Admitting Night Float (ANF)

On this rotation, you will be responsible for admitting patients to the Stroke and Ward services, and occasionally admissions to the Grad and EMU services.  While you will have some guidance from the CNF resident and the NICU fellow, you will evaluate the patient and develop a differential for them on your own.  You will also be responsible for keeping the patient stable overnight.

 

Important Contact information:

o   Rapid Response – 72743

o   NICU Fellow – 82665 (8COOL)

o   Neurology Consult Night Float – 86876

 

General Logistics

Schedule

  • Hours on-site are 7pm-9am, but you accept admissions that come in Monday-Saturday 5pm-5:30am, and Sunday 4pm-5:30am. If you are not leaving on time in the morning, please let the chief know.

  • Days of rotation depend on PA schedule, so check amion for exact schedule.

  • At 7pm, report to the NI-1 Call room, where the Consult Senior or General Consult Junior will let you know about pending admissions.

  • After getting signout from the Consult team, touch base with the Ward, Stroke, and NICU teams to see if there are any pending admissions or NICU transfers.

  • Also check emails to the “Neuro-Admissions” listserv for information about direct admissions (sent in from private NI attendings or VC10), and OSH transfers to the floor that were accepted by the NICU fellow.

  • Between 5:30-6 AM, Ann Marie or Terry (Neurology NPs) will contact you to get the one-liners, see who is sick, and discuss the big tasks for the hospitalization.

Who you admit

  • You will admit all patients from the ED or home (“direct” admissions), as well as outside hospital transfers, and NICU transfer going to Stroke or Ward. If another resident is serving as JNF, they will handle Grad admissions and NICU transfers going to the Grad service, as well as EMU admissions.  If a PA is serving as JNF, you will also handle these admissions.

  • Overnight, the CNF resident will contact you regarding people that they decide to admit, and will give you signout. Always clarify the level of care with the CNF resident (floors/SDU/NICU).  If you see the patient and disagree with triaging, it is your responsibility to discuss further with the CNF resident.

When you arrive:

  • Login to the ANF dynamic role on mobile heart beat and instruct teams/ED they can contact you that way instead of the pager.

  • Also forward the 87276 virtual pager to your personal pager. This will also send you notifications for Acute Stroke Codes

 

Other Info

  • One very important aspect of your job is getting patients up tothe floor and out of the ED – often this involves being in touch with the charge nurses to see which beds are empty and communicating this to the ED/admitting tohelp expedite the transfer of patients upstairs.

  • If you have ANY questions, discuss with the CNF resident or the NICU fellow. As an additional resource, you can also call the attending of service (it does not matter that they don’t know the patient yet).

  • You MUST call the attending-of-record if any points on the Trigger Protocol are met (see NIResidents.org).

Admission orders/overnight care

STROKE ADMISSION ORDER REQUIREMENTS September 2018

  • All patients require “Admit NYP Order Set” and “Neuro – Floor Admission Set” orders, in addition to Neurology-specific order sets if appropriate. Please choose the order set most appropriate to the diagnosis:

    • Neuro – Ischemic Stroke/TIA Order Set

    • Neuro – Post-Thrombolsys Order Set

    • Neuro – Subarachnoid Hemorrhage Order Ser

    • Neuro – Vasospasm Order Set

    • Neuro – Intracranial Hemorrhage Order Set

  • For all admits, remember to include a contact person, the junior resident name and pager that will be taking the patient the next day (short call) and the senior resident name and pager, and ward attending. You should include a line that states “until 7am please page 87276”.

  • Remember to order:

    • DVT prophylaxis (and time it for the morning). Hold if you think LP or another procedure the next day is likely

    • PT/OT (almost all patients need this)

    • Activity order (can they ambulate, etc)

    • Med reconciliation