DATOs Hours 

• DATO usually admits from 7am to 1pm.
• DATOs day ends at 6pm or when there is no more work for DATO to do after checking in with each Teams junior/senior resident.
  

DATO on Admitting 

• DATO has a cap of 5 admissions.
• In July/August, when the Team senior is acting as NATO, DATO may take a late morning admission (i.e., 6:45am) to unload the burden of the Team senior, at the discretion of the DATO.
• HAL/MICU transfers are better served if the admitting intern is the first to evaluate and synthesize all of the data. Therefore, if HAL/MICU transfers are posted late in the morning (12:30pm or later) those patients should be held over for the intern to admit at 1pm.
• HAL transfers that arrive to the floor before 1pm, should be assessed for stability by the DATO. If the patient requires any urgent care, the patient should be formally and completely admitted by DATO.
• Admissions are completed with orders in POE and the patient relatively stabilized as the intern may not get to see their DATO admissions until later in the day.
• NB: Interns should write BRIEF "accept notes' for their DATO patients on the day they are admitted.

DATO, The Team Assistant 

• DATO exists for the post-call intern but takes direction from the Team senior.
• DATO should contact one of the Team Junior/Senior residents at some time after morning rounds (usually after 1pm) to see if there are any ways that DATO may be of assistance to the Team.
• In the afternoon, the DATO is best utilized if the Team resident uses DATO to help get the post-call interns duties completed. If there are no such duties, then DATO may be used to help with other duties that the team needs accomplished (see examples below).
• DATOs usage in the afternoon should be restricted to those tasks that do not require an intimate knowledge of the patient. Those tasks are best handled by the primary team.
• DATO has been (and can be) used for: ordering radiologic studies, supervising procedures that a Team intern is performing, doing procedures for a busy Team (i.e., on the weekend when there is only one intern available to do procedures), helping with a crashing patient, drawing blood, requesting medical records and other such tasks.
• DATO should not be used for: writing notes, family discussions, preparing signouts, teaching (a teaching resident exists for this purpose as do the Team residents), calling consults, preparing for afternoon report, discharge worksheets, discharge summaries or other such tasks.

DATwo? 

• In July/August, there are 2 DATOs so that one person can have their ACGME 1 in 7 days off.
• A DATO needs to be available in the hospital at 7am to start admitting.
• If one DATO gets too busy with admissions or afternoon duties, the second DATO is expected to be readily available to assist when the first DATO requests it.
• It has been our experience that out of seven days, a second DATO has been necessary on one or two days.

NATOs Hours 

• NATO A arrives at 10pm and admits from 1am until 7am
• NATO B arrives and admits from 1am until 8am
  

NATOs Roles 

• Each NATO admits up to 5 patients to the Osler and Nelson services
• Each admission requires a complete note and admission orders
• Sign-out of the patient(s) to the accepting intern(s) generally takes place between 8 and 9am after the patient has been deemed stable for a transfer of care
• The NATOs also provide help with procedures to the on-call interns, and should be available to lend their clinical judgement to the on-call interns if requested
• NATO A also serves as the in-house covering officer for the cardiology nurse practitioner service patients; there is also a home-call cardiology fellow assigned to these patients who must be kept apprised of any events that may occur
  

NATOs Miscellany

• It is helpful to the on-call interns if each NATO sends them a page announcing their arrival, as it is often difficult to find out who is assigned to NATO on a given night
• Pages from the floors during the day (and hence, during sleep) may be minimized by providing the name/number of the accepting intern in the POE on admission
  

Sunday/Monday Morning Quarterbacks Philosophy

• The quarterback role was devised in order to increase our program's compliance with the '30 hour' rule, providing aide to the post-call interns which should allow them to leave the hospital by 2pm on Sunday and Monday
• As there is usually only one SAR or JAR on these mornings on the Osler and Nelson Services, respectively, the quarterback is essential to work-hours compliance
  

Quarterback Logistics

• The quarterbacks consist of residents on the CASE rotation, and are assigned to each of the Osler, Nelson, and Oncology services
• The number of quarterbacks, and the number of services they cover, are variable and dependent on the number of residents on any given block of CASE
• The residents on CASE are free to make their own schedule for the quarterback blocks, and should provide this schedule to the ACS responsible for the jeopardy schedule in a timely fashion
  

Quarterback Roles

• The quarterback should ideally be present for rounds on their assigned team in order to primarily triage what services they might be able to provide, in case the intern who is post-call is reticent to sign-out any duties
• Appropriate duties for the quarterbacks include: help with a decompensating patient, blood draws, requesting outside hospital records, help with procedures, performing procedures, ordering studies, and other duties that do not require the detailed knowledge of a patient
• Inappropriate duties include: writing notes, conducting family discussions, making discharge worksheets, and any other duties that require the detailed knowledge of a patient and their long-term plans