Cross Cover

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General Guidelines

  • Cross cover is a significant part of clinical education. It is how inexperienced clinicians start to develop their own gestalt and clinical judgement.
  • There is no amount of hand-off or predetermined guidance that can prepare anyone completely for this, and there is no substitute for this experience.
  • Believe in yourself, but when in doubt, call the upper-level or attending.
  • Rely on nurses and support staff, but do not allow them to dictate orders or dictate plan of care.
  • Do not allow nursing/staff to get away with sloppy or lazy work. If they are calling, it is reasonable to expect them to have investigated what the patient normally takes at home for a problem or to have checked vitals if there is concern about stability.
  • Early on in training, visit the patient at bedside. As more experience is accumulated, concerns may be addressed more frequently over the phone.
  • Always think twice before prescribing potentially altering medications such as opioids, pain medication, benzos, sleep aides, benadryl, etc. Know the basics of the Beers Criteria.
  • When in doubt, lay eyes on the patient. There is no substitute for this.
  • It is ok to say, "NO".
  • Most events should be recorded in the EPIC Hand-Off tool, and reported to the primary team.
  • Significant events or order changes, not just rapids and codes, need to be documented in a "progress" or "significant event" note in the chart.

On-Call Cross Cover

  1. The on-call team should record any events in the "Event" box and any new tasks in the "To-Do" Box using the EPIC Hand-Off tool for items that changed after assuming care.
  2. The on-call team should verbally report any cross-cover events that occurred after assuming care to the night float team.
  3. If significant, it is also important for the on-call team to notify the primary team in the morning.
  4. EPIC Hand-Off is expected to be updated before night float takes over.

Night Float Cross Cover

  1. The night float resident should record events in the "Event" box and Tasks in the "To-Do" Box in the EPIC Hand-Off tool during the night.
  2. The night float resident verbally reports cross-cover events that occurred overnight.
  3. If an order was changed, then it is important enough to mention.
  4. Defer on providing too much information.