Night float coverage

[reluctnt surgn]

My program's nightfloat is in constant flux trying to make it work and have what seems like too many people in-house. I was just curious what other programs do - specifically how many residents are in-house on a given night and how many patients each person covers. Thanks for any input.

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[DrDawg]

We don't have night float. At our university hospital we have a junior, and a PGY3 in house overnight. They cover 3 services 60+ patients typically, sometimes way more. At our two community hospitals only one resident in house. One of these places has a typically census of 45pts. Our childrens hospital has one junior resident on call as well.

 

[Smurfette]

Hmm...

2 interns (cover anywhere from 20-50+ pts each)
1 senior (sees new consults/admits, backs up interns)
1 chief (is paged/woken only to operate)

Other hospitals we work at have a traditional call system...2-3 juniors on call, one senior in house, chiefs on home call.

 

[SocialistMD]

At our main teaching hospital, we have anywhere from 7-9 general surgery residents/interns in house on any given night.

4-5 interns
-1 covers endocrine/HPB/Trauma (can approach 100 patients on any given day)
-1 covers vascular/transplant (census runs around 60ish)
-1 covers thoracic (+ consults)
-1 covers colorectal/urology (census runs around 50ish; typically covered by a non-categorical intern)
q3 intern in the ICU
2-4 juniors
-1 in the ED seeing all consults
-1 on the floor seeing all consults/helping interns in case patients get sick(er)
q3 R2 in the SICU (x2), q3 R2 in the CTICU
1 chief (R4)
-senior in-house surgical resident and trauma chief

 

[Winged Scapula]

At our main teaching hospital, we have anywhere from 7-9 general surgery residents/interns in house on any given night.

4-5 interns
-1 covers endocrine/HPB/Trauma (can approach 100 patients on any given day)
-1 covers vascular/transplant (census runs around 60ish)
-1 covers thoracic (+ consults)
-1 covers colorectal/urology (census runs around 50ish; typically covered by a non-categorical intern)
q3 intern in the ICU
2-4 juniors
-1 in the ED seeing all consults
-1 on the floor seeing all consults/helping interns in case patients get sick(er)
q3 R2 in the SICU (x2), q3 R2 in the CTICU
1 chief (R4)
-senior in-house surgical resident and trauma chief

That is pretty much how my residency program ran albeit with different combos (ie, we didn't cover urology) and lower census.

 

[Smurfette]

Hmm...

2 interns (cover anywhere from 20-50+ pts each)
1 senior (sees new consults/admits, backs up interns)
1 chief (is paged/woken only to operate)

Other hospitals we work at have a traditional call system...2-3 juniors on call, one senior in house, chiefs on home call.

I forgot some of the random "others" on off-services

1 PGY2 in SICU
1 PGY2 in burn ICU
1 PGY2 in Trauma ICU
1 PGY4 or 5 on trauma call

These guys are normally doing their own thing and the regular night float teams don't deal with them (unless xferring someone to the SICU)

 

[m3rkury]

Nightfloat team
1 Chief (supervises everyone. Mainly in house for trauma coverage.)
1 Midyear (covers the ICU & ER consults)
1 Intern (covers ~60-70 floor patients)
1 Intern on call (covers ER & floor consults)

All team members cover trauma. The appropriate level resident goes to any emergent OR cases.

 

[dpmd]

One night float doing a month rotation (early in the year a 3 or a 4, later in the year a 2 or 3) covers the trauma service (varies but I have seen it as high as 40 or so), responds to traumas, and supervises the on call intern.

One intern on call-covers floor calls and consults for general surg, plastics, urology, ENT (in house census usually around 20, but varies), responds to traumas.

Back up chief-home call (later in the year a 4 takes more of this), gets called in when a case goes to OR at night (night float usually does the case, while the chief covers for them), theoretically will be called in if things are too busy but I have never seen it happen even when things are hectic, gets called if there are questions.

 

[ChiSoxMD]

We have a night float as well.

1 intern that covers the floor patients (General surgery, endocrine, Thoracic, Trauma, Surg Onc, Transplant, Vascular) - somewhere around 100 patients

1 intern that handles all new consults

1 second year in the SICU and Transplant ICU

1 in house 4 or 5 to staff the consults, go to the OR, and for trauma (we are a level 1 center so we have to have a 4 or greater in house at all times).

It generally works pretty well although we are sometimes a bit short staffed (3 traumas within 10 minutes, dying patients in ICU, consult bomb going off, etc). If the night float team is completely overwhelmed, there are some residents on apprenticeship type rotations - and they can be called in to see consults for their service (though this rarely happens).

 

[MediCane2006]

At my program's main hospital....

1 intern covering SurgOnc, HBP, Plastics (usually 25-40 patients)
1 intern covering Vascular, Colorectal, Transplant (usually 15-20 patients)
1 intern + 1 PGY-3 covering the SICU (the PGY-3 also acts as the senior on-call for the above two interns)
1 intern + 1 chief on call for Trauma/Acute care surgery
1 intern or PGY-2 in the Surgical Cardiac unit

At affiliate hospitals it's usually an intern who's backed up by a moonlighter.

Works out well, and our work hours don't suffer...

 

[Doc Ivy]

We have 2 residents in house at night covering anywhere from 50-75pts

1 intern mainly covering the floor pts for: three GenSurg services, Transplant, Vascular, Colorectal, Thoracic, Breast, ENT etc and cross covering the ICU, ER consults only if the senior is in the OR

1 senior (could be an r2, r3, r4) covering ICU pt's on the the above services , consults and ER

Chief (r5) on home call who only rarely get called to come in and operate