Night float cross cover

[Shams al Deen]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

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[whoknows2012]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

I covered 25-30 most nights and could admit up to 4 and 1 micu/ccu transfer. That was very manageable.

 

[rokshana]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

Depends on how many teams there are ...80 is difficult but doable... but then usually not admitting too

 

[tartesos]

Back in my day..... 100 cross cover and 8 admissions was a good night !

 

[jdh71]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

We had two interns who split 60. So I guess I cross covered 30 while doing admits.

 

[Crayola227]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

Yes, this is what I did. Capped at 3-4 admits, I believe.

I got good at creating "comfort" and protocol driven order sets to try to avoid some calls. It was day's job but I made sure as many patients as I could, I threw in orders like bowel, OTC pain meds, melatonin for sleep, etc. Like, if I ended up in their chart anyway it was just a few clicks to add that kind of thing. Use your common sense and try not to step on day team's toes.

 

[xoggyux]

My residency had 5 teams. Team caps were 20 so theoretical max would have been 100 cross cover. Obviously not all teams were capped so I would say on average either half of that, up to 80% of that on very busy times. During the most busy times of the year, we would have 2 interns at night. There was always a resident but interns were expected to be the first line, resident for advice/help. Four admissions were the norm and it was rare for interns not to cap (certainly once I became a senior I made sure that interns capped first). I never felt overwhelmed and most nights actually first slow with long periods of 2-3 hours of quiet were you could possibly sneak a snore. Sometimes patients would come back to back and it would be a bit demanding but never really overwhelming to be honest. Our ED was super aggressive with admissions though so about 50% of the admits were easier soft admissions which made it easier. Night floor residents did not attend to codes though, our night ICU residents did that job.

 

[gutonc]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

"Standard" is a relative term. But your experience is not unusual or outside the norm.

My residency had 2 inpatient rotations, Univ and VA. VA had five 2 intern teams with caps of 8 each so 16x5 = 80 possible X-cover plus, because it was the VA and nothing ever happened with reasonable speed, by the time the day's discharges had happened and the rooms were ready for new patients, it was usually 8pm, so the ER and ICU would vomit 7 or 8 patients on the floor at once. Fortunately there were 2 night interns so it was more like 30-40/intern + admits split.

At the Univ it was 5 teams with a 12 patient cap, so up to 60 + admits. The good residents helped with the admits, the lazy ones went to bed.

 

[Splenda88]

I was curious how many patients is standard for an intern to cross cover on during a night on wards, while also taking new admissions? Is it standard for an intern to be first call on like ~60 patients while admitting a few new ones throughout the night?

That is not the standard where I am and where a few of my classmates are. Intern do not admit while doing cross cover. They have anywhere from 70-100 patients for cross cover


I would be wary of a program that let interns admit this early on during night float without a PGY2-3 looking over their shoulder...

 

[gutonc]

That is not the standard where I am and where a few of my classmates are. Intern do not admit while doing cross cover. They have anywhere from 70-100 patients for cross cover


I would be wary of a program that let interns admit this early on during night float without a PGY2-3 looking over their shoulder...

Of course there's a senior there. Or possibly even an attending. Or both. Don't be ridiculous.

 

[aafisahar]

That is not the standard where I am and where a few of my classmates are. Intern do not admit while doing cross cover. They have anywhere from 70-100 patients for cross cover


I would be wary of a program that let interns admit this early on during night float without a PGY2-3 looking over their shoulder...

be wary of programs that hold your hands.

I was cross cover my 3rd week at the VA, ~50-60 patients (4 teams x 18ish patients) and a cap of 4 admissions (ideally 3 floor 1 ICU but could be 4 floors). A senior was in-house and an attending could theoretically be found if need be. It was fine.

The only way to get good is by doing. If mommy watches you while you ride on the tricycle, you'll never get out of your comfort zone.

 

[wjs010]

be wary of programs that hold your hands.

I was cross cover my 3rd week at the VA, ~50-60 patients (4 teams x 18ish patients) and a cap of 4 admissions (ideally 3 floor 1 ICU but could be 4 floors). A senior was in-house and an attending could theoretically be found if need be. It was fine.

The only way to get good is by doing. If mommy watches you while you ride on the tricycle, you'll never get out of your comfort zone.

I feel like most programs are like this. I go to a program where everyone is happy and not too overworked and it’s considered Cush, and that’s how it is for us. Except it’s 5 overnights when I was an intern last year.

 

[Splenda88]

be wary of programs that hold your hands.

I was cross cover my 3rd week at the VA, ~50-60 patients (4 teams x 18ish patients) and a cap of 4 admissions (ideally 3 floor 1 ICU but could be 4 floors). A senior was in-house and an attending could theoretically be found if need be. It was fine.

The only way to get good is by doing. If mommy watches you while you ride on the tricycle, you'll never get out of your comfort zone.

If you have a senior in the house, that is fine. But OP was not clear in his post. My program is tough a program. PGY1 are one call Q3 for 2 months. There is no hand holding

 

[Splenda88]

I feel like most programs are like this. I go to a program where everyone is happy and not too overworked and it’s considered Cush, and that’s how it is for us. Except it’s 5 overnights when I was an intern last year.

Consider yourself lucky...

 

[rokshana]

be wary of programs that hold your hands.

I was cross cover my 3rd week at the VA, ~50-60 patients (4 teams x 18ish patients) and a cap of 4 admissions (ideally 3 floor 1 ICU but could be 4 floors). A senior was in-house and an attending could theoretically be found if need be. It was fine.

The only way to get good is by doing. If mommy watches you while you ride on the tricycle, you'll never get out of your comfort zone.

Also be wary of places that throw you in the deep end without any support...that’s just as bad(if not worse since your chances of killing some one is greater)...you need to learn how things are done properly, otherwise you can develop a poor base of knowledge and then just build on bad habits...graduated autonomy is the better method...

 

[Splenda88]

Also be wary of places that throw you in the deep end without any support...that’s just as bad(if not worse since your chances of killing some one is greater)...you need to learn how things are done properly, otherwise you can develop a poor base of knowledge and then just build on bad habits...graduated autonomy is the better method...

Well, safety be damned...