New Resident work hour rules and effect on Psych residency

[kugel]

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Dr Bagel,
Since you won't be making the admit decision at the VA, and the VA has a pretty extensive EMR system, any chance of doing the consulting via telemedicine and entering orders from a remote location computer?
Just wondering.
I'm hoping this kind of thing will catch on and make psychiatrists much more available to pt's everywhere.

 

[Doctor Bagel]

Dr Bagel,
Since you won't be making the admit decision at the VA, and the VA has a pretty extensive EMR system, any chance of doing the consulting via telemedicine and entering orders from a remote location computer?
Just wondering.
I'm hoping this kind of thing will catch on and make psychiatrists much more available to pt's everywhere.

As far the the admits go, the goal is actually to not have to step foot in the VA. We'll do the orders remotely when we're over on the university side. So ideally, we'll only have to venture over the VA ED if they specifically want us to talk to a patient. Since the NF person will only be about a quarter of a mile away, though, I don't think we'll see any fancy telemedicine stuff going on.

 

[Manicsleep]

You may not be using telepresence or anything really fancy but telemedicine is getting very advanced and costs are really coming down.

There has been talk of using this to have attendings supervise residents. Though I haven't heard of it in psychiatry (even thought that may be the most appropriate field).

 

[heyjack70]

Sounds annoyingly complex. It must look good from the ACGME ivory towers though. I hear that in 100 years the interns will be supervised at home by attendings that never worked anything beyond a 2 hour shift.

 

[digitlnoize]

Sounds annoyingly complex. It must look good from the ACGME ivory towers though. I hear that in 100 years the interns will be supervised at home by attendings that never worked anything beyond a 2 hour shift.

That attending gig does sound pretty sweet. 😀

 

[WhoisJohnGalt]

Figured I may as well update things from my side as well. We have eliminated in-house coverage of both the private hospital and the VA hospital after 9pm. The plan for the VA side is similar to Dr Bagel's, in that the ER will decide who to admit, page us, and we will (from home) verbally accept the patient and the ER will click a "standard orders" admit button. We will also provide phone coverage for house-officer type stuff from the VA psych floor, as well as phone curb-sides for urgent consults. The plan is that we will only come in from 9p-8a for suicide attempts on the floor (which happened once all of last year).

This all sounds great (who doesn't love sleeping in their own bed?) BUT the VA has been so resistant that I expect to get just as many pages, no more sleep and just lose a post-call day for at least the first few months. In addition, until the interns get "credentialed" to work with indirect supervision, the 5 of us PGY2's will be covering essentially q5 (our 3 PGY3's will cover a Friday each, other than that, we cover the rest). And our program director hasn't decided when she thinks the interns will qualify, so it's indefinite q5 call for us. Once they are qualified, we will still be responsible for the 9pm-8am home call as interns aren't allowed to take home call but they should at least help with a big chunk of the "short call" and weekend burden.

So that's how we're doing it. NO idea how this is going to work (or not) but I'm definitely skeptical of this being an overall improvement in our lives from intern year.

 

[Manicsleep]

If you are supervising from home using telemedicine, its pretty much like working.

Also, telemedicine is being used in other ways right now. I know several surgeons who do this with their residents/ER docs by simply having them take a picture/video of wound/imaging and texting it when they are on call.