Importance of Night Float??

[regulator2000]

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My friend has suggested me to only apply to IM programs with NIGHT FLOAT, as it makes the residents life much easier, and a person can actually have a bit of a social life.
is that true? Is night float very beneficial??

 

[elwademd]

My friend has suggested me to only apply to IM programs with NIGHT FLOAT, as it makes the residents life much easier, and a person can actually have a bit of a social life.
is that true? Is night float very beneficial??

http://drslounge.studentdoctor.net/showthread.php?t=427424

i think having someone come in from 9-12 hours (different programs have a different length of "night float") to relieve you makes a big difference. it may allow you enough time to rest that night, so that the next day you can spend time at the gym/with your significant other/go to the movies/walk your dog/something else that you may desire to do when not so wrapped up in residency.

it also allows someone to come in fresh to take care of patients, so you can think of the benefit as twofold- for the residents and the patients.

 

[VCMM414]

it also allows someone to come in fresh to take care of patients, so you can think of the benefit as twofold- for the residents and the patients.

To play devil's advocate a bit, the nightfloat system also increases the number of hand-offs in patient care, which is expected to have an adverse effect in patient outcome. Having someone fresh but less familiar with the patients is not necessarily the better solution.

 

[Venus21pam]

To play devil's advocate a bit, the nightfloat system also increases the number of hand-offs in patient care, which is expected to have an adverse effect in patient outcome. Having someone fresh but less familiar with the patients is not necessarily the better solution.

I totally agree. We have night float in my hospital but all of us hate it.
We would rather be overnight q4 than be q4 until 10-11pm and be relieved by night float and here is why:
1) it increases number of sign-outs and we don't know patients well enough
2) we usually end up staying way longer than the scheduled 10pm relief by night float d/t patient issues on the floors, still working on the admitions that came in late, finishing our dictations etc. etc. we then show up in am after few hours of sleep and have a whole day of work ahead of us (like 10-11h) so we're exhausted
3) because night float interns admit every night we have tons of new patients in am that need to be picked up by day shift because night float doesn't follow any of them - again more sign-outs, we don't know the patients as well because they were admitted by someone else and so on and so on
4) the night float person usually doesn't get out until 11 or so because the attendings want to round on all new pt in am WITH the admitting intern and that of course takes forever (because am is the first time that the attending hears about the overnight admitions)
5) if we had the night float intern join the day team we would have an extra person to help out and the post call person would always get out by noon
AND we would have more continuity and learn more rather than just do scut trying to discharge as many as we can so we can admit max number each day - it should be more about learning and patient safety then maximum speed and volume

Just my 2 cents...

 

[deleted4401]

The hand-off issue is a big problem, I agree. Yet, if the errors made with a night-float system equal the errors made in a traditional system (which is probably the case, no hard data on it yet), then at least with night float, sleep is preserved for more hours x more people.

In any case, I like the idea of "utility men**" rather than night float. I think q4 overnight is a better way to go for inpatient months, but the key is to get them out post-call after 28-30 hours. Utility men may be assigned to come in for 11a to 11p shifts. They handle any post call work (all overnight people MUST go home at 12p, no questions no arguments) and then after that, depending on the hospital layout either 1) admit those that the call team cannot 2) work in the ED 3) cover clinic for post-call 4) be available for jeopardy until 11pm or a combination of the above. Saturdays and Sundays off, so a medium difficulty month, but with lots of variety.

That's one idea.

** men may be substituted by women in all circumstances

 

[angel80]

I interviewed at many hosptals that had tried the night float system and went back to traditional calls for various reasons (mostly because of persistently violating the rule that you must be off duty for 10 hours before you can come back to work-which doesn't work if you leave the hospital at 10pm). In my program, we are Q5 overnight call. We take call as a team. When we are post-call there is a "day float" team that you sign out to at noon that takes care of any work that you weren't able to get done. Also, I can't stand taking over a case that someone admitted the night before. I would much rather admit my own patients. Most of the time, in a night float system, you have to stay later when you are not all call. In our system, you usually leave between 3-5pm when you are not on call or post call. In the end, the hours work out to being about the same. I end up averaging between 60-70 hours per week.

 

[regulator2000]

anything elsee??🙂

 

[lushmd]

I don't know how common it is, but at my medical school they use what might be best described as a hybrid system. Specifically, on floor months residents have Q5 call. Call is taken as a team, with three teams on call any given night (generally, they go round robin until ~11 PM and then each team takes a 3 hr shift during which time they handle the admits, the idea being to allow people to get at least some rest; there is no cap on admits that I am aware of, but the team as a whole generally caps at 15-16 pts). In addition to the call teams, there are also night float residents (I don't recall how many people are on night flight any given night) that cover the teams whose residents are not on call that night. From a med student perspective, this system seemed to work pretty well in that you generally admitted all of the pts on your team, when on call your main responsibilities are admissions and tending to your pts, and when not on call your pts were being cared for by the same night float residents night after night.

BTW, although I think that the system worked well, rest assured that those guys busted their @sses...just the nature of the program/pt population.

 

[regulator2000]

what is Q5, 4???

 

[lushmd]

what is Q5, 4???

Q4 Call: every 4th night
Q5 Call: every 5th night

 

[irish79]

This is how it works at UMass University hospital:

As an intern, we admit 2 patients per day from 7:00am to 5:30pm. Every 4th day we are called "late stay" and on this day, we do admissions from 5:30pm-7:00pm. At 5:30, unless you are late stay, you sign out to the nightfloat intern who covers all housestaff patients from 5:30pm-7:30am. He/she is only responsible for managing patients on the floor over night and does not do admissions. The nightfloat RESIDENT is the one who does the admissions overnight. In the morning, each of the interns is assigned one of the admissions which was worked up from over night and this goes towards your total of 2 admissions for that day. This leaves you with one admission sometime during the day to work up and admit. On weekends, we have a possible 3 admissions/intern since we have more time (no rounding on weekends). I think this works pretty well, as I get ample exposure to the treatment and management of patients without over night call (unless you are nightfloat which is more like shift work: 3 days at University, 3 days at Memorial, 3 days off). I have yet to do nightfloat, so maybe I'll hate it after that! I know for now I am enjoying it much more than q4 in medical school.

 

[2008md]

This is how it works at UMass University hospital:

As an intern, we admit 2 patients per day from 7:00am to 5:30pm. Every 4th day we are called "late stay" and on this day, we do admissions from 5:30pm-7:00pm. At 5:30, unless you are late stay, you sign out to the nightfloat intern who covers all housestaff patients from 5:30pm-7:30am. He/she is only responsible for managing patients on the floor over night and does not do admissions. The nightfloat RESIDENT is the one who does the admissions overnight. In the morning, each of the interns is assigned one of the admissions which was worked up from over night and this goes towards your total of 2 admissions for that day. This leaves you with one admission sometime during the day to work up and admit. On weekends, we have a possible 3 admissions/intern since we have more time (no rounding on weekends). I think this works pretty well, as I get ample exposure to the treatment and management of patients without over night call (unless you are nightfloat which is more like shift work: 3 days at University, 3 days at Memorial, 3 days off). I have yet to do nightfloat, so maybe I'll hate it after that! I know for now I am enjoying it much more than q4 in medical school.

This sounds like a great system. How long has UMass been doing this? Are there any other programs with this particular type of system?