Home pager coverage for inpatients during intern/residency?

[Armadillos]

Was curious what people's experience is as far as home pager call covering your inpatients during residency? I know a lot of programs have night float teams that cover this so its not even an issue. But for the programs thats still have it, how often are people usually getting paged in the middle of the night?

Im starting to look at programs a little harder and seems to be so many variables these days with everyone having pretty different set ups.

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[Elisabeth Kate]

interns are not allowed to have overnight duties or unsupervised activities thus part of your concerns are no longer substatiated

Interns can have overnight duties in the hospital. They just can't work more than 16 hours and can't be unsupervised, so home pager call for interns is out. I interviewed at places that did home pager call, but the intern usually did short call in-house until 9 p.m., then the PGY 2 or 3 was on home pager call for the rest of the evening. I think how busy it is depends on the location, the type of hospital it is, and if it has a psych ER that's staffed overnight.

 

[slappy]

plus i only give my pager number out to very few patients. and they cant leave a message.

Curious why you'd do this instead of just giving out your office and/or program coordinator's number?

 

[TexasPhysician]

interns are not allowed to have overnight duties or unsupervised activities thus part of your concerns are no longer substatiated. personally i turn my pager off after 5pm and i am at one of the programs traditionally considered to be hard core. the on-call resident will take care of pages after this time. plus i only give my pager number out to very few patients. and they cant leave a message.

Home call not in a hospital is not considered duty hours. You can be on home call all year as long as you get vacation. Home call is exempted per my understanding. IM fellows at my place take home call 24/7 for months.

 

[eastcoastdr]

I do get a couple pages here and there at home. I've been in residency about 6 weeks now and have gotten about 3-4 after hours pages. Pages from the lab about certain test results. Occasionally someone in my department will page me by mistake (thinking that I was on call when I wasn't). I think people are pretty good about checking who to page and what time it is before they actually send it out. I have thought about totally turning off the pager when I'm not home but I'm terrified that I'll miss that ONE critical page if I do. I'd rather be woken up at the middle of the night if my patient is coding and someone needs to ask me a question on the spot, than have that patient die or whatever. Obviously if it starts becoming a problem and I'm getting paged repeatedly after hours I'd do something about it. But for now, a page here or there is fine.

 

[Doctor Bagel]

I do get a couple pages here and there at home. I've been in residency about 6 weeks now and have gotten about 3-4 after hours pages. Pages from the lab about certain test results. Occasionally someone in my department will page me by mistake (thinking that I was on call when I wasn't). I think people are pretty good about checking who to page and what time it is before they actually send it out. I have thought about totally turning off the pager when I'm not home but I'm terrified that I'll miss that ONE critical page if I do. I'd rather be woken up at the middle of the night if my patient is coding and someone needs to ask me a question on the spot, than have that patient die or whatever. Obviously if it starts becoming a problem and I'm getting paged repeatedly after hours I'd do something about it. But for now, a page here or there is fine.

Are you expected to be available all the time for this type of stuff? No one can be available 100% of the time, so there's always a possibility of missing something. I also think it's a stressful way to live to always feel like that critical page could be coming in. In my hospital, they have a paging system where you can change your paging status. When I rotated on hospital services, I always switched it to "out of hospital, not available" when I left if I wasn't on call. That way, no one would think I was available if they paged me mistakenly, so it's not like any bad thing would happen because I didn't return a page.

 

[eastcoastdr]

Are you expected to be available all the time for this type of stuff? No one can be available 100% of the time, so there's always a possibility of missing something. I also think it's a stressful way to live to always feel like that critical page could be coming in. In my hospital, they have a paging system where you can change your paging status. When I rotated on hospital services, I always switched it to "out of hospital, not available" when I left if I wasn't on call. That way, no one would think I was available if they paged me mistakenly, so it's not like any bad thing would happen because I didn't return a page.

No we are not expected to be responsible. But you are right it is stressful to feel like an important page could come in at any moment. Luckily I've only gotten dumb pages, or pages by mistake from a colleague. We have a similar paging system too! I just haven't figured out how to use it correctly yet...I know there is a way to change it to "out of hospital not available" like you said. I know that if you change your status to that, there's no way to transmit a page to that pager. Maybe I will look into that tomorrow! Thanks for bringing that up.

 

[NickNaylor]

No we are not expected to be responsible. But you are right it is stressful to feel like an important page could come in at any moment. Luckily I've only gotten dumb pages, or pages by mistake from a colleague. We have a similar paging system too! I just haven't figured out how to use it correctly yet...I know there is a way to change it to "out of hospital not available" like you said. I know that if you change your status to that, there's no way to transmit a page to that pager. Maybe I will look into that tomorrow! Thanks for bringing that up.

FWIW, while you can do this online at our hospital system, the phone operators at the hospital can also do this for the residents. Might be worth checking into as that would probably make things easier for you.

 

[whopper]

Did the rules change? When I was a resident, if you did home-pager call, you were considered off-duty for purposes of work hours despite being on-call, and still expected to go to work the next day. That was different than doing an all-nighter in the hospital, where they had to let you have the next day off, and it did count as part of your work hours.

If things have changed, well at least when I did residency, home-pager duty was at first preferred, but the county's population skyrocketed during my 4 years of residency and because of that, the hospital (that was the central hub for psychiatric patients for the county) rapidly expanded and all of a sudden instead of being called just a few times a night, you were called all-night long. My program was divided into two locations. 1-where residents did all-nigher calls, the other they did home calls. All the residents thought home-calls were better, until that is our fourth year where the residents doing home call were being called all night.

And same thing happened with consults. Because the hospital expanded consults went from having nothing to just a few a day to having over a dozen a day when you compared my PGY I year to PGY IV year.

 

[TexasPhysician]

Correct. Home call does not count against duty hours. Only when you are in the hospital does the clock start.