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Team C:

                Attending

                Consult Senior 1 (CS1)

                Consult Senior 2 (CS2)

                Off-service Rotators (IM, NS)

                Medical Students (sometimes an M4)

                Dayfloat (2nd priority)


Summary of Consult Team Responsibilities/Workflow (full details below)


General:

  • Rotation begins on Saturday: CS1 is on (8AM until inpatient work completed), CS2 is on (8AM-Noon); see Weekends section below
  • On Weekdays, Consult team is responsible for all ED and inpatient consults, 8:00AM to 5:00PM, Monday-Friday
    • Typically, CS1 covers the consult pager and will delegate/triage incoming consults among self and the other team members
  • Consult team responds to inpatient stroke activations (Team A responds to stroke activations from the ED)
    • Stroke activations are first discussed with the covering B.I.G. attending/fellow, but final staffing is with Consult attending (and to whom your stroke activation note is sent for cosigning)
    • If Consult team is experiencing high volume, may discuss with Ward Sr about delegating inpatient stroke pages to Wards team
    • Likewise, if Wards team is experiencing high volume (especially during Ward Jr day off, morning didactics of Psychiatry intern), then Consult team may cover stroke pages from the ED


Continuity Clinic:

  • New as of the 2019-2020 academic year: Adult residents on consults will not have continuity clinic


Weekdays:

  • 7:00-8:00AM: 
    • show up, pre-round as appropriate
    • page Nightfloat to get signout on all follow-ups
      • If non-urgent consult is paged by consulting team at 7:00AM or later, may be delegated from Nightfloat to Consult team (effective May 9, 2017)
      • If urgent, must be seen by Nightfloat
  • 8:00AM-5:00PM: 
    • morning rounds: overnight follow-ups (if any) then old consult follow-ups (if necessary)
      • if patient seen overnight by Nightfloat is still in-house (ED, inpatient), should still be seen at least once by the attending even if there are no active issues
      • it is attending-dependent re: when rounding starts, and whether you should pre-round in person on patient
      • it is up to the discretion of the attending and each consult resident whether a given patient needs to be seen in follow-up that day
    • see new ED and inpatient consults throughout the day
    • afternoon rounds: staff new consults, medical student teaching
    • cover all inpatient stroke activations (primarily CS2, with CS1 as backup)
      • discuss the case with the stroke attending/fellow first, then staff with and send your note to the Consult attending 
    • it is each consult resident's responsibility to write orders/H&P/med rec/code status for patients they are admitting or anticipate admitting to the inpatient service
  • 5:00PM: 
    • page Dayfloat to give verbal signout
    • send email to Dayfloat and Nightfloat on active existing consults and FYI's, including pending results and anticipated disposition


Weekends:

  • CS1 covers one weekend day when Ward Sr is off (see Days Off below)
    • Week 1 of block: cover Saturday
    • Week 2 of block: cover Sunday
  • On the weekend day that CS1 is on, the following responsibilities are covered:
    • 8:00AM-NOON
      • cover Team A service in a Ward Senior role, including rounding
      • old consult follow-ups, if necessary (after Team A rounds)
      • backup CS2 (Saturdays) or Ward Jr (Sundays) for:
        • new consults
        • stroke pages
        • phone calls 
    • NOON-5:00PM
      • NOON: Dayfloat takes over coverage of everything new (new ED/inpatient consults, stroke pages, phone calls) until 8:00PM
      • CS1 continues coverage of Team A in Ward Senior role until Team A completes all work and ready for signout
      • finish staffing/rounding on any remaining old consult follow-ups
      • once all active inpatient work is completed (any time between NOON-5:00PM):
        • signout of Ward Jr and Psychiatry intern to Dayfloat, with CS1 as backup/supervisory role as needed
        • send signout email to Dayfloat and Nightfloat re: new consults/admits from 8AM-NOON and updates on old consults
  • CS2 covers the following responsibilities on Saturday mornings:
    • 8:00AM-NOON
      • new consults from ED/inpatient
      • stroke pages
      • phone calls
    • NOON: 
      • verbally signout to Dayfloat (Week 1) or Ward Jr (Week 2)
      • send signout email on your consults/admits to CS1/Dayfloat/Nightfloat (Week1) or Ward Jr/Ward Sr/CS1/Nightfloat (Week 2)
  • New for 2018-onward: The daytime Neurology NICU resident signs out to both the night midlevel as well as the on-call Neurology resident. The signout to the midlevel should be the "real" signout, the signout to the on-call resident can be quite brief. The midlevel will cover the NICU resident's pager. The on-call Neurology resident continues to have responsibility for all Neurology inpatients, they are just no longer first contact on the ICU Neurology patients.

Days Off

- CS1 has the weekend day off that Ward Sr and Team A are on call:

  • Week 1 of block: Sunday off
  • Week 2 of block: Saturday off 

- CS2 has Sundays off



Summary of Weekday and Weekend Coverage



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