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nights

There are two residents and three interns on night float rotation together for the week. The residents supervise cross-coverage and all admissions. Two of the interns will cross-crover teams 1, 2, and 3 and teams 4, 5, and 6 respectively. The third intern will help the residents admit. 

hours

Default Hours: Monday – Saturday, 6 PM – 7:15 AM, 1 weeknight off and everyone gets Sunday night off. IF there is a moonlighter secured for both Saturday and Sunday nights then housestaff work Mon-Fri night with Sat/Sun off. This is NOT guaranteed.

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On your first night, report to the Chief's office at 5pm for orientation. On all other nights report at 6pm for sign-out in the Team 2 room. You will receive 2 cross-cover pagers, 2 MAR pagers (A & B) and a consult pager from the on-call teams. You should also hold the Team 2 vocera logged in as Team 2 for code & rapid calls. 

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Morning sign out is at 6:30-6:45am outside the Freedom Auditorium. New admissions from overnight are signed out in the medicine conference room on the fourth floor across the Freedom Auditorium where distribution is posted at ~7:00am.

admission orders

All CPRS admission orders should be assigned to “Medicine Night Team A” or “Medicine Night Team B” on CPRS with the night resident and intern names, the night attending, and the appropriate Night Team pager number for staff to contact the correct admitting team.

pagers

MAR A = 9516-3822

Xcover A = 9516-0151

MAR B = 9516-3284

Xcover B = 9516-0035

Med consult = 9259-3286

morning email

​The 2 overnight residents should send ONE e-mail to the Chief Residents (dcvamcchiefs@gmail.com) by 6:30am with the following information:

  • List of overnight admissions (LastNameInitial, Last4, and floor unit assignment, e.g. 3E, 4E/4C, 2D)

  • Note if any patient is a bounce back and to which team or resident (see bounce back policy)

  • Current census for each of the 6 Medicine Teams from the overnight sign-out (exclude discharges)

  • Current Census of COVID+ patients on each medicine team

  • How many admissions were before vs. after midnight

 

On Weekend mornings, the Chief residents will email you back about team assignments for the patients and sign out will occur outside the Chief’s Office.​

medical admitting officer / attending coverage overnight
must call events

  • Code Blue or significant Rapid Response

  • Transfer to the ICU or significant change in clinical status

  • Patient leaves AMA

  • Death of a patient that is unexpected (inform the overnight attending and make sure primary team informs their attending in the AM)

  • Significant hemodynamic instability requiring intervention

  • New onset neurologic finding

  • Medication or treatment errors resulting in increased patient monitoring, intervention, or patient harm

  • Challenges determining level of care (floor, tele, PCU, MICU) for new admissions

  • Anytime you are unsure of the next step in work up or management

  • Any other clinical management or difficult system question you might have

The Medical Admitting Officer (MAO) is a hospitalist who is in-house from 6pm - 12am who holds the MAR A pager and is the first call from the ED for admissions. They help triage admissions and help with the flow of patients from the ED and the floor. They will distribute admissions to the night team as they come in and staff those admissions. 

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After midnight, the attending hospitalist is at home and available by phone each night. This attending is different each night, see the night float orientation email with the names and phone numbers of those attendings. Please call the attending if you have any medical or logistical question. Must call events are listed to the left. 

transfers

If a patient is transferred from another VA, please look in the patient’s CPRS chart for the attending acceptance note.  If there is no accepting physician already you can not accept the patient.  Please call the overnight attending if there are any questions.  The attending acceptance note should have a general history and reason for transfer. If the note mentions printed medical records or other materials, those will likely be found in the Team 2 room unless otherwise specified in the transfer note. See the Transfer Policy for more detail.

cross-covering

If you evaluate a patient or make significant medical decisions for a patient overnight, please write a brief Medicine Cross Cover Note in SOAP note format and explain your reasoning and decision making process. If a patient falls overnight, please write a fall note and explain your reasoning and decision-making process. There is a separate CLC and inpatient medicine fall note, so make sure to use the inpatient medicine falls assessment.

consults

Please return all pages on the medicine consult pager. If you are called for a new consult, please see if the consult question is urgent or can wait until the morning. Also assess if the consult needs to be transferred to medicine. If you make any recommendations, please write a brief “Consult Medicine Inpt” note and specify that a full note is to follow in the morning. Co-sign your notes to the Attending On Call. Let the chiefs know in the morning email if there were any new consults overnight that need follow up by the consult resident. Please leave the med consult pager in the chiefs office during the week and give the med consult pager to the appropriate call team on the weekend.

rapid responses & code blues

The night team responds to both rapid responses and code blues and are alerted through the pager system and the vocera system. One of the night residents, the first to the rapid, will be the one running it. Code blues are typically run by the MICU team, however if you are the first to arrive the night resident should start running the code. Other members of the rapid response team and code teams include an ICU nurse and a respiratory therapist; anesthesia comes to code blues as well (if you have any difficulty contacting anesthesia, vocera "Anesthesia on Call."

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Patients should be stabilized at their current location and then moved to a bed with increased monitoring if needed (they should NOT be sent to the ED). If you go to a rapid response as the on-call resident, please write a note under the rapid response template note (Rapid Response Team (RRT) Physician Note). If you run the Code Blue, please write a Code Blue: Medicine note. 

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Please click here to see more about Rapid Responses and Code Blues.

fyi's

  • Lab draws: Phlebotomy is not in house from 10pm to 4am. If you need help with lab draws overnight, vocera “Nurse Supervisor.”

  • On call schedules: If you are unable to access the On Call Consult Schedules overnight, contact the ER because they have printed call schedules. 

  • Procedures: If you are not signed off on procedures, please assess if the procedure needs to be done by the ER team as part of their triage. You can also ask the MICU team for help.

  • Food: Panera at WHC is no longer available to non-MedStar Employees. UberEats or the delivery app of your choice is likely your best bet.

  • Admitting Team (starting 7/29/2024)

    • The admitting team has started on service. Their role is to assist on-service teams with admissions between 2-10PM. For those residents on the service, further details will be provided via email the week before your rotation.​

    • Please Note: 

      • 1. Receiving handoff from the ED is the primary team's responsibility. Once you receive hand-off and the ADT order is placed, the senior resident can discuss with the attending whether or not a patient is suitable for the admission team. However, the admitting team is not a primary service; the primary team is still responsible for the patient. Once the admitting team completes the admission, they will staff the patient with the primary team attending. The residents on the primary team are expected to be present as this will serve as the admitting team's handoff of the patient to the primary team.

      • 2. For late, call day admissions (between 5:15-6) that are given to the admitting team, it is expected that the primary team provides a brief signout to the appropriate night-float intern, as the patient being admitted is still part of their service. They should also tell the night-float intern that the admitting team will come sign out the patient by 10PM. Senior residents should also expect a call from the admitting team with their attending for handoff. These patients should not be included in overflow sent to the chiefs the following morning as they already have team assignments (aka the call team).

      • 3. Any patient admitted after 6PM by the admitting team will be signed out to the night team senior residents by 10PM. They should be included in the overflow email sent to the chiefs the following morning.

        • The MOD (Medical Office of the Day) will triage patients and assign them to the admitting team or the night team. The last admitting team admission can occur at 8:45PM with handoff to night team required by 10PM.​

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