This document provides an overview and tips for interns completing a nightfloat rotation, which involves covering patients overnight for other medical teams. The key responsibilities as the intern on nightfloat are to handle cross-coverage of medical patients, complete tasks assigned by the day teams, and address any changes in patients' conditions. The night typically involves receiving signout from the day interns, making a to-do list, completing tasks and responding to calls, then providing signout in the morning. General tips include understanding the variety of nights that may occur, prioritizing communication with residents, and efficiently organizing tasks.
This document provides an overview and tips for interns completing a nightfloat rotation, which involves covering patients overnight for other medical teams. The key responsibilities as the intern on nightfloat are to handle cross-coverage of medical patients, complete tasks assigned by the day teams, and address any changes in patients' conditions. The night typically involves receiving signout from the day interns, making a to-do list, completing tasks and responding to calls, then providing signout in the morning. General tips include understanding the variety of nights that may occur, prioritizing communication with residents, and efficiently organizing tasks.
This document provides an overview and tips for interns completing a nightfloat rotation, which involves covering patients overnight for other medical teams. The key responsibilities as the intern on nightfloat are to handle cross-coverage of medical patients, complete tasks assigned by the day teams, and address any changes in patients' conditions. The night typically involves receiving signout from the day interns, making a to-do list, completing tasks and responding to calls, then providing signout in the morning. General tips include understanding the variety of nights that may occur, prioritizing communication with residents, and efficiently organizing tasks.
As an intern, you will typically have about 2 weeks of Nightfloat, (NF)
typically divided eually between !offitt (during your "#$$ %onth) and &F$' (during your () %onth)* (+cept for very, very rare circu%stances in which you %ight be asked to help ad%it a patient with the resident NF, your pri%ary ,ob as -ntern NF is to handle the cross.cover for all of the %edicine patients (e+cept the patients cared for by the on.call tea%(s)*) /his allows the on.call interns to focus on ad%itting* 0ou will typically be given a nu%ber of patient care.related tasks (e*g* checking vitals1eyeballing pts, checking labs, etc) to do* 0ou will also be the pri%ary physician to assess and proble%.solve when any of the patients you2re covering has a change in clinical status* /his can be a scary thing (particularly if you2re doing NF early in the year), but re%e%ber that you always have a resident NF there to back you up, as well as -#"1##" residents* 0ou should never feel alone3 4e%e%ber that the night (and the week15 days1whatever), no %atter how harrowing, 6-77 co%e to an end* 0ou will %ove on to so%ething else, and you will greet the nightfloat with tre%endous relief and happiness when 08" are the one on call trying to ad%it and cross.cover at the sa%e ti%e* Intern NF, Typical Night Arrive 9 :;<=.5p% Figure out who the interns on-call are (at Moffitt, 2 teams are on call M-F, 1 team on weekeds at !F"#, 1 team is on call e$ery night% Figure out who the &esident NF is (on 'mion under (shift)%* The resident NF will arri$e at +,-.pm* $et signout, pick up cross.cover pager(s) /ontact the on-call interns (usually pager0o1 works 0est% to ask for signout* 's a courtesy, offer to meet them where they are to get signout* 2ick up the cross-co$er pager(s% o 't Moffitt, this is the Intern NF pager (33--&4FF%, which stays in the resident room in a small wicker 0asket when you5re not there o 't !F"#, these are the Intern (') and (6) pagers, carried 0y the on-call interns until you arri$e* 7ist your na%e and pager as -ntern NF on the white board in the resident roo%* !ee (!ignout) section under ("eneral Tips and 'd$ice,) 0elow !ake your /o )o 7ist 6efore the on-call interns arri$e to sign out, get ready to organi7e the To 8os (see (Making a To 8o 9ist) under ("eneral Tips and 'd$ice,) 0elow% >atient #are 9 5;?@p%.:;?@a% (or 5a% on weekends) /ompleting (To 8o) Tasks, triaging and managing patient pro0lems &ignout in A! 9 A;?@.:;?@a% (or 5a% on weekends) &eporting 0ack to the primary teams on the e$ents of the night Attend 4esident 4eport (optional but encouraged, :;?@.5;?@a% !.F e+cept /hurs) "eneral Tips and 'd$ice :ating and sleeping o 't Moffitt, (ating; you are gi$en an allowance for eating on NF (;+<night%* The caf= (2 nd floor% is open until 11pm* >n-call teams will often meet for ice cream around 1.,-. or 1.,3? @ Aoining up with them, if you ha$e time, is always nice @ makes you feel less lonely in the sometimes lonely world of NF* For late night hunger pangs, there are $ending machines on the 2 nd floor as well (to your 9:FT, away from cafeteria, from the ele$ators%* &leeping; you are assigned a call-room, listed on one of the 0ulletin 0oards in the resident room, along with the door code which you5ll need to get in o 't !F"# (ating; The caf= closes 0y Bpm, 0ut the resident lounge (on the 2 nd floor 0y the chapel% gets stocked with food at +pm* Food items usually include 0asic stuff like fruit, crackers<granola 0ars, cookies, chips, water* !ometimes there are microwa$ea0le foods like Cuiches and peanut 0utter and Aelly* &leeping; you are assigned a call-room in the 0asement, which you access $ia the sensor attached to one of the cross-co$er pagers 4nderstand and anticipate the $ariety of nights that you will e1perience on NF, o Most often, there5s a solid 0ackground of calls for stupid scut stuff (filling out '>!es, restraint orders, diet orders, etc etc%, mi1ed in with a smaller num0er of potentially real medical stuff (0leeding, dropping #ct, !>6%, and not unusually one patient who is acti$e and potentially sick or decompensating* 8> N>T #:!IT'T: T> /'99 D>4& &:!I8:NT >N NF E#:N !>M:>N: ":T! !I/F >& D>4 8>N5T FN>E IF !>M:T#IN" I! !:&I>4!, >& 8>N)T FN>E E#'T T> 8>* The >N9D way that you can screw up as an intern is 0y N>T calling for help when you should ha$e* Dour residents will e1pect to hear from you ' 9>T, 0oth on NF and on the wards in the first few months* o &arely, you will ha$e a night when multiple patients are crashing* &est in the knowledge that these nights are truly rare, and when they happen, you and your resident may well end up working as a team with one of you at the 0edside of each patient, since, after all, you can only 0e in one place at one time* o &arely, you will ha$e a "9>&I>4! night when the calls, e$en for scut, will 0e few* :nAoy them as much as possi0leG !ignout o 8o N>T, under any circumstances, try to 9:'&N all of the patients as they are signed out to you* The key things to listen for are these few things, 2eople who the primary team identified as sick, who may crash o$ernight* If time permits, talk 0riefly or round on these folks with your resident NF when he<she arri$es, so that you know what to anticipate* 2eople who ha$e had any cross-co$er issues (this is good 0oth 0ecause people who ha$e 0een acti$e during the day<e$ening often will continue to 0e so and, if nothing else, you5ll 0e the one communicating what happened to the primary team in the morning%* Dou should make sure you understand any notes that ha$e 0een Aotted down 0y the cross-co$er interns* To 8o tasks for you (often +pm<MN<CHh la0 checks, f<u on consultant recs, etc%* These should 0e written on the signout sheet anyway, so if you don5t go through these with the on-call intern signing out, no 0ig deal* o Ask the people signing out to you to filter their signout for the above details 9 Bust tell %e about the people who are sick or who have been active 9 so that you don2t get overwhel%ed* Making your To 8o 9ist o 6efore the on-call interns arri$e to sign out, get ready to organi7e the signout* "et a fresh sheet of paper and make a few categories, 9ist of the floors where medicine patients usually are 't Moffitt, 13M, 139, 1.!, I-I/4, Misc floors 't !F"#, ?', ?/, ?8, 36 9a0s<radiology o 's the on-call interns are signing out (or after they lea$e, when you look 0ack through the signout sheets%, write down the name and team of the patients that you ha$e To 8os for* For e1ample, if the on-call team tells you to check I<> on Ms* !mith on team 6 in 13M at MN, put down (Team 6, !mith, I<> at MN under your (13M) list* If it5s a la0 check, try to figure out when the la0 is due (typically la0s take an hour or so to get results once they5re drawn, so check for +pm la0s around Ipm%, then write down the pt5s name, team, and time to check la0 under your 9a0s category* o /aking =.C@ %inutes %ake this list at the beginning of the night will save you /8N& of ti%e during the night, since you2ll get your /o )os done in the fewest a%ount of tripsD also, you2ll be less likely to forget to do one of your /o )os, which are all buried in a huge stack of papers* o 's you get calls to fill out forms or e$aluate patients during the night, you can easily add the pt5s name (and team% to your To 8o 9ist 2atient care o 'nticipate a lot of pages early on in the e$ening and lots of To 8os early on in the e$ening* !tupid cross-co$er scut stuff usually dies down after 12-1 'M* o Try to make sure 0y I,-. that +pm la0s you5re supposed to check ha$e actually 0een drawn, if they5re not pending in the computer* 2hle0otomy draws are only C2h, on the e$en hours* o ' word on $er0al orders, Jer0al orders are accepted at Moffitt in emergency situations (the nurse will ask for your name, then will lea$e a sticker in the order section of the chart for you or the primary team to sign later% Jer0al orders are not accepted on any floor at !F"# o Ehen paged 0y the nurses, the first Cuestion to ask if which team the patient is on* This will help you find the patient in a 0ig stack of sign-outs* !uggestion, (/arry a copy of the roster of the current medicine teams, so that you can identify a pt5s team num0er<letter 0y intern or su0-i*) !uggestion, (>nly when I ha$e located the patient do I ask them whatKs going on*) /his ensures that you2ll actually hear what they2re saying* Make a note with the time L issue on the signout each time you5re paged !uggestion, (Ehen lea$ing notes on the sign-outs, try to use a non-0lack pen* ItKs easier to pick out what youK$e written, it distinguishes 0etween you and the on-call intern when youKre e1plaining in the morning what happened*) o Ehen the nurse is calling regarding a change in the patient5s clinical status, your ne1t Cuestion should 0e, (Ehat are the $italsM) Ask for a F"77 set of E&* o /heck the signout section ('nticipate 2ro0lems) to see if the team has any d1 or r1 ad$ice for you* o /onsider what additional information or inter$ention might 0e helpful to ha$e the nurse get started while you5re on your way to see the patient (e*g* get an :F", call for a /N&, put the pt in Trendelen0erg if hypotensi$e and altered, call &T% o !tart thinking through your differentials, get additional information or help as necessary, while you5re on your way @ re%e%ber that it2s A76A0& best to err on the side of calling your resident earlier rather than later3 o !uggestion, (Ehile itKs always 0est to see the patient for most issues, I do gi$e $er0al orders for things that are $ery straightforward (e*g* last night a nurse called 0ecause a sta0le, 2--year old patient had recei$ed am0ien ? mg and still couldnKt sleep, so I ga$e a $er0al order for additional 'm0ien ? mg without seeing the patient%* o For any maAor management decision, inter$ention, or change in pt5s clinical status, you should lea$e a 0rief note (e*g* (:$ent Note)% in the chart o !uggestion, (Ehen nurses or pharmacists ask me to change management<meds that are not urgent or wonKt change anything o$ernight, I defer to the primary team and tell them that IKll pass their concern<suggestion on to the primary team*) &esident 0ack-up o Though it may not feel like a glamorous Ao0, you will learn a tremendous amount on NF, particularly in terms of how to triage and manage patients who are getting sick* Ehile you should certainly do your 0est to assess the patient and come up with your plan for what to do ne1t, when in doubt, call your resident3 o The resident NF is your primary 0ackup howe$er, don5t forget that there are always multiple senior residents who can help you, on-call medicine or cardiology residents, I/4 residents !igning out to the primary teams in the 'M o Try to 0e 0ack in the resident room 0y H,-. or Bam (especially in the 0eginning of the academic year% to gi$e signout to the primary teams* o Feel free to let people know if there was so%ething unclear, %issing, or wrong in their signout* Bust as %uch as you2re learning how to cross.cover, they need to learn how and what is appropriate to sign out to NF* -f you do it in a constructive, diplo%atic way, they will thank you for it* !uggestion, Make sure to pro$ide feed0ack in the morning* If there were notes that were really helpful, acknowledge that* If you felt that they signed out something without making it clear what was to 0e done with that information, also let them know that, so that they can impro$e in the future* >ne thing that I ga$e feed0ack on was when people asked me to check results (especially of radiology studies% without letting me know what I was looking for or how the plans would change*) o If interns ha$en5t arri$ed 0y B,-.am on weekdays (e1cept Thurs% or +am on Thurs<weekends, you should lea$e their signout in a marked spot in the resident room (usually on or near the white 0oard%* 9ea$e your name and pager O in case they want to contact you with details Morning &eport o Dou5re e1pected to go to (&esidents5% Morning &eport, which happens at B,-.- +,-. on e$ery weekday e1cept Thurs* :nAoy the opportunity to hear some cool cases and how the residents are approaching them* (Dou may also end up cross co$ering on one of the pts presented later on in the weekG%