Geriatric Medicine

VII. Resident Caps and Other Workload Issues

A. Resident Caps

The maximum cap per resident at any given time is 8 primary patients + 1 consult patient. Please note that co-managed patients (with surgical services) count as primary patients. The total cap for Geriatrics Service is 16 primary service patients. These primary patient cap and consult cap are independent of each other.

For example, if the Short Call resident currently has 5 primary patients and 1 consult patient and a new consult is requested, the resident cannot take that consult. The new consult will be forwarded to the Long Call resident.

  1. Primary patients, including patients co-managed with surgical services (cap of 8 per resident)
    When the resident reaches the cap for maximum number of patients (8), the resident may not accept additional admission until a discharge has physically left the hospital. Rolling cap is enforced. When counting the resident census for cap determination, patients with discharge orders remain in the census until they have physically left the hospital premises.
  2. Consult patients (cap of 1 per resident)
    Each resident takes a max number of 1 consult at any given time. If both residents are capped for consult, the Geriatrics resident who gets paged for consult apprises Geriatrics Attending of new consult. The Geriatrics attending will perform the consult independently and will keep the patient until signed off. If there are 2 attendings on service, any new consult will be staffed by: Short Call attending if between 7AM-2PM, or Long Call attending if between 2PM-4PM. Re-consults on patients previously staffed and signed off by resident/attending team will be forwarded to the original attending if original resident is capped, for continuity of care; if original attending is no longer on service, such re-consult will be triaged per Geri residents’ capacity. If the original resident is not capped for consult, the re-consult will be taken by the original resident if still on service regardless of the call cycle/time of day, for continuity of care. Re-consults previously followed independently by attending will be triaged per Geri residents’ capacity if the original consult attending is no longer on service.

B. Short Call

  1. Hours admitting

    • 7:00 AM – 2:00 PM, except when a patient is directly admitted by a UCLA geriatrician from the office, home or SNF but the long call resident is already capped and the short call resident is not capped for total number of primary patients (i.e., has  less than 7 primary patients). In this particular instance, the short call resident may admit the patient between 2:00 PM – 4:00 PM. This direct admit policy is effective 10/10/2022.

    • It ends sooner when own cap is reached.

  2. Maximum number of daytime de novo admissions: 2, except when a patient is directly admitted by a UCLA geriatrician from the office, home or SNF but the long call resident is already capped and the short call resident is not capped for total number of primary patients (i.e., has  less than 8 primary patients). In this instance, the short call resident may admit more than the usual 2 de novo admissions to accept the direct admit, even if the resident has already admitted 2 earlier. If the short call resident has had less than 1 de novo admission, the direct admit counts towards the usual max of 2. This direct admit policy is effective 10/10/2022. Overnight holdover patients with MRAN only: If a holdover has an MRAN (i.e., the patient was paged out between 5AM-7AM and the overnight resident essentially eyeballed the patient, placed holding orders and a brief MRAN), the patient counts towards the daytime resident's 2 de novo patients. Holdover patients with an MRAN only almost always don't have much in the way of full history/workup, so it is essentially a brand new patient for the day Geri resident; these patients require a full H&P by the accepting Geri resident

  3. Maximum number of overnight admissions that can be accepted: 4

  4. Maximum number of new consults: 1

  5. Total number of consult patients at any given time per resident: 1

 

C. Long Call

  1. Hours admitting

    • Weekdays: 2:00 PM – 4:00 PM, or earlier if the short call resident is capped

    • Weekends: 7:00 AM – 4:00 PM

    • It ends sooner when personal cap is reached.

  2. Maximum number of daytime de novo admissions: 2, except when a patient is directly admitted by a UCLA geriatrician from an outpatient site or SNF but the short call resident is already capped and the long call resident is not capped for total number of primary patients (i.e., has  less than 8 primary patients). In this instance, the long call resident may admit more than the usual 2 de novo admissions to accept the direct admit if the resident has already admitted 2 earlier. If the long call resident has had less than 2 de novo admission, the direct admit counts towards the usual max of 2. This direct admit policy is effective 10/10/2022. Overnight holdover patients with MRAN only: if a holdover has an MRAN (i.e., pt was paged out between 5AM-7AM and the overnight resident essentially eyeballed the patient and put in holding orders and a brief MRAN), this patient counts towards the daytime resident's 2 de novo patients. These patients almost always don't have much in the way of full history/workup, so it is essentially a brand new patient for the day Geri resident.

  3. Maximum number of overnight admissions that can be accepted: 4

  4. Maximum number of new consults: 1

  5. Total number of consult patients at any given time per resident: 1

D. Work Hours

  1. Residents are to remain available for patient care responsibilities from 7:00AM – 5:00PM. Residents must be accessible by pager all times and be available in-person to address patient care matters that require the resident to be physically present during this time period.

E. Day Off

  1. Geriatrics residents take one day off per week, on the weekend day that falls on their “Short Call” day.

  2. The Nurse Practitioner will provide coverage for the off-day resident’s patients.

F. Extraordinary Circumstances

There are unusual extenuating circumstances when the admission policy may require emergent reconsideration in order to meet extra-ordinary acute service needs of the health system.  Decisions to temporarily modify the admission policy in response to these situations will be made jointly by the Health System leadership, the Department of Medicine, the IM Residency Program leadership, the Hospitalist leadership, and the Geriatrics leadership.