Admission Limits
Department of Medicine
University of California, San Francisco
San Francisco Veterans Affairs Medical Center

Medicine Wards:

• Resident physicians will distribute admissions among members of their individual teams.
  
• Interns will be responsible for no more than five admissions per twenty-four hour period and no more than eight admissions per forty-eight hours.
  
• Sub-interns will be responsible for no more than five admissions per twenty-four hours and no more than eight admissions per forty-eight hours.
  
• Resident physicians will be responsible for admitting patients and writing detailed admission notes in excess of five admissions per intern or per sub-intern per twenty-four hour period.
  
• Total admissions per medicine team will not exceed ten per twenty-four hour call day. A Jeopardy resident will be activated for any admissions in excess of ten per medicine team per twenty-four hour call day. It is the responsibility of the medicine resident to notify the Chief Medical Resident on call (719-2626) in order to activate the Jeopardy system. (Based on available data, medicine teams exceed ten admissions per twenty-four hour call day less than once per month.)
  
• Resident physicians will be responsible for writing a brief admission summary for each patient admitted to the intern or sub-intern within twenty-four hours of the admission.
  
• Admissions in excess of five per intern or sub-intern (up to a total of eight patients per intern or sub-intern) will be re-distributed to the intern or sub-intern on the post-call day.
  
• On average, an intern will not be responsible for the ongoing care of more than 12 patients; a resident will not be responsible for the ongoing care of more than 24 patients. When patient load exceeds these limits, patients will (when it is safe for the patient) be distributed among housestaff on the Medical Service.
  
• Resident physicians will be responsible for ensuring that individual intern and sub-intern patient loads do not compromise patient care and educational goals.
  
• Resident physicians will be responsible for notifying the chief residents if admissions exceed the maximal cap or if patient care is compromised; jeopardy or night float residents will be mobilized by the chief residents to cover any additional admissions to the medical service.