10-hours between shifts?

[0382938]

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I wondered if some current interns/residents at places with nightfloat could speak to how their program approaches this rule. It has been said (and it would seem to be true) that this rule tends to work to the detriment of places with nightfloat, where the work hours are, in reality, much better than other places. Most interns I have talked to in these programs say they leave between 9:30 and 11:30 on long call, with more tending toward the later. I'm pretty confident that they aren't then waiting until 9:30 to come in the next morning. In the days of nearly universal 80-hour compliance (at least in IM), are programs essentially ignoring this part of the rules? (Note: I have no personal affection or hatred for this rule; I'm just trying to get a sense of what really happens. I'll be an intern next year.)

 

[elwademd]

in my program, call is from 7 am until 7 am (24 hours). night float comes in at 9pm, and covers the rest of the shift (9pm to 7 am). you would leave at 9pm and return at 7 am, giving you 10 hours.

 

[0382938]

in my program, call is from 7 am until 7 am (24 hours). night float comes in at 9pm, and covers the rest of the shift (9pm to 7 am). you would leave at 9pm and return at 7 am, giving you 10 hours.

Sure (and thanks), but I'm talking about those programs without 24 hour call, where the primary team goes home after long call in the evening (usually well after 9) and then comes back the next day for a full day.

 

[gutonc]

Sure (and thanks), but I'm talking about those programs without 24 hour call, where the primary team goes home after long call in the evening (usually well after 9) and then comes back the next day for a full day.

Our VA wards system is like this. Long call is 0800 - 1400 the next day. NF comes in at 2000 and picks up all further admits. You finish your work and then either go home (if it's a reasonable hour) or crash in a call room w/ your pager OFF until time to pre-round. Basically, it's a 30 hour call w/ 12 hours of NF coverage so the 10 hour rule doesn't come into play.

As for our "true" NF rotations, the expectation is that when NF shows up, you hand stuff off and leave...kind of like the ED. In general it works pretty well (assuming you're not mid-code or knee deep in a 6 procedure admission (my record last year...b/l IJ's for CVVH, a-line, LP, thoracentesis, paracentesis) this usually works pretty well. There are certainly times when it doesn't work perfectly but my program schedules 11 hours b/w shifts to buffer this somewhat.

 

[ekydrd]

When it comes to the 10 hours between shifts that applies to any continuous shift, including long (24 hours + 6 hours) regardless of night float. Technically when one is on long call the call is from 7am-7am with an additional 6 hours of duty without new patient responsibilities, so leaving at 11:30pm and coming back in at 6 or 7 am is not really a violation, but on a non-call day leaving at 11:30pm then coming back at 7am is.

 

[0382938]

I think I followed that, but the thing is, most places with "true" night float that I've seen treat the post-call day as a different shift, because it's a "regular" day (i.e. home at 5 pm or whenever the work is done, not 1 pm). So if they're treating it like a 2nd shift for that purpose, they should be allowing 10 hours between, right?

 

[ekydrd]

I think I followed that, but the thing is, most places with "true" night float that I've seen treat the post-call day as a different shift, because it's a "regular" day (i.e. home at 5 pm or whenever the work is done, not 1 pm). So if they're treating it like a 2nd shift for that purpose, they should be allowing 10 hours between, right?

I get ya! Yes, it's probably a violation if there is not 10 hours between two separate shifts. There may be lots of reasons the interns are staying so long though, so I can't really say for absolute. If night float comes in at 8pm then technically the call teams shift is done... but there is still work to be done. Does it all have to be done that night? Probably, but I have seen interns stay well past their hours just because they don't want to hand anything off to the night float or on coming team. Sometimes you have to realize there is no real stopping point to the work. It is never ending. Plus, the number of admissions that came in that day may have been huge. Several months ago I had clinic in the afternoon of a call day and had another upper level cover for me. When I got back I was inundated with admissions... and neither of us left until well past 10pm... and he wasn't even supposed to stay. He was just helping me out!

 

[0382938]

I'm So Scared Of Intern Year!!!!!!!!

 

[internal plan]

I'm So Scared Of Intern Year!!!!!!!!

I am pretty sure it's going to be uber chill and laid back. We'll probably get out most days pretty early and go lay at the beaches. That's mostly why I am staying in Cali 😀

 

[0382938]

I am pretty sure it's going to be uber chill and laid back. We'll probably get out most days pretty early and go lay at the beaches. That's mostly why I am staying in Cali 😀

whereas I will stay in the uber hierarchical and overworked Northeast and will DIE. But at least I'll know you're happy. Thanks. 🙂

 

[zeloc]

I get ya! Yes, it's probably a violation if there is not 10 hours between two separate shifts. There may be lots of reasons the interns are staying so long though, so I can't really say for absolute. If night float comes in at 8pm then technically the call teams shift is done... but there is still work to be done. Does it all have to be done that night? Probably, but I have seen interns stay well past their hours just because they don't want to hand anything off to the night float or on coming team. Sometimes you have to realize there is no real stopping point to the work. It is never ending. Plus, the number of admissions that came in that day may have been huge. Several months ago I had clinic in the afternoon of a call day and had another upper level cover for me. When I got back I was inundated with admissions... and neither of us left until well past 10pm... and he wasn't even supposed to stay. He was just helping me out!

At my program the wards team caps at 2000, so if any admits come in right before that it would obviously violate the work hours because no one is going to sign out their admits to the night float.

How does the 24 hour continuous call rule work? Don't most MICU shifts have 31 hour calls (0700-1300 the next day, with patient responsibility during this entire time)? Or does it only apply to non-critical care rotations?

 

[dragonfly99]

At my program the wards team caps at 2000, so if any admits come in right before that it would obviously violate the work hours because no one is going to sign out their admits to the night float.

How does the 24 hour continuous call rule work? Don't most MICU shifts have 31 hour calls (0700-1300 the next day, with patient responsibility during this entire time)? Or does it only apply to non-critical care rotations?

If you're asking about the 30 hour rule (with 24 hrs for admission) the way it generally worked in our MICU was that the on call team took admissions from 7a.m. to 7a.m. Admissions that came in after 7a.m. on the post-call day would go to the new/next admitting team. We generally started rounds between 7a.m. and 7:30, and rounds would go on x several hours...so the post-call intern is presenting but not actually "taking" the new admissions.