ACGME-Compliant Schedule Clearinghouse

[vuillaume]

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I thought it might be interesting to start a thread on the topic of what schedules work the best for balancing ACGME compliance with patient continuity/resident education. No doubt it will take programs a couple of years to figure this out. What have all of your experiences been so far?

We might as well use this space to throw out systems that don't work and promote systems that do.

We've pretty much run the debate about whether the rules are worthwhile into the ground, so we way as well figure out the best way to enhance our training within its constraints.

 

[triathlete411]

I think this is a great idea for a thread.

My suggestion - do away with prerounding. It is a waste of time. The labs are never back, the nurses haven't finished recording all of the vitals or tallying the Is and Os. That would shave off at least five hours a week.

 

[LaCirujana]

We don't pre-round at my program and it works just fine. The person who has been on call should be aware of any looming/active catastrophes and anything else can wait until the team swings by. Definitely a time-saver. Plus pre-rounding just sucks.

Our 2 lightest services cross-cover each other, so the interns are basically q4 to q5 (or better). One of the services has a lot of operating time for the interns, so minimizing the on-call time helps them get in the OR without violating work hours.

We're still working on our worst service--trauma/burn. We're looking at a few more PAs to do the d/c summaries, pulling a PGY-2 from another service to help cover cases (since we have ER residents on the service who can't operate and the remaining surgical residents get slammed post-call) and possibly creating a non-teaching service managed by PAs and/or NPs with attending oversight but no resident coverage after initial triage. Just ideas right now...

 

[Apollyon]

I just started on CAD (cardiology), with 67 patients on the service (and average around 20 pt turnover daily). There are PA's and NP's that see their own pts, and our schedule has 6 interns (four CAD, and 2 dedicated, one each to Electrophysiology and the private attendings' group). We have 5 nights of long call in the block, in at 7am, out at noon the next day (enforced - if you stay later, it is your own fault), short call on other days 7a-7p (admitting every day), with one week of night float (7p-7a Monday through Saturday), and several days built in when you go home at noon (to keep you under the hours).