Cardiovascular Medicine Fellowship Program General Cardiovascular Medicine Fellowship Clinical Rotations Cardiology inpatient / Night Float
Cardiology inpatient / Night Float Rotation
Introduction/Overview 
The in-patient rotations include telemetry service at both University Hospitals Case Medical Center as well as the Louis Stokes VA Medical Center. At UH, the fellows round on two inpatients services (one comprised of housestaff and the other with NPs/PAs). The Night Float rotation is an adjunct to inpatient ward training and outpatient clinical service. It is designed to enable all three years of cardiology fellows to enhance their knowledge and skills in inpatient management, acute care and phone triage. Fellows are expected to hone proficiency in the diagnosis and management of inpatient cardiologic problems as well as an approach to patient care typical of a well qualified cardiologist. Learning occurs through practice of familiar procedures, hands on supervised clinical experiences, teaching residents, as well as evening and morning sign-out rounds with the CICU fellow and CICU attending and the consult fellows for Night Float rotation and with telemetry service attending on inpatient services. Fellows are expected to develop their skills in clinical problem solving, diagnosis, therapy, management, communication and interpersonal skills, as well as supervision of residents. The rotations should enhance independence, self-confidence, and procedural skills, while permitting an enhanced degree of independence. All admissions to the Cardiac Intensive Care Unit are supervised by the night float fellow, as well as any urgent nighttime cardiology consults. On a case-based individual basis, the fellow also provides personal teaching through supervision of the on-call resident in the CICU. During their night float rotation, fellows are relieved from all day-time clinical responsibilities.
Principle Teaching Methods
Direct Supervision of Patient Care
The Night Float fellow gains experience via Direct Patient Care and Resident Supervision, and Sign-out Rounds which take place every evening between 5:00 – 6:00 pm and again every morning between the hours of 7:00 to 8:00 am. The evening rounds address specific CICU patients and active issues in care. Morning Sign-out Rounds include review of specific cases and management overnight, along with all new admissions and should include guideline driven reference material and decision making related to specific cases. There is a separate sign-out with the fellows from the General Cardiology Consult Service as well as the Electrophysiology Consult Service as the results of the evening dictate. The fellow rotating through in-patient telemetry services gains experience via Direct Patient Care and Resident Supervision, reviewing clinical data (including catheterization and echos) with the attending, and making decisions for daily management of patients with heart failure, coronary artery disease evaluation, conduction abnormalities, as well as myriad of other cardiovascular disease processes.
Clinical Content
Patient Characteristics
UHCMC serves a primary care urban local population in Cleveland, Ohio and the surrounding suburbs and is also a tertiary care referral center for Northeast Ohio and the University Hospital Health System. Patients present with the full spectrum of acute and chronic cardiologic problems.
Patients admitted to UHCMC come from a broad mixture of ethnic and socioeconomic backgrounds. Patient ages range from young adults to the elderly. There is an equal mix of male and female patients. All patients seen during the rotation are inpatients receiving care for acute medical problems. Clinical encounters include the initial evaluation at the time of admission on the ward or in the emergency room which includes a full history and physical.
Procedures
Fellows have the opportunity to supervise residents and practice procedures with which they are already familiar (central lines, arterial lines, thoracentesis, paracentesis, lumbar puncture, swan ganz catheters, pacing wires, balloon pump management, transthoracic echo), and have supervised exposure to those they are not (as above and also including transesophageal echo, pericardiocentesis, IABP insertion, emergent left heart catheterization) under the direct supervision of attendings or other qualified fellows.
Services
UHCMC has a full range of services available for participation in patient care. There are full service intensive care units, an emergency room staffed 24 hours by attending physicians, and full mix of surgical and subspecialty consultative services.
