UF Health Shands Hospital is a 1000+ bed, not-for-profit tertiary care hospital. It is a Level One Trauma Center and remains a major referral center for 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 five general medicine teaching services: Blue, Red, Orange, Gold, and Green. Excluding the Green Service, each ward team is comprised of an attending, an upper-level resident (PGY 2 or 3), two-three interns, and medical/PA students. In addition, each team has a case manager who helps facilitate discharge planning.
There is no overnight call on any of the inpatient ward services.
The call schedule rotates for each team on a four day cycle:
- Early Call – Admitting from 7 am to 1 pm, five admissions total
- Middle Call – Admitting from 1 pm to 4 pm, five admissions total
- Late Call – Admitting from 4 pm to 7 pm, six admissions total
- Golden Day – no admissions
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 one in seven days off averaged over 4-weeks, and a vigorous system is in place that assures residents remain fully compliant with all duty hour regulations.
The Green Service
The Green Medicine Service provides a unique opportunity for residents to simulate hospitalist life. It is comprised of two upper-level residents that work directly under one of our Hospitalist attendings. Each resident on service is offered autonomy in caring for their patients. There are no interns on service. Green Medicine is designed to provide upper-level residents an experience in learning self-sufficient, efficient, and cost-effective inpatient management.
The Bridge Resident
The “Bridge” is an upper level resident (one at Shands hospital and one at the VA) whose responsibility is to receive sign out from the housestaff teaching services and respond to emergency response calls from Monday through Friday from 7am to 7pm. This resident serves as a “bridge” between the day and night teams, allowing the day teaching teams to leave the hospital prior to 7pm after their admissions and work responsibilities for the day are complete. Their sole purpose is to support the inpatient teaching services.
The Sub-Specialty Teams at Shands:
In addition to the general medicine services, Shands has three sub-specialty services: Cardiology, Hematology/Oncology, and GI-Liver. Each service allows the residents to interact and learn from world-renowned experts in each sub-specialty field. The Cardiology and GI-Liver sub-specialty service has one upper-level resident, and two-three interns. Due to the focused nature of care and emphasis on specialized teaching, the team caps are lower with a cap of 18 on Cardiology and 16 on GI-Liver. The Hematology/Oncology sub-specialty service has a fellow, one upper level resident and two interns. The team cap for Hematology/Oncology is 20 patients. There is NO overnight call. These teams are required to follow the same hours and day off requirements as our General Medicine Inpatient Services.
Shands Night Team
The Shands night team is comprised of two upper-level residents and one intern. They work from 7 pm to 7 am. The purpose of the night team is to allow each general medicine and sub-specialty team to go home at the end of each day. The intern on the night team is responsible for providing cross coverage to floor-level patients on all medicine housestaff associated services. One upper level resident supervises the cross cover intern, performs up to two admissions overnight, and provides direct cross cover to our Intermediate Care (step-down) patients. The other upper level resident serves as the overnight admitting officer. This resident is located in the ED and admits patients as “holding notes” to the call and sub-specialty teams the following morning. The overnight admissions resident can admit up to a total of six patients during his/her shift. Additionally, the overnight admitting officer provides cross cover to the Hematology/Oncology patients overnight in the South Tower.
The Intensive Care Units
The Shands Medical Intensive Care Unit (MICU)
The MICU is a 36 bed unit in the North Tower that is staffed by three upper level residents and six interns rotating on a q3 day admitting call schedule. The MICU is under the direct supervision of Pulmonary/Critical Care attendings. In addition, the Pulmonary/Critical Care fellow has a vital role on the MICU team. There is 24-hour in-house Pulmonary Attending or Fellow coverage. 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. The rotation allows for residents to become proficient in invasive procedures such as central and arterial lines, thoracenteses, paracenteses, and lumbar punctures. Importantly, there is NO 24 hour call. There is a dedicated night float (7 pm-9 am) consisting of one-two upper level residents and one intern alongside a Pulmonary/Critical Care attending and fellow. The night float provides cross cover to MICU patients and handles overnight (7 pm-7 am) admissions to the MICU.
The Coronary Care Unit (CCU)
In the East Tower, the CCU is staffed by one upper-level resident alongside a Cardiology fellow during the day. The CCU is directly supervised by the Cardiology attendings. The CCU residents admit patients with the help of the fellow from 7 am to 7 pm. After 7 pm, the CCU patients are admitted directly by either the Cardiology fellow on call or an upper-level resident. Night cross cover to CCU patients is provided by the upper level resident . In the CCU, residents receive direct exposure to acute myocardial infarctions, decompensated heart failure often requiring mechanical support, life threatening dysrhythmias, ventricular-assist devices, and cardiac transplantation.