Night call coverage

[jubb]

With all this IOM Hours stuff I've been thinking a lot about night call coverage and am trying to find a research project I can do.

I'm trying to figure out what are the common types of night coverage systems in use in surgery residency and how they work out. Just wondering if I could get some input from the forum about the different ways it's done.

Seems like Night Float is a popular system. Do these typically cover every general surgery(and gen surg subspecialty rotations) patient in the hospital, or do they frequently leave some services out to cover themselves with home cal or traditional call schedule?

When a traditional call schedule is used(q3 or q4 call) do these cover every general surgery patient in the hospital or are there usually multiple teams covering 1-2 services each.

Homecall - how common is this really? Mainly just for midlevels and chiefs, or for interns as well?

What other night call coverage systems are there?

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[SocialistMD]

Here is our system:

Interns:
Night float 1 covers Endocrine Onc/HBP/Trauma-Acute Care (categorical)
Night float 2 covers Vascular/Transplant (categorical)
Night float 3 covers Colorectal/Urology (subspecialty)
Thoracic has its own internal nightfloat where two interns rotate one week of days and one week of nights
Plastics is q4
SICU is q3
Elective general surgery/MIS is home call rotated between the intern, R-3 and R-5 on service
Peds is q4

R2:
The only "night float"-esque rotation is the ED, where you are on a week of days and then a week of nights, rotated for the entire block

R3:
Night float fields all in house consults from all general surgery services (Vascular, HPB, General Surgery, Colorectal and Transplant).

R4:
Night float is the night trauma chief.

R5:
No in house call.

It seems to work under the current work hour restrictions.

 

[butterfly0660]

Here's how we do it:

Our trauma service handles all acute general surgery stuff and has an intern, junior and chief in house at all times, call is q3. We do this rotation every year.

For all other services:

Interns:
All other general surgery, vascular, peds, CT, etc are divided into 2 call pools of 4 services each. Each has an intern in house (avg 5-6 calls/month)
All other services (urology, plastics, etc) have their own call schedule and are typically home call

Juniors (2-3's)
On all other rotations take home call for new consults not handled by Trauma (ie peds, vascular, etc)- number of calls varies widely

Chiefs (4-5's)
Home call, usually approx q2; provides intern backup, etc, usually for 2 services

 

[Smoke This]

Our system:

Trauma center: interns cover floors and help out at level 1 traumas, juniors cover burn ICU and traumas/ER consults/burn admissions; interns are q4-5 or so and junior call is covered by a junior-level night float 5 days/week with the remaining 2 days covered by the other 3 juniors in the call pool; chiefs (2 R5s and 1 R4) leave at 7pm most days and are only in house overnight 3d/week if I'm not mistaken

VA: interns cover floors, juniors/moonlighters cover the SICU and consults; interns and juniors are q4 at most; chiefs see consults before staff get involved and their call is widely variable (q2-3 sometimes, on for whole weekend then several days off)

University: interns cover all adult surgery service floor patients, junior covers CVICU, consults/ER, SICU as well if internal ICU call pool not covering (which is most of the time), interns are q5-6 and junior call also has junior-level night float 5d/week, additionally there is a short call junior to help out with consults and ICU admissions most evenings; chiefs also see consults here before calling staff; peds (intern and R4) alternate home call for this service only

Private hospital: (R3-4) straight q4, about half the time off on weekends, the other half doing Friday/Sunday call

 

[drdrew267]

a reality but can be just downright dangerous for patients...

It works in our residency for junior residents covering SICU.

It fails dangerously at least once a month for the interns covering two of the most "high-maintenance" services in the hospital. Why? Because not all interns are created equal and have not faced the weeding process junior residents have gone thru... do you think a prelim surgery resident who applied to radiology or anesthesia will go through the trouble of documenting an issue and call the chief if he doesn't know the patient beyond a five minute sign-out? heck no! Do you think all categoricals necessarily will either? If so, then you must be at a pretty special program!

Bottom-line, when you are on call for YOUR service, they are YOUR patients meaning you take ownership of them. It's a sad fact that 99% of night floats are only thinking "keep 'em alive till dawn" and not only does that compromise patient care, it can endanger their lives as well.

 

[AlloImmune]

Here's our system

R1:
1 Intern - Hepatobilliary, Colorectal, and Surg Onc
1 Intern - Trauma (floor only), Abdominal Transplant, and Vascular
1 Intern - Thoracic, Cardiac Surgery, and Heart-Lung Transplant (1/3 a month for 1-2 months)
1 Intern - Plastics, Urology, Ortho, and ENT
1 Intern - VA nights (half a month for 2 months, the other half is VA days)

R2:
SICU q3 (2 months a year)
CT surgery ICU nights (2 wks a month, 2 months a year)
Peds Surgery - home call every night for 1-2 months
Consult/ER/Trauma nights (rarely...usually covered by R3)

R3:
Consult/ER/Trauma nights 1-2 months

R4:
In-house night chief 1-2 months - covers all general services (but not CT or subspecialties)

R5:
No night float

 

[sponch]

Here's our system
Peds Surgery - home call every night for 1-2 months

I think I would shoot myself if I had to take home call for peds every night. I don't know what it's like where your program is but where I am home call means it counts as you being home even though most of the time you're not.

 

[AlloImmune]

I think I would shoot myself if I had to take home call for peds every night. I don't know what it's like where your program is but where I am home call means it counts as you being home even though most of the time you're not.

We don't end up having to come in too much, but the peds nurses never seem to realize that you are not in house. They like to call nightly around 2 am with stupid questions, requests for orders such as changing the concentration of formula, and updates on your patients with normal vital signs. (I got written up 3 times in one night for "refusing" to enter several non-urgent orders while I was not in house and the nurse "didn't feel comfortable" taking verbal orders.) We don't have to cover new consults or ED admits at night, and our PICU and NICU are closed units. Usually only have to come in for unstable patients or direct admissions.