Call Schedules

[zeloc]

I am doing research on various call systems and wanted to find out your opinions on your programs' systems. I would like to find out what are the best systems. If you feel yours is, what is it about it that makes it very efficient/workable, etc?

Does it involve a night float system, Q4 overnight, or a combination?
Do interns admit vs. doing float coverage?
How do weekend admissions work and do teams cap early?
Are admitting notes duplicated by interns and residents?
How is the system perceived by the attendings?

Feel free to comment on anything that you would like, am just giving some questions for thought.

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[IMrankhelp]

Honestly there is no point in doing this right now. With the new 16 hour intern rules many programs will be completely overhauling their systems. Q4 overnight as we know it today (24-30 hour shifts) can't exist anymore. More night float and more handoffs is the wave of the future.

 

[zeloc]

The IOM report are just suggestions. I don't think the ACGME has mandated anything either, they are just suggesting the 16 hour idea.

If these do pass, the programs have to overhaul the systems into SOMETHING. My question is what are the best/most efficient systems as there are many possibilities and I would like to know what is working very well now in order to incorporate some of these ideas into a program. Q4 may be over but there are many variations of night float systems, some of which work much better than others.

 

[NotAProgDirector]

I don't think the ACGME has mandated anything either, they are just suggesting the 16 hour idea.

Incorrect. The ACGME rules have been published for comment. The comment period is basically a sham. They will be confirmed with any editing (as much political compromise was involved in their development), and become active July 2011.

 

[BlazerMed]

People will either go: A) Full night float, which means more picking up patients in the morning that were admitted overnight or B) intern arrival will be staggered morning/night, so they can still admit their own patients.

 

[Instatewaiter]

Many people, especially the people at the q4 places feel this will really be the first ACGME requirement that is going to negatively impact training.

 

[gold&black2005]

Many people, especially the people at the q4 places feel this will really be the first ACGME requirement that is going to negatively impact training.

hearing the same thing at my program...but not sure that it will necessarily negatively impact training *if* programs are able to adapt in a manner that makes sense (i.e. not night float --> more handoffs --> more errors/breakdowns in communication).

With a little bit of adjustment, what might work well would be either of the models presented at MGH/Bigelow or Hopkins/Osler...just move start time back to 4 PM, methinks.

 

[dreamfox]

Incorrect. The ACGME rules have been published for comment. The comment period is basically a sham. They will be confirmed with any editing (as much political compromise was involved in their development), and become active July 2011.

so starting next year all residents are going to get f****d, while the interns have it easy? how can the acgme expect every program to change in one year to accommodate these changes?

 

[BlazerMed]

I think for regular ward months, it won't be too terribly difficult to figure out a way to change the schedules without interfering with training or patient care.

The hardest part with be how the ICU schedules have to be worked out. I think the only program I interviewed at last year that didn't have overnight call in the ICU as an intern was Duke with that quasi-ICU experience they have at the community hospital. Of course, I may not be remembering that exactly right.