How many patients do you manage on your services?

[DrSatan]

I was wondering how many patients you typically have on any inpatient services (general, stroke, consult, epilepsy, etc.), as well as what your highest patient amount may be. Do any of you have caps? Do you have >1 resident per service? Do you have APPs helping?

With patients now coming to the hospital & our social workers still cut in half, we have had issues getting people out. Our lists are exploding. We typically have 5-8 on general, 4-5 on stroke, 8-13 on consults, & 1-3 on epilepsy all managed by 1 resident each +/- APPs. APPs take the easy patients, but only work 4 days per week. We're at 15 general & 10 stroke patients right now & 2 of 3 APPs are off for the next 1.5 weeks. We also don't have a hard cap from what I understand. Is this a reasonable patient load for 1 resident to handle?

What do you all do?

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[Telamir]

Consult only service. Fluctuates from 12-18 typically. Highest I've ever had was 25 and that was insane. I have 1 APP with me doing followups or easy straightforward consults +/- 1 medicine resident (honestly isn't much help). Patients are typically high acuity with many of them in the ICU (sometimes up to 40% of my service is ICU). We don't divide by stroke/epilepsy etc. Also don't have a primary service (a must, imo).

 

[Postictal Raiden]

Consult only service. Fluctuates from 12-18 typically. Highest I've ever had was 25 and that was insane. I have 1 APP with me doing followups or easy straightforward consults +/- 1 medicine resident (honestly isn't much help). Patients are typically high acuity with many of them in the ICU (sometimes up to 40% of my service is ICU). We don't divide by stroke/epilepsy etc. Also don't have a primary service (a must, imo).

Is this now as an attending or in residency?

 

[Telamir]

As an attending. In residency we had a primary and a consult service. Between the two of them typically like 20 patients divided between two juniors. Seniors didn’t see patients directly. No APPs.

 

[Spinothalamic]

So how many patients is each resident seeing? We have general and stroke inpatient services. Each service has one PGY2 and a senior +- rotating residents or students. No APPs. At most I probably rounded on 16? Averaged around 8-9, rarely would get lucky and have just a few

 

[Postictal Raiden]

So how many patients is each resident seeing? We have general and stroke inpatient services. Each service has one PGY2 and a senior +- rotating residents or students. No APPs. At most I probably rounded on 16? Averaged around 8-9, rarely would get lucky and have just a few

Very similar here in my program

 

[Telamir]

In my program between old/new/discharges/etc you'd see ~10-14 patients a day. On the weekends there was a resident taking new admits/consults and another resident who rounded on the entire census so it varies. On call we didn't cap so we could see up to ~10-11 admissions on our own at the worst. Typically 6-7 admissions/consults.

 

[MudPhudHopeful]

At my program, we have a VA that usually has a 2-3 on our service and a handful of consults. At our main hospital we have a general service, stroke service, two consult services, a neuro-oncology service, and an EMU service. The stroke and general services are usually capped (cap is 20 but we go over if we have to), which is divided among two PGY-2 residents. The consult services each have anywhere from 10-20 on the list at any given time (though not every patient on the list is seen everyday), divided between a senior and junior resident or a senior resident and APP. The neuro-oncology service has 0-1 or 2 at any given time. The EMU service usually has a 4-5 at any given time but this week we had 8 (cap is 10), dividing among a resident and 1-2 APPs.

When you are on night float, you get the joy of handling any cross cover on all the above services along with admitting patients to all those services that come overnight. An average number or admissions/consults overnight is around 7-9, a really good night is 2, a really bad night is 18. Thankfully, there is usually an APP to help with cross cover and admissions, but not always.


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[Neurogeneral]

During residency, our inpatient census (stroke and general) would typically range from 20 to 35 patients. There was also a separate very busy consult service. Neuro ICU and EMU were also their own separate services.

The inpatient service was manned by 3-4 residents (combination of mostly PGY2s but also usually one PGY1 neuro or neurosurg resident). We would also have an inpatient senior as well but he/she would not see patients. The number of patients per resident would not be onerous but our rounds would start at 8 am and could last til 4-5 pm easily.

Call would be busy regardless of whether it was short call, night float, or long call. During long call, the number of consults/admissions could be 8 or so at the low end but could go up to 17-18 consults at the higher end. In addition you are taking care of all the inpatients already on the service.

 

[Thama]

During residency, our inpatient census (stroke and general) would typically range from 20 to 35 patients. There was also a separate very busy consult service. Neuro ICU and EMU were also their own separate services.

The inpatient service was manned by 3-4 residents (combination of mostly PGY2s but also usually one PGY1 neuro or neurosurg resident). We would also have an inpatient senior as well but he/she would not see patients. The number of patients per resident would not be onerous but our rounds would start at 8 am and could last til 4-5 pm easily.

Call would be busy regardless of whether it was short call, night float, or long call. During long call, the number of consults/admissions could be 8 or so at the low end but could go up to 17-18 consults at the higher end. In addition you are taking care of all the inpatients already on the service.

For us that was roughly the census on each service, somewhat less on stroke but far more throughput. Stroke would admit 5 to 12 per night, general 3 to 6. But there were call residents for each service separately. Consults overnight would be handled by night float and could be 3-4 at the low end up to 15 or so depending on the night.

 

[mrbreakfast]

Stroke and general = average 10-20 patients each, each manned by an intern (usually off-service), a junior, as well as a senior, who only sees patients if the census is high. Stroke also has an APRN, who sees patients pending placement, and a fellow, who obviously doesn't see patients. We also have a VA service, which has a lower census but also sees consults. None of our services are capped.

EMU and NCU are separate services. EMU is generally 6-8 patients and is covered by a junior or senior + a fellow. NCU is 20+ patients but is manned by 2-3 interns (mostly off-service), a senior, a fellow, and 1-2 APRNs/moonlighters. Our NCU also takes overflow from other ICUs and thus can have some extremely critically-ill patients. These are typically co-managed by the fellow.

We have a pretty busy consult service. It's covered by 2 interns, a junior, a senior, and an APRN, but each will see 5-7 consults a day.

Overnight call is covered by a junior and a senior. A typical night is double-digit admits and double-digit consults.

 

[Postictal Raiden]

Stroke and general = average 10-20 patients each, each manned by an intern (usually off-service), a junior, as well as a senior, who only sees patients if the census is high. Stroke also has an APRN, who sees patients pending placement, and a fellow, who obviously doesn't see patients. We also have a VA service, which has a lower census but also sees consults. None of our services are capped.

EMU and NCU are separate services. EMU is generally 6-8 patients and is covered by a junior or senior + a fellow. NCU is 20+ patients but is manned by 2-3 interns (mostly off-service), a senior, a fellow, and 1-2 APRNs/moonlighters. Our NCU also takes overflow from other ICUs and thus can have some extremely critically-ill patients. These are typically co-managed by the fellow.

We have a pretty busy consult service. It's covered by 2 interns, a junior, a senior, and an APRN, but each will see 5-7 consults a day.

Overnight call is covered by a junior and a senior. A typical night is double-digit admits and double-digit consults.

Your hospital is pretty busy, but also each service is adequately staffed imo. Doesn't seem that residents are overworked.

Night calls seem like a nightmare though.

 

[GuillainMollaret]

Not a resident anymore, but typical service censuses below from when I was. All staffed by intern, junior, senior. Addition of fellow and mid-level on stroke. No caps.

Stroke: 15 to low 20s

General: 10 to 20

Consults: 1 to 2 per hour on average. Follow up consults typically seen by NP unless complicated. Busiest service, biggest team with several off service rotators

VA: small inpatient service with 2 to 4 patients plus consults (1 to 3 per day)

Night call: junior and senior. 10 to 15 consults per night, around 1/3 to 1/2 of those were typically admitted.

 

[Postictal Raiden]

Not a resident anymore, but typical service censuses below from when I was. All staffed by intern, junior, senior. Addition of fellow and mid-level on stroke. No caps.

Stroke: 15 to low 20s

General: 10 to 20

Consults: 1 to 2 per hour on average. Follow up consults typically seen by NP unless complicated. Busiest service, biggest team with several off service rotators

VA: small inpatient service with 2 to 4 patients plus consults (1 to 3 per day)

Night call: junior and senior. 10 to 15 consults per night, around 1/3 to 1/2 of those were typically admitted.

Even the VA was staffed by 3 residents (intern, junior, senior)? If so it must had been a vacation rotation lol

 

[GuillainMollaret]

Even the VA was staffed by 3 residents (intern, junior, senior)? If so it must had been a vacation rotation lol

No, the VA was just a junior and senior. After morning rounds, the junior would handle consults during the day while the senior did VA clinic. Still a vacation though compared to other services.

 

[mrbreakfast]

Night calls seem like a nightmare though.

#1 issue for our residency program: the day staffing is solid, we don't violate hours, conferences are well-protected, good amount of clinic/elective time, and the call schedule isn't bad...but when you're on call, you reliably get annihilated. As someone interested in hospital quality control in general, it's something I've been thinking about a lot. I think eventually we'll add a third overnight resident, but probably not during my residency.