MC Guidelines

June 2009

Role of the MC

• Ensure patients get to the right location– This means seeing patients!!– Help the ED provide excellent care to our patients

• IM consult for other departments• Leader of the Night Float Team

– Help with sick floor patients– Supervise procedures– Lead codes– Education of team

General

All relevant policies are on Carmen

• UTD census data on OneSource: Clinical care → Applications → BedLink →Census → Medicine

• On-call chief is available to help as well

MC schedule

• Sunday-Thursday, the MC and night team are on the same schedule

• Friday and Saturday, the MC will be senior residents on elective months

• Hours are 6 pm until 7 am

• Med/Peds exception

When you get in…

• Please make sure to go to the transfer center (N715 Doan) when your shift begins to talk with them about all the expected outside hospital transfers coming in for the night and get the final service census counts

• Forward pager 1125 (Internal Medicine Triage) to yourself

Consults

• You are responsible for medicine consults overnight (can try to defer non-urgent consults to am)

• Gen Med consults: Staff with Hospitalist on call at night (X1008)

• Specialty consults can be staffed with subspecialist if needed, otherwise gen med

• Cardio consults:– Staff with cardio consult attending on call until

midnight – After midnight staff with the cardio triage attending

Heme• He 1: multiple myeloma, CLL, Lymphoma, Complicated

Benign Heme patients such as sickle, TTP (cap 18)• He 2: acute leukemics, He 1 overflow (cap 24)• HNP: He 1 overflow (covered by James moonlighter –

can take admissions overnight)– It is an attending only run service, so doesn’t get very big

• JH1: hospitalist service – can take sicklers, other benign heme (factor deficiencies), onc patients that are coming in for reasons other than their cancer

• BMT: can take Heme overflow

*The Heme triage attending or the Chief on call can help you figure out where a patient can go if things get tight!

Onc

• Onc 1 census 16

• Onc 1 and Onc 2 can take the same kinds of patients– Ideally, switch between admitting between the

2 services if James moonlighter not too busy– Onc 1 does NOT fill up first – JH1 can take onc patients coming in for

reasons other than their cancer

Transplant

• TM1 remains the same at 10 patients

• TM2 really doesn’t “exist”

Gastroenterology services

• GE2 (cap 16) can admit all hepatology patients, and severe IBD/pancreatitis/GI Bleeds, etc.

• GE1 no longer exists as of July 1st.

Gen Med

• Can admit to any gen med service-try to keep numbers fairly even

• Remember the hospitalists—esp for prisoners and anticipated short-stays

• Me1 (10), Me2 (10), Diab (16), Me5 (16), Me7 (16)

Hospitalists

• Their cap (JH1+HH1+GM 6) is 75• Should get all prisoners

– Exceptions: Subspecialty issues (Heme/Onc, GI, Neph)

• Look at their census multiple times through the night-they discharge late

• They have a swing shift person who does admissions until 10 pm

• Page 1008 for admissions or to staff consults

Service Caps

• HRT1= 16 HRT2= 16 CHF= 16

• Me1= 10, Me2= 10, Diab= 16, Me5 = 16, Me7 = 16

• GE = 16, NP1 = 16, IN1 = 16, He1 = 18, Onc1 = 16, TM1 = 10

• Me6 + HH1 + JH1 = 75

• He2 = 24, Onc 2 = 21

Night Float Changes

• Gen Med = 1 resident, 2 interns

• Six-pack = 1 resident, 2 interns

• Heart = 1 resident

• There will be an additional “float” resident who is to help with admissions, procedures, etc given increased capacity. Will not be responsible for cross coverage. Do not waste the extra body.

Good Luck!