The shift structure has changed as of July 2016
Team 1
7a-3p | 2p-11p
MD Staff:
One attending
One EM3 (supervises Core and Red Zone)
One EM2
At least one EM1, IM1/2, or other off-service residents
Core and Red Zone patients should be staffed with both the Team 1 attending and the EM3.
Periphery, CDU and Yellow Zone patients should be staffed with the Team 1 attending only.
9a-6p EM1 staffs with 7a-3p attending until 2p and rest of shift with 2p-11p attending
6p-2a EM1 staffs with the 2p-11P attending until 11p and then with the 11p-7a attending afterwards
Team 2
10a-6p | 5p-1a
MD Staff:
One attending
One EM3 (supervises Core and Red Zone)
One EM2 10a-6p
At least one EM1, IM1/2, or other off-service residents starting at 12p-9p
The 5p-1a shift has an EM2 and other EM1, IM1/2, or off-service rotator
Core and Red Zone patients should be staffed with both the Team 2 attending and the EM3.
Periphery, CDU and Yellow Zone patients should be staffed with the Team 2 attending only.
Team 3 (Weekdays)
7a-3p OBS / 3p-11p
MD Staff:
One attending
Team 3 attending takes all the observation sign-outs from the overnight team
May have a 12p-9p resident which would split the shift between the AM and PM attendings
The 3PM-11PM has 1 EM1 and usually has more time for teaching. But there may be a 12pm-9pm, 6pm-2am or medical student as well.
Team 1 Overnight
(Team 1) 11p-7a
MD Staff:
One attending
One EM3 (supervises Core and Red Zone)
One EM2
At least one EM1, EM2, IM2, or Pediatric EM Fellow
Overnight attending takes observation sign out from all evening teams
Carries transfer phone and coordinate transfer requests with bed facilitator and ED resource nurse
Weekend Differences
MD Staff:
There is no 3pm-11pm shift on weekends, so the Team 2 shift comes in at noon and works 12pm-9pm, overlapping with the 5pm-1am shift
In the morning, the 10AM EM2 staffs with the 7a-3p Obs attending for 2 hours (10AM-12PM) including taking triggers during this time
After 12PM, once the list is tidied and no critical pending actions the 7a-3p Obs attending can coordinate sign-out with the 12p-9p attending
Surge Shift
8pm-3am
On Mondays and Tuesdays we have an attending-only 8pm-3am shift to help with extra volume.
This is subsidized at a rate of $75/hour and sign-ups are emailed out months ahead of time.
Expectations
• Primary patients (no residents are assigned to shift)
• See at least 14 patients, unless # to be seen is < 3
• Stay for entire shift, unless # to be seen is < 3
• Focus on patients with longest Door to Doc time
• You don’t see triggers
• Most of your patients are dispositioned
• Before signing out, must do the following on all patients:
• Home meds ordered, ED Handoff complete
• HPI and MDM complete
• ED OBS ordered correctly, consults and orders placed for OBS patients (stress test, PT/CM consults)
• Patient/family aware of plan
• Expected volume of > 2 patients per hour
Sign out
• OVN attending takes sign-outs, if they are quiet and tucked.
• Active/complex patients should be signed out to OVN residents at OVN attending discretion.