A.  Shands MOLE TEAM / LATE STAY System

The mole system is a night float based call system that was implemented in the spring of 1997. The mole team consists of four residents. The team begins its two week mole block on Sunday and works one 24 hour shift. The next Monday through Friday mole team shift starts at 6:00 p.m. and finishes at 8:00 a.m.  A Saturday call team covers 24 hours on Saturday as described below. The mole team returns for its second week of work as described above Sunday through Friday. The mole team completes its assignment Saturday at 0800 and has the rest of the weekend completely off.   Please note carefully that the mole team duties are much more like shift work than a traditional overnight call. During your mole assignment, your shift is from 6 pm to 8 am instead of during the day. As such, all mole team members should expect to be available for work in-house at Shands Hospital at all times during that shift. There is NO guarantee that any mole team member will be allowed to go home even if there are no clinical duties for him / her to perform. In the event that clinical responsibilities do allow for one or more mole team members to go home during the shift, the daily priority to go home will be determined by a schedule prepared by the chief residents and provided to each mole team. No other schedule is permitted or will be honored. THE FACULTY MEMBER ON CALL MAY REQUIRE ANY MOLE TEAM MEMBER TO REMAIN IN-HOUSE AT ANY TIME. For example, if first and second mole team members are junior residents and a complex cardiovascular case is posted, a more senior member of the mole team will likely be asked to stay and help the junior resident and the faculty member with the case. Going home while assigned to your mole shift will always be an unexpected bonus - NEVER A PRIVILEGE!

SPECIFIC MOLE TEAM DUTIES:

• Provide anesthesia care for cases between the hours of 6 pm and 8 am weeknights and all day Sundays.  Cases may include scheduled cases either running late or starting late as well as all emergency cases.
• Perform preoperative evaluations for
  • All inpatients scheduled on the published add-on list - Room A1 in the schedule
  • All inpatient add-on cases posted to the schedule after the printed schedule is published.  Please note - these cases MAY be put into OR rooms by the anesthesia team at night.  You need to check the posting time by each patient's name on the printed schedule to make sure that it was posted early enough to be seen by the resident assigned to that room.  If you are not sure, either call the resident involved to see if he/she saw the patient or go to the ward where the patient is located and check for the preoperative evaluation.    There are thus three places to check for add-on cases:
    • The posted OR schedule (Room A1)
    • The handwritten scheduled add-on list given to you by the charge nurse
    • The posted OR schedule - all rooms - check posting time.  No cases should be put into rooms directly without the knowledge of the person carrying the 494-4990 pager.
  • All inpatients either admitted through the emergency room and posted for surgery the next day or posted for the same evening.
  • All patients seen in the emergency room, scheduled for surgery, and then discharged home to return for their surgical procedure later (lowest priority preop - could be seen in our preop clinic on a scheduled basis).
  • Make sure room R5-265 (Monday-Thursday) or H-6120 (Friday) are open and available for conference no later than 6:45 am each morning.  Make sure coffee pot and conference computer sign-in are plugged in and ready to go.
  • Sign out and return locked drug-box (anesthesia workroom) key to the OR pharmacist, and verify controlled substances counts both at the beginning and the end of the mole shift.
    • Maintain complete responsibility and accountability for narcotic keys and drug distribution during the entire shift.
  • On Friday night, please make sure all rooms are set up for Saturday morning scheduled cases.  Do not allow anyone from the mole team to go home before this task is completed.  Cases added on prior to 7am Saturday should have rooms set up and ready to go prior to 8am Saturday.  If you need to call in additional help to get rooms set up, please do so.

SPECIFIC LATE STAY AND SATURDAY CALL TEAM (NOT MOLE) DUTIES:

• Resident assigned to the late stay team are expected to relieve residents who are not on the late stay team or the mole team who have cases expected to continue significantly past 5 pm. 
• When the late stay resident has completed his or her cases for the day and had a short break, he or she should report to the resident or faculty carrying the 494-4990 pager for assignment.
  • In general, residents who were late stay the day prior will be the first residents to be relieved.
  • Residents assigned to the CV are expected, with few exceptions, to complete their own cases.  These two residents may develop their own internal late stay schedule if they desire.  If relief is appropriate for these residents, it will generally come from the mole team, not the late stay team.  Effective July, 2003, CV residents SHOULD be relieved by the mole team no later than 7pm to allow them to see their preoperative patients for the next day and leave the hospital by 8 pm.   
• Late stay residents are not to go home until all residents who are not assigned to the late stay team or the mole team who wish to be relieved have left the hospital and the preops of all the non-late stays are finished. 
• Once the last non-late stay resident has left the hospital, late stay residents may be relieved by the mole running the board.  Please note that excessive numbers of case turnovers MUST be avoided, and in general, no more than 2 reliefs should occur in a given case.  Thus, cases that would be expected to go past the duration of the late stay shift should be left for the mole team to relieve. No late stay is to leave until the trauma room is setup.  No late stay is to leave prior to 6pm unless this is cleared by the AOD.  A late stay should not relieve another late stay from a room. There is no longer a late stay numbering system.  Late stays will be sent into rooms determined by their level of training by the AOD.  They will be relieved on their post-late stay day by the AOD based on the time they clocked-out.
• If a resident assigned to FSC is also on the Shands late stay team (should not happen unless a resident is filling in at FSC for a resident assigned there who is on vacation or at a meeting, or on Fridays), he or she will function as the late stay resident for FSC that day and remain there until all resident duties at FSC are completed.  If more than one resident at FSC is assigned to the late stay team, only one resident should remain at FSC and the other should return to Shands for assignment when his/her cases are completed.  At the time all resident duties at FSC are completed, the resident staying late at FSC should page the resident / faculty carrying the 494-4990 pager to determine if he /she is needed to relieve a resident at Shands.  If the resident is needed to return to Shands, he /she should do so expeditiously and remain at Shands until relieved. On Friday, the resident @ FSC who is on Shand Teaching Hospital (STH) call on Saturday is considered late stay at (STH) on Friday.
• Late stay duties include but are not limited to:  relieving residents not on call, completing preoperative evaluation of patients (for non-late stays first), setting up of the trauma room (must be set up by a late stay NOT A MOLE!).
• Saturday call team members must set up rooms for Sunday scheduled cases.  Cases added on prior to 7am Sunday should have rooms set up and ready to go prior to 8am Sunday.  If you need to call in additional help to get rooms set up, please do so.

The VA is NOT covered by the Shands Mole or Late-Stay Team.

People not assigned to a mole team in any given month have "late stay" duties minimum once a week. These people are the ones covering, as the name implies, the late rooms on a given day. When they become available following completion of their scheduled cases, late stay residents will immediately check with the person carrying the scheduling pager (494-4990) as described above regarding their assignments.   Residents with late stay duties (i.e. non-mole residents) are also responsible for one Saturday 24 hour call per month. This call may be in the general Shands OR or in OB based on qualifications.

If you are a resident not assigned to either late stay or mole duties on a given day, you are also expected to check with the person carrying the scheduling pager (494-4990) regarding any possible additional assignment for the day. The preoperative evaluation clinic frequently requires extra people late in the afternoon, and you may be asked to see one or two patients prior to going home. It is an absolute policy that you must check with the person carrying the scheduling pager prior to going home at the end of any clinical day. You must also clock out in the clinical office prior to leaving.  Failure to check out may result in your being called back to the hospital to "continue" your day.

Late stay and call requests for upcoming rotations will be done via e-mail to one of the chief residents.  Once the schedule is posted, it will become finalized by the Friday of the week it was posted. Every effort is made to honor all requests. However, these are "requests" and not all requests can be granted. Mole schedule for CA-2 and CA-3 residents will be completed by the end of June during the preceding academic year, and requests must be received by the end of May, following completion of your clinical assignment schedule. CA-1 assignments will be completed by the end of July of the academic year. That way, residents will know many months in advance of their mole assignments and can plan appropriately.

B. OB Call Schedule

This schedule is prepared by the chief residents.  In general, residents assigned to the OB rotation will take call on Friday nights and Sunday during the day (8am to 8pm).  Each resident will cover 2 weekends - Friday and Sunday only.  Friday call duties begin at 4pm and end at 8am Saturday.  Sunday call duties begin at 8am Sunday and end at 8pm Sunday.  All other days of the rotation are free from call duties, and all Saturdays are free.  On Sunday through Thursdays, OB overnight duty is covered by an OB Mole Resident.  This resident will begin duty at 8pm and end at 9am (this resident is expected to attend the educational conference at 8am following their duty).  OB Mole shifts are available only to residents who have completed a full rotation in OB Anesthesia.  On Saturday, the OR call team will cover OB from 8am Saturday to 8am Sunday. 

C. Surgical ICU Call Schedule

This schedule is prepared by Dr. Layon or his designee (usually Dr. Larry Caruso). The names listed on the schedule are the resident, fellow, and attending respectively. These individuals cover all PODS of the SICU, BICU, and Overnight Recovery from 8:00 a.m. until 8:00 a.m. the following day.  In general, three residents will be on call each night and call will be every third to every fourth night during the month.  One day per week and one weekend per month will be completely free of clinical duties. 

D. Pain Call Schedule

The Acute Pain Service (APS) will be covered at night on a rotational basis by the residents assigned to the Regional Anesthesia Rotation (REG), the recovery room (RR), and the preoperative evaluation clinic (OP). The schedule is prepared by the chief residents.  Call is taken from home.  Only 1 weekend per month will be covered by each resident on the APS unless that month contains (5) weekends.

E. VA Call Schedule

Residents assigned to the VA OR, the VA Pain Clinic, and VACT rotations will participate in VA Medical Center Call only.  They will have no call or mole responsibility at Shands.  Call will be covered on a rotational basis by the VA OR and VACT residents with the residents assigned to VA Pain taking only weekend call.  This schedule is prepared by the Chief Residents, assisted by VA staff.

F. Clinical Anesthesia Teaching /Call Schedule

This schedule is prepared by Dr. Berman and shows all faculty clinical assignments and call assignments on a daily basis.

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updated 3/2008