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

Teams:
Academic ward teams (4): Comprised of one supervising resident, two interns, 2-3 medical students, and 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, 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 7am 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 7am-5pm, and they are the only team admitting patients from 5pm - 7pm.
Weekends: The long-call team takes admissions from 1pm - 6:30am the next day. Interns split the shift (day intern 7am-9pm, night intern 8am - 6:30am). 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 on person from the team stays to cross-cover on the team's patient 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 teamon weekdays from 7am -5pm. This allows the to get thier work wrapped up in time for check-out at 6pm.

Pre-call
:
The team rounds, finishes floor work, and on person from the team stays to cross-cover on the team's patient until formal check-out at 6pm. They do not take admissions unless they have a bounce patient.

Sample Intern Schedule

Monday                Tuesday      Wednesday Thursday       Friday           Saturday     Sunday            

Short Call
(Admissions
7am-5pm, team
stays until 6pm
checkout)

Pre-Call
(No
admissions,
one resident 
stays until 6pm
checkout)

Long-Call
(Admissions
7am - 7pm, team
can admit
until 7pm)   

Post-Call
(No
admissions,
one resident
stays until
6pm
checkout)  

Short-Call
(Admissions
7am-5pm,
team stays
until 6pm
checkout)   

Pre-Call
(No
admissions,
supervisor
decides
who needs
to round
this day) 

Long-Call
(Supervisor
and day
intern arrive
at 7am, interns
checkout
to each
other at
8pm when
night intern
arrives) 

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

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Post-Call
(No
admission
night intern
and
supervisor
done no later
than 11am
and 2nd intern
stays until 6pm)

Short-Call
(Admissions
7am-5pm,
team stays
until 6pm
checkout)

Pre-Call
(No
admissions,
one resident
stays until
6pm
checkout)

Long-Call
Day Intern
(Admissions,
7am-7pm,
team can
admit until
)

Post-Call
(No
admissions,
one resident
stays until
5pm checkout)

Short-Call
(Round and
admit first
two patients
or stay until
1pm)

Pre-Call
(No
admissions
only rounds)

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

Hospitalist Team:
This teamis composed of two upper-level residents, and a staff memeber. Monday-Thursday, this isteam is responsible for crosscovering for the floor teamsand for overnight admissions (7pm-7am). Patients admitted by this service 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 member s take care of their own patients, hold the admissionspager for all of the floor teams, and triage patient appropriatly. Upper-level residents on this service spend two weeks as day-time rounder, two weeks on night shift, and one week on vacation.

VA Wards:
The inpatient wards rotation at the VAMC is another inpatient general internal medicine experience. Team typically average around 6 patients which provides suffiant 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.

 

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