Intern admission caps and patient loads

[pediatdabeach]

Hey folks....
I'm a second year at Miami Children's. I want to get a feel for intern admission rates and patient loads at other programs.

• What is the average admissions your interns get per call?
• If your program has a cap, how does it work?
• How many patients do your interns carry on average and do you have a cap?

Thanks so much for any responses.

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[pedinchucktown]

I'm a second year in Charleston, SC at MUSC peds and we're looking into the same thing. Currently we have two interns and one upper level on the wards overnight (upper level is night float). One intern covers general peds, the other covers heme/onc and cardiology kids. The children's hospital is often at max capacity (at least my pager leads me to believe so), although the frequency of that is seasonal. Admission rates, also, are seasonal. We have no caps as of now, but we have committee looking into the possibility. In general most nights have around 8 admissions, but almost everyone experiences a 12-15 admission night. It is a team effort between intern and upper level, but with the night float system, the intern will be rounding on all of them in the morning, so usually it is in the best interest of the intern and patient to have the intern see all of them. Heme/Onc and cards together will have maybe 4 admissions per night, most of them sickle cell or fever with leukopenia. Of course, none of this includes the ICU's (PICU, NICU, PCICU).

How about you?

 

[PalmTreeDreamer]

Resurrecting a dead thread here. Does anybody have any patient caps for interns on floor service? Trying to get a comparison from different programs. No need to state your program if you aren't comfortable, just what your cap is if you have one. Thanks in advance!

 

[mvenus929]

We do not have specific caps. Our interns can see anywhere from 0 to 20 patients on any given day, though we tend to recognize that the ability for the interns to actually pay attention to and manage the details of 20 patients is difficult. During the busy months of the year, our hospitalist teams frequently have interns and second years seeing 8-9 patients, and the senior managing up to 20. Our level 2 nursery during the busy months can see as many as 18 babies per intern. It generally hovers around 12-14. If certain services are getting really busy, either the seniors will start seeing patients or they will pull an intern from another service to help out, but there isn't a specific number at which this happens.

Oh, and regarding the questions in the OP--all of the admissions to the hospital have to be overseen by either a second or a third year resident. So interns and students can start the H&P, but the senior still has to go see them and talk to the parents and read over the H&P. So the interns do some admissions, but not most of them.

As far as how many admissions happen--we have 4 main teams in our hospital. One of them primarily gets scheduled admissions, and the number admitted per day usually ranges from 0-5. One rarely gets admissions at all, maybe 2-3 per week. The third gets probably 1-2 admissions per day on average, with a huge flux depending on which attendings are on service (some love to admit everyone, some turn just about everyone away). The final is our hospitalist team, and during the summer, they probably get 2-4 admissions throughout the course of a 24 hour period. During the winter, they can turn over their entire team in a 36 hour period, so the admissions per 12 hour shift are usually somewhere between 4 and 8.

 

[RySerr21]

my program does not have a cap on the number of admissions you can do in a given day. the teams are capped at 20 (two interns two seniors), so each intern on a given day will round on 10 patients. If your team is at 18 but you admit 4, then two kids will go to a different, attending only team. The exception is on the weekends, when teams are at half capacity and there are only a senior and an intern on a team responsible for rounding on that same team with a max of 20. On those cases, obviously the senior helps out the with the progress notes, etc.

On nights, there are two teams (each with a senior and an intern). Average admission night is 5-6 per team. Ive done up to 12 over night (830pm to 7am admittig shift). In a 24 hr shift the avg is probably around 10-12 for a team. The worst ive seen is in the low 20s.

 

[PalmTreeDreamer]

Thank you so much for your responses!