TEAMS BALTAZAR, HIMELFARB, KASSEL and TABATZNIK
How it Works
Baltazar, Himelfarb, Kassel, and Tabatznik are teaching teams that manage patients admitted to Sinai Hospital. Two teams are on call each day - either teams Himelfarb and Baltazar or teams Kassel and Tabatznik. All four teams accept acute care admissions and the cap for each patient is 8 patients.
When the team is on call, there is a short call intern that takes all the admissions that came overnight (6.45PM - 6.45AM). The long call intern takes all the admissions that come during the day (6.45AM - 6.45 PM). Interns cap at 8 patients. Interns can take up to 5 new admissions and 2 ICU transfers per 24 hour period. Residents do NOT carry patients, but they are responsible for the whole team’s patients [maximum of 16 patients]. Non call interns can sign out to the long call intern no sooner than 4pm.
There are four designated days off during a four week block of inpatient medicine - one golden weekend [off Saturday and Sunday] and two grey weekends [off either Saturday or Sunday]. This will be designated on Amion.
Admission Workflow
The number of patients that an admitting intern or resident is open for is based off of the number of patients present on the list in the morning. We do not utilize rolling caps [aka if a patient is discharged throughout the day, the cap does not increase] on acute care floors (we do on Mendeloff).
On the Weekend:
The team call schedule is the same - either team Himelfarb/Baltazar or team Kassel/Tabatznik are on call on either Saturday or Sunday.
There is only one intern on call, and he/she takes both overnight admissions and daytime admissions. Therefore, on weekends, there is only a long call intern [no short call].
On weekends, overnight admissions can be given to the on call interns, however he or she must be open for two admissions during the day.
On the weekend, interns and residents can be marked as “in-house”. This means that on that day they are not on call, and do not accept overnight or pending admissions. Instead, “in house” interns or residents come to round on their team’s patients, write notes, discuss the plan with attending and follow up on issues/execute the plan for the day. One intern covers the entire team on either Saturday, Sunday, or both. Once the work is done and their patients are tucked in, in house intern or residents can sign out to the on call intern from the sister team (Himelfarb signs out to Kassel, Baltazar signs out to Tabatznik and vice versa). The in-house intern will sign-out to the on call intern no sooner than 4pm.
On the weekend, the on-call resident will cross-cover the team that they are on call with (i.e. Himelfarb/Baltazar or Kassel/Tabatznik). The in-house resident will cross-cover the non-call (post-call) teams for continuity. The cross-covering resident, should get a brief sign-out in advance from the resident you are cross-covering for on the Friday before the weekend.
References
Medicine Floor Team Guide
Medication Reconciliation Tips
How to: Floors like an Intern
How to: Write an H&P
How to: Write a SOAP Note
How to: Cerner
Courtesy of Dr. Khunkhun on how to deal with common pages. Very helpful for interns on floor rotations and night float. Click on image for the slides!
What to do on Clinic Days
Floor residents and interns are expected to sign out their patients to their co-intern or cross covering resident on clinic days. They are also expected to follow-up on their patients and make sure that their patients are tucked in and that all pending issues are addressed prior to leaving Sinai after clinic.