Sorry to intrude, but I wonder...
1. Since the surgeon on-call usually gets 5+ calls/night, do surgeons end up spending the whole night at the hospital instead of going home and having to come back every time the pager goes off?
2. What happens when more than one emergency occur and there's only one on-call surgeon? For example, if a trauma surgeon is operating on a critically-injured patient and the paramedics drop off another critical case, what happens?
Thanks,
To answer Q2 first, At our level 1 trauma center, there is a "backup" trauma attending, that is usually only called in if two OR cases are going at the same time. But otherwise, if the trauma attending is in the OR (with the chief resident or fellow) the midlevel resident is in charge of the trauma bay and does the evals, calls into the OR with updates or if needed, the attending will scrub out and the chief/fellow will remain in the case and continue damage control.
As far as Q1, it depends on the setup I guess. In a situation with residents who are in house overnight, my attendings only ever come in if they need to operate overnight. Otherwise, the residents do all the evaluating and paperwork, and the attending just sees them in the morning if they needed to stay. Likewise, if you don't have residents, you may have a PA to cover new consults. Otherwise, if its a non-critical consult, you probably delegate it to the AM, and urgent/emergent ones you'd come in i guess.
My program varies on service (and only discussing the nighttime shifts):
VA: PGY1 covers all floor pages and ER consults, PGY2/3 covers the ICU. Maybe 2-3 consults a week there overnight
University: Three different services are covering "consults". Trauma is its own dedicated team. Rarely do they have a no hitter. The average 24hr period results in 11 consults (they have done the stats), a good 75% of those occur at night. My worse night was 21 consults in an 8hr stretch from 8pm to 4am. This is a team though that consists of at least a senior level resident (Fellow, PGY5 or PGY4), and midlevel resident (PGY3 or 2) and some scattering of interns/ER docs/etc. And the attending is in house and when **** is hitting the fan, either in the OR or in the trauma bay running the show, so while stressful, doesn't fall entirely onto any of the residents. The transplant service covers their own stuff, and again, if you get 1-2 consults a week, its a stretch. But you also cover the procurements and admitting the preop recipient, which could count as consults, which happens about once a week at our institution. All other patients (gen surg, surg onc, vasc, CT, we don't have peds at university), floor calls by the NF intern, ER consults by the NF midlevel. Average maybe 2-4 a night, frequently had no hitters, but also could get hit with double the expected, plus these patients have a much higher tendency to crap out than the typical consult I see at the private hospital.
Private Hospital: NF team consisting of an intern (answers floor pages on the 100+ gen surg, vascular, thoracic, peds, onc, colorectal pts), a PGY2 that covers the ER/floor consults, and a PGY4 which is the in house chief to cover chiefy things and to operate. That ER manages to give about 10-12 consults a night (I literally think no one in Bergen County NJ should have a gallbladder still, but they seem to find there way to our ER), although I have had the incredibly rare (of 7 weeks of NF, so 35ish calls, maybe 1 or 2 times) had close to a no hitter. Also have had stretches with 16-20 calls, where I sent each of my 3 med students to see non-urgent ones, while I saw a few more critical ones, and send the intern to see the DVT consult or to drain the back pus.
