ER Shift question

[MikeTheGipper]

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I've heard a lot about how emergency physicians typically don't take call and when their shift is up then that's it and they can go home. I was wondering, what if at the end of one's shift he/she still has a patient or two who's test results aren't back, or still needs an x-ray, etc. Do the doc's on the next shift take over or would you have to stay late until the more was known about the patients condition?

 

[drguy22]

I've heard a lot about how emergency physicians typically don't take call and when their shift is up then that's it and they can go home. I was wondering, what if at the end of one's shift he/she still has a patient or two who's test results aren't back, or still needs an x-ray, etc. Do the doc's on the next shift take over or would you have to stay late until the more was known about the patients condition?

o no..the next shift takes over...at least thats what happens at my institution...

 

[Hallm_7]

It depends on the place. Many places have overlapping shifts to help with this, so the new doc comes on an hour before the old doc leaves. That way the new guy can take all the new patients while the old doc can clean up charts and dispo as many patients as possible (discharge vs admit). Other places don't overlap their shifts so several of these patients will be "signed out" to the new doc coming on so that they can leave at a reasonable time. For example, if you need to rule out an MI you have to sit on the patient for a minimum of 6-8 hours to get the needed cardiac markers back from the lab. This patient would be signed out to the new attending meaning they would get the full history of present illness, med history, outstanding lab values, consultations, etc.

Regardless, in my experience an ER doc rarely leaves right at the end of their shift. Most stay 30 minutes to an hour after the shift is over to make sure their patients are dispo'd and all critical labs and studies are ordered. Shift change always presents a myriad of possibilities for mistakes (as is true in any job or profession), so EDs try to minimize these mistakes as much as possible and staying a little longer than your shift technically ends is a way to accomplish that.

 

[Hercules]

Regardless, in my experience an ER doc rarely leaves right at the end of their shift. Most stay 30 minutes to an hour after the shift is over to make sure their patients are dispo'd and all critical labs and studies are ordered.

It completely depends on the place and the reimbursement structure. All of the 7 EDs where I do moonlighting work pay by the hour, and it is an incredibly rare occurrence to see someone stay after they're off the clock. That said hourly reimbursement is not the model most of us want to work in. At places that pay based on productivity you usually only get credit for dispositioned patients, so most physicians sign out as little as possible.

 

[southerndoc]

Most groups that are fee-for-service do not sign out patients. In my three months as an attending, I've probably received less than 20 sign outs.

 

[WilcoWorld]

Most groups that are fee-for-service do not sign out patients. In my three months as an attending, I've probably received less than 20 sign outs.

Wow, that sounds nice, I probably got 20 sign-outs in my last 2 shifts... but I'm sure there are plenty of down-sides to this at the end of your shift.

 

[njac]

So as an attending, working shifts, are you paid hourly or by salary or? Is it a flat fee per shift?

 

[DrQuinn]

I'm at a place now (academic), paid salary. There is ZERO incentive to either see a lot of patients, or to have a clean signout.

That being said, I pride myself on my signouts, and am usually out of there within 10-30 minutes of my "end of shift." Being a good signout doc is KEY, as I truly believe in karma. Also, I COULD pick up 3 more patients with 45 minutes to go, but the vast majority of those patients wouldn't have gotten any XRs or labs in that time, so I owuld just sign them out with all the liability going to the oncoming doctor....

Q

 

[southerndoc]

Wow, that sounds nice, I probably got 20 sign-outs in my last 2 shifts... but I'm sure there are plenty of down-sides to this at the end of your shift.

Yes, there are downsides. You stay after your shift about an hour, sometimes two hours. It all depends on how much is left over. If I get a d-dimer that's positive at 4:30, and my shift ends at 6, I'll just sign out the CT because I know it won't get done and read until after 6. If I have several patients waiting, I'll usually hang around.

No sign outs is not only good for the oncoming physician, it's also good for the patients. Sign outs are bad times for patient safety.