Inpatient Rotations at Shands Teaching Hospital
Shands Teaching Hospital is a 618+ bed, not-for-profit tertiary care hospital. It is a Level One Trauma Center and remains a major tertiary care referral center for significant portions of the Southeast. The hospital is served by over 110 medical specialties. The patient population is diverse including common medical ailments as well as the rare and challenging once-in-a-lifetime cases.
The General Medicine Inpatient Teaching Services
At Shands, there are 4 general medicine teaching services: Blue, Orange, Gold, and Green. Excluding the Green Service, each ward team is comprised of an Attending, one PGY 2 or PGY 3 resident, two interns, and medical students. In addition, each team has a patient care resource manager (PCRM) who helps facilitate discharge planning.
There is no overnight call on any of the inpatient ward services.
The call schedule is for each TEAM in the following pattern:
Short Call – Golden Day – Long Call – Post Call
This means the team is on Long Call every 4 days. The Short and Long Call teams alternate admissions each day. Long Call is from 7am to 7pm. Short Call is from 7am to 3pm. There is no Short Call on weekends or holidays. During a Long Call day, the team can admit up to 10 patients. During the Short Call day the team can admit up to 5 patients. Each general medicine team is capped at a total of 20 patients.
If a team has reached its admission’s cap or its team cap of 20, overflow patients are admitted to the Hospitalist Service. All residents are given 1 in 7 days off averaged over 4 weeks, and a vigorous system is in place that assures residents remain fully compliant with all work hour regulations.
The Green Service
The Green Medicine Service provides a unique opportunity for residents. It is comprised of 2 upper level residents that work directly under one of our Hospitalist attendings. Each resident on the service is offered independence in caring for their patients. There are no interns on service, and there is no medical student teaching responsibility. The service designed to provide upper level residents an experience in learning self-sufficient, efficient, and cost effective inpatient patient management.
The Subspecialty Teams at Shands:
In addition to the general medicine services, Shands has 3 subspecialty services: Cardiology, Oncology, and GI-Liver. Each subspecialty service has a fellow, one upper level resident, and two interns. Each service allows the residents to interact and learn from world renowned experts in each subspecialty field. Due to the focused nature of care and emphasis on specialized teaching, the team caps are lower at 16 patients. Each subspecialty team admits patients daily from 7am to 7pm, with exception of GI- Liver which admits until 5pm. There is NO overnight call. These teams are required to follow the same hours and days off requirements as our General Medicine Inpatient Services.
Shands Night Team
The Shands night team is comprised of 2 upper level residents and one intern. They work from 7pm to 7am. The purpose of the night team is to allow each general medicine and subspecialty team to go home at the end of each day. The intern on night team is responsible for providing cross coverage on all medicine housestaff associated services. One upper level resident supervises the cross cover intern and provides direct cross cover to our Intermediate Care and CCU patients. The other upper level resident serves as the overnight admitting officer. This resident admits patients as “holding notes” to the call and subspecialty teams the following morning. The admissions resident can admit up to a total of 8 patients.
The Intensive Care Units
The Shands Medical Intensive Care Unit (MICU)
The MICU is a 12 bed unit that is staffed by 4 upper level residents and 4 interns rotating on a q4 overnight call schedule. The MICU is under the direct supervision of Pulmonary and Critical Care attendings. In addition, the Pulmonary Fellow has a vital role on the MICU team. The approach in the MICU is for true multi-disciplinary care. There are dedicated pharmacists, social workers, and case managers who also round with the MICU team.
The MICU cares for the very sickest medicine patients in the hospital. In the MICU residents become proficient in invasive procedures such as central and arterial lines, thoracentesis, paracentesis, and intubations. This is the ONLY overnight inpatient service at Shands.
The Coronary Care Unit (CCU)
The CCU is a 6 bed unit staffed by one upper level resident along with a Cardiology Fellow. The CCU is directly supervised by the Cardiology attendings. The CCU resident admits patients with the help of the fellow from 7am to 7pm. After 7pm, the CCU patients are admitted directly by the Cardiology fellow on call. Cross cover to CCU patients is provided by the upper level resident on the night team. In the CCU, residents receive direct exposure to acute myocardial infarctions, decompensated heart failure, life threatening arrthymias, and cardiac transplantation.
