Parkland Health and Hospital System (PHHS)

The teaching ward service will be composed of 10 teams, each with one resident, one intern, a fourth year medical student, and 2 to 3 third year medical students.  Two teams take “long call” every fifth night.  On the day after the post-call day, these teams assume the care of patients admitted the by night float resident (so-called “short call”).  In addition to the teaching services, a non-teaching service (NTS) will be developed at PHHS to admit patients in rotation with the teaching service and to take patients beyond each team’s designated cap.  This service will be staffed by board-certified/eligible internists, who will also provide overnight coverage.

PGY-1 Ward Schedule:

• Take overnight, in-hospital “long call” every fifth night
• On weekday (Su-Th) call, admit patients with team resident (PGY-2 or PGY-3) from 7:00 am to 9:00 pm, then admit patients with night float resident (PGY-2 or PGY-3) from 9:00 pm to 12:00  midnight 
• On weekend (Fri-Sat) call, admit patients with team resident (PGY-2 or PGY-3) from 7:00 am to 2:00 am
• Leave Hospital by 1:00 pm on post-call day
• One half-day continuity clinic per week (always at same hospital as ward rotation)
• One day off per week

PGY-2 and PGY-3 Ward Schedule:

• Take “long call” every fifth night
• On weekday (Su-Th) call, admit patients with team PGY-1 from 7:00 am to 9:00 pm; sign out to night float resident at 8:30-9:00 pm; go home; return to hospital post-call at 7:00 am and work full post-call day
• On weekend (Fri-Sat) call, admit patients with team PGY-1 from 7:00 am to 2:00 am and spend night in hospital; leave by 1:00 pm on post-call day
• One half-day continuity clinic per week (alternates between PHHS and DVAMC)
• One day off per week

Night Float Schedule:

• Two night float residents (PGY-2 or PGY-3) each night Su-Th (one per on-call team)
• Take sign-out from on-call resident at 8:30-9:00 pm
• Admit patients to on-call team with on-call PGY-1 from 9:00 pm to 12:00 midnight
• Admit patients to next day's call team from 12:00 midnight to 4:00 am; sign these patients out to oncoming “short-call” team at 7:00 am
• Present patients admitted with on-call team at post-call attending rounds at 7:30 am
• Leave hospital by 9:00 am
• Two days off per week

PHHS MICU Service:

• The MICU service consists of one attending physician, one pulmonary/critical care fellow, and four housestaff teams, each composed of one upper-level resident and one intern
• Teams take in-hospital overnight call every fourth night
• On call days, teams admit patients  7:00 am to 7:00 am the following day
• Post-call teams sign out remaining work to pre-call teams at  1:00 pm and leave the hospital
• The MICU service may transfer patients without ongoing pulmonary issues who no longer require a critical care bed to the general medicine ward services

PHHS Cardiology Service:

• The Cardiology service consists of two attending physicians, two cardiology fellows, and four housestaff teams, each composed of one upper-level resident and one intern
• Teams take in-hospital overnight call every fourth night
• On call days, teams admit patients from 7:00 am to 7:00 am the following day
• Post-call teams sign out remaining work to pre-call teams at  1:00 pm and leave the hospital
• In addition to all patients with a primary cardiac diagnosis requiring placement in the Cardiac Care Unit (CCU), the Cardiology service admits non-unit patients with primary cardiac diagnoses, including:
  • Arrhythmias (including pacer/AICD issues)
  • Valvular disease
  • Syncope (if a cardiac etiology is suspected)
  • CHF requiring intravenous inotropes/vasodilators, in the setting of acute coronary syndrome, complicated by significant valvular disease, complicated by arrhythmia
• The cardiology service may admit such patients to the floor until  2:00 am or until a total of seven patients (including floor and unit) have been admitted, whichever occurs first
• The cardiology service may transfer patients without ongoing cardiac issues who do not require a critical care bed to the general medicine ward services

PHHS Renal Transplant Service:

• The Renal Transplant Service consists of one attending transplant physician, one renal fellow, and two senior residents
• A transplant ward, located on the tenth floor of Parkland Hospital, has a dedicated nursing staff, pharmacist, and case-managers
• The fellow and two residents take overnight home-call every third; they care for patients with post-transplant complications or those who require management of other common medical problems in the setting of  a transplanted organ
• The on-call resident is the first person to evaluate the recipient of a new organ and is the primary caregiver for the recipient of the kidney post-transplant.  This resident plays an important role in coordinating the care of the transplant patient from the moment the patient is informed that a kidney is available
• The residents and fellows also help staff the very active renal transplant clinic at Parkland  Hospital

PHHS Inpatient Hematology-Oncology Service:

• The Inpatient Hematology-Oncology service consists of one attending physician, one heme-onc fellow, and two upper-level residents
• A Heme-Onc ward, located on the seventh floor of Parkland Hospital, has a dedicated nursing staff, pharmacist, and case-managers
• The two residents admit patients during the day from 7am to 5pm.  After 5pm, any further admissions are admitted by the General Medicine Service and are transferred to the care of these residents the next morning.  These two residents have no overnight or home call
• In addition to admitting patients for treatment of their oncologic diagnosis, this service also admits patients with complications of their therapy, such as neutropenic fever Other primary hematological diagnoses, such as sickle-cell anemia and its complications, TTP, and ITP are managed by this service
• Residents will have two weekends off per month