Call rules at the VA?

[Hurricane]

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We do home call at the VA. Used to be, we left at 10 when we were on-call, and deferred non-urgent weekend consults to be seen by the consult team on Monday. But this year we were told that there are new national rules that say psych must be in-house until 11 when on call, and all psych consults must be seen within 24 hours, or within 1 hour if the person requesting the consult says it's "urgent" whether or not it actually is urgent. (and these rules are directed only at psych, not any other service)

Like I said, we were told these rules came down from the national level. But when one of our residents mentioned them to a resident at another program, they had never heard of any of this. Does anyone else here have these rules at their VA?

I hate the VA...

 

[Solideliquid]

What year are you?

At my program first call consists of psychiatric coverage in our hospital and the VA from 4:30pm to 7:30am. If you are on call on a weekend it's 24 hour call. If you are called to see a consult on call and it's not urgent you can defer it to the consult team as you said for the next day.

However if the consult is urgent the patient should be seen when you have time (meaning sometime during your call). In my program non-urgent psych consults may be seen within a 24 hour period.

What is this going home at 10pm on call stuff? I'm in the wrong program.

EDIT: No, I have not heard of a new rule stating you must see a consult within one hour if it is "urgent". And urgent consult should be seen by you that night, but not within one hour of the call if you have more pressing bidness to attend. Heck, our medicine residents don't come within one hour to see "urgent" consults.

 

[Puffle]

We had our rules change recently as well. Used to be, you went home around 5 on weekdays, and if someone came in needing to be admitted, you called in orders from home and saw them the next morning. Now, they say if someone needs admission, you must drive in from home and see them within an hour. And the same rule now applies for weekends, too.

And we never used to have go in for Urgent Care patients during the week, but they changed that rule, too. They gave us the same "national rule" bs, too, but these rules only apply to residents, not attendings. I think it's just a case-by-case thing. The VA is notorious for strictly following the rules, but then can never actually show you the rulebook.😉

 

[atsai3]

But this year we were told that there are new national rules that say psych must be in-house until 11 when on call, and all psych consults must be seen within 24 hours, or within 1 hour if the person requesting the consult says it's "urgent" whether or not it actually is urgent. (and these rules are directed only at psych, not any other service)

Our VA too. The entire VA is on high alert in the aftermath of the Walter Reed PR disaster.

-AT.

 

[Hurricane]

Bumping this up because after having voiced our displeasure with the current system (led by me and my big mouth 😉 ) we've been told they'll change the call system if we can come up with some reasonable proposals. So I'm wondering what the call is like at other places.

At our VA, and I'm guessing at other VAs across the country, the returning vets coupled with the increased screening/lowered threshold for admission has resulted in a pretty substantial increase in admissions. So whereas we used to leave at 10 (now 11) and take call from home, now people end up staying up all night, making it a de-facto q4 in-house call.

So... I'm kinda leaning towards the idea of a night float. Does anyone here have a night float at their VA? How do you make it work?

Also, do you have to take crisis calls? We do, and we all hate them, because you have to drop everything you're doing and get stuck on the phone for up to an hour. That's the first thing we're axing, and proposing either the attendings or NPs take them.

 

[tr]

Bumping this up because after having voiced our displeasure with the current system (led by me and my big mouth 😉 ) we've been told they'll change the call system if we can come up with some reasonable proposals. So I'm wondering what the call is like at other places.

We have in-house call with someone there all the time. Schedule is variable but it works out to about q5 or q6 I think.

So... I'm kinda leaning towards the idea of a night float. Does anyone here have a night float at their VA? How do you make it work?

Twelve residents per year; we each do four weeks of night float (split 2 and 2) over the course of a year. Night float is 6 nights a week, and Saturday nights are farmed out as an overnight call to someone on a day rotation.

Also, do you have to take crisis calls? We do, and we all hate them, because you have to drop everything you're doing and get stuck on the phone for up to an hour. That's the first thing we're axing, and proposing either the attendings or NPs take them.

Yes, we have to take crisis calls, but after several people got stuck on the phone for hours (delaying admissions to talk to inebriated frequent flyers playing coy games with their identities) we've been instructed to keep them brief. Basically assess for suicidality, send a team out if there's a risk, otherwise if they just want to talk, direct them to the available hotline for vets.