned to the on-call team. On Saturday and Sunday, two patients will be assigned to both the on-call & post-call teams (no short call on the weekends).
Long Call: Teams take long call every 4th day & admit 3-4 new patients, 1 ICU transfer, and up to 2 consults between 8 AM and 6 PM. This team will receive 1-2 on call floats from the night before. The team on long call will cap at 6 PM and will stay until the night float arrives at 8pm & must leave by 9 PM.
Post Call: The team that has been on long call the day before will accept 1-2 floated patients from the night before.
Short Call: Teams that were on call two days previously are on short call during the week on non-holidays. Short call teams will admit 2 patients before 4 PM. and accept 1-2 floated patients from the night before. There is no short call & no short call floats on weekends.
Pre-call: The pre-call day is the day before long call. No floated patients or admissions
Night Float: When the night float arrives at WakeMed at 8:00 PM, s/he will obtain cross-cover sign-out from the on call team and begin any admissions/consults assigned uniquely to them by the Hospitalist. If not busy, the night resident will assist the long call team in completing the days’ work so that they can leave by 9:00 PM. The night float will cross cover the teaching service patients as well as perform up to 4 new patient encounters in their shift. Two of the new patient encounters are to be called to the night resident by 3 AM an all of the new patient encounters are to be capped by a 6 AM cap to allow the night resident to finish by 7:30 AM for sign out to arriving interns & residents. The night resident will attend AM resident’s report to sign out his / her patients with the residents. The night float will not have general code blue duties–only on those patients on the teaching service.
Conferences: Attendance at AM report is mandatory for all resident who do not have the day off.
Signout: Supplying the night resident with good sign-out information to minimize the impact of hand-offs of care will be vital to assuring patient safety & continued quality care. Teams leaving before the night float arrives will generate a detailed computerized report in the work-suite on 3C. Two lists should be printed; 1 for the night float & 1 for the long call team. The list for the night float must be placed in the night float tray. All teams leaving WakeMed should sign out to the long call team who will act in a cross cover role until 8PM when the night float arrives. The night float will arrive, report to 3C, obtain the sign-out lists and meet the long call team for more detailed sign-out with the understanding that the night float assumes care of the patients in a cross cover role. The team on long call will sign out formally to the night float before leaving. Calls fielded by night float with regards the long call patients prior to the long call team signing out to the night float should be redirected to the team on call. Sign-out must occur by 9PM.
Sign-out in the morning will occur at 7:30 AM in 3C. At this time, interns and residents arriving to Wake can perform an expedited review of significant cross cover events. During the week AM report starts promptly at 8:00 AM in 3 Andrews conference room. The night float will go over those new cases & distribute them to the teams. This will be finished by 8:30 allowing the NF to leave WakeMed. When there is no AM report, the night float can sign out significant events and assign floats to teams prior to leaving directly from 3C.
Typical Weekly template for the 4 teams under the night float system.
Mon / Tues / Weds / Thurs / Fri / Sat / SunNF 8P-6A / 4 NPE / 4 NPE / 4 NPE / 4 NPE / 4 NPE / 4 NPE / 4 NPE
Post
Floats / 1-2 floats / 1-2 floats / 1-2 floats / 1-2 floats / 1-2 floats / 2 floats / 2 floats
Long
Floats / 1-2 floats / 1-2 floats / 1-2 floats / 1-2 floats / 1-2 floats / 2 floats / 2 floats
Admissions
8A-6P / 3-4 / 3-4 / 3-4 / 3-4 / 3-4 / 3-4 / 3-4
ICU Xfers / Up to 1 / Up to 1 / Up to 1 / Up to 1 / Up to 1 / Up to 1 / Up to 1
Consults / Up to 2 / Up to 2 / Up to 2 / Up to 2 / Up to 2 / Up to 2 / Up to 2
Short
Floats / 1-2 floats / 1-2 floats / 1-2 floats / 1-2 floats / 1-2 floats / X / X
Admissions
8A-4P / Up to 2 / Up to 2 / Up to 2 / Up to 2 / Up to 2 / X / X
Pre-call / X / X / X / X / X / X / X
Long call: 8 AM-6 PM: 3-4 admits + 1 ICU transfer + 1-2 floats + 2 c/s. Leave by 9pm
Post call: 1-2 float
Pre-call: clinic / days off
Short call: M-F 8 AM – 4 PM. 2 admits + 1-2 float
Night float will arrive at 8:00 PM, get sign-out, help on call team & perform up to 4 NPE
New patient encounter (NPE) = admission or consult
NF should attend morning report M-F and leave by 8:40 AM
NF will cross cover the 4 teaching services
NF will not have Code Blue responsibilities
NF can call the on call attending for all ?s & the Intensivist or Hospitalist for immediate patient needs.