Duty hours in the ED

[InTime]

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What schedules do other ED residents work in the ED?

We are scheduled 19 hour shifts, with half scheduled 10 hours and half 12 hours. After the shift and about half an hour sign-out, residents average another 2 hours finishing paperwork and patients; some stay longer.

Half of our shifts are overnights, so we switch circadian rhythms 3-4 times in a month. There is no overlapping of resident shifts; if a non-emergent patient comes in 20-30 minutes before sign-out, they must be seen.

ACGME says "While on duty in the ED, residents may not work longer than 12 continuous scheduled hours. There must be at least an equivalent period of continuous time off between scheduled work periods." Our off-service residents follow this, but we don't seem to follow this.

How many shifts/hours do you do? Is it legit to work 12 hours, and then do paperwork for another couple of hours? What is residency life like in your ED?

 

[dotcb]

These are important questions to ask and consider when interviewing and choosing a residency. For you - this pain will be temporary. Can bring it up to residency leadership or chiefs as a potential wellness/burnout issue. They may or may not be open to hearing you. In my experience - shifts over 8 hours are life killers. Keep this experience in mind when selecting your next job.

 

[pianoman511]

My program does 18 - 12 hour shifts per month when on service, generally only staying about 1/2-1 hour afterwards to complete paperwork/sign out. This decreases to 17 shifts 2nd year and 16 shifts 3rd year. I agree with docb, when you're staying two hours after (minimum), that means only 8 hours between shifts and more likely 6-7 hours given travel time home/taking care of things....definitely recipe for burnout and more importantly you end up being unable to do much outside of work (didactics, life in general, etc).

 

[Zanegray]

This. We have one twelve hour shift. 10a-10p on weekends. Ugh it KILLS ME every time.

 

[Cerberus]

As a graduating chief, I know more about the duty hour rules than I would like to. While a 12hr shift followed by 2 hours cleaning up is brutal, it is not a duty hour violation. The 12hr rule applies to "Direct clinical care" i.e. seeing and evaluating new patients. If I am not mistaken I think you are limited to 4hours of work following the 12hrs of direct clinical care (although I'm not sure as >2hrs is very rare at my program).

 

[EM2BE]

I'm surprised this has not come up yet - why are you staying so long after shifts? If you are doing sign outs, you shouldn't have to stay >2 hrs past a shift. I've stayed an hour at most most days after a 12 in which sign out happens. It's why you have sign out - so that you don't have to follow up with stuff after a shift. There are things you should never sign out (pelvic, rectal) and a few phone calls to make inevitably after sign out (pt's results came back within the last 30 min of shift). This is something which could be worked on to improve residency situations.

I am at 2 different EDs for residency. One is consistently 12s, other is 9-10 hour shifts. The 9-10 hr shifts we have 1 hour of overlap, so I leave about 1 hr late (without signout unless you are waiting on psych placement or a study which is pending, but all dispo stuff ready with what you expect it to be). The other place has 12s, no overlap. Sign out, then finish up last minute stuff as mentioned above. Finishing charting away from people is ideal if possible so that you can focus and get out.