Inpatient rehab coverage

[Atlantic]

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Would any of the residents like to comment on the number of patients they cover on an inpatient service and while on call (including home call)? I'm curious to see what the average is at other programs.

 

[Karaoke]

At NYU, it depends on where you're on call. We
have 6 separate call systems.

At Rusk (overnight call), you cover a maximum
of 75 patients.

On Cardiac (overnight call), max of 25 patients.

At Bellevue (overnight call), max of 50 patients.

At Manhattan VA (home call), max of 8 patients.

At HJD (home call), max of 40 patients.

At Brooklyn VA (home call), zero inpatients.

These numbers may very well change in the
coming months as we explore the possiblities
of combining call coverage. The downside would
be covering more patients during a call. The upside
would be sharply decreasing the number of calls
per month.

 

[axm397]

at RIC - inpatient load varies from about 8 up to 18 per resident.
On call - in-house coverage of the whole building - up to 160 patients including peds.

weekends - 2 "notewriters" that clear patients and do admissions and 1 resident on call Saturday and Sunday.

Weekend admissions range from 0 (very rare) to 10+ per day.

 

[drusso]

Someone will have to post recent numbers, but at Mayo it hovered around 30.

 

[specepic]

Someone will have to post recent numbers, but at Mayo it hovered around 30.

At Mayo, average census has been 4-8 pts/ junior resident during the day, covering about 30 at night (home call) as you said. The PGY-3's are now an 'extra' junior rather than on their own so the teams are often: 2 PGY-2's, 1 Pgy-3, 1-2 PGY-4's per either Spine or Brain. Peds is now divided b/t inpt and outpt and at times 2 res's are assigned inpt. The peds census is usually quite low (0-3), but those residents share the home call and have to do off floor consults (but still a mellow rotation).

On the weekends two residents share the call (one goes from Friday 5 pm until Sat 11pm , the other from then until Monday 7am). They come in each a.m. (sat/sun) and round with an attg, usually out by noon.

 

[ampaphb]

On the weekends two residents share the call (one goes from Friday 5 pm until Sat 11pm , the other from then until Monday 7am). They come in each a.m. (sat/sun) and round with an attg, usually out by noon.

Split weekends are in place at several programs - to me, it just seems like all it accomplishes is to screw up two people's weekend plans, rather than just the one.

 

[topwise]

At Stanford, the individual inpatient census can range from 2-3 patients (rarely) to 17 patients (also, rare). Average is probably 6-12 patients per resident.

On call (home call), you cover 30 to 50 patients, depending on what campus. And there are, unfortunately, after hours and weekend admissions.

 

[SCIronMike]

At UC Irvine, the PGY2 residents have inpatient rotations either at the VA or at UCI. UCI has just opened a brand new rehab unit, but has downsized to 14 beds. Two residents cover this 14 bed service. At the VA, two residents cover the 10 bed service. PGY2s take home call and cover these 24 beds.

The PGY4 residents have inpatient rotations at Long Beach Memorial Hospital. Each of 3 residents covers 20-25 beds. The PGY4 residents take home call and cover these 60-70 beds.

 

[Diamox]

Dalhousie (a small Canadian program)

We cover 60 or so inpatients (home call). 5-6 call per month. Full weekend block from Friday-Monday 0800. No after hours or weekend admissions.

All of the inpatient services have 11-12 patients per 1 resident and we do 2-3 clinics per week during all inpatient rotations. Occasionally, we have to cover for other staff and deal with 22-24 patients for a week or so.

I'd be interested to hear if others do this mix of in and outpatients.

 

[olafa]

at RIC - inpatient load varies from about 8 up to 18 per resident.
On call - in-house coverage of the whole building - up to 160 patients including peds.

weekends - 2 "notewriters" that clear patients and do admissions and 1 resident on call Saturday and Sunday.

Weekend admissions range from 0 (very rare) to 10+ per day.

to clarify- do the 2 notewriters write notes on all 160 potential patients? Sounds like writers cramp to me?

 

[axm397]

we have 4 attendings who round on the patients (peds attending + 3 adult inpt attendings) - they usually do all the notewriting. The notes are computerized so no handwriting.

the notewriters usually clear the patients in the morning and do the admissions. the resident on call may round with one of the attendings and help them write notes. each attending writes about 30-40 notes.

 

[dc2md]

each attending writes about 30-40 notes.

come on! 30-40 notes per day. i don't care if they are computerized, that's nuts. i mean just to see the patients and address all the issues they're having and adjust meds and write other orders would take all day for 30-40 patients.

hey axm, post an example of a daily patient note...yes of course omitting all patient identifiers (HIPAA HIPAA HIPAA).

okay, as for LSU, we are at one hospital (not stand-alone). we have 3 teams and a consult team. one team is SCI, stroke, and ortho only. the other two teams are TBI mostly with a little SCI/stroke/ortho. each team usually has a max of 13 patients (11-13 average). one resident and one attending per team. each resident is on home-call for their 13 patients Monday at 7am to Friday at 5pm. each resident is then on weekend call once a month. this includes coming in a writing about half the notes (the attending on for that weekend write the other half). and that residents takes home-call for all 40ish patients for the weekend. oh, and no admits on the weekend.

 

[Finally M3]

Michigan: On service, the most I've had was 15 patients. On call (home call), maximum would be around 40. No call PGY4

Weekends, 2 residents plus one attending rounds on all the patients, notes are split between the residents. Computerized notes.

 

[Diamox]

Bump

What about the U of Cincinnati program? Anyone have the details?

 

[OMMFellow06]

At Baylor/UT Houston it varies depending on the call pool

As a PGY2 we do home call
pool 1 - roughly 60 patients
pool 2 - roughtly 40 patients

As a PGY3 in house call covering roughly 100 patients

As far as how many patients per resident on the service varies quite a bit from hospital to hospital and service to service.

 

[Atlantic]

Any updates for on-call census at different programs? I'm assuming these are all for acute rehab...please specify if your program also covers skilled nursing or long term acute care. Thanks!

 

[ShrikeMD]

we have 4 attendings who round on the patients (peds attending + 3 adult inpt attendings) - they usually do all the notewriting. The notes are computerized so no handwriting.

the notewriters usually clear the patients in the morning and do the admissions. the resident on call may round with one of the attendings and help them write notes. each attending writes about 30-40 notes.

Y'all admit on weekends? Who determines the suitability for a weekend admit?

 

[axm397]

Y'all admit on weekends? Who determines the suitability for a weekend admit?

the weekend admissions are pre-screened on Friday - usually they are ortho patients on a "track" - usually gets to rehab post op day #3 and other cleared patients waiting for a bed to open up.

The weekend "notewriting" residents go to Northwestern (where most admissions come from) and "clear" the patients for transfer in the morning one last time. There are 3 attendings + peds attending on every weekend and 2 notewriting and 1 call resident for each day on every weekend.