Night Float

Night Float

One of the most challenging aspects of being a full-spectrum, team based primary care family physician is being prepared to care for highly complex, multi-system impaired patients who rely heavily on Urgent Care and Emergency Services for their often unstable conditions. These patients are often hospitalized at great cost to them, their families and the health system for exacerbations that could be managed in a well-run team based primary care setting. One of the most important aspects of learning to care for these complex patients is doing a thorough and efficient history and physical exam---pinpointing which conditions are deteriorating, at what pace, and what immediate interventions might shift them back into balance, thus eliminating the need for hospitalization.

On this rotation, second year residents are given the chance to focus solely on Admissions, without multiple double-jeopardy distractions like cross covering units, going to the operating room, etc. This rotation is supervised by professional Nocturnists who are highly skilled at doing efficient and complex admissions in the middle of the night, without the typical specialist backup that is available during the day.  It is an excellent rotation in which to practice independent thinking, creating wide differentials, and an initial plan. Residents will admit patients directly to the teaching service, where patients will be followed by their own co-residents.

Goals and Objectives:

• Focused, timely history and physical examination and initial management for complex, newly admitted patients to inpatient services.
• Real-time hand-overs in a structured way to and from daytime teaching services.
• Effective engagement with supervising Nocturnist and consultants to set framework of care and breadth of differential and treatment plan.
• Perform bedside evaluations for complex overnight emergencies under direct supervision of the Nocturnists.

Location(s): Residency Practice, Concord Medical Center

Distance from Family Medicine Residency Practice: 0.0 m – 6.0 m

Night Float Sample Schedule, Education Experiences: