IX. Resident and Team Caps, and Other Workload Issues

(Clarified 3/21/22)

A. Caps

1. The cap per resident is 8, including consults. If the cap of 8 has been reached, the resident may not accept an admission to his or her own panel until his or her anticipated discharges have physically left (please refer below to subsection B. Long Call pertaining to admission rules during long call).
2. The cap per team is 16, including consults managed by the residents.
3. The total cap (i.e., hard cap) for the Geriatrics Service is 32 patients. This number could be lower than 32 if the non-call resident has less than 8 patients.

B. Long Call

1. Hours Admitting
   
   1. 2:00 PM - 7:00 AM on weekdays
   2. 12:00 Noon - 7:00 AM on weekends and university holidays
   3. It begins sooner when the Short Call has capped.
2. Number of admissions
   1. The total number of admissions caps at 5. Once capped, please make sure to inform the following that you are already capped:
      1. Night Triage Officer (pager 82005) AND,
      2. The SM-ED Unit Secretary (Ext. 98405)
   2. If the resident can keep less than 5 to his or her own panel due to exceeding the cap of 8, the remainder of the 5 total admissions will be redistributed to the short call the following morning
   3. Once the Long Call cap of 5 is reached, only Geriatrics practice admissions may be called out to the Santa Monica Night Float (pager 90016) and admitted as holdovers for Geriatrics from 7:00 PM onward; panel admissions cannot be given as holdovers to the Night Float. The number of holdovers that can admitted by the Night Float for redistribution to the Geriatrics team the following day should not exceed 3, but may be less this number, depending on the number of open slots the following day’s short and long call residents have available. Please advise the Night Float how many slots are available and note that holdovers or admissions cannot be given to the following day’s non-call resident, except for bouncebacks or when subsection F applies (Extraordinary Circumstances, see below).  The Geriatrics Long Call resident should stay signed on to pager 91907. Admissions before 7:00 PM called out to the Night Float are to be discussed with the Chief Resident On-call. The holdovers are presented by the Night Float the following morning to the Short Call admitting resident (unless he or she is capped, in which case they are to be presented to that day’s Long Call resident ). The Geriatrics admitting resident then assumes responsibility for these patients, completes a full H&P, and presents to the attending physician during rounds.
   4. All 5 admissions of the long call resident must have a full H&P regardless of whether these patients stay on own service or redistributed to the short call.
   5. Once the Geriatrics Service cap is reached,  Geriatrics Long Call resident or the SM Night Float resident is to notify the Hospitalist Service (pager 30060) to admit Geriatrics practice patients, until the Geriatrics service census is reassessed the following day. These patients will stay on the Hospitalist service until discharge

C. Short Call

1. Hours Admitting
   
   1. 7:00 AM - 2:00 PM on weekdays
   2. 7:00 AM - 12:00 NOON on weekends
   3. It ends sooner when own cap is reached.
2. Number of admissions
   1. The total number of admissions caps at 3.

D. Work Hours for Non-Long Call and Non-Post Call Residents

1. Non-long call and non-post call residents are to remain available for patient care responsibilities until the end of the workday at 5:00 PM on weekdays, and until 12 :00 noon/or until work is done on weekends and UCLA holidays.
2. Residents must be accessible by pager and if necessary, be available in-person to address patient care matters that require the resident physician to be physically present during this time period.
3. Pagers should not be signed out to the long-call resident earlier than 5:00 PM on weekdays. On weekends and UCLA holidays, pagers should not be signed out to the long call resident earlier than 12:00 noon.

E. Bouncebacks

1. Geriatrics patients who are re-admitted while the resident caring for them on prior admission is still on service will bounce back to that resident.
2. The bounceback will count towards the original resident's panel size. If the resident is also on call, the bounceback will count towards the resident's admission cap only if the resident also wrote the Admission H&P.

F. Extraordinary Circumstances

1. There are rare extenuating circumstances when the admission policy may require emergent reconsideration in order to meet the acute service needs of the health system.  Decisions to temporarily substantially 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 service leadership.