Wards

General Internal Medicine Wards (University Hospital):
We have recently revamped our wards system to create a unique model that maximizes resident education, assures continuity of patient care, and adheres to the new ACGME work hour restrictions.  

Teams:
Academic wards teams (4).  Comprised of one supervising resident, two interns, 2-3 medical students, and a staff physician.
Hospitalist team (1): Comprised of two upper-level residents, an intern, and a staff physician. 

Call Schedule:
Our call schedule is based on a 4-day rotation based, but our teams only stay overnight Friday-Sunday.  Monday-Thursday, two of our four teams admit patients, and all teams check out to the Hospitalist Team at night during formal check-out at 6pm.  On weekend call, one call team admits from noon until 7 am the next day.   Supervisors average about 3 overnights per month.  Since interns do a “split-shift” with their weekend call, they average 1-2 overnight shifts per month. See details below.  Residents work an average of 65-70 hours per week while on University wards.

Long-call Team: Weekdays:  With the exception of clinics or days off, the whole team is available to admit patients on their call days Monday-Thursday.  They share admissions with our short-call team from the hours of 7 am -5 pm, and they are the only team admitting patients from 5pm-7pm. Weekends:  The long-call team takes admissions from 1 pm to 6:30 am the next day.  Interns split the shift (day intern 7 am to 9 pm, night intern 8 pm to 6:30 am).  The supervisor works the entire shift. They then hand-over patients to a night intern who is responsible for overnight cross-cover, but does not take admissions.

Post-call:  The team rounds, finishes floor work, and one person from the team stays to crosscover on the team’s patients until formal check-out at 6pm. They do not take admissions unless they have a bounce patient.  
Short-call:  The team shares admissions with the long-call team on weekdays from 7 am – 5 pm. This allows them to get their work wrapped up in time for 6pm check-out.
Pre-call: The team rounds, finishes floor work, and one person from the team stays to crosscover on the team’s patients until formal check-out at 6pm.  They do not take admissions unless they have a bounce patient.

Sample Intern Schedule

Formal checkout from floor teams to the Hospitalist teams at 6pm
Monday-Thursday and floor teams to Long call team Fridat at 5pm

Formal checkout from floor teams to the Hospitalist teams at 6pm
Monday-Thursday and floor teams to Long call team Fridat at 5pm

Hospitalist Team: This team is composed of two upper-level residents, one intern, and a staff member.  Monday-Thursday, this team is responsible for crosscovering for the other floor teams and for overnight admissions (7 pm to 7 am ).  Patients admitted by this service stay under their care and are not handed-off to the academic wards teams, thus maintain continuity and avoiding unnecessary hand-offs.  During the day, the team members take care of their own patients, hold the admission pager for all of the floor teams, and triage patients appropriately.  Upper-level residents on this service spend two weeks as a day-time rounder, one week on night-shifts, and have one week of vacation.  Interns spend one week as day-time rounder, two weeks on the night shift, and one week on vacation.

VA Wards: The inpatient wards rotation at the VAMC is another inpatient general medicine experience.  Teams typically average around 6 patients which provides sufficient time for further study and investigations in regards to patient care.  The call rotation alternates days with Creighton Internal Medicine so teams are on call only every 6 days.  Duty hour changes have helped to create an innovative day intern/night intern system on call days to ensure compliance with duty hours and to avoid resident burnout.