Need help staying up 30 hours

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Has anyone found anything that makes staying up 30 hours straight more bearable? I'm on q4 and our service is such that we never get to sleep at night and I'm having a really hard time with it. I normally get 8hrs of sleep at night and that's what I'm accustomed to, so before a call night I try to do 10 or more. I also normally drink 2 cups of coffee in the morning and I've tried holding back on the morning coffee and then drinking several cups through the night. It keeps me awake but doesn't help my focus too much. The worse part is morning rounds, I'm a complete zombie and can't even answer the simplest questions. Trying to finish all my floor work before I have to leave at 1PM due to the 30 hour limit is the most brutal part, I just feel like dying. Any suggestions?
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Modafinil is pretty good combined with methylphenidate. I didn't quite get the kick out of donepezil. Combine with coffee in modest amounts, to bridge the periods when the methylphenidate starts to wear off.
 
I drink coffee during the day, drink water through the night, and then drink coffee again starting around 4 AM to get me though 12/1 pm. I've found that hydration plays a HUGE role in how awake I feel overnight.
 
SoCuteMD said:
I drink coffee during the day, drink water through the night, and then drink coffee again starting around 4 AM to get me though 12/1 pm. I've found that hydration plays a HUGE role in how awake I feel overnight.
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Yes! I too drank water all throughout the night (on trauma surgery clerkship) and tried to avoid getting too comfortable (e.g. sitting down...). This may sound crazy, but in the early morning I'd put on some running clothes, change my socks, splash water on my face and jog around the block 5 or 6 times before rounds. Woke me right up...

Of course, this was a short experience and I'm not sure what would work for an extended time period (i.e. the OP's situation).
 
AVNRT said:
Yes! I too drank water all throughout the night (on trauma surgery clerkship) and tried to avoid getting too comfortable (e.g. sitting down...). This may sound crazy, but in the early morning I'd put on some running clothes, change my socks, splash water on my face and jog around the block 5 or 6 times before rounds. Woke me right up...

Of course, this was a short experience and I'm not sure what would work for an extended time period (i.e. the OP's situation).
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Yeah, I don't know how well it would go over for interns to leave the hospital and jog around the block. If a code was called on your patient (or a cross-cover patient) and you didn't hear it, that'd REALLY be trouble.

I am also obsessive about brushing my teeth post-call - that somehow makes me feel a tiny bit better in the morning.

My friend brings a pair of clean scrubs to work for herself on post-call days.

One of my fellow interns showers post-call. Just a quick, 5 minute splash-off, but a shower nonetheless.
 
100% agree with the opinions above --

Hydration. Like, TONS of hydration. I prefer diluted juice from the hospital drink dispensers. Hospital air is dry, your insensible losses are high, you're probably running around like crazy. And besides, the sensation of a constantly-full bladder should keep you going strong all night 🙂

Toothbrushing and a splash of water on the face @ 3am, or 6/7am when you resume regular daily prerounding/rounding does wonders.

At some point during the night, sit down for 5 min (no matter how busy you are), take yer shoes+socks off and take a breather. More of a stress reliever than an insomnia-inducer, but it does go a long way.
 
i would always change my socks about 4-5 am, brush my teeth, splash water on my face and go get a GIANT cup of coffee. Maybe a refill if time allowed.

Sometimes, in the colder months, I would go stand outside in my lab coat in the middle of the night for just a few minutes... also seemed to help.
 
Conditioning by running ultramarathons; 50k, 50 miles, 100k, 100 miles.
if you can run for 30 hrs anything else seems easy by comparison.
http://ws100.com/
 
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Great, thanks for all the advice!
 
J DUB said:
Provigil......lasts about 8hrs!!

Take it around 2AM!! 😀
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hmm, are there any long term side effects, esp. since most of us do not have excessive daytime somnolence, just excessively long work hours?

also, how would you obtain it? writing a prescription for yourself?
 
lakeplacid said:
hmm, are there any long term side effects, esp. since most of us do not have excessive daytime somnolence, just excessively long work hours?

also, how would you obtain it? writing a prescription for yourself?
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1) Writing for controlled substances for yourself is considered a big no-no.

2) Even if you wrote it for yourself, your insurance company will most likely reject it unless you had the rx preauthorized by a 'specialist' - i.e., psych or sleep med doc.
 
RegularNihilist said:
Modafinil is pretty good combined with methylphenidate. I didn't quite get the kick out of donepezil. Combine with coffee in modest amounts, to bridge the periods when the methylphenidate starts to wear off.
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lol your recommending ritalin. why not adderall it lasts longer? Why stop with Schedule 2 drugs...try snorting a line of cocaine 🙂

I joke 🙂 You could visit some body building websites and pick up a bottle of ephedra. diet pills are good for keeping people awake.
 
I'm a bit like the OP. I have/need very good sleep hygiene and generally try to avoid caffeine when I'm not on call, so call is particularly hard sometimes. I always get 7-8 hours of sleep on non-call nights and never drink more than caffeinated beverage a day.

My tips for long calls--lots of hydration. Drink as much water as you can. The air in hospitals is so dry, it can make you feel awful. I'll drink caffeine before dinner but never after dinner on the chance that I may actually get a chance to sleep during the night. Always change your socks and underwear (I don't care about the outerwear so much). Brush your teeth at least twice while on call and reapply the deodorant in the AM. Have a good sized dinner but try to avoid middle of the night junk food binges and greasy food--it'll just come back to bite you.

I guess overall, I try to keep to as "normal" a schedule as possible. In other words, I don't normally drink coffee at dinner and I don't normally eat hamburgers at 3am so I try not to do that when I'm on call either. I think it's better for you in the long run and will make you feel more rested overall for call.

Never ever underestimate getting five to ten minutes to get off your feet and just tune everything out. I know there are nights when you can't even do that sometimes, but usually, you can if you try.
 
Provigil (modafinil) is your best bet. When you're so tired that you feel like you're about to pass out or start crying (or both) and you feel like you've reached your limit, take one and 20 mins later you're like new. It lasts several hours and unlike ritalin you don't have all the peaks and valleys, and unlike caffeine/ephedra you don't feel jittery and anxious, and you don't have to pee every five minutes. Only downside is that it's very expensive ($11/tab), but your insurance may cover it if it was prescribed for shift work sleep disorder.

The company that makes Provigil recently put out a similar drug called Nuvigil (maybe because the patent for Provigil expires soon?) and I know they're offering a free 30 day trial with a coupon you print from the website.

Other stuff mentioned in this thread will make you more comfortable (e.g. fresh socks, shower, etc), but when you're on your 29th hour of call and you still need to present a new admission to your attending, it's naïve to imply that a splash of water to the face, a quick jog, or brushing your teeth will do anything to help you power through. Unfortunately, you're expected to be just as alert and responsible on hour #29 as you are on hour #2, regardless of whether or not you've had any sleep, and I don't know how I would have made it through any of those calls without meds. There should be protected rest time, just like pilots have. Sadly, it will probably take another tragedy like Libby Zion to expose how hazardous and unhealthy the current system is before anything will ever be done about it.
 
lakeplacid said:
hmm, are there any long term side effects, esp. since most of us do not have excessive daytime somnolence, just excessively long work hours?

also, how would you obtain it? writing a prescription for yourself?
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Nothing more than what most stimulants cause that I am aware of...some SJS

Doc. Dont write for yourself...conflict of interest!
 
mcindoe said:
Sadly, it will probably take another tragedy like Libby Zion to expose how hazardous and unhealthy the current system is before anything will ever be done about it.
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It wasn't the exhaustion of the residents that caused her death, but the lack of supervision onsite, and the administration of demerol to someone taking phenylzine causing an unrecognized/untreated serotonin syndrome. I'm not even sure serotonin syndrome was a named condition back then.
 
tkim said:
It wasn't the exhaustion of the residents that caused her death, but the lack of supervision onsite, and the administration of demerol to someone taking phenylzine causing an unrecognized/untreated serotonin syndrome. I'm not even sure serotonin syndrome was a named condition back then.
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Yeah but the bottom line is that the patient died because there was a problem with the system that made it inherently unsafe for patients, and it took a tragedy to occur before anything was done to fix it. The current system is unsafe, both for patients and residents, and sadly it will have to take a tragedy to bring the issue to the forefront and finally put an end to such a ridiculous system.
 
mcindoe said:
Yeah but the bottom line is that the patient died because there was a problem with the system that made it inherently unsafe for patients, and it took a tragedy to occur before anything was done to fix it. The current system is unsafe, both for patients and residents, and sadly it will have to take a tragedy to bring the issue to the forefront and finally put an end to such a ridiculous system.
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the jury actually found the patient largely at fault for lying about her drug use. This only resulted in change to residency hours because the patient's father was in the media and made it his personal crusade. Neither the medical community nor the jury in this case found that long hours actually caused this death.
 
At any rate, stay away from the prescription drugs. ALL drugs have side effects. And caffeine can only give you a short, couple of hour burst of alertness, and has a high tolerance component. So unless you are caffeine naive, or just use it for the last couple of hours in your shift, it probably won't help much. Plus it's a diuretic, so to the extent you believe the posters who are saying hydration is the key, caffeine works against you. Truth of the matter is that having difficulty staying up over 30 hours has a large mental component. The human body can stay awake several days if it must. If you convince yourself you need 8 hours, you will have a much harder time staying up than someone without such notion.
 
Law2Doc said:
Truth of the matter is that having difficulty staying up over 30 hours has a large mental component. .
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like I said, conditioning. I know I can work a 24 hr shift because I know that I can run that long so anything else is easy.
there are folks who run 150, 200, 350 miles without stopping. these folks are obviously more hard core runners than I am but they keep doing it because they know they can. truth of the matter is that anything longer than a half marathon is all mental.
 
It may be true that staying up for 30 hours has a large mental component. But do you believe that most residents have the ability and discipline to handle this challenge? Mental conditioning and marathon running requires practice and experience, and these skills take time to develop. Yet here you have the most inexperienced people doing the 30 hour "marathon" shifts. how does that make any sense??

Let me ask you this- if you had to be hospitalized, how would you feel if you found out that the doctor responsible for your care has been working for the past 28 hours without any sleep? Would you trust their judgment?

Would you board a plane if you were told that the pilot was awake working for the preceding 27 hours?

If you would answer "yes" to either of these scenarios, then I would question your judgment as well.
 
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I agree with most of the comments above. Also, if you can fit in a nap, even 10-20 minutes, that might help. Sometimes it's not possible when you are an intern.

With my 20/20 hindsight, I think there is nothing wrong with Provigil, if you need it. It wasn't around when I was an intern. I think you should do your homework about it,and definitely look up the side effects, etc. It probably won't hurt you any more than excessive caffeine.

I agree w/drinking plenty of water. also, bring snacks in case you don't have time to eat (candy bars, Power Bars, etc.).
 
mcindoe said:
It may be true that staying up for 30 hours has a large mental component. But do you believe that most residents have the ability and discipline to handle this challenge? Mental conditioning and marathon running requires practice and experience, and these skills take time to develop. Yet here you have the most inexperienced people doing the 30 hour "marathon" shifts. how does that make any sense??

Let me ask you this- if you had to be hospitalized, how would you feel if you found out that the doctor responsible for your care has been working for the past 28 hours without any sleep? Would you trust their judgment?

Would you board a plane if you were told that the pilot was awake working for the preceding 27 hours?

If you would answer "yes" to either of these scenarios, then I would question your judgment as well.
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Not to take anything away from your global point, but the flaw in your analogies is that you assume the resident is the person who is really in charge. That typically isn't the case. The attendings are usually the ones who have the final say over the decision making. A resident working 30-hours is more like a flight attendant working 30-hours. Sure, s/he may get my drink order wrong or spill it on me, but the plane isn't going to crash.

Regarding the "conditioning" for 30-hour shifts, that used to happen in medical school. Now that many medical schools are not requring overnight call or are not making medical students stay post-call, it is tougher to make that transition.
 
"Now that many medical schools are not requring overnight call or are not making medical students stay post-call, it is tougher to make that transition."

This is exactly true for me, I was only made to take one 24 hour call during all of med school!
 
"If you convince yourself you need 8 hours, you will have a much harder time staying up than someone without such notion."

This also seems to ring true for me, I've always believed I need 8-9 hours of sleep.
 
pillowhead said:
In other words, I don't normally drink coffee at dinner and I don't normally eat hamburgers at 3am so I try not to do that when I'm on call either.
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At 3AM my head is normally on a pillow and I'm sound asleep. If I'm awake, I might as well eat a hamburger. It's so completely unnatural to me to be awake all night, I don't know what else to do. I might as well eat a hamburger or drink a cup of coffee. I mean heck, the only other time I'd be awake at 3AM I'd probably be really drunk. Can't get away with that one on inpatient though.

SocialistMD said:
Now that many medical schools are not requring overnight call or are not making medical students stay post-call, it is tougher to make that transition.
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That's nice. Today I'm going into my second 30 hour shift of this rotation. My attending seemed pissed I even wanted to go home at the 30 hour mark last time. WTF? Yay! Old school work ethic! The reality of crushing is with hard hours is that it just makes us students want to go into cushier subspecialties.

I find it awesome that half this thread is about using controlled substances just to stay awake for your job. What a goofy system.

PS: Will someone write me for some provigil? I can't actually find time to get to student health.
 
SocialistMD said:
Not to take anything away from your global point, but the flaw in your analogies is that you assume the resident is the person who is really in charge. That typically isn't the case. The attendings are usually the ones who have the final say over the decision making. A resident working 30-hours is more like a flight attendant working 30-hours. Sure, s/he may get my drink order wrong or spill it on me, but the plane isn't going to crash.

Regarding the "conditioning" for 30-hour shifts, that used to happen in medical school. Now that many medical schools are not requring overnight call or are not making medical students stay post-call, it is tougher to make that transition.
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I don't know about that. There's always an attending on the record in theory, but as a resident, you are often writing orders unsupervised, and are the one making the decision as to whether there is something you need to wake up the attending about. Don't underestimate your ability to injure a patient as a resident. You are OFTEN the only one to see a patient on overnights. I do agree that med school call makes overnights seem more doable. But I'm not sure that's the real justification for call. A better argument is always going to be that a lot of patient care, and most of the codes, happen after hours.
 
I agree with law2doc.
Residents and interns on overnight call are the ones providing the care. In general there is no attending or fellow present, unless you are in the ER or something. YOU are the one writing the orders and doing procedures so being tired definitely can affect patient care. However, so could having a doc who doesn't know the patients. Doing 30 hour call is just something you have to get used to if you are doing surgery or IM or maybe peds at a hospital that still has a traditional call system. But I agree it is definitely malignant to complain about residents leaving at 30 hours. In hindsight I think that 24ish hour calls would have been much better...we always had to stay 30 and even at times had clinci postcall, which was definitely brutal. Sometimes patients would remark that I seemed tired (I would think "NO ****!").
 
In this month's issue of the Mayo Clinic Proceedings (Vol 84, No 11), there is an interesting editorial entitled "Fatigue, Countermeasures, and Performance Enhancement in Resident Physicians." It mentions an Institute of Medicine recommendation of residents admitting only for 16 hours and requiring a 5-hour protected sleep period each night. There is also a RCT featured exploring a pharmacological approach to combat effects of shift work disorder.

It concluded "In patients with excessive sleepiness associated with chronic SWD of moderate or greater severity, armodafinil significantly improved wakefulness during scheduled night work, raising mean nighttime sleep latency above the level considered to indicate severe sleepiness during the daytime. Armodafinil also significantly improved measures of overall clinical condition, long- term memory, and attention."
 
How are you guys getting these drugs? Are you seriously prescribing them for yourself?

Drinking lots of water/soda kinda helps me but then I just have to pee more and I don't have time. Sometimes I'll be seeing a pt and have no clue what their sayin cuz I'm so focused on my bladder which I realize hasn't been emptied in like 12 hrs.
 
If physicians were truly caring about their colleagues then the IOM recommendations for 5 hours protected sleep time each night should have been implemented yesterday. Instead residency programs are dragging their feet on this. I remember reading that interns/residents have an increased rate of MVAs post call which is likely fatigue related.

I do not understand how anyone justifies asking human beings to work 30 hours without sleep when it is totally contradictory to basic human physiology.

All the talk here about using drugs to try and get through this is sad.
 
exPCM said:
If physicians were truly caring about their colleagues then the IOM recommendations for 5 hours protected sleep time each night should have been implemented yesterday. Instead residency programs are dragging their feet on this. I remember reading that interns/residents have an increased rate of MVAs post call which is likely fatigue related.

I do not understand how anyone justifies asking human beings to work 30 hours without sleep when it is totally contradictory to basic human physiology.

All the talk here about using drugs to try and get through this is sad.
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👍 👍 👍
 
exPCM said:
If physicians were truly caring about their colleagues then the IOM recommendations for 5 hours protected sleep time each night should have been implemented yesterday. Instead residency programs are dragging their feet on this. I remember reading that interns/residents have an increased rate of MVAs post call which is likely fatigue related.

I do not understand how anyone justifies asking human beings to work 30 hours without sleep when it is totally contradictory to basic human physiology.

All the talk here about using drugs to try and get through this is sad.
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God forbid you suggest such things... we re doctors, we re supposed to treat ourselves like crap, after all OTHER professions do it to, why shouldnt we?
 
surrender903 said:
God forbid you suggest such things... we re doctors, we re supposed to treat ourselves like crap, after all OTHER professions do it to, why shouldnt we?
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The reason the IOM rules are slow to be embraced is three fold. First, patients are worst off under our system right after the handoff, when a new doctor who doesn't know much about them assumes their care. Shorter hours means more handoffs. These rules aren't about physician well being, they are for the patients. Second is financial- it is costly to increase staffing to account for shorter shifts. Third is educational. Fewer hours working means you have the opportunity to see and learn that much less (especially relevant to procedural fields where you get better at things the more you do). And finally there's tradition-- the old schoolers trained a certain way, so you should to. It's not as simple as saying 30 hour shifts seem too long.
 
I think my longest shift as a med student was 39 hours. The only sleep I got were a few 15-20 minute naps between cases the next day.

Pretty much every shift that month doing q4 was over 30 hours.

And it was the BEST month EVER. Ya, ortho guys are crazy! 😀
 
Law2Doc said:
I don't know about that. There's always an attending on the record in theory, but as a resident, you are often writing orders unsupervised, and are the one making the decision as to whether there is something you need to wake up the attending about. Don't underestimate your ability to injure a patient as a resident. You are OFTEN the only one to see a patient on overnights...A better argument is always going to be that a lot of patient care, and most of the codes, happen after hours.
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dragonfly99 said:
Residents and interns on overnight call are the ones providing the care. In general there is no attending or fellow present, unless you are in the ER or something. YOU are the one writing the orders and doing procedures so being tired definitely can affect patient care. However, so could having a doc who doesn't know the patients. Doing 30 hour call is just something you have to get used to if you are doing surgery or IM or maybe peds at a hospital that still has a traditional call system. But I agree it is definitely malignant to complain about residents leaving at 30 hours. In hindsight I think that 24ish hour calls would have been much better...we always had to stay 30 and even at times had clinci postcall, which was definitely brutal. Sometimes patients would remark that I seemed tired (I would think "NO ****!").
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You are confusing arguments. My point was that important decisions are made by the attending during daytime hours. I claimed that the pilot analogy was false, as the resident is not making important decisions after having been on for 27 hours, because that should be about 9am, a time when the attending is in house, the day team is back, etc... and that resident shouldn't be in the position to have to make those big decisions. Overnight, if something bad is about to happen or happens, it is the resident on call's duty to go up the chain of command to inform the true decision makers for the patient's care. Any mistakes made in medication dosing should be caught either by the nurse or the pharmacist. Furthermore, decisions made overnight occur within the first 24 hours of the shift, not the last six (of a 30 hour shift). The argument being made here (this thread) is against a 30-hour shift, not a 24-hour shift. If errors were to occur overnight, they would occur anyway in the 24-hour shift supported by dragonfly.

Law2Doc said:
I do agree that med school call makes overnights seem more doable. But I'm not sure that's the real justification for call.
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It may not be the justification, but it helps in the adjustment to long working days. On my surgery rotation, I was Q3; on OB/Gyn, medicine and pediatrics, I was Q4. On surgery, we didn't go home post-call until around 4 pm most days (our educational conference was in the afternoon and we were expected to stay for it). On medicine and peds, we went home around 1 (after lunch conference). On OB/Gyn, we went home after morning rounds (~25 hours). After that "conditioning," I've never really had any trouble as a resident working the 24-30 hour shifts when I have to (my hours as a resident are actually much less due to the 80-hour work week implementation and being at a program that has a night float system for the residents).

I agree that, with the exception of the ICU, a 30-hour day really isn't necessary (at least in surgery, when our rounds are over by 7am except in the ICU, which is why I make that the exception). I do think the post-call resident should be present for rounds, as they are the ones most familiar with the current status of each patient, but I don't think they really need to be present to do anything following rounds.

exPCM said:
If physicians were truly caring about their colleagues then the IOM recommendations for 5 hours protected sleep time each night should have been implemented yesterday. Instead residency programs are dragging their feet on this. I remember reading that interns/residents have an increased rate of MVAs post call which is likely fatigue related.

All the talk here about using drugs to try and get through this is sad.
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I agree that talk about people using drugs to try and get through this is sad. However, that is the American way. We all complain about how are patients would rather have a pill to do something for them (lose weight, control diabetes, etc...) than modify themselves to get something accomplished. Residents before us were working 36 hours on Q2 call without many of the drugs mentioned (as they didn't exist). I'm not saying the system was right, I'm simply saying generations of physicians did it before us without that crutch.

As addressed by Law2Doc, there are several reasons the IOM recommendations haven't been implemented. The feasibility of implementation of such a plan is quite difficult, especially for some smaller sub-specialties or small programs with few residents. What you would end up with is an already overburdened cross-covering resident responsible for twice the number of patients they currently cover to allow for the protected sleep time, leading to an arguably worse patient care environment.
 
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Law2Doc said:
And finally there's tradition-- the old schoolers trained a certain way, so you should to. It's not as simple as saying 30 hour shifts seem too long.
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This is one of the few things that I hate about medicine. "the old schoolers trained a certain way" So? Because you did it makes it right? Or some how justified?

Please. You should have stuck with your other reasons and left this good ol boy derpiness out of your otherwise solid argument.
 
surrender903 said:
This is one of the few things that I hate about medicine. "the old schoolers trained a certain way" So? Because you did it makes it right? Or some how justified?

Please. You should have stuck with your other reasons and left this good ol boy derpiness out of your otherwise solid argument.
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As you noted, this is a fourth reason inmylist of three. I agree it's the least valid, but it plays a big role in whether the established older dogs adopt things. While it isn't an argument grounded in facts or logic, it's probably the hardest one to overcome in real life.
 
Law2Doc said:
The reason the IOM rules are slow to be embraced is three fold. First, patients are worst off under our system right after the handoff, when a new doctor who doesn't know much about them assumes their care. Shorter hours means more handoffs. These rules aren't about physician well being, they are for the patients. Second is financial- it is costly to increase staffing to account for shorter shifts. Third is educational. Fewer hours working means you have the opportunity to see and learn that much less (especially relevant to procedural fields where you get better at things the more you do). And finally there's tradition-- the old schoolers trained a certain way, so you should to. It's not as simple as saying 30 hour shifts seem too long.
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These three reasons are IMO total BS propaganda straight from the PD playbook.

1. There are actually hospitals out there that do not have any residents and manage to give excellent care - think about it. They have handoffs between attendings as well. The attendings are not forced to work 30 hours without sleep either.
2. Yes - financial is a factor - when I am getting 100K plus per resident from CMS and the resident is doing valuable work for me and getting paid 50K and letting me sleep at night in my own bed - now that is a sweet deal.
3. In Europe they have a 56 hour per week limit and I have met many excellent European physicians - and if you factor in being able to go straight into a medical school program from high school in Europe the total length of training does not end up being longer.

Whenever you hear a PD say that the prime focus of the program is "getting the work done" - Run away very fast if you have other options.
 
exPCM said:
1. There are actually hospitals out there that do not have any residents and manage to give excellent care - think about it. They have handoffs between attendings as well. The attendings are not forced to work 30 hours without sleep either.
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👍👍

Correct, in the "real world" after residency I will NOT be working 30hrs at a time without sleep. Handoffs should not figure in the debate about residency work hours, as it does not figure in the debate regarding how long staff work in private practice. You can't apply it to one without the other.
 
exPCM said:
These three reasons are IMO total BS propaganda straight from the PD playbook.

1. There are actually hospitals out there that do not have any residents and manage to give excellent care - think about it. They have handoffs between attendings as well. The attendings are not forced to work 30 hours without sleep either.
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To play devil's advocate, perhaps they know how to give appropriate sign out because they worked 30+ hours a shift and learned what was important to mention in sign out. There are multiple reports documenting handoff issues due to the inability of junior residents to recognize what is important to stress and what isn't. Furthermore, most community hospitals (at least, those of which I am familiar) have in house PAs overnight that basically take care of the intern/resident level work.
 
SocialistMD said:
To play devil's advocate, perhaps they know how to give appropriate sign out because they worked 30+ hours a shift and learned what was important to mention in sign out. There are multiple reports documenting handoff issues due to the inability of junior residents to recognize what is important to stress and what isn't. Furthermore, most community hospitals (at least, those of which I am familiar) have in house PAs overnight that basically take care of the intern/resident level work.
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Interesting post. However, I would claim that you don't need to stay up 30 hours straight in order to learn what is important to mention in signout. I do not see any PAs working at night in the hospitals in my area. I wonder what the longevity on the job is of the night PAs in your area. The PA students I have met most often want to work 8-5 on weekdays as PAs in specialists offices.
 
We had "night PAs" in Pennsylvania community hospitals where I moonlighted as well, and there's one Urology one here I've seen.

I saw them for GI and IM in Pennsylvania, often in the ED in the middle of the night doing admissions.
 
exPCM said:
However, I would claim that you don't need to stay up 30 hours straight in order to learn what is important to mention in signout.
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Of course you would; you don't think it is necessary to work a 30-hour shift. 😉

As I'm sure you know, one must spend time with patients to know what is wrong with them and what they are telling you (through changes not only in vitals and lab values, but in mental status, complaints, appearance and other "values" that aren't as quantitatively expressed). In most instances, it is the trend in these findings that is important to hinting at impending disaster. If you have 3-4 sets of eyes over a 30 hour period looking at the patient, the changes can often be too subtle to notice compared to one set of progressively tiring eyes that will still be able to pick up on the differences. Knowing who needs extra attention and who doesn't comes with seeing those trends in real time, and I don't know that we are offering that experience now in our training programs.

I do not see any PAs working at night in the hospitals in my area. I wonder what the longevity on the job is of the night PAs in your area.
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They work in shifts, much as do our nurses. They are on a week of days, a week of evenings and a week of nights, etc... There are also a couple that only work the weekend nights as part-time employees. The longevity on the job ranges up to over 20 years. In the three years I have been working with them, none have quit.
 
SocialistMD said:
Of course you would; you don't think it is necessary to work a 30-hour shift. 😉

As I'm sure you know, one must spend time with patients to know what is wrong with them and what they are telling you (through changes not only in vitals and lab values, but in mental status, complaints, appearance and other "values" that aren't as quantitatively expressed). In most instances, it is the trend in these findings that is important to hinting at impending disaster. If you have 3-4 sets of eyes over a 30 hour period looking at the patient, the changes can often be too subtle to notice compared to one set of progressively tiring eyes that will still be able to pick up on the differences. Knowing who needs extra attention and who doesn't comes with seeing those trends in real time, and I don't know that we are offering that experience now in our training programs.


They work in shifts, much as do our nurses. They are on a week of days, a week of evenings and a week of nights, etc... There are also a couple that only work the weekend nights as part-time employees. The longevity on the job ranges up to over 20 years. In the three years I have been working with them, none have quit.
Click to expand...

Now that must be a joke. Do you sit in your patients rooms watching them for 30 hours looking for subtle changes? This post is the height of melodrama. What happens is most docs only see the patients on the wards during rounds once or twice a day or when called by a nurse. There are many sets of nurses who constantly change shifts. Knowing who needs extra attention? What attention is that? Do you sit at the foot of their bed to give extra attention?
 
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