24+6

[tofurious]

So has anyone ever questioned exactly what you are supposed to do during the "+6"? Are your residency programs making you stay for the full 6 to transfer care to every single pharmacist, consult service, and PCA (ie, patient care) or actually letting you get out after a quick transfer?

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[doc05]

are you serious?? +6 just means greater leeway in signout rounds, didactics, etc.

 

[bof]

+6 nothing, you are WORKING 30 hours if you are lucky. the +6 is supposed to be for wrapping up non-patient care stuff, write notes, put orders in etc etc. unless you are in NY with the 24 +3 hours, expect to be working 30 hours.

 

[tofurious]

+the +6 is supposed to be for wrapping up non-patient care stuff, write notes, put orders in etc etc.

Does it take anyone 6 hours to finish notes, put in orders, attend to all the non-patient care things? It seems that programs are basically using the +6 to prolong patient care hours even though the +6 is not meant for patient care (except NY of course, since someone did die there).

 

[cadoc]

All signs point to further ACGME work hour restrictions...even as early as next year. Keep your eyes out for the lawsuit against RUSH U: a family is suing the university because one of their residents killed their daughter in a car accident after working a 30+ hour shift. Rush U says that they aren't responsible for what their residents do after they get off work. Problem is that they are responsible for the consequences of forcing employees to work 30+ hours. Why isn't anyone asking: if we aren't safe to drive a car, why is it safe for us to admit patients, write orders, or operate? This case may mean huge changes.

 

[dkwyler94]

All signs point to further ACGME work hour restrictions...even as early as next year. Keep your eyes out for the lawsuit against RUSH U: a family is suing the university because one of their residents killed their daughter in a car accident after working a 30+ hour shift. Rush U says that they aren't responsible for what their residents do after they get off work. Problem is that they are responsible for the consequences of forcing employees to work 30+ hours. Why isn't anyone asking: if we aren't safe to drive a car, why is it safe for us to admit patients, write orders, or operate? This case may mean huge changes.

I am a fourth year, but the majority of my rotations this year have been Sub-I's, so I am working the same hours as the residents and interns with call and everything. I have been at a few hospitals. Basically it seems universal that 24+6=30hour shift. They should just say you work 30 hours. The typical is you get there at say 6am. Round on your patients and do your normal day stuff, then you stay through the evening and night admitting patients, covering your patients, and everyone who you are covering. At 6am the next morning, you start just like any other day with normal rounding and everything. It really is the same as any other morning. Instead of staying around in the afternoon, you then sign out. (PS this is referring to IM)

Honestly, I used to think 30 hours was radiculous, but I am really amazed at how sharp I still feel. If I don't feel safe to drive home, I will go to the call room after checkout and sleep until I feel I can drive safely. I think we still need to be responsible for our actions just like any other time. If you are too tired to drive, don't drive.

 

[MidwestMD]

Does it take anyone 6 hours to finish notes, put in orders, attend to all the non-patient care things? It seems that programs are basically using the +6 to prolong patient care hours even though the +6 is not meant for patient care (except NY of course, since someone did die there).

...are you saying that you typically finish all of your work before 1pm post-call with time to spare? I had thought that the +6 WAS intended for pt care, what else would you be doing w/ that time? For me, even though I finished my admission H&P's before AM rounds w/ the attendings, I still have to re-round on the new admits in the AM, write progress notes for my old pt's, f/u on studies from the night before (CXR's, CT's, u/s's), order NEW studies for the following day, call in consults, obtain OSH records, f/u on EVERYONE's AM labs, WRITE tomorrow's AM labs for everyone, and work on sign-out. Granted, I have a day float and my SMR to help w/ the vast majority of these issues, but I still find myself hard-pressed to get out by 1pm (and that's assuming I came in at 7am the morning before). Maybe I'm just incredibly inefficient...or maybe my program truly is malignant...j/k.

 

[blotto geltaco]

For me, even though I finished my admission H&P's before AM rounds w/ the attendings, I still have to re-round on the new admits in the AM, write progress notes for my old pt's, f/u on studies from the night before (CXR's, CT's, u/s's), order NEW studies for the following day, call in consults, obtain OSH records, f/u on EVERYONE's AM labs, WRITE tomorrow's AM labs for everyone, and work on sign-out. Granted, I have a day float and my SMR to help w/ the vast majority of these issues, but I still find myself hard-pressed to get out by 1pm (and that's assuming I came in at 7am the morning before).

That sounds about exactly like my post long call days.

 

[tofurious]

Granted, I have a day float and my SMR to help w/ the vast majority of these issues, but I still find myself hard-pressed to get out by 1pm (and that's assuming I came in at 7am the morning before). Maybe I'm just incredibly inefficient...or maybe my program truly is malignant...j/k.

We have an odd system where you start at 1PM on the day of your overnight call, and you start your 30 hours then. So you are admitting patients as something between a regular resident and a night float, and there is frequently plenty of time after the AM rounds where you are done with things but you are not "transferring care" (rounding on patients and writing orders are transferring care). Of course, you miss out on the didactic and ward learning that you otherwise would have gotten during the morning of your call day.

 

[FungManX]

Hey guys,
I'm not a med student yet.. but hoping to be soon,
I'm just wondering, with all these 30 hr long rotations and stuff during 3rd and 4th year med and residency, how much time off after that do you get before your next shift starts?

If your on call, is there a specific amount of time that they HAVE to give you before you start your next shift?

 

[tofurious]

If your on call, is there a specific amount of time that they HAVE to give you before you start your next shift?

On call or not, you have to have 10 hours. Does it always happen? No.