how does your program handle call?

Discussion in 'Psychiatry' started by spaslam, May 13, 2008.

  1. spaslam

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    My program is considering revamping our call system. We currently do:

    1st yrs have 3 overnight calls per month, covering M, Tu, Th., Sat.
    2nd yrs have 2 overnight calls per month, covering M, Tu., Th., Fri.
    3rd yrs have 3 overnight calls per TWO months covering Wed., Sun.

    We find the overnight calls, including the 24 hr shifts on wknds to be very busy. We cover up to 3 hospitals (University (ED, 23 inpt beds, consults), VA (ED, 16 inpt beds, consults) and state psych hospital [100 chronic beds]). So we are trying to design an additional short call person to be on until 10 pm or so, or go to a night float system. I am wondering what your thoughts are and what your program does. Thank you.

    -Sunny Aslam
    SUNY Upstate
    Syracuse, NY
     
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  3. Anasazi23

    Anasazi23 Your Digital Ruler
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    Our program covers only one hospital as of this writing (that will be changing soon most likely).

    All calls are overnight.

    PGY Is do about 3-4 calls/month on floor coverage only. They handle transfers, ER admits, and medical issues on the psych floor.

    PGY IIs cover either floors or ER, and are on about 3 times per month.

    PGY IIIs cover ER only and take only about 2 calls/month.

    PGY IVs have only attending-style call whereby they come in on weekends only and see new admits, new C/L consults, and the like. They are the first to be called by junior residents regarding dispo, clinical decisions, etc, and it goes up the chain of command from there.

    How many residents in your program? Sounds like you might benefit from a night-float, as hard as they are to implement.
     
  4. atsai3

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    We cover three hospitals (University, VA, County). Calls are split up by site and by year.

    PGY1's rotate only at County and take overnight call there approximately q6-7, and they cover only the psych ward and emergent consults. Non-emergent consults are deferred to the day consult team or to the weekend consult resident. On weekends, a PGY2/3 comes in to do consults just during the day (8a-4p), and the PGY1 does emergent consults at night.

    PGY2/3/4's do night float weeks at the VA. Weekend overnights and days (Fri 5p-8a, Sat 8a-Su 8a, Su 8a-5p) are covered by additional PGY2/3/4's. Duties are mostly ED consults and floor consults. This site is not that busy.

    PGY2/3's do night float weeks at the University site, and cover the ward, floor consults and ED consults. Weekend overnights and days (Fri 5p-8a, Sat 8a-Su 8a, Su 8a-5p) are covered by additional PGY2/3's. During the days, there is a very high volume of floor & ED consults, and during the nights it is primarily ED consults. This site has been so busy that last year a short-call system was implemented: a PGY3/4 comes in at 5p-8p to help the night floater; typically this entails at least 1-2 admits or 1 ER consult, and the short call resident leaves at 8p sharp. (On weekends, there is no short call.)

    Hope this helps
    -AT.
     
  5. spaslam

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    our program has seven in each of the PGY 1-3 yrs and five 4th yrs currently. 4th yrs can moonlight, but otherwise take no call. thank you both for your replies.
     
  6. Hurricane

    Hurricane Senior Member

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    We rotate at a variety of sites, so the call varies depending on where we are.

    At our main county hospital, there is one PGY1 and one PGY2 covering the 19 bed unit. Each resident takes pager call from home a week at a time, for alternating weeks. We're able to do this because we have a dedicated psych ER that handles most of the admissions, and the ER resident writes the admit orders. And a separate consult service covering the rest of the hospital. We have a similar deal at our private hospital, two PGY2s taking pager call alternating weeks, thanks to our intake social worker, psych ER, and consult service.

    Our VA system is in flux right now, because they are restructuring the inpatient teams to be single a hospitalist service, and the unit is semi-closed for renovation and awaiting new staff hires. In the past we have had to be in-house until 11 PM, then taken pager call from home. We were allowed to admit from home, but had to come in to discharge anyone from the ER. But currently we have to stay in house, and averages out to be q4. The exception to this is when there is a moonlighter resident on Fridays, Saturdays, and Sundays (5PM-midnight). During that time we can leave and take pager call to cover the floor (54 beds when it is up and running at capacity), while the moonlighter covers the ER and consults. It's nice, because the moonlighter makes extra money, and it provides some relief for the on-call resident.

    As for PGY3s, the only call they have to do is backup call if the ER gets too busy. No call for PGY4s except for pager call when they're on consults.
     
  7. whopper

    whopper Former jolly good fellow
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    1st year: 6 calls/month, 4 on weekdays, 2 on a weekend.
    2nd: 5 calls/month, 4 on weekdays, 1 on a weekend.
    3rd: 2 calls/month

    My program is split into 2 locations-Camden & ARMC (services Atlantic County NJ which includes Atlantic City).

    Camden-calls are all-nighters. Called On-site calls.
    ARMC-you can go home at 10pm but you can get beeped afterwards until 8am (called off-site calls), though it is nice being able to sleep at home. If you get beeped, you don't have to drive to the hospital. You can just do admissions & orders over the phone. If you should happen to have to go back to the hospital, you automatically have 10 hrs of time where you don't have to start the next day. I've only had to drive to the hospital only twice during my 3 years of doing calls, and I really didn't have to if I didn't want to, I did it because I was trying to help out.

    Most residents who go to my program pick which location & usually stay at that place for 4 years. While they are still the same program, its not easy simply interchangeably changing residents because both locations are 1 hr away & residents don't want to commute, & we don't want to force anyone. However in the past, if residents wanted to make a switch, they were allowed to do so if the dept approved.
     
  8. Solideliquid

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    PGY 1: All night calls from 4:30pm to 7:30am. Interns are responsible for all psychiatric patients on medical floors (urgent consults), our two psych units (adult and child - any issues that should arise), and admissions from the ED.
    Typically it is 5-6 calls per month, one of which is a weekend (one Saturday or Sunday) 24 call from 8am to 8am the next day.

    PGY 2: Same context but only on call twice per month.

    PGY3: (soon I shall be upgraded to this level of heavenly goodness because...read on) PGY has NO FIRST CALL. PGY 3 residents take backup call, meaning we are available for questions over the TELE--phone.

    PGY 4: No call. Take back up call same as PGY 3s.

    Front loaded, I love it.
     

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