Welcome to the CCU. The CCU is located in the East tower on the 7th floor, unit 76. The CCU has both cardiology critical care patients and advanced heart failure patients. The team list can be found under the provider team of CCU. All patient admitted to this service should have this provider list selected and all residents taking care of a given patients should assign themselves as part of the treatment team. This allows for easier communication between nursing and residents about patient issues. The day shift starts at 7am and ends at 7pm, with a dedicated night team. There are mandatory walk rounds immediately prior to these times between the night team and day team. Following these rounds there is time to pre-round on your patients prior to teaching rounds. Teaching rounds occur with both an MCT attending and an advanced heart failure attending.
As of January 2019 unless specified the service has been split into CCU and Advanced Heart Failure. The CCU will consist of one IM resident and 1-2 ER residents. This team will follow the CCU patients and will not round with the heart failure service. This should limit your time rounding and allow you to focus on these critical care patients. Residents are permitted and encouraged to leave the unit to see procedures in the cath or EP lab, provided one member of the team (resident or fellow) is available on the unit at all times to perform cross cover responsibilities. This includes being able to go to the ER to perform an admission.
CCU
Admitting Times: 7am-7pm
Cap: 14 (additional patients will either be managed by the Cardiology Fellow or mid-levels, preferably the non-ICU heart failure patients)
Holding Note Cap: unlimited
Days Off: Residents are to take 1 day off in every 7 averaged over the rotation. Days off should be determined at the start of the rotation between the residents and CCU fellow and attending physician if need be. One resident is permitted off on a given day. When a resident is off his patients will be followed by the other resident(s). If coverage of the other residents patients plus their own patient load exceed 8 patients, the CCU fellow will cover the remaining patients. Keep in mind, if a resident is capped and the fellow is covering the other residents patients, the resident working that day can still perform admissions these patients will then just be placed on the list of the resident who is off. Residents can admit up to the total team census of the the cap of 14 or 5 patients in a 24hr period which ever comes first. All overages will be performed by the CCU fellow.
Continuity Clinic: No
Team Room Number: East tower 7528
Team Room Extension: 38613
The ER residents will be off one day in every seven to be worked out with the resident at the start of their rotation. Additionally, they will be excused from morning work on Tuesdays to attend their educational conference. The are expected to return after their conference to complete their days work and take on new patients. Any issues with not returning after conference should be brought to the attention of the chief resident. On days when the IM resident is off the ER resident should be under the direct supervision of the CCU fellow and ideally this should not coincide with the day the advanced heart failure resident is off.
Advanced Heart failure
Rotation Description: The Advanced Heart Failure rotation is a two week long rotation. The service is led by the UFH Cardiology Heart Failure attending. Residents follow patients on the Heart Failure inpatient team (MCH) at UFH that are located under ICU or IMC level care, though all significant ICU requirements are handled by CCM (this includes procedure, intubation, and vent management). Residents will learn the diagnosis and treatment of advanced heart failure and workup for patients undergoing transplant evaluation. The resident will work with the heart failure extenders, Cardiology fellow, Heart Failure fellow, and attending on MCH. In general the resident will cover a maximum of 8 patients with particular focus on IMC level patients located on the 6th and 7th floor of the East Tower. Floor patients will be handled by the fellows and extenders.
Residents may participate in any of their patient’s procedures at the discretion of the MCH attending but can utilize CCM for any procedure as indicated if CCM is following the patient and aiding in management. Residents are not required to attend their continuity clinic or housestaff conferences but may attend should their schedule allow. They may also attend cardiology grand rounds and heart failure conferences as outlined below.
Resident work days start at 7am obtaining sign out on patients from night team. Residents will be located in the CCU call room on in the East tower. Residents will only round with the Heart failure team and not the CCU team. Residents will carry a max of 8 patients per day. Residents may sign out to the CCU team at 5pm to cover their patients until the night team arrives. Residents will receive one day off in every 7, to be decided with the Heart Failure fellows based on census and the best available day for patient care. On the residents day off the heart failure fellows cover their patients including all notes. There are no night responsibilities on this rotation.
If your name is listed second on the schedule you are the advanced heart failure resident. Please remain flexible with the heart failure team and the rules above as at time it may be more beneficial to your learning to follow patients on the floor for a brief period if your census is low. Please understand the overall goals of this rotation are exposure to advanced heart failure patients, management, advanced devices and complex medical management.
Continuity Clinic: No
Team Room Number: East tower 7528
Team Room Extension: 38613
Downgrades/Transfer
All downgrades from the CCU should get first priority to MCT and if MCT is capped than the patient may remain in the CCU until space or can be taken onto the MCI service which is run by a midlevel and an attending. Patients should be transferred from the CCU to general medicine or hospitalist teams infrequently as there is often an issue with patients being transferred out of the East Tower to an available bed in the north tower. In the event that a patient is planned downgrade/transfer to a teaching team or to MHS the CCU will assume full responsibility for that patient including rounding, orders, notes, etc until the patient is physically in a new bed in the North Tower.
Advanced heart failure patients will remain on the MCH service. When they are floor level patients their care should be transferred from the resident to the mid-level or fellow to allow for new learning opportunities for the residents. This may not always be possible so please remain flexible.
Night team
Night admissions to the CCU are determined appropriate and initially evaluated for admission by the CCU fellow or directly by an attending. The fellow or attending will them communicate to the Night CCU resident the details of the case and plan for admission. Residents will not independently evaluate or determine the need for CCU admission. The Night CCU resident will also perform crosscover duties for the MCT service. The Night CCU resident can perform up to 4 admissions overnight (to MCT or CCU) but at anytime if their crosscover or CCU responsibilities are too time consuming they can state they are not available for an MCT admission in which case the resident AOD in the ER will perform the admission if in the ER and the fellow will perform the admission if directly admitted to the East Tower. Any admission over 4 patients must be CCU level admissions and the resident may admit them if they are able too if not they should work closely with the fellow and the night fellow should either perform the admission or cover all the crosscover responsibilities of the resident so that they are free to perform these additional admissions.