Call ...

[Chickenandwaffles]

Why do some PMR programs have home call and others have in-house call? I mean I guess I don't get why some hospitals would make it possible for residents to not have to be in house while for others, they would have to be in house. Thoughts?

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[Paddington]

Ones with bigger/busier/sicker (more Neuro-rehab, cancer) inpatient units tend to have to have in house call.

 

[Taus]

Also consider whether it's a stand-alone rehab hospital vs. a unit/wing of a large acute care hospital where there are other physicians available to see a patient urgently if needed.

 

[Chickenandwaffles]

Also consider whether it's a stand-alone rehab hospital vs. a unit/wing of a large acute care hospital where there are other physicians available to see a patient urgently if needed.

Well that's the thing. The program I'm going into has home call during pgy3/4, but apparently in house call during pgy 2, and nightfloat which is puzzling to me. It is a very large medical center as well, not a stand alone rehab place, which i can definitely understand why would have in house call, but at this program, every other specialty under the sun is represented, so I don't quite follow why there would be nightfloat for PMR. I would imagine that if any patient gets significantly ill, medicine/surgery/neuro, etc. would take over. How does having a PMR resident on night float help the situation?

 

[Paddington]

What is there not to understand? Routine issues requiring your attention, which may not require in person evaluation:
Pain medication
Insomnia
Diet orders, DVT prophylaxis orders the admitting resident forgot to put in
Radiographs, labs, done in the afternoon that need follow up

Issues that may (should?) require in person evaluation:
fever
fall
urinary retention, catheter issues
Hypertensive or tachycardic episodes in neuro-rehab patients
Altered mental status, possible recurrent strokes in stroke patients
PEG tube problems
Codes

And the list goes on and on. Maybe you have medicine consulted on all of them and in house to see the patient, but if you don't - or if they're in another building or normally only there 8-5 - then you will be needed to address those issues.

 

[Chickenandwaffles]

What is there not to understand? Routine issues requiring your attention, which may not require in person evaluation:
Pain medication
Insomnia
Diet orders, DVT prophylaxis orders the admitting resident forgot to put in
Radiographs, labs, done in the afternoon that need follow up

Issues that may (should?) require in person evaluation:
fever
fall
urinary retention, catheter issues
Hypertensive or tachycardic episodes in neuro-rehab patients
Altered mental status, possible recurrent strokes in stroke patients
PEG tube problems
Codes

And the list goes on and on. Maybe you have medicine consulted on all of them and in house to see the patient, but if you don't - or if they're in another building or normally only there 8-5 - then you will be needed to address those issues.

No medicine program that I know of in any part of the country only has residents 8-5. Every medicine residency program in the country, and certainly at this program, has someone there 24/7. Yes, the issues you mentioned may require in person evaluation, but clearly those issues can occur with any patient in any hospital in any program, and many programs still don't require PMR residents to be on site, so clearly it can be done without residents being on site, particularly for those with a medicine resident already there anyways.

 

[mjakec]

My program has home call but there's been nights I wish I was taking in house call with a place to sleep for the 30 between pages all night.

Even though we have every specialist you can think, we are expected to see the patient first and then consult them if needed (ie: no calling a medicine resident to come see one of our patients that they don't and aren't following for some chest pain or new fever). The only times I've called another service before I've seen the patient is when someone is crashing (and I still have to come in to write the DC/Transfer summary).