General Principles
Interns and residents are scheduled for night float in 2 week increments throughout the year. Sundays and Wednesdays are designated days off for one senior resident on night float and are solo nights [covers MAO and Rapid] for the second senior resident. For the first three months of the academic year, there are no solo nights to help ease the transition for the new interns.
Admission Rules
Each teaching team is on call every two days [Q2]: Himelfarb/Baltazar vs. Kassel/Tabatznik. For the ICU step down unit, Mendeloff A/Mendeloff B alternate admitting every other day.
On weekdays,
When a teaching team is on call, the short call intern will take all overnight admissions and can be capped to 8 patients. The long call intern will NOT take any overnight admissions, however will admit during the day up to a cap of 8 patients.
Mendeloff long call and post call can be capped overnight.
Pending admissions for the long call intern(s) or Mendeloff should be discussed with the senior resident on the admitting team and added to the respective team list by the night float MAO.
On weekends and holidays,
There is only one intern on call for Himelfarb/Baltazar and Kassel/Tabatznik. He/she can take both overnight admissions and any day admissions up to a cap of 8. The on-call intern on Himelfarb, Baltazar, Kassel, or Tabatznik should be left open for 2 admissions on their weekend or holiday call day.
For IMC admissions, admit only to the on call Mendeloff resident. The resident can be capped for a total of 5 hospitalist patients and 1 private patient.
Responsibilities
Residents cover the MAO pager [admitting and consult pager] and the Rapid Response pager.
Interns cover the patients on the floor. Receive sign-out from the daytime interns at 6:45pm - each intern carries three teams [Mendeloff A, Mendeloff B, Tabatznik, Himelfarb, Kassel, and Baltazar]. Responsibilities are to follow up on requests from day team, answer pages, evaluate patients, help in emergencies, etc. Interns are responsible for completing 2 admissions and 3 event notes during each night float 1/2 block. This should be submitted to the Chief Residents at the end of the rotation for evaluation.
If there are any issues…
Contact the nocturnist via the Medicine Gate Keeper phone.
Contact the on call Medicine Chief Resident 24/7.
Admitting Guidelines
Per the ACGME, each night float resident can admit up to 10 new patients and accept up to 4 transfers per shift. Additional transfers are counted as new admissions.
On nights when there is only one night float resident on duty, this is known as a solo night. One resident covers MAO and the rapid response pager.
The cap for admissions for the NF MAO on solo nights only is five, including consults. Emergent consults take priority always. Admissions are to be equally distributed amongst all open teams. This does not include consults.
Only urgent or emergent consults will be seen overnight. NF MAO can discuss stratifying consults with the nocturnist. Sign out must be obtained from all consults overnight and added to the consult list on CORES. At 6:45am, NF MAO is to give verbal, in person sign out for all pending consults to the consult resident. On holidays, NF MAO is to give verbal sign out to the attending covering the medicine consult service at 6:45AM.