How much sleep while on call?

[glorytaker]

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I was just wondering about call nights your internship year. What is your sleep pattern on a usual night? Do you get 20-30 minutes of a nap and a call. Is it pretty much broken sleep all night or no sleep at all? Do you keep the beeper right next to your ear so you can hear it and wake up?

 

[FACS]

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[FACS]

I was just wondering about call nights your internship year. What is your sleep pattern on a usual night? Do you get 20-30 minutes of a nap and a call. Is it pretty much broken sleep all night or no sleep at all? Do you keep the beeper right next to your ear so you can hear it and wake up?

That sort of depends a little on the specialty program and rotation. 😉

 

[radonc]

That sort of depends a little on the specialty program and rotation. 😉

radonc...home call, sleep a good 6-8 hours...

 

[blue2000]

General surgery intern at a busy, high volume academic program...

1) At our county hospital...none. Ever. Well maybe 30 minutes once with two interrupting pages.

2) At the U...when I was cross covering gen surg...very little.

3) One time, on CT surg, with only five patients in the unit and another 13 on the floor, three whole hours of un-interrupted sleep.

So, to reiterate. Not a whole hell of a lot. In some ways, call is best when you're so crazy that you don't even realize you're running on fumes until the next day when you crawl into bed. The slow trickle of semi-important pages is the worst pain of all.

 

[glorytaker]

General surgery intern at a busy, high volume academic program...

1) At our county hospital...none. Ever. Well maybe 30 minutes once with two interrupting pages.

2) At the U...when I was cross covering gen surg...very little.

3) One time, on CT surg, with only five patients in the unit and another 13 on the floor, three whole hours of un-interrupted sleep.

So, to reiterate. Not a whole hell of a lot. In some ways, call is best when you're so crazy that you don't even realize you're running on fumes until the next day when you crawl into bed. The slow trickle of semi-important pages is the worst pain of all.

Thanks! However, I should have mentioned I'm going into Internal Med and not surgery, which I think is way more intense. I was thinking more like on a regular medicine call, ICU call, or Cardio call night.

 

[southerndoc]

Thanks! However, I should have mentioned I'm going into Internal Med and not surgery, which I think is way more intense. I was thinking more like on a regular medicine call, ICU call, or Cardio call night.

More intense in some places, yes. It really varies by institution. Surgery is more controlling of their patients, and therefore more likely to get called. Medicine usually covers more patients.

 

[blue2000]

More intense in some places, yes. It really varies by institution. Surgery is more controlling of their patients, and therefore more likely to get called. Medicine usually covers more patients.

I think institutional variation is key. One time on ortho I cross covered 125 patients; admittedly the nature of ortho is that they are not sick (and if they get sick, they get covered by medicine) but surgery can cross cover as many (or often more) patients than medicine does at my institution. I think this is a question that is difficult to answer in generalities, and is a good question for the residents when you interview different places.

In a weird way, call can be a blast, especially if you like your team and are seeing neat things. It can also hurt you real, real bad.

 

[2ndyear]

A lot of institutional and service dependent variation. I did a transitional year so I had call within different teams. For me:
Medicine: Covered half of the whole service at night, big hospital with two interns on, we split it up by location. Calls all night about everything from BP, fever, rapid A-fib. Eventually you get a hold of what you need to see and what gets a phone order. I learned pretty quickly that it's better to just see the patient a lot of the time rather than calling something to the nurse. A couple of morning reports where you present the patient that you got called on all night for hypotension that kinda responded to fluid boluses, only to get burnt on either an MI or developing sepsis will kill you. Admissions were capped at 5, best to get them done early but more than likely 3 am was spent admittiing in the ER.

Peds: I did it in the summer. Not too bad. Winter is another story. The resident carried the heme-onc beeper and that was crazy all night long. A few late night admissions, but most kids sleep pretty well and unless they're really sick the nurses don't like to wake them up either.

Surgery: Covered a lot of patients = lots of floor calls. Mostly medicine type stuff as these are still sick patients. They still have MI's, throw emboli to their pulmonary vasculature, etc. Consults in the ER were hit or miss some nights. Going to the OR was fun at night because the residents would pass some cases (OK, mostly appy's) to me as an intern (who wasn't going into surgery). Cool. Then the next morning it was more fun to round on 15 surgical patients and go home by 9 than rounding on 5 medicine patients and hurrying to get out by 1 pm. Bowel sounds +, VSS, AF

ICU: I did a few months of unit time and I learned a trick early on from a senior resident. Set your alarm for a few random times at night, say 10 pm, midnight, and 2 or 3 am. Get up and make brief rounds (quick walkby) on the patients. Ask every nurse present what is going on with the patients, any issues, etc. Really saves on the calls that wake you up that way.

 

[DOtobe]

I'm an FP intern in a ~200-bed hospital. We have a night float system so our only overnight calls are on Friday and Saturday nights. We are assigned to cover either the units (~ 50 beds) or the regular floors (~150 beds). We are the only residents in the hospital, so we get all the cross cover and do all the admissions. We try to trade pagers for a while overnight so we can sleep at least for an hour or two. On night float, however, the intern covers the whole hospital's cross cover and does admissions, so there is almost no sleep. I was lucky if I got a half an hour of sleep when I was on night float.

 

[karbouzie]

I always wonder how u guys can keep it up and not get enough sleep, coffee doesnt work for everyone and eventually ur body gets used to it so its not so effective.... don't mean to offend anyone, but are there other "ways" used to stay up? rn't pple more likely to make mistakes if haven't got enough sleep? and someon'e health and life depends on u?

 

[mackie]

Int Med . . . a few times I've gotten 5 straight hours (very few times). Most of the time it's more like 30 minutes to 2 hours.

 

[fourthyearmed]

Peds intern - Most nights if I'm lucky I'll get to lay down and maybe sleep 20-30 minutes without a page or having to get up. On a good night, might lie down 2-3 hours total although not necessarily asleep due to answering pages. On a bad night, no sleep! Bad nights with no sleep are usually due to lots of admissions because a lot of cross cover can be done from the bed (yes they can have tylenol or mylicon or diaper cream or whatever).

 

[3dtp]

I always wonder how u guys can keep it up and not get enough sleep, coffee doesnt work for everyone and eventually ur body gets used to it so its not so effective.... don't mean to offend anyone, but are there other "ways" used to stay up? rn't pple more likely to make mistakes if haven't got enough sleep? and someon'e health and life depends on u?

And that is really the issue, isn't it?

You are 100% correct and there are studies going back to the 1890s that demonstrate this. You are more likely to make mistakes, you are more likely to be irritable and less likely to remember what you didn't do. The effects of acute fatigue are worrisome, acute on chronic fatigue more so.

Coffee doesn't work for anyone, beyond a certain point. The ACGME has info on their web site on this.

Two programs I know about in IM
1. Two interns split the night. One covers admits between 5P-M, the second between M-7. You are guaranteed at least 4-5 hours in that program. You went home at 1 post call.

2. Two interns cover all night from 4 P - 8 A. No one sleeps not even a wink. This program kept post call residents there "until the work was done." This usually meant 40 hours on duty. This program also worked its residents around 110 hours per week.

An OBG program with night float:
Call was every other weekend and you ran from 6 A Friday - 7 A, Sat and 7A Sun - 7P Sun. OR 7A Sat - 7 A Sun. You didn't sleep, but it worked very well. The golden weekends allowed you to relax completely, get a lot of study done and have time to enjoy life. The program worked you steady 80 hours, but was religious about following the rules.

Oh, and PDs won't tell people at interviews if they're gonna follow the rules. I think that everyone should ask their prospective programs for the names/numbers of a couple of residents who are recent grads of a program who took jobs outside of the local community (where they're not dependent on the program's hospital for privileges or referrals) for reference checks. You can be the programs will read your letters of ref, so turnabout is fair!

 

[Orange Julius]

Oh, and PDs won't tell people at interviews if they're gonna follow the rules.

On the contrary. ALL PDs tell you they're going to follow the rules.



Unfortunately, most of them are FOS. 🙁

 

[karbouzie]

Coffee doesn't work for anyone, beyond a certain point. The ACGME has info on their web site on this.

oright, this other question might make some laugh and others get offended but im really curious... i came across a survey done by university of Michigan about 7% of students using ADD medication for non-medical reasons.... i never met undergrads doing it but i guess not many admit it.... im wondering if some med students and residents would try this in order to stay focused and concentrate on their work while staying up loooooong hours....

 

[karbouzie]

Coffee doesn't work for anyone, beyond a certain point. The ACGME has info on their web site on this.

oright, this other question might make some laugh and others get offended but im really curious... i came across a survey done by university of Michigan about 7% of students using ADD medication for non-medical reasons.... i never met undergrads doing it but i guess not many admit it.... im wondering if some med students and residents would try this in order to stay focused and concentrate on their work while staying up loooooong hours.... 😴

 

[karbouzie]

oooops sorry i posted twice 😛 ... apparantly i should get some sleep

 

[Pir8DeacDoc]

is it hard to imagine the answer to that question?


Personally never gone that way but know of classmates that had gone the ritalin route and others that have gone the white powder route. Some people can't realize that doing well isn't that important.

 

[avgjoe]

oright, this other question might make some laugh and others get offended but im really curious... i came across a survey done by university of Michigan about 7% of students using ADD medication for non-medical reasons.... i never met undergrads doing it but i guess not many admit it.... im wondering if some med students and residents would try this in order to stay focused and concentrate on their work while staying up loooooong hours....

of course people are trying this.. i'm a totally straight-up, never tried anything type and it has crossed my mind a time or two (not seriously yet but one never knows!)

btw, i saw a study that said that residents post-call were equivalent to those who had 3+ drinks in their system.

 

[Furrball2]

Call and sleep: in IM
On gen med once got 2 hours, but nothing to 30 min more typical. We cap every night and 11:3- PM ED diuresis with three patient's to each intern is murder. Each intern X-covers up to three or five other intern / residents pagers. X-cover can be very ugly.

MICU: depends if the gremlins are out. One night I slept three hours. Most nights nothing when the patients were having fun coding / dropping pressure simultanelously.

VA-Spa: when you spend 5 hours drawing your own labs on cross cover not much sleep obtained.

Sub-specialty services: probably 1 hour. But when the BMTrs are sick....

 

[DrBloodmoney]

Pathology:

Home call for a week at a time.

Sleep all 6-8 hours with usually one call per night between 12a and 7a lasting for about 5-15 minutes. Haven't ever slept at the hospital. It's nice.

 

[Uzr]

Bumping old thread from 2006...would love to know more about this now. Have certain hospitals/schools changed things so that students are able to get more sleep while on call or is it the same?

 

[Reaganite]

radonc...home call, sleep a good 6-8 hours...

Hell yeah, did only one after hours case my entire residency 🙂

 

[Law2Doc]

Bumping old thread from 2006...would love to know more about this now. Have certain hospitals/schools changed things so that students are able to get more sleep while on call or is it the same?

There are no uniform rules that apply to "students", but that isn't who this thread is about. Med schools can set whatever rules for students they want, or have no rules whatsoever. in terms of residents, the ACGME has adjusted duty hours at least twice since this thread started. Do a google search for ACGME and "duty hours" for the specifics. These days instead of the prior 30 hour shifts some of us worked, many people are on for long strings of 13 hour night float shifts, 6 days a week for up to months at a time.

And guess what, there has been no evidence that errors have decreased.

 

[Bostonredsox]

The only that has changed with hotter residency hours is post shift car accidents. By due said if it was up to him we'd work 100 hours per week and he'd bus us to the hospital on their dime.

One other thing has changed with less hours. Competency. Less hours, less patients, less exposure, weaker skill sets.

 

[Law2Doc]

The only that has changed with hotter residency hours is post shift car accidents. By due said if it was up to him we'd work 100 hours per week and he'd bus us to the hospital on their dime.

One other thing has changed with less hours. Competency. Less hours, less patients, less exposure, weaker skill sets.

...And lots of didactic conferences nixed because of hour limitations. Less education generally.

And honestly, after a long stretch of many days of night float are you really less tired? I think this was a huge loss for patients. Sounded good on paper, seemed to make intuitive sense to people who never worked a 30 hour shift, but didn't translate to real life.

 

[Daiphon]

The only that has changed with hotter residency hours is post shift car accidents. By due said if it was up to him we'd work 100 hours per week and he'd bus us to the hospital on their dime.

One other thing has changed with less hours. Competency. Less hours, less patients, less exposure, weaker skill sets.

Yep.

http://www.ncbi.nlm.nih.gov/pubmed/23529771/?

http://www.ncbi.nlm.nih.gov/pubmed/23529502

I wonder how many more nails need to be put in this coffin... bad policy begets bad delivery of care. Blech.

Sent from my DROID BIONIC using Tapatalk

 

[survivordo]

As others have said, it clearly varies by what program you're in. But here is a pro-tip for sleeping while on call - if you sleep on your side/stomach then attach your beeper to the V-neck of your scrubs. This makes it easy to find (as opposed to placing it on the table beside you) and before I started doing this I woke up more than once after having rolled over onto it and shut it off/missed pages.

Survivor DO

 

[cabinbuilder]

I trained at a small hospital and after few calls I got into a system with the nurses.

I would round early in the evening to each floor and take care of any potential stupid, irritation calls (like tylenol for a fever, etc) before laying down. We came to an understanding that MN to 4am was off limits so I could get at least 4 hours of sleep in a row. Once I had that, I'm good to go. My perspective was a little different since I had already gone through having babies and being up all night nursing, etc and going to work the next day. Call was a piece of cake compared to newborn life.

Of course admissions from the ER is a different entity but even then I tried to anticipate and be pro-active on potential admits. Usually by 11pm the ER doc would know if anyone was brewing as a potential admit and I tried at least to get basic orders written prior to laying down.

But we had a small program, covered about 60 beds (not responsible for OB) total so it was very manageable. Of course the nurses have to like you in order to get their co-operation.

I slept with my beeper and my phone. I slept with my phone the whole year I was chief in case one of my interns needed help because the attendings never came in.

 

[Law2Doc]

I trained at a small hospital and after few calls I got into a system with the nurses.

I would round early in the evening to each floor and take care of any potential stupid, irritation calls (like tylenol for a fever, etc) before laying down. We came to an understanding that MN to 4am was off limits so I could get at least 4 hours of sleep in a row. Once I had that, I'm good to go. My perspective was a little different since I had already gone through having babies and being up all night nursing, etc and going to work the next day. Call was a piece of cake compared to newborn life.

Of course admissions from the ER is a different entity but even then I tried to anticipate and be pro-active on potential admits. Usually by 11pm the ER doc would know if anyone was brewing as a potential admit and I tried at least to get basic orders written prior to laying down.

But we had a small program, covered about 60 beds (not responsible for OB) total so it was very manageable. Of course the nurses have to like you in order to get their co-operation.

I slept with my beeper and my phone. I slept with my phone the whole year I was chief in case one of my interns needed help because the attendings never came in.

That only works if it's a small place and you are only carrying one beeper. You don't have time to make friends with nurses all over the hospital every call. Plus I've been at a hospital that decided that 2am is a nice quiet time for nurses to meet and reconcile all the orders for the day, so they end up having to call the on call doctor at 2-3 every night to get details on things that were (mis)ordered 12 hours ago by someone else on your team. Some non physician administrator somewhere figured this was a more efficient and less disruptive time for this than trying to do this in real time during the day. Not as big a deal now that it's night float and you are expected to sleep in the daytime, but back in the days of 30 hour calls, this was evil.

 

[nlax30]

In a community based IM program. On nights and weekends it's one senior and 2 interns on, covering usually 40-60 floor patients and probably around a dozen unit patients.

These days if I get any sleep it's a good night, most I've had us maybe 3-4 hours. Recently they've started making the senior carry the admit pager so I'll still get paged by the ER and that's variable.

We just recently transitioned to full EMR with documentation and electronic order entry so helping with that aspect of things is keeping me up as well.

 

[cabinbuilder]

That only works if it's a small place and you are only carrying one beeper. You don't have time to make friends with nurses all over the hospital every call. Plus I've been at a hospital that decided that 2am is a nice quiet time for nurses to meet and reconcile all the orders for the day, so they end up having to call the on call doctor at 2-3 every night to get details on things that were (mis)ordered 12 hours ago by someone else on your team. Some non physician administrator somewhere figured this was a more efficient and less disruptive time for this than trying to do this in real time during the day. Not as big a deal now that it's night float and you are expected to sleep in the daytime, but back in the days of 30 hour calls, this was evil.

Very true. I was the only one carrying a beeper. Plus all the nurses LOVED my husband (CNA) so they worked with me for him. It's all about networking.