How does taking call from home work?

[ThreadMaker]

I was reading something about residents taking home call on a website for a residency program. So how exactly does this work?

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[cabinbuilder]

I was reading something about residents taking home call on a website for a residency program. So how exactly does this work?

Field calls after hours for your clinic. OR field calls from the nursing floor (usually for tylenol or laxative or someone just went into a-fib or pain meds not holding). OR they tell you there is an admission that you will take over in the am (many places the ER will write admit orders for you and tuck them in).

Really depends on the program and what is expected.

My residency we never took call from home. Too many variables and we were expected to do our own admissions from the ER.

 

[Winged Scapula]

We only did home call for a very few off service rotations.

"Beep Beep Beep"
"Yes, yes...ok, I'll be there in 10 minutes".
Back home in bed..."Beep Beep Beep"
"Really? I just left...ok, I'll be there in 10 minutes."
Driving home..."Beep Beep Beep"
"****. What now? Fine. I'll turn around.
Decide to stay in call room. No going home early post-call because you had "plenty of sleep" on home call.

😡

 

[Law2Doc]

I was reading something about residents taking home call on a website for a residency program. So how exactly does this work?

Most of the time being on call means being in the hospital. Some rotations/specialties have home call where you can leave the hospital but keep your pager on and nurses, doctors, consults can call you any time they need you. May mean you get to go home and sleep in your own bed but may also mean everyone in your household gets woken up 8 times a night by your pager, and you have to drive into the hospital multiple times a night. So it's really only a benefit on very light services where there's a good chance you won't get paged.

 

[SouthernSurgeon]

Our home call rotations were total BS. Home call counts against the 80 hour rule, but does not count toward the 24 hours of continuous duty call. So you don't have a post-call day and the program gets to work you.

The services that abuse home call at my hospital the most are plastics, urology, ENT, peds surg (for their fellows), and CT.

CT was the most egregious because the residents cover such a broad range of duties. I had a nice stretch where I operated all day on a Monday, was "home call" Monday night and went out for a heart/lung donor, then operated all day again Tuesday, then Tuesday night spent my next "home call" in the ED taking care of an LVAD patient and an aortic dissection, then operated all day Wednesday again.

 

[Dejavu]

Mostly you go home and wait for someone to call.

Sorry, had to do it.

 

[Smurfette]

We only did home call for a very few off service rotations.

"Beep Beep Beep"
"Yes, yes...ok, I'll be there in 10 minutes".
Back home in bed..."Beep Beep Beep"
"Really? I just left...ok, I'll be there in 10 minutes."
Driving home..."Beep Beep Beep"
"****. What now? Fine. I'll turn around.
Decide to stay in call room. No going home early post-call because you had "plenty of sleep" on home call.

😡

Sounds like my ENT rotation but without mention of the projectile hemoptysis and flying trach phlegmballs.

Depends on what service you are covering on home call as to how "bad" it is. Some rotations rarely require you to go in at night (although phone calls from nursing can seem relentless).

 

[LucidSplash]

Sounds like my ENT rotation but without mention of the projectile hemoptysis and flying trach phlegmballs.

Depends on what service you are covering on home call as to how "bad" it is. Some rotations rarely require you to go in at night (although phone calls from nursing can seem relentless).

Ugh peds surg call here. "What? You are paging me at 2am to notify me that you are giving tylenol, which I already wrote for on the admission orders, to the child with a perforated appendix who has a fever that I told you they would have? Thanks."

"The child's mother is upset that the child is NPO for surgery but their throat hurts and they want a popsicle and you want me to come explain AGAIN why they need to be NPO?"

"What do you mean that you think the child is sad and lonely and needs benadryl? Benadryl will make them go to sleep and stop hitting the call button but it's really not a treatment for 'sad.' Oh, all the child-life professionals have gone home and locked up the iPads and so they need Benadryl?"

 

[MediCane2006]

Ahh, home call. Last night, as I was sitting in the ED in the wee hours waiting for the conscious sedation nurse to show up so I could sew up a kid's face, I had this priceless exchange with the ED attending::

ED - wow,you've been waiting awhile, sorry
Me - yeah, thanks [big yawn]
ED - wow, I know who's sleeping in tomorrow!
Me - yeah, NOT ME.... I've got a full day of cases
ED - wait - you don't get the day off!?!? oh god....

The team magically showed up 5 seconds later, and the attending basically hustled me out the second the lac was closed.

Today was NOT fun.....

 

[Winged Scapula]

Ugh peds surg call here. "What? You are paging me at 2am to notify me that you are giving tylenol, which I already wrote for on the admission orders, to the child with a perforated appendix who has a fever that I told you they would have? Thanks."

"The child's mother is upset that the child is NPO for surgery but their throat hurts and they want a popsicle and you want me to come explain AGAIN why they need to be NPO?"

"What do you mean that you think the child is sad and lonely and needs benadryl? Benadryl will make them go to sleep and stop hitting the call button but it's really not a treatment for 'sad.' Oh, all the child-life professionals have gone home and locked up the iPads and so they need Benadryl?"

Ok, now I know you are living my life over again.

Everything you've written above has happened to me.

My favorites were the 0200 pages from the peds residents, asking...no, telling us to put in a port for chemo on one of the kiddos who'd been in house for days.

PR: "yeah, we need a stat port on this kiddo so he can get his chemo"
GS: "sooooo...how long has this kid been here? And why is the port stat?"
PR: "he's been here for a week and my attending wants the port stat so we can start chemo tomorrow. You can just add it on to your schedule tomorrow as first case."
GS: "(sure that the kid had needed a port for a week but the intern simply forgot to consult us and just now remembered). uh yeah, no. The first case isn't going to be bumped. We'll get to it when we can."

Sadly, our Peds Surg attendings kissed everyone's arses so we never got to tell the Peds team what we thought of their plans or calling us last minute with everything.

Ahh, home call. Last night, as I was sitting in the ED in the wee hours waiting for the conscious sedation nurse to show up so I could sew up a kid's face, I had this priceless exchange with the ED attending::

ED - wow,you've been waiting awhile, sorry
Me - yeah, thanks [big yawn]
ED - wow, I know who's sleeping in tomorrow!
Me - yeah, NOT ME.... I've got a full day of cases
ED - wait - you don't get the day off!?!? oh god....

The team magically showed up 5 seconds later, and the attending basically hustled me out the second the lac was closed.

Today was NOT fun.....

That would be funny if it weren't true. For some reason, it seems to be a widely held thought that on-call surgical fellows and attendings go home post-call and don't have cases/office hours.

 

[gutonc]

To answer the OPs question more universally:

Poorly

 

[SouthernSurgeon]

Ok, now I know you are living my life over again.

Everything you've written above has happened to me.

My favorites were the 0200 pages from the peds residents, asking...no, telling us to put in a port for chemo on one of the kiddos who'd been in house for days.

PR: "yeah, we need a stat port on this kiddo so he can get his chemo"
GS: "sooooo...how long has this kid been here? And why is the port stat?"
PR: "he's been here for a week and my attending wants the port stat so we can start chemo tomorrow. You can just add it on to your schedule tomorrow as first case."
GS: "(sure that the kid had needed a port for a week but the intern simply forgot to consult us and just now remembered). uh yeah, no. The first case isn't going to be bumped. We'll get to it when we can."

Sadly, our Peds Surg attendings kissed everyone's arses so we never got to tell the Peds team what we thought of their plans or calling us last minute with everything.

Two words that boil my blood even though I haven't rotated on peds surg in over a year:
Broviac. Repair.

Ugh. I hated peds surg so much.

Or when the nurse told me (as a PGY3) that "no offense" but she really needed to ask the fellow before accepting my order.

 

[Winged Scapula]

Two words that boil my blood even though I haven't rotated on peds surg in over a year:
Broviac. Repair.

Ugh. I hated peds surg so much.

Or when the nurse told me (as a PGY3) that "no offense" but she really needed to ask the fellow before accepting my order.

While we're on the topic of pediatric nurses how about those phone calls for lost or difficult IV access?

When you'd respond appropriately that you would be up to see the kiddo and get an IV in, you'd be met with a tirade which pretty much said there's no way in hell we're allowing any resident to touch this child.

 

[Arcan57]

While we're on the topic of pediatric nurses how about those phone calls for lost or difficult IV access?

When you'd respond appropriately that you would be up to see the kiddo and get an IV in, you'd be met with a tirade which pretty much said there's no way in hell we're allowing any resident to touch this child.

Ahh pediatrics, where the decision making never falls below attending level. I enjoyed the calls from the nurse at 0300 telling you to renew prn meds that were set to expire in the afternoon.

[Me]"Hi this is Dr. Arcan, I was paged"
[peds nurse] "Yeah, pt x in rm 236 needs an order of tylenol."
[Me] "Did they spike a fever?"
[peds nurse] "No"
[Me] "Are they in pain?"
[peds nurse] "No"
[Me] "Ok"
...silence.....
[peds nurse] "So are you going to put that order in?"
[Me] "Why do they need tylenol?"
[peds nurse] "I was going through the orders and saw that the tylenol expires at 6'oclock tonight and wanted to make sure it was renewed before I came back on shift"
[Me] (thinking) "Only 20 more days, I can do anything for 20 days...."

Of course any reply other then yes would then lead to every nurse on the floor paging you in 5-10 minute increments until you apologized to the original nurse. Failure to apologize by the am would lead to being written up for impeding patient care. Of course, during my rotations in pedi world I had (and was expected to have) the same level of functionality as an artificial plant except that artificial plants still look good after being in the hospital for 30+ hours.

 

[cabinbuilder]

So one of my favorite "you've gotta be kidding me calls"

5am on Sunday, I round on everyone in house for the weekend so I"m gonna be there eventually.

Nurse: I checked the blood sugar and it's low - 75
Me: So how much insulin does the patient usually get?
Nurse: Oh, he's only on oral meds
Me: Ok, so is the patient symptomatic and feeling bad?
Nurse: No, he's sleeping without complaints
Me: I'm hanging up the phone now

 

[LucidSplash]

While we're on the topic of pediatric nurses how about those phone calls for lost or difficult IV access?

When you'd respond appropriately that you would be up to see the kiddo and get an IV in, you'd be met with a tirade which pretty much said there's no way in hell we're allowing any resident to touch this child.

Ugh. Ditto. Also ditto on the Broviac Repair.

Also my all time favorite: stat consult from the pediatrons for pt admitted on the floor with "acute abdomen." Rush to hospital from home, arrive to find patient sitting on the edge of the bed eating a cookie larger than their head. 😡

 

[MediCane2006]

I'm literally getting chest pain from the PTSD that these pedi surg stories are triggering,...

 

[Bacchus]

We don't have a peds residency or pediatric surgery (fellowship?). Family medicine gets to field all of the pediatric floor calls overnight and does the admissions for any kiddos coming in house. Its brutal sometimes and its unfortunate that I'll be dealing with it for 3 years.

At this point, my stock response is pretty simple: "I understand you're frustrated and feel you're between a rock and a hard place. But, the attending knows about this case and does not want to deviate from the plan." I usually just say this because there hasn't been an "OMG, I NEED TO CALL THE ATTENDING NOW" moment.

My last call we had a methadone baby who would wake up cranky but would immediately fall back asleep if held or papoosed tightly. I don't remember the NAS score, but the nurse always threatened to calculate it. Basically, there was no indication to put the kid back on narcotics and he just needed to be cared for, like a baby.

I hate being paged consistently for quick fixes. No, I'm not giving ativan to a kid that's at risk of respiratory depression because he's consuming an elephant's load of morphine for his sickle cell crisis. Yeah he'll probably shut up, but everyone does when they're tubed.

 

[Smurfette]

I'm literally getting chest pain from the PTSD that these pedi surg stories are triggering,...

Me too. I think my blood pressure doubled at the repressed memories that are being triggered by this thread. I had forgotten all about Broviacs. Thanks a lot. 😡

To steer the convo away from pediworld, as an attending, aside from the stupid Tylenol order requests in the middle of the night, the most annoying call I fielded from home went like this:

me: (3 am) This is Dr. Smurfette, returning a page.
RN: Hi. Ms X, one of your partner's patients in room 1234 wants a cigarette really bad. Can I get an order for a nicotine patch?
me: (thinking wtf???) um...no. That can wait until morning.
RN: she says she'll sign out AMA if she doesn't get a patch or get to smoke. Can I let her go outside to smoke?
me: If she goes outside to smoke, she needs to do it off hospital property. If she leaves the property, she needs to sign an AMA form.
RN: So she needs to sign out AMA to smoke? That doesn't seem right. A patch is a lot easier.
me: Yes, she would need to sign the form. Because as a doctor, my medical advice is not to smoke, as well as not to leave hospital grounds if sick enough to be an inpatient.
RN: well, she is not going to take this news well. Are you sure she can't get the patch? She's scheduled for the OR in the AM.
me: [now wide awake and absolutely not going to give patch based on principle] No, she can't have the patch. First, it's going to need to be removed for surgery anyhow. Second, it takes time to take effect. It does not provide instant relief.
RN: oh, ok. I'll tell her. Bye.

1 hour later:
RN: she is going crazy here. Can I get that order for a nicotine patch?
me: no.

5:30 am, essentially same page and conversation.

6 am: RN calls my partner despite him being off, dissatisfied with my responses. Asks him for order for patch. Answer: no.

 

[cabinbuilder]

Me too. I think my blood pressure doubled at the repressed memories that are being triggered by this thread. I had forgotten all about Broviacs. Thanks a lot. 😡

To steer the convo away from pediworld, as an attending, aside from the stupid Tylenol order requests in the middle of the night, the most annoying call I fielded from home went like this:

me: (3 am) This is Dr. Smurfette, returning a page.
RN: Hi. Ms X, one of your partner's patients in room 1234 wants a cigarette really bad. Can I get an order for a nicotine patch?
me: (thinking wtf???) um...no. That can wait until morning.
RN: she says she'll sign out AMA if she doesn't get a patch or get to smoke. Can I let her go outside to smoke?
me: If she goes outside to smoke, she needs to do it off hospital property. If she leaves the property, she needs to sign an AMA form.
RN: So she needs to sign out AMA to smoke? That doesn't seem right. A patch is a lot easier.
me: Yes, she would need to sign the form. Because as a doctor, my medical advice is not to smoke, as well as not to leave hospital grounds if sick enough to be an inpatient.
RN: well, she is not going to take this news well. Are you sure she can't get the patch? She's scheduled for the OR in the AM.
me: [now wide awake and absolutely not going to give patch based on principle] No, she can't have the patch. First, it's going to need to be removed for surgery anyhow. Second, it takes time to take effect. It does not provide instant relief.
RN: oh, ok. I'll tell her. Bye.

1 hour later:
RN: she is going crazy here. Can I get that order for a nicotine patch?
me: no.

5:30 am, essentially same page and conversation.

6 am: RN calls my partner despite him being off, dissatisfied with my responses. Asks him for order for patch. Answer: no.

So glad to see someone on the same page as me. "If you are well enough to smoke, then you are well enough to go home". I do the patch sometimes, but not before surgery. What? That's when I start ordering ativan for both the patient and the nurse. HA

 

[Buzz Me]

We only did home call for a very few off service rotations.

We take home call here every single day of fellowship, except for your 4 days off a month and vacation weeks. That includes when you're "post-call" (we take occasional in-house call here too).

 

[dragonfly99]

"Ahh pediatrics, where the decision making never falls below attending level. I enjoyed the calls from the nurse at 0300 telling you to renew prn meds that were set to expire in the afternoon.

[Me]"Hi this is Dr. Arcan, I was paged"
[peds nurse] "Yeah, pt x in rm 236 needs an order of tylenol."
[Me] "Did they spike a fever?"
[peds nurse] "No"
[Me] "Are they in pain?"
[peds nurse] "No"
[Me] "Ok"
...silence.....
[peds nurse] "So are you going to put that order in?"
[Me] "Why do they need tylenol?"
[peds nurse] "I was going through the orders and saw that the tylenol expires at 6'oclock tonight and wanted to make sure it was renewed before I came back on shift"
[Me] (thinking) "Only 20 more days, I can do anything for 20 days...."

Of course any reply other then yes would then lead to every nurse on the floor paging you in 5-10 minute increments until you apologized to the original nurse. Failure to apologize by the am would lead to being written up for impeding patient care. Of course, during my rotations in pedi world I had (and was expected to have) the same level of functionality as an artificial plant except that artificial plants still look good after being in the hospital for 30+ hours. "

****
This doesn't happen only in pediatrics. This happened to me multiple times as a medicine residency, on 30 hour overnight calls. At least I was in house and already being tortured, since we didn't have home call, ever. But I always felt like there should be some education of the floor nurses about some of this stuff that was more "housekeeping" and doesn't need to have a call to the resident between 1am and 6 a.m. It's different if there is a patient care issues, but a fair amount of it was just some form that needed to be signed, or a med order that expired at midnight but that was some PRN that was not/had not been used at all, likely PRN Tylenol or Zofran when the patient hadn't been having pain and/or nausea. My other least favorite 1a.m. call was an expired temporary DNR order that had been signed the night before by another resident(s) but expired at midnight b/c the attending on rounds the day before forgot to cosign it. Guess who gets to go to bedside at 1 or 2 a.m. and rewrite another temporary DNR order? The on call resident...it always made me uncomfortable b/c the order we signed was a preprinted one saying that we discussed with the patient/family about the order and that was what he/she/they wanted. Well, at 2 a.m. when the patient is sleeping, if I wake the patient up to rediscuss that (especially if patient is relatively stable) that seems ridiculous and would invoke the ire of the patient and family, and perhaps the RN. If I sign the temporary DNR with no discussion, that is technically improper also...I pointed this out to the nurses a few times but that had no effect whatsoever, and if I declined to sign the form then I would have been written up by the nurse. A lot of things that go on in the hospital at night that involve inappropriate pages to resident are system problems, IMHO. If all temporary DNR orders expired at 4 or 5 pm instead of midnight, that would have avoided that problem totally...

 

[rokshana]

that's why ill make the orders (restraints for example) for only 12 hours...then it DOES expire during the day.

of course the day nurses usually miss it cuz they are busy and the night nurses catch it between checking their Facebook accounts and bidding on ebay...

 

[Arcan57]

that's why ill make the orders (restraints for example) for only 12 hours...then it DOES expire during the day.

of course the day nurses usually miss it cuz they are busy and the night nurses catch it between checking their Facebook accounts and bidding on ebay...

Imagine the productivity gains if you were able to take the mechanics of Farmville or Candy Crush and have it be applicable to patient care. Say for every med you give a patient or everytime you did a vital sign check you got points that you could spend making a digital garden..

 

[dpmd]

My favorite home call story was on peds at 0600 for a kid who was just a couple of mls under the amount that would average 30ml/kg/hr. Not a patient in the unit, not an infant where a few mls may actually make a difference, not a kid with a foley. I am not sure why there was even an order to call if UOP < whatever (maybe it was just part of the admission order set), but it wasn't even like they were calling for just the last hour or whatever, it was the average for the entire shift. I managed to remain polite as I told the nurse we would be rounding shortly and that I had no new order, but my husband who was awakened by the call decided to recommend that the nurse pick the kid up and squeeze a couple of mls out. Luckily, I think the call disconnected before the nurse could hear that part. Who knows what would have happened if they had.

Seriously though, what the hell is wrong with people that they wouldn't bother to actually calculate things until the end of shift, then would bother someone when they know rounds would happen soon.

 

[Knowmedge MD]

We didn't really have the option of doing home call in my residency. While I know it seems more relaxing to be able to stay at home much of the night rather than be running around the hospital, there's certainly tremendous value in actively watching the condition of patients you admit evolve throughout the night.

 

[cabinbuilder]

Man, after reading all these posts I am so glad I never did inpatient peds.

 

[SouthernSurgeon]

My favorite home call story was on peds at 0600 for a kid who was just a couple of mls under the amount that would average 30ml/kg/hr. Not a patient in the unit, not an infant where a few mls may actually make a difference, not a kid with a foley. I am not sure why there was even an order to call if UOP < whatever (maybe it was just part of the admission order set), but it wasn't even like they were calling for just the last hour or whatever, it was the average for the entire shift. I managed to remain polite as I told the nurse we would be rounding shortly and that I had no new order, but my husband who was awakened by the call decided to recommend that the nurse pick the kid up and squeeze a couple of mls out. Luckily, I think the call disconnected before the nurse could hear that part. Who knows what would have happened if they had.

Seriously though, what the hell is wrong with people that they wouldn't bother to actually calculate things until the end of shift, then would bother someone when they know rounds would happen soon.

I've started torturing nurses when they call me and tell me that a patient's urine output is low or marginal.

I just act very sincere and serious and make them look back over several shifts, or calculate the /kg/hr output.

Then I just say hmmmm. I think we should just watch it for a while longer.

 

[LucidSplash]

We didn't really have the option of doing home call in my residency. While I know it seems more relaxing to be able to stay at home much of the night rather than be running around the hospital, there's certainly tremendous value in actively watching the condition of patients you admit evolve throughout the night.

I do not like home call. Maybe it is because uncertainty makes me anxious? I would rather be on call at the hospital for a set amount of time, working hard, knowing that at the end of that set amount of time, I will leave, even if that is late after a sleepless night. Home call is a tease and I can never really relax or sleep well because I am always thinking about getting called in. I can't really make plans because of the uncertainty and even ordering a pizza is rolling the dice. I actually get better sleep snatching an hour or 2 while on in-house call than I do sleeping 6 hours on home call.

People tell me this will change as I get older but I'm not sure. From my current perspective it seems like my in-house call trauma/acute care attendings have a more desirable lifestyle wrt call than my gen surg attendings that take home call. But I guess its good that there are different options for different people with different preferences.