Intra-Shift phasing

[boo2]

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Has anyone worked at a place where you spend the first part of your shift(5-6hrs) seeing higher acuity patients, and the second part of your shift seeing lower acuity patients(4-5hrs)?

How is it setup at your shop? Does it work well to get out on time and minimize signout? Or have you found it can keep the less acute patients waiting longer because you are tied up managing your prior patients?

This is assuming you are staying in the same patient care area, ie no separate fast track.

Thanks ahead for any advice or thoughts!

 

[southerndoc]

We have such high acuity at my place (130,000 volume level II trauma center) that we see high acuity patients our entire shift. My breakdown last month was 11% critical care, 67% level 5, 19% level 4, 3% level 3 and nothing lower. Fast Track handles a lot of stuff that is lower acuity.

I might want a setup like you describe later in my career, but right now I'm giddy at intubating 15-20 patients per month, having a couple STEMI's each month, etc.

 

[The White Coat Investor]

I think that's a great way to do it. I do it informally all the time. Grab the complicated ones early, the less complicated toward shift end. That's just good flow management. Doesn't work in a one doc shop though.

 

[Cerberus]

We have such high acuity at my place (130,000 volume level II trauma center) that we see high acuity patients our entire shift. My breakdown last month was 11% critical care, 67% level 5, 19% level 4, 3% level 3 and nothing lower. Fast Track handles a lot of stuff that is lower acuity.

I might want a setup like you describe later in my career, but right now I'm giddy at intubating 15-20 patients per month, having a couple STEMI's each month, etc.

Is this a training program? If so how are you getting that many tubes (unless you mean supervising, which i'm not sure keeps you at the level of competency). I ask since i'm working at a residency prog next year that does lots of tubes, but rarely does the attending actually intubate.

 

[The White Coat Investor]

Is this a training program? If so how are you getting that many tubes (unless you mean supervising, which i'm not sure keeps you at the level of competency). I ask since i'm working at a residency prog next year that does lots of tubes, but rarely does the attending actually intubate.

That's a buttload of intubations and critical care he's doing. That must be about 3 times the national average for critical care. 1-2 intubations a shift is a ton as well.

 

[boo2]

Well this thread got derailed quickly. Thanks for your input ActiveDutyMD!

 

[ccfccp]

The place I moonlight is set up in the pod system. There are 8 total pods (including peds and fast track.) Some of the pods are not open 24 hours and when they're getting close to closing the last 3 hours (of a 9 hour shift) they bring in only lower acuity patients. Then the last hour is no new patients. I think it works pretty well, and occasionally I have gotten to leave a few minutes early (happened last night...)

 

[docB]

We do this. I start in "the front" part of the ER where the sickest patients go. When my relief arrives I transition to the fast track and see lower acuity patients. I keep my sick patient from the front and finish them, I don't turn them over to the new guy. It works well.

 

[southerndoc]

Is this a training program? If so how are you getting that many tubes (unless you mean supervising, which i'm not sure keeps you at the level of competency). I ask since i'm working at a residency prog next year that does lots of tubes, but rarely does the attending actually intubate.

No, no residents in the entire hospital. Tonight we had 4 STEMI's in a 5-hour period (with another 2 STEMI's earlier in the day). I called the cardiologist for a cardiac arrest/STEMI I had and said "ready for another?" He just laughed and said "bring it on." Guy had a witnessed arrest in the field, AED shock by fire, arrived with a Combitube trying to pull the tube out. RSI'd him, intubated him, and sent him to the lab. Pulmonary dropped a cooling catheter in him afterwards and started the hypothermia protocol.

(For the record, I only had 1 of the STEMI's tonight.)

 

[alphaholic06]

We have such high acuity at my place (130,000 volume level II trauma center) that we see high acuity patients our entire shift. My breakdown last month was 11% critical care, 67% level 5, 19% level 4, 3% level 3 and nothing lower. Fast Track handles a lot of stuff that is lower acuity.

I might want a setup like you describe later in my career, but right now I'm giddy at intubating 15-20 patients per month, having a couple STEMI's each month, etc.

Damn, where do you work, and are you hiring?