Fellow residents: what is your inpatient service like?

[shaggybill]

Just curious what other programs are like as far as census, how y'all do rounds, etc. At my program, our census is generally 40-50, but can vary. It was up to 64 last week, and down t0 35 three days later. For intern year, we have four 1-month blocks of inpatient service, cross-cover probably 6-8 weekends, and then 5 weeks of night float that are M-F with weekends off. We start at 4-5 patients on first block , then increase by 1 patient for each subsequent block.

Third year resident runs the service. We get check-out by the night team at 7am. We have rounds at 11:30am after 30 minutes of teaching. Rounds are very to-the-point and includes the entire family medicine team, plus pharmacy, and any med/pharm students at one big table. We hit the highlights of the patient's major problems and what our plan is, then move on to the next patient. We don't spend time going over the entire problem list like HTN, DM regimen, etc. Rounds usually last 45 minutes or so. We spend the rest of the afternoon putting in our orders, discharges, and doing admissions. Each intern usually gets at least two admissions. Day team stops taking admissions at 5:15pm so that we can prepare for evening sign-out to the night team at 6pm.

So just curious, what's your program like? Pretty similar?

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[Bacchus]

I'm assuming you're at an unopposed program?

I was at an opposed program with hospitalists and an IM residency.

Our census varied. There were was always a first year and then a second or third year. Signout 0700 and 1700. No capping. Some days there may be 2 patients (heh heh heh) and others we'd average 14-17. The 14 to 17 were busy days. Those were most of my days. We usually pre-rounded with the attending and then walked around.

 

[teacherman84]

Just curious what other programs are like as far as census, how y'all do rounds, etc. At my program, our census is generally 40-50, but can vary. It was up to 64 last week, and down t0 35 three days later. For intern year, we have four 1-month blocks of inpatient service, cross-cover probably 6-8 weekends, and then 5 weeks of night float that are M-F with weekends off. We start at 4-5 patients on first block , then increase by 1 patient for each subsequent block.

Third year resident runs the service. We get check-out by the night team at 7am. We have rounds at 11:30am after 30 minutes of teaching. Rounds are very to-the-point and includes the entire family medicine team, plus pharmacy, and any med/pharm students at one big table. We hit the highlights of the patient's major problems and what our plan is, then move on to the next patient. We don't spend time going over the entire problem list like HTN, DM regimen, etc. Rounds usually last 45 minutes or so. We spend the rest of the afternoon putting in our orders, discharges, and doing admissions. Each intern usually gets at least two admissions. Day team stops taking admissions at 5:15pm so that we can prepare for evening sign-out to the night team at 6pm.

So just curious, what's your program like? Pretty similar?

40-50 patients? How big is the team? Is this just general med-surg or including ICU?

We don't even have that many beds in the hospital.

 

[JustPlainBill]

3 years ago at Parkland on FM wards --- Service was 14-17 -- average of 7 per intern with 2-3 for the pgy2 -- pgy3 was supervisory in nature. We always took our clinic patients who presented to the ER and were deemed needing admission -- no cap on those. Depending on how loaded the service was with our clinic patients, we'd usually fill the service with unassigned. Interestingly, the some of the IM teams would "forget" to check to see if they had our patients when they were in admission mode -- once they capped, the next morning they would "discover" that they had our patients, the attending got paid for the admission then they'd clear their service of our patients leaving them with a light load and stack us heavy OR they'd see the interesting FM patients until it was maintenance mode and then try to turf them to us.

We used to run a heavier service when we had patients at St. Paul. That inpatient service closed and we went strictly to Parkland. As I was leaving ,they were trying to open up St. Paul again and were considering running 2 teams and 2 night floats ----

 

[shaggybill]

40-50 patients? How big is the team? Is this just general med-surg or including ICU?

We don't even have that many beds in the hospital.

It is an unopposed program.

Our team usually includes 2 interns, 2 PGY2, 1 PGY3, and 4 attendings. At this point in the year, interns are capped at 6 pts each, PGY2 at 10 each, and the PGY3 will take any number of patients, depending on how "uncomfortable" the attendings are having to see patients without a resident assigned. Our attendings are awesome though, so it's all good, and they understand that the PGY3 is mostly there to run the show, put out a lot of the small fires that pop up, and to answer all the dumb questions from the interns (that would be me).

We see ALL patients that are part of our outside FM practice, which is about 8 different clinics in the greater metropolitan area. That includes those admitted to ICU. Though we aren't always the primary team in ICU, we are expected to still round on them and try to be active in their medical management, even if just in the periphery, until they are stable.

 

[teacherman84]

It is an unopposed program.

Our team usually includes 2 interns, 2 PGY2, 1 PGY3, and 4 attendings. At this point in the year, interns are capped at 6 pts each, PGY2 at 10 each, and the PGY3 will take any number of patients, depending on how "uncomfortable" the attendings are having to see patients without a resident assigned. Our attendings are awesome though, so it's all good, and they understand that the PGY3 is mostly there to run the show, put out a lot of the small fires that pop up, and to answer all the dumb questions from the interns (that would be me).

We see ALL patients that are part of our outside FM practice, which is about 8 different clinics in the greater metropolitan area. That includes those admitted to ICU. Though we aren't always the primary team in ICU, we are expected to still round on them and try to be active in their medical management, even if just in the periphery, until they are stable.

So PGY-2s aren't supervising...just seeing their own patients. It seems backward that you need 4 attendings to cover a service that 1 pgy-3 is expected to see. I don't see how the pgy-3 is seeing everyone let alone checking orders or teaching.

We have 2-3 interns with 1 senior (pgy2 or 3) and 1 attending. Senior runs the team and organizes didactics. Team tends to max at 15 for senior and maybe 18 total of we have the volume. We always have a handful of icu we are primary on.

 

[shaggybill]

So PGY-2s aren't supervising...just seeing their own patients. It seems backward that you need 4 attendings to cover a service that 1 pgy-3 is expected to see. I don't see how the pgy-3 is seeing everyone let alone checking orders or teaching.

We have 2-3 interns with 1 senior (pgy2 or 3) and 1 attending. Senior runs the team and organizes didactics. Team tends to max at 15 for senior and maybe 18 total of we have the volume. We always have a handful of icu we are primary on.

Yeah, PGY2s are seeing their own patients. Our PGY3s don't see everyone or check our orders. Their job mostly is assigning admissions to PGY1s and 2s and seeing their own small panel of pts, as well as the other administrative tasks that require attention throughout the day. The interns/PGY2s mostly communicate directly with our attending concerning pt care. I guess since our service is pretty high volume, we just do it a little different.

 

[NRAI2001]

Yeah, PGY2s are seeing their own patients. Our PGY3s don't see everyone or check our orders. Their job mostly is assigning admissions to PGY1s and 2s and seeing their own small panel of pts, as well as the other administrative tasks that require attention throughout the day. The interns/PGY2s mostly communicate directly with our attending concerning pt care. I guess since our service is pretty high volume, we just do it a little different.

What a weird system you guys have?? Where is this again, if you dont mind sharing?