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explain..
night float.. good thing or bad thing?
- Thread starter soon2bdoc2003
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Depends on the way you work and how schedules are set up.
Gen Surg residents on one of our services are p*ssed now because their system is going to be screwed up. They arranged a q3 call schedule that allowed them 2 golden weekends per month in addition to their 3 "official" off days. That system is about to go bye-bye.
Gen Surg residents on one of our services are p*ssed now because their system is going to be screwed up. They arranged a q3 call schedule that allowed them 2 golden weekends per month in addition to their 3 "official" off days. That system is about to go bye-bye.
N
njbmd
Hi there,
I am doing the "Night Float" thing right now. My schedule is 1800h-0700h Sunday-Friday nights. I get off around 0730h on Saturday morning and go back at 1800h on Sunday evening. On Friday night, I got 100 calls between the hours of 1800 and 2100h. Most of them were totally bogus things like "Do you REALLY want this patient to get such and such?" even though the primary team wrote the orders. "You know Mr. So and So" (Well, really, I DON'T know Mr So and So). I go from patient to patient doing things like evaluating chest pain, fever elevations and the like.
The down-side: Sometimes I end up doing things like putting in orders that the primary team forgot (sleepers, pain meds etc.) The learning value is zero but this is part of the 80-hour work week (averaged over 4 weeks). The other down-side is that many of my fellow residents do not know how to sign out patients. I do not get any operative time and I miss operating.
The up-side: I only have to do this rotation three weeks! I have great chief residents who know their patients and I don't hesitate to call them when I need direction. The other up-side is that some of my fellow residents do a good job and know how to sign out patients to a night-float resident.
Two weeks to go and I am counting every hour!
njbmd
😎
I am doing the "Night Float" thing right now. My schedule is 1800h-0700h Sunday-Friday nights. I get off around 0730h on Saturday morning and go back at 1800h on Sunday evening. On Friday night, I got 100 calls between the hours of 1800 and 2100h. Most of them were totally bogus things like "Do you REALLY want this patient to get such and such?" even though the primary team wrote the orders. "You know Mr. So and So" (Well, really, I DON'T know Mr So and So). I go from patient to patient doing things like evaluating chest pain, fever elevations and the like.
The down-side: Sometimes I end up doing things like putting in orders that the primary team forgot (sleepers, pain meds etc.) The learning value is zero but this is part of the 80-hour work week (averaged over 4 weeks). The other down-side is that many of my fellow residents do not know how to sign out patients. I do not get any operative time and I miss operating.
The up-side: I only have to do this rotation three weeks! I have great chief residents who know their patients and I don't hesitate to call them when I need direction. The other up-side is that some of my fellow residents do a good job and know how to sign out patients to a night-float resident.
Two weeks to go and I am counting every hour!
njbmd
😎
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Bad thing for patient care, but a neccessary evil for many busy programs to meet the new work hour rules
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Was a major issue in a few hospitals I've rotated through. It's a tough call, because they are dealing with an issue they've never had to before in the history of residency: work hour restrictions. One hospital I rotated through had a particularly rough time with continuity of care, since many of the residents were being heavily pimped by attendings as to certain issues regarding specific patients, and they did not know the answers since the night float did not tell them the full story. Additionally, some newly admitted patients are signed out by the night float to the morning team using a 40 second overview of the patient. Then 20-30 minutes later, some attending is going berserk over the fact that the resident doesn't know this patient like the back of their hand. Attendings have no concept of working in a night float system, and some are more understanding than others. I have to say I agree that patient care suffers due to the constant handing-over of patient care to new residents every 24 hrs or so. However, they are grasping at straws as to how to comply with these new laws. And if they come up with other systems, the poor guinea pigs that act as pilot subjects will a) be in a world of chaos trying to work in a new system, and b) get subpar training if it turns out not to work. It's a tough situation. We'll have to see what the future brings.
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The addition of cross-coverage or night floats is going to require residents to develop a whole new set of skills, namely those of giving and receiving a concise but complete sign-out and sign-in. This will serve those that end up in big group practices well in the future. However, with few people to role model these skills in many residencies (particularly the surgical residencies that have generally avoided these sorts of arrangements, in contrast to IM residencies) the development of these skills is going to be a wrenching change all across the board and will almost certainly result in some things being dropped and probably some sub-optimal care being given or optimal care being delayed. In the meantime, people are going to have to be extra diligent to ensure that the fewest patients get harmed during this changeover as possible.
When I did my medicine internship we had a night float at some hospitals and a day float at another. I didn't mind night float. I would go to morning rounds, go home and sleep a bit and then have the afternoon and early evening to enjoy. The crosscoverage was a pain but it was good training for how to decide what problems have to be dealt with right now and what can wait until morning. The admits were interesting and even if you admitted someone who was going to be a disposition nightmare they became someone else's problem in the morning.
Day float on the other hand sucked. The intern(s) and resident who had been admitting the day before just wanted to leave after rounds and you were picking up all their new patients on their busiest day- the first day after admission. You spent the whole day trying to complete a huge checklist they had given you and discovering they were wrong on the diagnosis or plan for half the patients
Day float on the other hand sucked. The intern(s) and resident who had been admitting the day before just wanted to leave after rounds and you were picking up all their new patients on their busiest day- the first day after admission. You spent the whole day trying to complete a huge checklist they had given you and discovering they were wrong on the diagnosis or plan for half the patients
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Interesting... The program where I am starting my residency this year has instituted a day float - but unlike your experience (correct me if I'm wrong), we get float coverage for the morning of our call. Thus we sleep in a bit and come in around noon conference. That way we're a bit more rested for call and can stay the extra time on post call days to take care of the huge checklist you mention and still stay within work hour regulations. The patients covered by the float team have been with us for a few days, so we know them pretty well and can give good signouts. Also, the float team appreciates that, since it's a call day, our list has been diuresed somewhat.
At least that's what they say happens... As I said, I'm a newbie yet to face the realities of the system, but it sounded like a fairly reasonable solution. Anyone else got any opinions/experience on this?
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i think i like the idea of night float. sure, it sucks when you're doing it (i haven't done it yet so i don't know exactly how much it will suck). but at our hospital, you take regular call til 9pm and then are allowed to go to bed (in-house), then night float takes over and pages you only if he is really swamped. so one month of hell is totally worth having decent calls the rest of the year. i think our night float gets the weekends off also (but he has to come in sun night 9pm)
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Night float is being tried for the first time at my program. It's from 7p-7a. So far, though, it has put most of the interns on the services covered over hours because we have had to come in early to write notes and run the list with upper levels before morning conferences. So now we've been told to go home before 7, field calls from home and leave a sign out list for the night float. Then we call the night float person and give them the list of things we've been called about from home (unless it can't wait, then we go in to do it until 7)
Also, when I'm on call, I cover 3 services. I never get any kind of sign out from one of those services. In fact, I wasn't even sure that I was supposed to be covering that service because I hadn't gotten a sign out. I asked about it, and was told not to expect it, as there is no intern on that service and an upper level should not be expected to sign out to an intern. In fact, I was told I should get used to cross covering without any sign out..that's what the chart is for. Makes me feel weird, becuase where I went to school there was always some kind of sign out.
Having said that, so far all the residents are great and I've never had any problem with calling anyone, they are always willing to help and very patient. My fellow interns say the same thing.
Also, when I'm on call, I cover 3 services. I never get any kind of sign out from one of those services. In fact, I wasn't even sure that I was supposed to be covering that service because I hadn't gotten a sign out. I asked about it, and was told not to expect it, as there is no intern on that service and an upper level should not be expected to sign out to an intern. In fact, I was told I should get used to cross covering without any sign out..that's what the chart is for. Makes me feel weird, becuase where I went to school there was always some kind of sign out.
Having said that, so far all the residents are great and I've never had any problem with calling anyone, they are always willing to help and very patient. My fellow interns say the same thing.
