Night Float Coverage

Coverage Roles and Expectations

Chief Resident

1. Operative resident with expectation to participate in all emergent cases and end-of-the-day elective cases
   • Will delegate case coverage as needed to intern when multiple ORs are running simultaneously or if a case is starting while a level 1 trauma is arriving imminently
2. Attends all level 1 traumas (delegates consult resident to run the trauma based on their experience level)
   • If there is a level 1 transfer that is stable (ie intubated TBI), chief may stay scrubbed in to OR case, but this should be pre-planned with the consult resident and trauma attending
3. Covers floor pagers for Pediatric Surgery and Thoracic Surgery
   • Must ensure that OR nurse knows to call back pages while scrubbed in (turn pager on LOUD)
   • Triages calls to determine what needs to be seen right away and what can wait until after OR
   • If patient needs to be seen while chief is scrubbed in to a case, then the chief will have OR nurse call another resident to see them
4. Sees consults for Pediatric Surgery and Thoracic Surgery, but may delegate to other residents as needed
5. Check in with SICU team multiple times nightly
   • Chief should be made aware of any active patients by SICU resident, should help with difficult resuscitation and procedural supervision
   • Attending should ultimately be first point of contact for unstable patient
   • Chief resident can be reached by ICU or other team members while in OR to appropriately triage where they need to be. In person preferred but phone call to OR also acceptable.
6. Receives direct sign out on new acute list patients from day teams (these are patients that they day chiefs have decided need special monitoring overnight)
   • Periodically runs the list with the rest of the night team to make sure patients have remained stable, received appropriate serial abdominal exams
   • Additionally checks in with night team to see if any other patients need to be added to this list
7. Reviews expectations with night team at the start of block and goes over any particulars of how they would like the service to run, clarifies roles as needed

Consult Resident

1. Covers floor pagers for Bari/MIS and colorectal
2. Triages, sees, and staffs consults for all surgery services except pediatric surgery and thoracic
   • May be asked to see the pediatric and thoracic surgery consults as well if chief is in the OR
   • Delegates consults to other available residents if overrun with multiple consults
   • Notifies attending from corresponding service if there is a consult at risk of not being seen in a timely manner and all residents are busy
   • Tells chief about critically ill consults, acute surgical abdomens, or cases otherwise being booked for OR overnight
   • Informs SICU resident and intern for any consults being admitted to their services and items to follow-up on
3. Coordinates with trauma APPs for trauma consults; ensures timely response
4. Runs all field trauma and trauma transfers after 7 pm (up until that point ED runs them), will be supported by chief early on in rotation especially with running level 1s
   • Responsible for assigning all tasks in the trauma bay including procedures
5. Supports intern with clinical questions/concerns, especially when chief is in the OR
6. Assists SICU resident with procedures and decision-making along with chief
7. Participates in OR as second resident and joins for TA cases (should rarely be the only resident covering a case unless there are two “senior level cases” going, which is then up to discretion of chief)

SICU Resident

1. Manages SICU patients alongside APP
2. Calls attending early to run the list and coordinate a time for brief rounds
3. Performs trauma patient procedures
   • Attends all L1 traumas and goes to L2 traumas when available
   • Notifies chief and consult resident if they are doing a procedure in SICU for oversight and to let the team know they won’t be present at level 1s
4. Attending should ultimately be first point of contact for unstable patient. SICU resident should primarily communicate with attending directly regarding patient care.
5. Should keep chief and consult resident on active patients so they can provide support. This includes updating the chief resident while they are in the OR either in person or by phone to OR.
6. Keeps open line of communication with SICU APP on all patients in SICU (even if the list has been divided for first call)

Intern

1. Covers floor pagers for EGS, elective, transplant, surgical oncology, vascular
   • Triages calls and alerts seniors to critical issues, discusses plans with seniors as needed
   • Performs post-op checks on patients out of OR late in the day
   • Sees and staffs all direct admits for covered services
2. Completes primary and secondary on all trauma activations, may also be asked to do this on trauma consults and should be ready to coordinate with trauma APPs
3. Start notes for consults as they pop up on the list and assist consult resident by either tag-teaming consults or seeing a consult independently when asked