Updated 7/2/2024 CARDIOLOGY A
Responsibilities:
Supervise all admissions: Most general cardiology admissions & transfers come to Cards A. You are paged from the ER about potential admissions and should help triage them to the appropriate service. See On Call for cardiology services and how to triage patients to the correct service. The fellow cannot accept outside hospital transfers, only the attending.
Lead work rounds.
Help coordinate procedures: If ordering a TEE or cath procedure for one of your patients, please communicate with the respective cardiology fellow on that service. If transferring a patient to the ICU, help with that coordination/sign-out.
Read echos for Card A patients (weekends only). Once first years start taking triple call, the weekend Cards A fellow will read the weekend echos for Cards A patients.
Team Structure:
The current structure of the team is Cardiology A attending, cardiology fellow, four residents (2-3 are there each day), one prelim intern (typically neuro or ophtho), and a sub-I (most months).
Team cap of 14 patients
The team also consists of social work, case management, pharmacist
The residents will have a “check-in” (5-10 minutes ~ 8:30 am) as well as a 12:30 pm session. You will chat with the social worker team, who helps to create follow-up appointments, arrange discharge plans, and obtain outside records.
The intern and Sub-I should NOT be your responsibility directly. You should make sure one of the 4 residents is overseeing this intern and then supervise the residents as needed. Similarly, the Sub-I should be paired with a resident.
TYPICAL DAILY SCHEDULE:
8:30 AM: rounds start with a focused discussion with social work/case management about planned discharges for the day
8:40 AM: present new patients from overnight, followed by olds. Typically, we round outside in the hallway or at the patient's bedside. During rounds, you are often communicating with the echo/cath fellows about coordinating urgent procedures for the day.
12:30 PM: social work/case management for the remaining patients. Run by the residents.
1-5 PM: teach residents, check in on sicker patients, and help coordinate care for other patients. Admit new patients from the ER and patients who are transferring out of the units (CCU/CICU) to the floor.
5-8 PM: Card A coverage/consults
Expectations:
Be as involved as possible in the high-level management of your patients.
Supervision of residents: Preround in the AM and check in with the residents before rounds to see if they have questions. If there are procedures that you know are certain, let the cath/echo lab know (fellow and cath/echo lead - see below). Come up with your own plan and lead rounds in conjunction with the attending.
Be in touch with the general cath fellow, echo fellow, and EP fellow. I recommend getting in touch with that person and exchanging cell phone numbers on Day 1 and if you have consults/procedures, contact them immediately. We all appreciate a text heads-up rather than a page late in the morning/afternoon. Check-in with the residents regarding this so that you let them know if you have already communicated with a consultant. Also, make sure they don’t feel like you are squashing their autonomy. Generally, it is easier for us to communicate with one another, but it should not be at the expense of resident education.
Know what procedure you are asking for and why. Make sure you check NPO status, relevant labs (platelets, coags, Cr, etc) and consentability of the patient.
Coronary angiogram: if obstructive disease is found, is the patient a candidate for PCI (ie. can they be on DAPT, might they be a CABG candidate, etc.)
RHC: is it a possible leave-in swan; if so please communicate to the cath team
Outside images: get them! Try to get images pushed over from outside hospitals if patients don’t transfer with a disc. Edie the social worker can help with this or sometimes calling the Transfer Center through the operator.
Expectations do vary by attending. Highly recommend talking with whoever the attending is as soon as they start (you’ll have 2 throughout your month since they rotate q2weeks) about your goals. Check in periodically and at the end of the rotation for feedback.
Let your attending know when you have 1/2 day of clinic. The pager should be forwarded to them during this time. Call paging operated and ask for the On Call Schedule to be updated during the time of your clinic.
Consult RESPONSIBILITIEs:
Please see the consult rotation tab for more details.
You cover consults weeknights 5p-8p typically MWF while on the rotation, but please check MedHub as this varies with vacation/coverage. The echo fellow typically covers T/Th.
You also cover consults on weekends as well Sat/Sun 8a-8p.
As needed, staff consults over the phone with the attending covering consults in the evening (check Qgenda. It will be either the day time consult attending or card A attending and route your note to them. Make sure that you communicate with the consulting day team and add to the consult list in Epic so they are aware (U Card Consults, NOT General Cards Consult)
You may get calls from the community care line nurse from patients who have questions, concerns, and occasionally requests urgent refills. Generally your job is to assess symptoms/complaint and recommend a plan of management. That may be - take another dose of lasix, or call your clinic in the morning, or, if there is any doubt, have them come to the ER.
Document. Always leave a telephone encounter in Epic if you spoke with a patient (talking about what you discussed, your recommendations, especially if you said to come to the ER and they refused). Make sure they understand what could happen if they do not (death, MI, stroke, other horrible things that apply, etc) and route this encounter to the primary cardiologist.
Sign out/Care transitions:
This goes without saying but please create verbal or email sign out to your covering fellow over the weekend. Also, giving the nocturnist a heads up about patients coming in (particularly if they sound sick) is helpful, or if there are current patients on the card A service who are taking a turn for the worse, letting the nocturnist (and possibly the CCU) know is very helpful.
OTHER TIPS:
Put these phone numbers into your favorites:
Cath Lab Charge RN: Refer to Logistics tab —> Contacts for phone number. They essentially supervise everything that happens in the lab. In addition to communicating to the general cath fellow about add on procedures, let them cath lab RN know. They will appreciate this!
Echo Lab Lead Sonographer: Refer to Logistics tab —> Contacts for phone number. When your attending says “expedite this echo” you can call your echo first year colleague, but the real person who makes things happen is the lead sonographer.
After-hours procedures (5p-8a): all echos, caths go through the “procedure fellow” whom you can page through the operator.