Intern PPH

[iish]

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At the start of intern year, what is considered an acceptable PPH. I'm at about 0.5 right now and feeling sometimes like there is too much on my plate. At the end of my shift when I think about what interventions these patients actually required, I don't know what I even did with my time, but it feels like I'm constantly doing something. This is about 1-2 weeks into intern year. What is an acceptable PPH at the end of intern yr?

 

[JacobMcCandles]

At the start of intern year, what is considered an acceptable PPH. I'm at about 0.5 right now and feeling sometimes like there is too much on my plate. At the end of my shift when I think about what interventions these patients actually required, I don't know what I even did with my time, but it feels like I'm constantly doing something. This is about 1-2 weeks into intern year. What is an acceptable PPH at the end of intern yr?

As an intern, you aren't the one responsible for moving the department. Your responsibility should lie in learning. Don't grade yourself on how many patients you see, grade yourself on what you're learning.

 

[iish]

As an intern, you aren't the one responsible for moving the department. Your responsibility should lie in learning. Don't grade yourself on how many patients you see, grade yourself on what you're learning.

I agree completely and while I'm not concerned about moving the department, I don't want to be seen as lazy by my seniors and attendings

 

[NERDY]

I remember reading some where at the end of PGY 1, you should be at 1 pph so you are doing fine. You probably are learning a new hospital, computer system, etc. Speed will come with time.

 

[OccupyTheED]

PPH should NOT be a concern at this point. Learn Emergency Medicine. Period. Speed comes with time and increasing your fund of knowledge. Do a good job for the few patients that you're seeing and don't try to overwhelm yourself too soon.

 

[gro2001]

Also PPH is so system dependent that no one except residents at your program can answer that question. Hospital systems can vary so widely in efficiency as well as set up, (ie: are you seeing all levels of acuity, are the lowest acuity patients filtered out by RME type areas, are the sickest patients filtered out by crit care type areas, are there nursing protocols, does a senior resident put in orders before the junior sees the patients, etc) it can easily change you average PPH by a factor of 2 or more.

 

[e30ftw]

What is an acceptable PPH at the end of intern yr?

I'm a new PGY-2 and yesterday saw 23 patients in a 10 hour shift. So that's basically at the end of intern year..

a lot of those where easy dispos although my admit rate was around ~30% for the shift.

You're in your orientation month. Just try to learn the computer system and how to order meds, chart, dispo, call consultants, etc.. expectations are low now.. by your 3rd or so ED month you should be seeing 1 pt /hr at least..

 

[Rendar5]

I'm a new PGY-2 and yesterday saw 23 patients in a 10 hour shift. So that's basically at the end of intern year..

a lot of those where easy dispos although my admit rate was around ~30% for the shift.

You're in your orientation month. Just try to learn the computer system and how to order meds, chart, dispo, call consultants, etc.. expectations are low now.. by your 3rd or so ED month you should be seeing 1 pt /hr at least..

Don't scare the kid, that seems an outlier in the realm of EM. at the end of my 3rd year, there was still no one who would even approach 2pph except for one of our two chiefs. very hospital dependent. but yeah, by the end of intern year 1pph is acceptable and pretty common across the board.

 

[DoctorTinyCat]

An attending at my program said that for your first 3 months in the ED, they expect about 0.5pph. You should focus on doing whatever you're doing well rather than doing it quickly. They said that at the end of intern year, they expect 1pph. Of course it depends on the acuity of your shop, but I think those are pretty reasonable guidelines.

 

[EM2BE]

Our PD wants us seeing 2pph by the end of intern year. If you aren't, you get talked to. I know this is also an outlier because other places don't have these standards from what I've seen.

 

[deleted547339]

Our PD wants us seeing 2pph by the end of intern year. If you aren't, you get talked to. I know this is also an outlier because other places don't have these standards from what I've seen.

Whoa.....where do you go? (Please don't be my program. Please don't be my program) Feel free to PM if you don't feel comfortable putting it up on here.....of don't PM if you're not comfortable with that either, lol.

 

[Iride]

To the OP- I completely agree with you and feel the exact same way.... I am right at about .5 pph and feel like im somehow busy the whole time.... Im thinking we will pick it up as we go though! Best of luck!

 

[deleted109597]

It depends on a lot. Specifically, how is your department laid out, how many residents are working at any time, etc.
If all the other interns are seeing 0.5 pph, you're fine. If all you see are the high acuity patients who get big workups and get admitted, it's probably ok.
If you're working fast track, it's probably not ok.

Yes, right now you need to learn the medicine, but you also need to learn good habits at the same time. Efficiency doesn't mean speed. You can gain speed after you learn the medicine. It's tougher to gain efficiency. Once you're able to keep track of all of it in your head or on your list, carrying 10 patients at a time can be done. But the efficiency is what is key.

Every program should (but doesn't) give you a list of the pph of each person in your class and the classes ahead of you. Not at the end of the first month, but twice a year at your bi-annual review. Keep it anonymous, but you should know your speed and the speed of everyone else, as well as an average. Sure, half will be below average. But if you're an outlier, you should seek out help in what you're lacking.
If anything, we do an incredibly poor job of giving constructive criticism of residents. Speed, while not important as an intern, is very important at your community job. You can learn in residency while you've got a safety net, or you can learn as an attending and don't.

 

[EM2BE]

Whoa.....where do you go? (Please don't be my program. Please don't be my program) Feel free to PM if you don't feel comfortable putting it up on here.....of don't PM if you're not comfortable with that either, lol.

Trust me, from what I've seen on your old posts, you are safe.

 

[Mechanic]

15-16 room pods. Each pod has an upper (pgy 2 or 3) and a intern. Intern expected to hold 3-4 of those rooms at a time. No or rare standing orders initiated. Electronic charting.

Interns expected to see new pgy 1 expected >1pph (our slowest one was 1, but most started off 1.3, 1.4)
New pgy-2 >2 pph

So agreed depends on your shop. I remember trying to find these type of threads, but you can't rely. If I saw 0.5 I'd get a talk to. I remember reading on here that the ACEP expected for an attending was 2.5pph (does anyone know where this # came from?), but I remember bringing that up to an attending once and he burst out laughing basically saying that pph would not keep you employed very long.

 

[gro2001]

15-16 room pods. Each pod has an upper (pgy 2 or 3) and a intern. Intern expected to hold 3-4 of those rooms at a time. No or rare standing orders initiated. Electronic charting.

Interns expected to see new pgy 1 expected >1pph (our slowest one was 1, but most started off 1.3, 1.4)
New pgy-2 >2 pph

So agreed depends on your shop. I remember trying to find these type of threads, but you can't rely. If I saw 0.5 I'd get a talk to. I remember reading on here that the ACEP expected for an attending was 2.5pph (does anyone know where this # came from?), but I remember bringing that up to an attending once and he burst out laughing basically saying that pph would not keep you employed very long.

It's also very shop dependent for attendings. From talking to attendings that work or have worked in very different parts of the country it seems that for the same attending it can vary from being very difficult to see 2 pph at a dysfunctional county facility to easily seeing 4-5 pph at a well run community hospital with nursing protocols and scribes, etc. Once again, the only comparison you can make is to others working at your ER in the same year.

 

[Daiphon]

15-16 room pods. Each pod has an upper (pgy 2 or 3) and a intern. Intern expected to hold 3-4 of those rooms at a time. No or rare standing orders initiated. Electronic charting.

Interns expected to see new pgy 1 expected >1pph (our slowest one was 1, but most started off 1.3, 1.4)
New pgy-2 >2 pph

So agreed depends on your shop. I remember trying to find these type of threads, but you can't rely. If I saw 0.5 I'd get a talk to. I remember reading on here that the ACEP expected for an attending was 2.5pph (does anyone know where this # came from?), but I remember bringing that up to an attending once and he burst out laughing basically saying that pph would not keep you employed very long.

The 2.5 comes, roughly, from averaging your level 1-5 billing (and thus, in an imperfect way, your patient complexity) thus "paying" for yourself in the hospital's eyes... hospitals look at your salary as an advance of sorts, expecting your billing to cover itself whilst they make a killing on "facilities charges" & the like.

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[jwwrig1]

My first shift as an intern last year I saw 13 in 12 hr shift and have never seen less than that unless it was a really slow night shift. Now as a PGY-2, I've hit >2pph every shift so far. I would say this is the norm for my residency with some seeing more.

 

[deleted547339]

My first shift as an intern last year I saw 13 in 12 hr shift and have never seen less than that unless it was a really slow night shift. Now as a PGY-2, I've hit >2pph every shift so far. I would say this is the norm for my residency with some seeing more.

Holy cow. I saw 9 pt in a 12 hour shift this weekend and was pretty proud of myself. I could have probably done 1 more in the beginning of the shift as it was slow in the morning. Most were sick, had to put a line in one patient. Are you doing everything (orders/charting/procedures/writing scripts) yourself? Do you have any NPs/PAs to see the fast track-type stuff? Also, I'm assuming you're using some kind of EMR, right?

 

[e30ftw]

I wouldn't really sweat it since it's still July and technically orientation month for most EDs. once you know the system you will see more. if you see <1pph in a few months I would just wonder wtf you are talking about with these patients but now it's to be expected.

I'll just re echo I saw >1.5 pph for most of intern year and every shift of pgy2 so far have seen >2pph other than today which was totally awesome and i only saw 16 in 9hrs and just sat around shooting the $h!t all day feeling lazy.

 

[JacobMcCandles]

I'll just re echo I saw >1.5 pph for most of intern year and every shift of pgy2 so far have seen >2pph other than today which was totally awesome and i only saw 16 in 9hrs and just sat around shooting the $h!t all day feeling lazy.

I'll just re-echo that this isn't the norm for most places for intern year. Depending on how the intern functions in a given department, I don't think most departments are set up to where an intern can routinely see >1.5pph.

 

[namethatsmell]

Also depends if you need to run everything by an upper year/attending and if you're required to finish charting you patients before taking another couple on.

Our program has new interns (like myself) run almost everything by a senior or an attending for the first couple of months. Waiting to present a patient slows me way down, but it leads to great teaching so I think it's more than worth it.

I've averaged around 0.8-1 pph this month. Exception being I just worked a shift with an attending who kept handing me a new chart or two immediately after I presented...I saw 14 pts (3 of whom ended up going to the unit) in 8 hours...my head was spinning (and I had to stay an extra hour to finish up charting), but it was a good preview of things to come.

 

[namethatsmell]

Also, anybody else noticing that they're getting stuck in tangential conversations with patients/families? ie: "Oh wait new intern, before you leave I just need to tell you about about every bowel movement I've had in the last 3 weeks."

I feel like every 2nd or 3rd patient I end up getting stuck in the room for 15+ minutes due to stuff like this...and it kills me.

 

[ensuii]

Also, anybody else noticing that they're getting stuck in tangential conversations with patients/families? ie: "Oh wait new intern, before you leave I just need to tell you about about every bowel movement I've had in the last 3 weeks."

I feel like every 2nd or 3rd patient I end up getting stuck in the room for 15+ minutes due to stuff like this...and it kills me.

Just interject ("So I'm thinking our plan is going to be...k?") and leave

 

[EM2BE]

You will quickly learn how to cut people off when they are on tangents. You have to or you will never get around to seeing other patients. One reason nursing home demented patients can be my favorite type of patient (they don't talk, or repeat everything they say, won't remember you by the time you get back, mean or nice - most of the time doesn't matter to me).

 

[OccupyTheED]

These PPH numbers are all relative and system dependent, I saw 13 in 12 the other day but I also put in lines/drew labs on 6 of them, personally dragged a few to radiology and spent 30 minutes trying to find a working translator phone for one patient. In a place with better ancillary services I could easily see more.

 

[RustedFox]

These PPH numbers are all relative and system dependent, I saw 13 in 12 the other day but I also put in lines/drew labs on 6 of them, personally dragged a few to radiology and spent 30 minutes trying to find a working translator phone for one patient. In a place with better ancillary services I could easily see more.

Yep.

This. and then This again.

My current gig does a great job of trying to free me up to do the important things. The only real drawback at my present gig is their obsession with "metrics that don't really matter". There are mechanisms to try and "win" that game as well, but the end result is the same: its bad for patients in the long run.

 

[deleted109597]

These PPH numbers are all relative and system dependent, I saw 13 in 12 the other day but I also put in lines/drew labs on 6 of them, personally dragged a few to radiology and spent 30 minutes trying to find a working translator phone for one patient. In a place with better ancillary services I could easily see more.

And this is why we often tell people to think twice about going to a place where you're going to be a phlebotomist/transporter instead of a resident.

In the end, the more patients you see, the more you will learn. Starting slow isn't a problem, but learning efficiency and improving over the year is important.

Don't feel like you need to see 3+ pph as a resident though.

 

[OccupyTheED]

And this is why we often tell people to think twice about going to a place where you're going to be a phlebotomist/transporter instead of a resident.

In the end, the more patients you see, the more you will learn. Starting slow isn't a problem, but learning efficiency and improving over the year is important.

Don't feel like you need to see 3+ pph as a resident though.

You make a fair point, my program certainly isn't for everyone but we put out good docs and most who graduate from my program don't have any issues getting the job of their choice.

 

[SserPrun95]

I'm a new PGY-2 and yesterday saw 23 patients in a 10 hour shift. So that's basically at the end of intern year..

a lot of those where easy dispos although my admit rate was around ~30% for the shift.

You're in your orientation month. Just try to learn the computer system and how to order meds, chart, dispo, call consultants, etc.. expectations are low now.. by your 3rd or so ED month you should be seeing 1 pt /hr at least..

How on earth do you do that? Follow up on their labs write the note and then dispo them? I run just about everything by an attending bc they don't like us to order CTs without talking to them. Granted I'm a brand new intern. Even if they didn't I'd spend at least 10 min writing the note and putting in orders and that doesn't include time talking to patients

 

[e30ftw]

don't worry, you will see a thousand or more patients this year at your hospital and in that time will learn how to use the system to move patients efficiently and safely where they need to be..In time you will see patients faster and spend less time/effort chiefing.. the key is to learn common EM procedures and to recognize patterns in pt presentation which guide workup. Recognizing when patients don't fit the patterns and need reevaluation should be upper-level/attending responsibility.

 

[DoctorMedic]

My shop encourages 3rd years to have at least 5 at a time, 2nd years 4 at a time, and interns carry 1-3, so far I am averaging just under 1pph after orientation month. We do all charting, procedure s, Rx, etc..have fast track NP on other side we rarely help.