logo Click here for the Department of Medicine Home Page Click here for the UC Irvine Home Page Click here for the School of Medicine Home Page
 
 

Department of Medicine Night Program

Program Overview, Policies, Job Description »

ICU/DOM Nocturnist Roles and Responsibilities 

  

The primary goals of the DOM Nocturnist are to improve patient safety, resident supervision, and visibility of the Nocturnist to residents and nursing staff, without conflicting with other fellow/staff clinical responsibilities.

 

Here are a few guidelines that will help you achieve those goals.   These are the activities that the director and department chair will focus on when considering each Nocturnist's performance.

ICU

■ Come for signout at 6 PM in the ward 7400 (MICU) team room.  Speak directly with the MICU and CCU Fellows, if available for high-level signout.  Focus on key information, like which patients are acutely unstable, and which active issues should be prioritized.

■ Participate in resident signout for both MICU and CCU services.  Insist that the residents print you a copy of their paper signouts.

■ Pick up the Nocturnist pager (pgr #1010), which is located in the 7400 workroom on the bulletin board above the printers.  Carry this pager all night.  It receives Codes Blue and Rapid Response Team pages, but not airway emergencies. 

■ You are not on the Code Blue team, and you are not required to attend codes.  However, you should promptly see any patients with declining status on your services or on wards 7200 or 7400, and you should always help your team out as best you can.

■ See any new MICU or CCU admissions/transfers as early in the hospital course as possible - prior to arrival in the ICU, if possible.

■ At least once during the night, visit the 3T, 4T, and 5T nurses stations to see if there are any active patient safety issues, and to let the nurses know they can reach you if any such issues come up.  This should only take 10-15 minutes.

 

■ Write a brief event note for any new MICU/CCU admissions/transfers, or whenever your involvement changes management significantly.  These notes should be pertinent and concise.  In Epic, use "Create in Note Writer" --> Title "progress note" --> "blank note." DO NOT write, dictate or cosign an H&P. 

■ Non ACGME fellows and Faculty may bill for critical care time, if appropriate

■ Periodically throughout the night, you should personally round on the CCU and MICU patients located on wards 7200 (CCU) and 7400 (MICU)

■ Once or twice during the night (e.g. at Midnight and 4AM), contact the medicine ward admitting residents at UCI pgr 1763 to hear brief presentations of the admitted patients, and to make any appropriate suggestions.  You do not need to see these patients, and you do not need to complete any documentation. On average, this should not take more than 30 minutes.

■ Sing or attest CDDC admission notes for pre-procedure patients once the Night Float Resident has completed the evaluation.  This requires attending evaluation of the patient.  If the ICU Nocturnist is very busy, they can ask the Medicine Nocturnist to cover this duty - but this must be a Nocturnist-to-nocturnist request, not initiated by the residents.

■ Come to signout at 6 AM.  Directly communicate admissions and issues you were involved in with the MICU and CCU Fellows, if available.  If fellows are not available, communicate this high-level information to the ward senior residents.  Your signout takes priority over resident signout, but SHOULD NOT REPLACE resident signout.  You are encouraged to participate in resdient signout after your own signout, time permitting.

■ At the end of your shift, return the Nocturnist Pager (pgr #1010) to the storage area above the printers in the 7400 workroom.

■ If all of the above responsibilities are met, and you have downtime, fell free to spend it as you wish.  There is a private Nocturnist Office just outside the entrance to the MICU with a phone, computer, mattress, and a locker.  You must provide your own padlock.  Make sure you are available by the p1010 pager or by phone if you are not physically with the residents.  You are intended to be a closely cooperating team, and there should be no delay if you want to contact each other.

■ Do not leave the hospital during your shift.

■ Supervise all resident procedures, or do them yourself if they are not able.  Staff: please write or cosign procedure notes with apporpriate billing codes.

Medicine Nocturnist

■ Come to signout at 6:30 PM in the 7800 Team L workroom.  You should pick up the 4622 pager at that time, which is carried by the Team H resident during the day.

■ Go to the Team O office in the Hospatilist building at 7PM for Team O signout.  Exchange contact information with them at that time.

■ Be available by pager all night

■ When a new Team O admission is called to the NP, you should both begin evaluating immediately to determine if you agree this is an observation patient.  Guidance regarding this process will be periodically updated.

■ The Team O NP calls the ED for handoff, then writes the H&P and places the orders

■ If you disagree with the Observation admission decision, you must work with the ED case manager to identify what needs to be documented to meet InterQual criteria for inpatient admission.  You should write a note documenting what is needed. The Team O Nocturnist or NP should contact the medicine ward team to hand off the patient.  You should not insist the ED make another admission call to the ward residents.

■ If you feel the patient should be discharged from the ED, Faculty and non ACGME Fellows can admit and discharge the patient.  Anyone can write a medicine consult note recommending discharge, with a treatment and follow-up recommendations, for the ED to utilize.  Please be collegial and collaborative throughout this process, whichever path you choose.

■ The Medicine Nocturnist does an independent evaluation of the patient, and coordinates the plan with the NP.  Please review the orders and medication reconciliation to be sure the NP understands the plan and implements it correctly.

■ Faculty and Non ACGME fellows may attest the H&P.  ACGME Fellows should write a brief progress note or event note to document their evaluation, plan and supervision of the NP.  Non ACGME fellows may not bill.

Everyone

■ When submitting schedule requests, refer to the scheduling policies below.  Periodic audits are done, but it is your responsibility to comply with policies.

Schedules »

ICU / DOM NOCTURNIST SCHEDULES

NOVEMBER

DECEMBER

JANUARY

FEBRUARY

Scheduling Practices and Policies »

Scheduling Policy:
Individuals who are on the roster will receive an email every month soliciting schedule requests.  Please only submit requests as a reply to this email.  Requests submitted via SMS, phone call, hallway discussion, as part of an unrelated email, or as individual separate emails may not be included in the final schedule.

You may submit updated requests at any time, again as a reply to the solicitation email, until the schedule is complete.

  1. Definitions:
    1. Unrestricted Shifts:  Night shifts NOT followed the next day by clinical duties.
    2. Restricted Shifts: Night shifts followed the next day by clinical duties
  2. Policies
    1. PGY4: May not work ANY restricted shifts
    2. PGY5 and up: May work up to two restricted shifts per calendar month if it does not interfere with clinical duties.
    3. No Fellow may work night shifts if the next day involves patient work on an ICU rotation or any rotation specified by their fellowship program.
    4. Faculty: May work up to two restricted shifts per calendar month, but restricted shifts must occur at least 5 days AFTER any other night shift, to reduce fatigue.
    5. FELLOWS MAY NOT WORK NIGHTS WHEN THEY ARE ON CALL for the fellowship (a.k.a. "double dipping")
    6. Fellows may work up to 12 shifts per quarter
    7. Night Shifts count toward the 80 hour work week (averaged over 4 weeks).  Fellows must follow the department policies regarding work hours and reporting.

Individual divisions may create their own moonlighting policies that will not be listed here.  You must comply with these policies.  Some program directors have asked the Night Program Director to help enforce these policies as the schedule is created.  Periodic audits of call schedules and requests will be done to help ensure compliance.

Timesheets and Pay »

Timesheets

Timesheet (Excel) 
- Works best with microsoft office - tested on both Mac and PC
- You can only type into the fields you are allowed to change.  
- Functional with Apple/Mac Numbers and Google Sheets.
 

INSTRUCTIONS:

SUBMIT YOUR TIMESHEETS BEFORE THE LAST DAY OF THE CALENDAR MONTH. 

You should receive payment at the beginning of the following calendarmonth (approximately 30 days later).


Submit Timesheets to Rosemarie Anaya in one of the following ways:

■ Scanned email attachment:  ranaya@uci.edu  (PREFERRED METHOD)

■ In person:  City Tower, Suite 400 (4th floor)

■ Campus Mail:
        City Tower Suite 400, Zot: 4076
        101 The City Drive South | Orange, CA 92868

■ Fax:  714-456-7266.  Please include a cover sheet that states the document is for Rosemarie Anaya

Contacts and Text Paging links »

Contacts 

Tonight's ICU Nocturnist (MICU, CCCU, CDDC, Urgent Pre-op)

 714-506-1010

Tonight's Medicne Nocturnist (Teams O&L, ED dispo consults)

714-506-4622

 MICU/CCU Resident (Admitssions)

 714-506-6207

 MICU/CCU Intern (Cross Cover)

 714-506-3704

Ward Admit Resident (Medicine, CDDC admission, Med Consults)

 714-506-1763

Ward Cross Cover Resident (Pts already admitted to Wards & CDDC)

714-506-6575

 On-Call Chief Resident

 714-506-6666

 

Director, DOM Night Program:

H Clifford Fornwalt
333 City Blvd. West, Suite 400
Orange, CA 92868-3298
Zot Code (campus mail) 4076
4600 - UCI pager
cliff.fornwalt@uci.edu
 

Chair, Department of Medicine

Alpesh N. Amin
333 City Blvd. West, Suite 400
Orange, CA 92868-3298
Zot Code (campus mail) 4076
714-456-3880 - office
714-456-3871 - fax
UCI pager
anamin@uci.edu
 

Administrator, Night Program, Contracting and Payroll

Rosmarie Anaya
333 City Blvd. West, Suite 400
Orange, CA 92868-3298
Zot Code (campus mail) 4076
714-456-7898 - office
714-456-7266 - fax
ranaya@uci.edu
Resident Night Rotation and Resources »